Sinonasal

Bilateral vascular supply in juvenile nasopharyngeal angiofibromas

  1. Arthur W. Wu MD1,
  2. Sarah E. Mowry MD1,
  3. Fernando Vinuela MD2,
  4. Elliot Abemayor MD, PhD1,
  5. Marilene B. Wang MD1,*

Article first published online: 26 OCT 2010

DOI: 10.1002/lary.21337

Issue

The Laryngoscope

The Laryngoscope

Volume 121, Issue 3, pages 639–643, March 2011

Additional Information

How to Cite

Wu, A. W., Mowry, S. E., Vinuela, F., Abemayor, E. and Wang, M. B. (2011), Bilateral vascular supply in juvenile nasopharyngeal angiofibromas. The Laryngoscope, 121: 639–643. doi: 10.1002/lary.21337

Author Information

  1. 1

    From the Division of Otolaryngology–Head and Neck Surgery , David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A.

  2. 2

    Department of Interventional Radiology , David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A.

*200 UCLA Medical Plaza, Suite 550, Los Angeles, CA 900954

Publication History

  1. Issue published online: 18 FEB 2011
  2. Article first published online: 26 OCT 2010
  3. Manuscript Accepted: 28 JUL 2010

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Keywords:

  • Nasopharynx;
  • angiofibroma;
  • sinonasal tumors;
  • embolization

Abstract

Objectives:

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign tumor of the nasopharynx, exclusively affecting males in their teens and twenties. Historically, it has been thought that JNAs primarily receive their blood supply from the ipsilateral external carotid system. We demonstrate in our case series and literature review that bilateral vascular supply in these tumors is, in fact, very common.

Study Design:

Case series and literature review.

Methods:

We present four consecutive cases of JNA in a three-year period from a major tertiary care center. A literature review on the topic of vascular supply in JNA was performed.

Results:

The first patient's preoperative angiogram demonstrated only right-sided blood supply. However, significant bleeding was encountered, and an intraoperative angiogram showed significant new vascularization from the left ascending pharyngeal artery (APA), which was embolized. The surgery was completed successfully without further significant hemorrhage after converting to an open approach. Preoperative angiograms from the next three patients demonstrated bilateral vascular supply. Embolization and endoscopic resection was successful in these cases. Review of the literature demonstrates that bilateral vascular supply is not commonly documented; however, it may be more frequent than previously thought. Other series demonstrate bilateral vascularity from 0% to 100%. Combining patients from nine studies, including our own, we found that 57 of 157 (36%) patients had tumors with bilateral vascular supply.

Conclusions:

Bilateral vascular supply may be an underappreciated factor in JNA, and thorough radiographic investigation via angiography of bilateral carotid systems should be routinely done preoperatively. Laryngoscope, 2011

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