Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign but locally aggressive vascular tumor. The most critical preoperative preparation to reduce intraoperative haemorrhage is:

• A Administration of systemic antifibrinolytic agents (tranexamic acid) preoperatively
• B Preoperative MRI-guided cryotherapy of the tumor
• C External carotid artery ligation 48 hours before surgery
• D Preoperative angiography with embolisation of feeding vessels (typically maxillary artery branches) ✓

Explanation

JNA is a highly vascular fibrovascular tumor that bleeds profusely during surgery. Preoperative embolisation (angiography-guided embolisation of the internal maxillary artery and branches) performed 24–48 hours before surgery is the standard of care to reduce intraoperative blood loss. The main feeding vessels are branches of the internal maxillary artery (sphenopalatine artery in particular). ECA ligation is no longer recommended as it eliminates access for embolisation. Antifibrinolytics are insufficient.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.