JUVENILE ANGIOFIBROMA

JUVENILE ANGIOFIBROMA:  A benign tumor that is grows in the back of the nasal cavity, usually very aggressive and highly vascular. It is not very common. Most always found in adolescent males. Present with obstruction to one side and recurrent bleeding.
SYMPTOMS: 
1. Frequent nosebleeds or bloody mucus.
2. Nasal blockage, stuffy nose, or runny nose.
3. Obstruction of eustachian tube affecting the hearing.
4. Double-vision, d/t erosion into the cranial cavity placing pressure on the optic chiasm.
5. Recurrent ear infections, eye pain, and anosmia.
6. Difficulty breathing.
7. Easy bruising.
DIAGNOSIS: 
1. Submucosal mass located in posterior nasal cavity noted on physical exam.
2. CT.
3. MRI.
4. Arteriogram.
5. X-ray.
6. Biopsy may be necessary.
DIFFERENTIAL DIAGNOSIS:
1. Antro-choanal polyp--benign neoplasm.
2. Rhinosporidiosis--fungal infection of the nose.
3. Cancer.
4. Nasopharyngeal cyst.
5. Pyogenic granuloma.
TREATMENT: 
1. Surgical intervention, careful to minimize blood loss d/t the increased vascularity of the area.
2. Hypotensive anesthesia is the most common way of reducing blood loss.
3. Diethylstilbestrol is given 2-3 weeks prior to surgery to minimize blood loss.
4. Embolization via angiography may be performed to minimize blood loss.
5. Radiation therapy may be used for tumors that cannot be retrieved by surgery or have spread up into the cranial cavity, or where recurrence is the main issue.
6. Endoscopy may be used in conjuction with embolization.
7. Lateral rhinotomy is the most common treatment used today. The maxillary antrum is explored through an incision made along the lateral nasal border.
PROGNOSIS:
There is no prevention or cure. Some tumors may disappear on there own. Tumors may return after surgery.
COMPLICATIONS:
1. Anemia.
2. Pressure on the brain.
3. Spread of the tumor to adjacent structures or sinuses.
REFERENCES:
1. Angiofibroma definition: juvenile nasopharyngeal angiofibroma . (n.d.). Retrieved from http://www.health-res.com/juvenile-nasopharyngeal-angiofibroma.
2.Angiofibroma picture - photo gallery of angiofibroma ::disease gallery. (n.d.). Retrieved from http://health.bayaw.com/zoom/1464/Angiofibroma.
3. Juvenile angiofibroma. (2007). Retrieved from http://neuroradiologyonthenet.blogspot.com/2007_07_01_archive.html.
4. Juvenile angiofibroma angiogram. (n.d.). Retrieved from http://www.sciencephoto.com/images/download_lo_res.html?id=670034609.
5. Vorvick, L. (2009, September 9). Juvenile angiofibroma. Retrieved from http://www.healthline.com.



Angiogram