Juvenile Nasopharyngeal Angiofibroma: Management Challenges in a Tertiary Health Institution in Sokoto, Northwestern Nigeria

Aims: To highlight the diagnostic and therapeutic challenges in the management of the patient.

Background: Juvenile nasopharyngeal angiofibroma is a rare, benign, and vascular tumour that occurs almost exclusively in male teenagers. The tumour usually originate in the posterior nasal cavity around the sphenopalatine foramen and nasopharynx. It is characterized by spontaneous, recurrent and life-threatening epistaxis, nasal and nasopharyngeal mass. Also, it is non-infiltrating but could spread into soft tissues, foramina, orbit, intracranial, and regress at secondary sexual maturity. We report a case of a 13-year-old boy with Juvenile nasopharyngeal angiofibroma complicated by upper airway obstruction and highlighted the diagnostic and therapeutic challenges in his management.

Case Report: A 13-year-old Fulani teenager, presented with a one-year history of progressive bilateral nasal blockage, three months history of growth in the mouth, dysphagia, mouth breathing and epistaxis. Physical examination revealed a young boy in apparent respiratory distress, muffled voice, mouth breathing with rhinolalia clausa. Pinkish mass filled the right nasal cavity and nasopharynx. Computerized tomographic scan imaging showed a huge enhancing hyperdense mass occupying the nasopharyngeal, right nasal cavity and oropharyngeal airway. Had excision biopsy via combined lateral rhinotomy and transoral approaches under general anaesthesia. Histopathological studies confirmed the diagnosis of juvenile nasopharyngeal angiofibroma.

Conclusion: The patient had good result with invasive surgical intervention, despite, non-accessibility of CT angiography and embolization.