Recurrent intractable nasal bleeding in adolescent young boys is often a slam dunk .As a PG student ,our teachers told us to always rule out JNA or Juvenile Nasopharyngeal Angiofibroma .A mouthful to say and a handful(make it several hansful)to manage.One of the trickiest benign tumours affecting the nasopharynx.
Recurrent :It means repeatedly.
Intractable:Doesn’t stop .
Nasal bleeding:Blood comes out of the nose.
Juvenile:Occurs in adolescent males.
Nasopharyngeal:Is mainly originating in Nasopharynx (area of pharynx adjacent to posterior part of nose(.
Angiofibroma:Contains blood vessels(angio) and fibrous tissue.The tumour has variable composition of angio or vascular component and fibromuscular component.The more of the former, more it will bleed .
Significant problem:The blood vessels in the tumour have a single endothelial layer and lack muscular layer .They thus can’t constrict like normal blood vessels in the rest of the body.That’s the reason for intractable or continued bleeding which needs Nasal packing.
JNA or Juvenile Nasopharyngeal Angiofibroma is a benign tumor starting in the Pterygopalatine Fossa (a region at the base of the skull) which gradually increases in size to fill the nose, pharynx and the the maxillary sinus.
Surgery is quite extensive and needs specialized set up.Investigation needs CECT PNS as a basic first.Coagulation profile is a must before surgery.
Blood transfusion may be needed before ,during and after surgery.
The problem of JNA is its chance of recurring .Even with the best surgery the pseudopod like extensions into the bones make this a challenge. There’s even options for embolizing the tumour,to prevent excessive bleeding.
The recurrent Nasal bleeding can also occur in people with leukemia, blood dyscrasias and those with coagulation problems The age gender, history ,clinical examination and tests help rule out the other causes.
Writing this for #BlogchatterA2Z .Its a N.