A 35-year-old male presents with progressive nasal obstruction, unilateral blood-tinged nasal discharge, and a mass in the nasopharynx. CT shows a lobulated hypervascular mass in the nasopharynx with widening of the sphenopalatine foramen and erosion of the pterygoid plates. The diagnosis is juvenile nasopharyngeal angiofibroma (JNA). Regarding preoperative management, which intervention is most important to reduce intraoperative blood loss?
- A Preoperative radiation therapy
- B Preoperative selective embolization of the feeding vessels (typically internal maxillary artery) ✓
- C Preoperative high-dose corticosteroids
- D Preoperative hormonal therapy with flutamide
Explanation
Juvenile nasopharyngeal angiofibroma is a highly vascular tumor primarily supplied by the internal maxillary artery (branch of external carotid). The principal preoperative intervention to reduce life-threatening intraoperative hemorrhage is selective angiographic embolization of the feeding vessels, performed 24–48 hours before surgery. Embolization reduces blood supply to the tumor, allows safer resection, and decreases transfusion requirements. Hormonal therapy (antiandrogens) has been tried due to the androgen receptor positivity of JNA but is not used routinely as a preoperative preparation.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.