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Management of a recurrent right juvenile nasopharyngeal angiofibroma using direct tumorous puncture embolisation and a subtemporal-preauricular infratemporal fossa surgical approach
  1. Stefan Linton1,
  2. Navin Mani2,
  3. Hannah Stockley3 and
  4. Omar Pathmanaban4
  1. 1Otolaryngology, Manchester Royal Infirmary, Manchester, UK
  2. 2ENT, Manchester Royal Infirmary, Manchester, UK
  3. 3Interventional Radiology, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
  4. 4Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK
  1. Correspondence to Stefan Linton; Stefan.Linton{at}


A juvenile nasopharyngeal angiofibroma (JNA) is a benign vascular tumour that arises from the pterygopalatine fossa. It is seen near exclusively in young males though female cases have been reported. Symptoms are due to their high vascularity and mass effect. Commonly reported symptoms include: nasal obstruction, epistaxis and nasal discharge. The mainstay of treatment is surgical resection either via an endonasal endoscopic approach or open surgical resection. Preoperative embolisation has been shown to decrease intraoperative bleeding. Embolisation may be undertaken via a transarterial (TA) approach or, more recently, via direct tumorous puncture (DTP). Options for recurrent or residual disease may include revision surgery, radiotherapy or close clinical surveillance. The following case presentation describes the management of a recurrent JNA in an adult male using preoperative embolisation via a combination of TA and DTP embolisation and an open surgical resection via a subtemporal-preauricular infratemporal fossa approach.

  • ear, nose and throat/otolaryngology
  • interventional radiology
  • head and neck surgery
  • neurosurgery
  • otolaryngology / ENT

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  • Contributors SL wrote the main body of the article. NM contributed the images. HS reviewed the radiology portion of the discussion. OP reviewed the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.