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An angiofibroma is a benign tumor that grows in the nasal cavity. This type of tumor almost always develops in adolescent boys and might be called a juvenile nasopharyngeal angiofibroma. These tumors are not cancerous and only rarely become cancerous. Even so, these benign tumors can grow extremely rapidly and sometimes spread from the nasal cavity into other parts of the cranium.
The most common symptoms of angiofibroma are nasal congestion, headache, nosebleeds, facial swelling, difficulty breathing through the nose and nasal-sounding speech. Children with angiofibromas might also develop a condition called otorrhea, in which fluid drains from one or both ears. Diagnosis of these nasopharyngeal tumors is generally made on the basis of medical imaging tests such as MRIs, CT scans and X-rays. The child might also undergo an arteriogram, a procedure that allows the doctor to view the blood supply which feeds the tumor.
The underlying cause of angiofibromas is unknown. Because these tumors develop almost exclusively in boys between 7 and 19 years old, it is thought that hormones might play a role in triggering their growth. Genetic studies indicate the involvement of at least one gene known to play a role in the development of several types of malignant tumor.
There are three main types of treatment for juvenile nasopharyngeal angiofibroma: hormone therapy, radiation therapy and surgery. Hormone therapy involves the use of a drug called flutamide, which acts by blocking testosterone receptors. The activity of this drug is further evidence for a hormonal cause for the condition. Treatment with flutamide can shrink tumors by more than 40 percent.
Another treatment option for these tumors is radiation therapy. Although it has been reported that radiation therapy has cure rates of up to 90 percent, this treatment is not commonly used, because of its possible long-term side effects on fertility. Radiation therapy generally is used only in cases of recurring tumors or when the tumor has spread from the nasal cavity into other parts of the cranium.
Surgery might be necessary when the tumor grows large enough to block airways or causes repeated nosebleeds. When surgery is necessary, the size and location of the angiofibroma will dictate the type of surgical procedure used in its removal. Entry to the nasal passages where the tumor is located is often gained by the use of a Weber-Ferguson incision, which is a long incision made parallel to one side of the nose.
Another surgical approach is intranasal access, where an endoscope is used to provide access to the tumor through the nasal passages without making any facial incisions. This endoscopic technique is increasingly popular because it is much less invasive than other surgical techniques and has fewer risks and complications. For example, a Weber-Ferguson incision can cause temporary or permanent numbness of the cheek, a complication that is completely avoided by the use of intranasal endoscopy.