A 16-year-old boy presents with progressive nasal obstruction, recurrent epistaxis, and a mass in the nasopharynx visible on nasopharyngoscopy. CT shows a lobulated soft-tissue mass centered at the sphenopalatine foramen with bony erosion and avid enhancement. Angiography shows feeding from internal maxillary artery. The most appropriate preoperative step before surgical excision is:
- A Incisional biopsy to confirm diagnosis
- B Preoperative embolization of feeding vessels 24-48 hours before surgery ✓
- C High-dose radiotherapy to shrink the mass
- D Chemotherapy with cisplatin-based regimen
Correct answer: B. Preoperative embolization of feeding vessels 24-48 hours before surgery
Explanation
This is a classic juvenile nasopharyngeal angiofibroma (JNA) — a highly vascular benign tumor of adolescent males, arising at the sphenopalatine foramen and fed primarily by the internal maxillary artery. Incisional biopsy is contraindicated due to risk of massive hemorrhage. Preoperative angiographic embolization 24-48 hours before surgery significantly reduces intraoperative blood loss and facilitates complete excision. Radiotherapy is reserved for unresectable intracranial extensions. Surgery (endoscopic or open) after embolization is the definitive treatment.
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.