1. NASOPHARYNGEAL
ANGIOFIBROMA
PRESENTED BY KOMAL SOOMRO
4TH YEAR MBBS
ENT

2. OBJECTIVES
2.PATHOLOGY
1.INTRODUCTION
4.INVESTIGATION
5.TREATMENT
3.CLINICAL
FEATURES

3. INTRODUCTION:
• It is a benign but locally aggressive tumor.
• It is a rare tumor, though it is the commonest of all
the benign tumors of nasopharynx.
• The exact cause is unknown but it occurs mostly in
adolescent males. it is thought to be testosterone
dependant.
• These patients have hamartomatous nidus of
vascular tissue which get activated to form
angiofibroma when male sex hormone is released.

4. ANATOMY OF NASOPHARYNX
• It opens anteriorly into the nasal cavity.

5. SITE OF ORIGIN AND GROWTH:
 It arises from the posterior part of the nasal
cavity close to the superior margin of
sphenopalatine foramen from here tumor grows
into the nasal cavity, nasopahrynx and into the
pterygopalatine fossa running behind the
posterior wall of maxillary sinus.
 Laterally tumor extends into the
pterygomaxillary fossa and thence to
infratemporal fossa and cheek.

7. PATHOLOGY:
 The exact aetiology of tumor is unknown but it
tends to develop in males between 10 and 25
years old.
 Histologically it is composed of fibrous
connective tissues interspersed with variable
proportion of endothelium lined blood spaces.
 The vessels are just endothelium lined spaces
with no muscle coat therefore severe bleeding
may occur on taking biopsy and surgical removal
as these vessels can not contract to stop
bleeding.

9. EXTENSIONS OF THE TUMOUR:
 Nasopharyngeal angiofibroma is a benign
tumour but locally invasive and destroys the
adjoining structures. it may extend into:
1. Nasal cavity
2. Paranasal sinuses
3. Pterygomaxillary fossa
4. Orbits
5. Cranial cavity (middle cranial fossa)

11. CLINICAL FEATURES:
 Profuse and recurrent epistaxis.
 Progressive nasal obstruction and hyponasal
voice.
 Conductive hear loss and middle ear effusion.
 Extension of tumor in different directions
produces symptoms like facial swelling,
proptosis, diplopia,broadening of nasal bridge,
palatal buldge and cranial nerve palsies.
 On examination a pink or purplish lobulated soft
mass is seen. The mass may bleed on touch

13. INVESTIGATION:
• IMAGING STUDIES:
• Plain x-rays of the nasopharynx (lateral view) and
paranasal sinuses (occipito-mental view) will show the
presence of soft tissues mass.
• CT scan is particularly helpful to find the extent of the
tumour. In addition CT scan with contrast will show the
vascularity of the tumour.
• MRI is also helpful especially to see the extension of
the soft tissue tumour into the cranium, orbit and
infra-temporal fossa.

15. • ANGIOGRAPHY:
• Carotid or four vessel angiography (two carotids and two
vertebral) will show the vascular nature of the tumour, its
feeding vessels and extension of the tumour. In addition
during angiography embolization of the feeding vessel with
gelfoam can be done pre-operatively to shrink the tumour
and reduce bleeding during surgery.
• BIOPSY:
• It is contraindicated in suspected cases of angiofibroma
because it will cause profuse bleeding (as the muscular coat
of the vessel is absent).

17. TREATMENT:
 Surgical excision is the treatment of choice. various
surgical approaches to angiofibroma depending on
its origin and extension are listed below:
1. Trans-antral
2. Trans-palatal
3. Trans-mandibular
4. Lateral rhinotomy
5. Lateral pharyngeal
6. Mid facial degloving
7. Endoscopic
8. transplatine+sublabial (sardana’s approach)
9. Transmaxillary (le fort I approach)

18.  Profuse bleeding during surgery is the main
problem in removal of tumour so different
methods are described to reduce the bleeding:
1. External carotid artery ligation was employed
before surgery to reduce bleeding.
2. Estrogen therapy for three weeks before
surgery is also done to reduce the vascularity.
3. Now super selective embolization is done prior
to surgery in which after angiography
embolization of the feeding vessels is done by
gelfoam. Surgery is performed usually within 24
to 48 hours after embolization.

19.  RADIOTHERAPY:
 It has been used as a primary mode of
treatment. A dose of 3000 to 3500 cGy in 15-18
fractions is delivered in 3 weeks. Tumour
regresses slowly in about a year sometimes even
upto 3 years.
 CHEMOTHERAPY:
 Recurrent and residual lesions have been
treated by chemotherapy, doxorubicin,
vincristine, and dacarbazine in combination.
 HARMONAL:
 Diethylstilboestrol and flutamide have been
used as tumour occurs in males at puberty.