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Juvenile Angiofibroma
ALTERNATIVE NAMES: Sinonasal angiofibroma.
DEFINITION: Angiofibroma is a benign mass formed of fibrous tissue and blood vessels.
WHAT IS GOING ON IN MY BODY? Juvenile angiofibroma is a rare vascular mass that usually develops in the backmost part of the nasal cavity, often but not exclusively, in adolescent males. Because of the significant blood flow through the tumors, their main presenting symptom is massive nosebleed, which is often recurrent. Because there is a mass in the back of the nasal cavity, there may be unilateral nasal obstruction or chronic nasal discharge. In certain instances these tumors push into surrounding normal regions and can put pressure on the eustachian tube, thus causing fluid to build up behind the eardrum, with a mild conductive hearing toss.
WHAT ARE THE SIGNS AND SYMPTOMS? Since this is a tumor made of blood vessels, the main sign is massive nosebleeding, usually through both sides, although it may initially come out of one side or down the back of the throat. The patient may complain of unilateral nasal obstruction and drainage. On examination a mass is usually seen in the backmost area of the nasal cavity arising from just in front of the eustachian tube. If there is significant compression of the eustachian tube, then hearing loss consequent to fluid behind the eardrum may develop.
WHAT ARE THE CAUSES AND RISKS? There is some thought that there may be a hormonal cause of this tumor since most of these occur in young males. There are no known risk factors for the development of this process.
HOW TO PREVENT THE DISEASE: Since this is a sporadic process, it is not preventable.
HOW IS IT DIAGNOSED? On physical examination, a mass is seen in the back of the nasal cavity, usually arising in the area between the back end of the inferior turbinate and in front of the eustachian tube. CT scanning using an intravenous dye will demonstrate the mass highlighted by the dye, which suggests its vascular nature. The CT scan is also useful in determining the true extent of these tumors.
WHAT ARE THE LONG-TERM EFFECTS? Failure to remove these lesions can result in lifethreatening hemorrhage. Certain individuals have a more aggressive form of it, which can cause destruction of local structures.
AM I PUTTING OTHERS AT RISK? No.
WHAT ARE THE TREATMENTS? The main form of management of juvenile angiofibroma is surgical removal of the mass. In order to limit the blood supply of the mass and thus reduce bleeding during surgery, the blood vessels feeding the mass are delineated with angiography and then blocked to deprive the mass temporarily of its blood supply. This greatly facilitates the completeness and extent of its removal.
WHAT ARE THE SIDE EFFECTS TO THE TREATMENTS? Complications can occur from the angiography. These would include hematomas around the artery in the groin where the needle is placed. Rare injuries to the arterial wall can occur (dissection), which can affect the blood supply to the leg. The major side effect of surgery would include scarring, recurrence of the tumor, loss of feeling of the middle or lower third of the face, and massive life-threatening intraoperative hemorrhage.
WHAT HAPPENS AFTER TREATMENT? After successful removal of an angiofibroma, the symptoms usually cease.
HOW DO I MONITOR THE DISEASE? Because of the massive loss of blood during nosebleeds, this is a disease that should not be observed on a prolonged basis but should be investigated immediately. Since serious bleeding from the back part of the nasal cavity rarely occurs in young people, if it happens, particularly in an adolescent male, this tumor must be given first and foremost consideration.
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