Nasopharyngeal Angiofibroma

Excerpt

The earliest known documentation of nasopharyngeal angiofibroma dates to Hippocrates in the 5th century B.C. The condition is also known as juvenile nasopharyngeal angiofibroma (JNA), juvenile angiofibroma, or fibromatous or angiofibromatous hamartoma of the nasal cavity.

The term "nasopharyngeal" may not be entirely accurate. Some sources state that the tumor arises from the sphenopalatine foramen and posterior nasal cavity, while others suggest a more choanal and nasopharyngeal origin. Research consistently agrees, however, that JNA is a benign, highly vascular lesion comprising approximately 0.05% to 0.5% of all head and neck masses.

Though histologically benign, JNA often demonstrates aggressive features with local invasion into the nasal turbinates, nasal septum, and medial pterygoid lamina. The tumor commonly extends into the nasal cavity, nasopharynx, and pterygopalatine fossa, with larger lesions involving the sphenoid, maxillary, and ethmoid sinuses. Growth may also extend through the inferior orbital fissure and into the masticator space via the infratemporal fossa. Severe disease may involve the orbit or intracranial structures, reported in approximately 10% to 37% of cases.

JNA is a highly vascular lesion, typically with 1 or more feeding arterial pedicles. The most common primary arterial supply is the internal maxillary artery, a branch of the external carotid artery (ECA). Larger lesions may recruit multiple feeding arteries, sometimes bilaterally. The ascending pharyngeal artery is the 2nd most common supplying branch, followed by the middle meningeal, accessory meningeal, and facial arteries. Internal carotid artery (ICA) branches may also be recruited, most commonly the vidian artery and, less frequently, the ophthalmic artery.