A 16-year-old male presents with progressive unilateral nasal obstruction, recurrent epistaxis and a pinkish vascular mass visible in the right posterior nasal space that bleeds profusely on attempted biopsy. The most appropriate investigation before surgical planning is:

• A Punch biopsy of the mass in the outpatient clinic
• B Nasal endoscopy with excision under general anaesthesia as a primary step
• C Serum AFP and beta-HCG to rule out germ cell tumour
• D CT and MRI of the nose and sinuses with angiography for surgical planning and preoperative embolisation ✓

Explanation

This presentation is classic for Juvenile Nasopharyngeal Angiofibroma (JNA) — a highly vascular benign tumour arising from the sphenopalatine foramen in adolescent males, causing unilateral nasal obstruction and recurrent epistaxis. Biopsy is contraindicated due to severe haemorrhage risk. CT (shows erosion and widening of pterygomaxillary fissure) and MRI (shows extent and characteristic flow voids) are performed for staging. Preoperative embolisation of the tumour's feeding vessels (internal maxillary artery) is performed 24–48 hours before surgical resection to reduce intraoperative blood loss.

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.