Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign but clinically invasive tumour. It potentiates to bleed due to its high vascularity. This tumour accounts for 0.05% of all head and neck tumours, mainly targeted to male adolescence.
The tumour often arises from posterolateral aspect of the roof of nasal cavity in the region of sphenopalatine foramen. Local invasion of this tumour includes involving the nasopharynx, paranasal sinuses, pterygopalatine fossa and the infratemporal fossa. Larger tumour can also involve the orbit and cavernous sinus.
The most common JNA presentation is recurrent epistaxis with progressive nasal blockage. Invasive tumours may cause facial deformities, diplopia, proptosis, headache and blindness. Computer tomographic (CT) imaging is important for diagnostic, often with angiogram,3 and embolisation of feeding vessels.
Several staging classification has been proposed, however Fisch classification (Table 1) has been widely used for its practicality. Surgical resection remains the mainstay of treatment. Extensive uncontrollable blood loss is the challenge faced by surgeons. Thus, pre-operative angiographic embolisation is preferred.