ANGIOFIBROMA

Epidemiology
Angiofibromas occur almost exclusively in males and
usually in adolescence (sekitar 15 years), JNA. Females
with Angiofibroma should undergo genetic testing,
Deletion of chromosome 17 (Her-2, Suppressor Gene
p53)
Only 0.5% of all head and neck tumours, but are the
most common of benign nasopharyngeal neoplasms.
Clinical presentation
Nasal Obstruction (80-90 %), especially in initial stages
Epistaxis (45-60%)
Headache (25 %)
Facial Swelling (10-18%)
Other symptoms (Unilateral rhinorrhea, Anosmya,
Hyposmia, deafness and deformity of the cheek)
Pathology
Benign but highly vascular tumours.
Locally aggressive.
Most authors agree that JNAs arise from the posterior
choanal in the region of the sphenopalatine foramen.
Staging
Stage I
Ia: limited to nasal cavity/nasopharynx
Ib: extension into one or more paranasal sinuses
Stage II
IIa: minimal extension through into pterygomaxillary fossa
IIb: fills maxillary antrum or extending into the orbit via
the inferior orbital fissure.
IIc: extends beyond pterygomaxillary fossa into infratemporal
fossa (modified by Radkowski 4)
Stage III: intracranial extension
Bryan RN, Sessions RB, Horowitz BL. Radiographic management of juvenile
angiofibromas. AJNR Am J Neuroradiol. 2 (2): 157-66
Plain radiograph
CT
Visualisation of a nasopharyngeal mass
Opacification of the sphenoid sinus
Widening of the pterygomaxillary
fissure and pterygopalatine fossa
Erosion of the medial pterygoid plate, skull base
 MRI
Excellent at evaluating tumour extension into the orbit
and intracranial compartments.
DSA
Angiography, although not essential, is often useful in
both defining the feeding vessels as well as in
preoperative embolization
Supply of these tumours is usually via 3:
External carotid artery: majority
internal maxillary artery, ascending pharyngeal artery,
palatine arteries
Internal carotid artery: usually in larger tumours
sphenoidal branches, ophthalmic artery
Treatment and prognosis
Surgical resection (either open or increasingly
endoscopic)
Usually performed with pre-operative embolisation to
help with haemostasis
Irradiation may be an option if surgery is not possible
or only incomplete resection
In cases where there is skull base involvement a high
recurrence rate (up to 50%)
Complications
Acute haemorrhage
Differential diagnosis
Angiomatous Polyp: Variant Of A Sinonasal Polyp,
Located Toward Ostium/Hardly Extend To The
Nasopharynx, Elderly Age, Less Vascularity
Rhabdomyosarcoma (Head And Neck)
Nasopharyngeal Carcinoma (Npc)
Nasopharyngeal Teratoma
Lymphangioma: No Contrast Enhancement
Encephalocoele: No Contrast Enhancement
Esthesioneuroblastoma