A 16-year-old boy presents with recurrent profuse epistaxis and progressive nasal obstruction. Endoscopy reveals a lobulated reddish mass in the nasopharynx. MRI shows anterior bowing of the posterior wall of the maxillary sinus. The next most appropriate step is:
- A Endoscopic biopsy of the mass
- B Nasal packing alone and discharge
- C Contrast-enhanced imaging followed by embolization and surgical excision ✓
- D Radiotherapy as first-line treatment
Correct answer: C. Contrast-enhanced imaging followed by embolization and surgical excision
Explanation
The presentation is classic for juvenile nasopharyngeal angiofibroma: adolescent male, recurrent severe epistaxis, and the Holman-Miller sign of anterior bowing of the posterior maxillary wall. Biopsy is contraindicated because it can trigger catastrophic hemorrhage. Management is contrast imaging to define extent, preoperative embolization of the feeding sphenopalatine and internal maxillary branches, then endoscopic or open excision. Radiotherapy is reserved for unresectable or intracranial disease.
Reference: Scott-Brown's Otorhinolaryngology Head and Neck Surgery, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.