Juvenile Nasopharyngeal Angiofibromas

Juvenile nasopharyngeal angiofibromas (JNA) are tumors that occur in the back of the nose. They occur almost exclusively in prepubescent or adolescent boys. They are rarely diagnosed in males older than 25. This type of tumor is rather rare, accounting for .05% of all head and neck tumors. The appearance of JNA is stimulated by hormones, which accounts for their prevalence at the onset of puberty.
Various symptoms may occur when JNA are present. The most common symptom is nasal obstruction, which occurs in up to 90% of cases. Nosebleeds, usually occurring in one nostril are also common. Other symptoms may include ear infections, sinusitis, facial swelling, double vision, and loss of sense of smell.

Proper diagnosis will likely entail imaging studies such as an x-ray or CT scan.

These tumors are generally benign but can grow and spread. Proper diagnosis will likely entail imaging studies such as an x-ray or CT scan. Although some patients may undergo hormone therapy or radiation therapy, surgery is usually the recommended treatment. However, depending on the size and location of where the tumor has spread, surgery may be difficult. The fact that the tumors have a large blood supply, fed primarily by the carotid arteries, further complicates surgical removal.

Embolization is a procedure which may take place to decrease the risk of surgery. In this procedure, a catheter or tube is placed into the blood vessels supplying the tumor via the leg, similar to an angiogram. Materials are injected into the vessel to block off the blood supply and decrease the amount of bleeding which is likely to occur during surgery. Embolization generally takes place a few days prior to surgery.
When diagnosed early, embolization, in conjunction with surgery, tends to have very favorable results in the treatment and prevention of further recurrence of juvenile nasopharyngeal angiofibroma.

The embolization procedure from start to finish
Prior to undergoing embolization, patients are expected to sign a consent form and will have the opportunity to have questions answered. The anesthesiologist will administer medications and fluids through the use of an intravenous line (IV) into a vein in the hand or arm. He or she will also administer general anesthesia so that the patient will be completely asleep for the procedure. Blood pressure will be monitored through an A-Line, a thin flexible tube or catheter placed in an artery in your wrist. An electrocardiogram (EKG) will monitor heart rate and rhythm as well as oxygen levels. A specific type of catheter known as a Foley will be placed in the bladder to allow urine to drain.

Once the procedure is complete, the patient will be transferred from the operating room to either the Surgical Intensive Care Unit (SICU) or the Post-Anesthesia Care Unit (PACU). Here, a heart monitor will closely monitor vital signs. This machine is very sensitive and often sounds inadvertently; this is not cause for alarm. The nursing staff will assist in changing positions, but bed rest is required. Eventually, the patient can look forward to a normal diet and transfer to a room on a surgical floor. The Foley catheter will also be removed prior to leaving the bed for the first time.

Patients are expected to keep the leg that underwent surgery straight for several hours and a tube may remain in place at the puncture sight for several days. Once it is removed, the physician will apply pressure for about 20 minutes to prevent bleeding, and a device may be used to seal the puncture.