Presentation
Patient reports fullness in his right cheek. Parents note a progressively enlarging and painful right-sided buccal mass.
Patient Data
There is an avidly enhancing soft tissue mass with increased flow voids originating within the sphenopalatine foramen. There is widening of the pterygopalatine foramen and pterygomaxillary fissure. There is a large component within the right masticator space extending anteriorly and laterally into the right buccal space. The pterygoid musculature is displaced posteriorly. There is mass effect upon the right maxillary sinus with anterior bowing of the posterior wall and bony remodeling, without invasion into maxillary sinus. A small component of the mass is present within the right nasal cavity and right sphenoid sinus. There is widening of the right inferior orbital fissure, without evidence of involvement of the orbital apex. No evidence of mandibular invasion or intracranial extension is identified.
The angiogram demonstrates a large tumor blush on the right side with predominant supply from the external carotid artery, particularly from the maxillary artery and the middle meningeal artery.
Case Discussion
This is a case of a juvenile nasopharyngeal angiofibroma. This patient underwent a combined trans-nasal and trans-maxillary resection, which involved the infratemporal fossa and buccal space. Gross pathologic examination of the specimens revealed irregular tan-pink to white glistening tissue. Histopathologic examination of these tissues revealed inflamed sinonasal mucosa and fibro-collagenous stromal proliferation, consistent with angiofibroma. Postoperatively, the patient suffered no major complications. The patient has followed with otolaryngology for nearly 5 years postoperatively for routine surveillance without evidence of recurrence.
Co-authors:
Mason Soeder
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