Juvenile Nasopharyngeal Angiofibroma

Juvenile nasopharyngeal angiofibroma, also known as JNA, is the most common benign tumor of the nasopharynx, which roughly corresponds to the very back of the nasal cavity. These tumors tend to develop in males between 10 and 25 years old. Androgen hormones may play a part in the tumors’ growth. 

Common symptoms include nasal obstruction and severe or repeated nosebleeds. As the tumor grows, it can cause complete obstruction of both sides of the nose. Facial pain or headaches, visual disturbance, or change in facial appearance are all possible signs if the tumor grows large enough. Over time, the tumor can invade the eye socket or cranial cavity, causing blindness or other significant neurologic problems.

Evaluation

At UT Southwestern Medical Center, our physicians use nasal endoscopy as well as CT or MRI imaging studies to diagnose JNA. These tumors occur in a typical location in the nasopharynx and have characteristic features on radiologic studies. A biopsy is not usually required for planning treatment. 

One notable feature of JNA is the large blood supply and many blood vessels within the tumor. This vascularity is responsible for the nosebleeds seen with these tumors. The vascularity may also lead to significant blood loss during surgery. To reduce the amount of bleeding at the time of surgical removal, a procedure called angiography with embolization is frequently performed on the day before surgery.

Treatment Options

Surgical removal is the primary treatment approach for JNA. The historical method for surgically removing JNA involved facial incisions or cuts through the roof of the mouth. Modern endoscopic techniques have replaced these older approaches. The surgeons at UT Southwestern Medical Center are highly trained and experienced in endoscopic techniques.

With appropriate equipment and expertise, even very large tumors may be removed with an endoscopic approach through the nostrils. This results in an unchanged external appearance, reduced discomfort after the surgery, and shorter healing times. 

Since JNA tumors have the potential to recur after surgical removal, regular nasal endoscopic examination and imaging studies are often used to monitor for tumor recurrence in the years after surgery. Recurrent tumors that demonstrate growth are usually removed.

In rare cases, radiation therapy may be considered as a treatment option in very advanced, aggressive cases.