Juvenile angiofibroma

Recognized since ancient times by Hippocrates, juvenile angiofibroma is an uncommon, benign and extremely vascular tumour that arises in the tissues within the sphenopalatine foramen. Rarely, it is found at other sites in the nasal cavity and paranasal sinuses. Juvenile angiofibroma accounts for less than 0.5 percent of all head and neck tumours. It develops almost exclusively in adolescent males, though there are reports of this tumour being found in children, the elderly, young and even pregnant women. As it grows, the tumour extends into the nasopharynx, paranasal sinuses, pterygopalatine and infratemporal fossa. Larger tumours can involve the orbit and cavernous sinus. Juvenile angiofibromas are locally invasive, though a few have been reported to behave in a more malignant fashion. The vascular nature of juvenile angiofibroma has posed a significant problem for those charged with its management. In recent years, with the advent of endoscopic techniques, the surgical approach to this tumour has changed. This chapter aims to summarize current knowledge and management. PATHOGENESIS