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Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally aggressive vascular tumor that arises from the posterolateral wall of the nasal cavity, near the sphenopalatine foramen, and primarily affects adolescent males.

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Epidemiology

• Exclusively in adolescent males (typically ages 10–25)
• Accounts for <0.5% of head and neck tumors, but is the most common benign nasopharyngeal tumor in this age group
• Androgen-dependent growth suspected (AR expression, puberty onset)

Etiopathogenesis

• Originates from the fibrovascular stroma of the nasopharyngeal periosteum at the sphenopalatine foramen
• Spreads along natural foramina and fissures:
  • Pterygopalatine fossa → infratemporal fossa
  • Orbit, nasal cavity, sphenoid sinus
  • Cavernous sinus or middle cranial fossa in advanced stages

Other nasopharyngeal angiofibroma associations:

• Familial adenomatous polyposis (FAP)
• Gardner syndrome: Altered APC gene expression in this subset of nasopharyngeal angiofibroma)
• Carcinogenic HPV infection: HPV is known to be associated with head and neck squamous cell carcinoma (HNSCC).

Clinical Features

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JNA classically presents as a painless, progressive unilateral nasal obstruction. The main clinical presentation of JNA is unilateral nasal obstruction with or without epistaxis.

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• Recurrent, spontaneous epistaxis (most common presenting symptom)
• Nasal obstruction
• Facial swelling, proptosis (with orbital extension)