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Head and Neck
Diagnosis
Nose and Sinus
Benign Tumors and Tumor-Like Lesions
Juvenile Angiofibroma
Juvenile Angiofibroma
Bernadette L. Koch, MD; Surjith Vattoth, MD, FRCR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Juvenile angiofibroma (JAF)

            • Synonyms

              • Juvenile nasopharyngeal angiofibroma (JNA); fibromatous or angiofibromatous hamartoma
                • JAF of nasal cavity is more correct terminology
                • JNA is commonly used term, but tumor begins in nasal cavity, not in nasopharynx

            • Definitions

              • Benign, vascular, nonencapsulated, locally invasive nasal cavity mass

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Angiographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Scholfield DW et al: Midfacial degloving for juvenile angiofibroma: a case-series of 21 adult males: an alternative to the endoscopic approach and when it should be considered. Clin Otolaryngol. 46(3):659-64, 2021
                                              2. Schreiber A et al: Early Postoperative magnetic resonance in the diagnosis of persistent juvenile angiofibroma. Laryngoscope. 131(8):E2436-41, 2021
                                              3. Dourthe ME et al: Childhood nasopharyngeal carcinoma: state-of-the-art, and questions for the future. J Pediatr Hematol Oncol. 40(2):85-92, 2018
                                              4. Kim HD et al: Two cases of extranasopharyngeal angiofibroma mimicking choanal polyp in patients with chronic paranasal sinusitis. Auris Nasus Larynx. 46(2):302-5, 2018
                                              5. Windfuhr JP et al: Extranasopharyngeal angiofibroma revisited. Clin Otolaryngol. 43(1):199-222, 2018
                                              6. Rodriguez DP et al: Masses of the nose, nasal cavity, and nasopharynx in children. Radiographics. 37(6):1704-30, 2017
                                              7. Schmalbach CE et al: Managing vascular tumors---open approaches. Otolaryngol Clin North Am. 49(3):777-90, 2016
                                              8. Snyderman CH et al: Endoscopic management of vascular sinonasal tumors, including angiofibroma. Otolaryngol Clin North Am. 49(3):791-807, 2016
                                              9. Alshaikh NA et al: Juvenile nasopharyngeal angiofibroma staging: an overview. Ear Nose Throat J. 94(6):E12-22, 2015
                                              10. Huang Y et al: Surgical management of juvenile nasopharyngeal angiofibroma: analysis of 162 cases 1995-2012. Laryngoscope. 124(8):1942-6, 2014
                                              11. Boghani Z et al: Juvenile nasopharyngeal angiofibroma: a systematic review and comparison of endoscopic, endoscopic-assisted, and open resection in 1047 cases. Laryngoscope. 123(4):859-69, 2013
                                              12. Leong SC: A systematic review of surgical outcomes for advanced juvenile nasopharyngeal angiofibroma with intracranial involvement. Laryngoscope. 123(5):1125-31, 2013
                                              13. Yi Z et al: Nasopharyngeal angiofibroma: a concise classification system and appropriate treatment options. Am J Otolaryngol. 34(2):133-41, 2013
                                              14. Bleier BS et al: Current management of juvenile nasopharyngeal angiofibroma: a tertiary center experience 1999-2007. Am J Rhinol Allergy. 23(3):328-30, 2009
                                              15. Carrillo JF et al: Juvenile nasopharyngeal angiofibroma: clinical factors associated with recurrence, and proposal of a staging system. J Surg Oncol. 98(2):75-80, 2008
                                              16. Danesi G et al: Juvenile nasopharyngeal angiofibroma: evaluation and surgical management of advanced disease. Otolaryngol Head Neck Surg. 138(5):581-6, 2008
                                              17. Spielmann PM et al: Juvenile nasopharyngeal angiofibroma: spontaneous resolution. Ear Nose Throat J. 87(9):521-3, 2008
                                              18. Kania RE et al: Early postoperative CT scanning for juvenile nasopharyngeal angiofibroma: detection of residual disease. AJNR Am J Neuroradiol. 26(1):82-8, 2005
                                              19. Mann WJ et al: Juvenile angiofibromas: changing surgical concept over the last 20 years. Laryngoscope. 114(2):291-3, 2004
                                              20. Wormald PJ et al: Endoscopic removal of juvenile angiofibromas. Otolaryngol Head Neck Surg. 129(6): 684-91, 2003
                                              21. Jones BV et al: Magnetic resonance imaging of the pediatric head and neck. Top Magn Reson Imaging. 10(6): 348-61, 1999
                                              22. Davis KR: Embolization of epistaxis and juvenile nasopharyngeal angiofibromas. AJR Am J Roentgenol. 148(1):209-18, 1987
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Juvenile angiofibroma (JAF)

                                                        • Synonyms

                                                          • Juvenile nasopharyngeal angiofibroma (JNA); fibromatous or angiofibromatous hamartoma
                                                            • JAF of nasal cavity is more correct terminology
                                                            • JNA is commonly used term, but tumor begins in nasal cavity, not in nasopharynx

                                                        • Definitions

                                                          • Benign, vascular, nonencapsulated, locally invasive nasal cavity mass

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Angiographic Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Scholfield DW et al: Midfacial degloving for juvenile angiofibroma: a case-series of 21 adult males: an alternative to the endoscopic approach and when it should be considered. Clin Otolaryngol. 46(3):659-64, 2021
                                                                                          2. Schreiber A et al: Early Postoperative magnetic resonance in the diagnosis of persistent juvenile angiofibroma. Laryngoscope. 131(8):E2436-41, 2021
                                                                                          3. Dourthe ME et al: Childhood nasopharyngeal carcinoma: state-of-the-art, and questions for the future. J Pediatr Hematol Oncol. 40(2):85-92, 2018
                                                                                          4. Kim HD et al: Two cases of extranasopharyngeal angiofibroma mimicking choanal polyp in patients with chronic paranasal sinusitis. Auris Nasus Larynx. 46(2):302-5, 2018
                                                                                          5. Windfuhr JP et al: Extranasopharyngeal angiofibroma revisited. Clin Otolaryngol. 43(1):199-222, 2018
                                                                                          6. Rodriguez DP et al: Masses of the nose, nasal cavity, and nasopharynx in children. Radiographics. 37(6):1704-30, 2017
                                                                                          7. Schmalbach CE et al: Managing vascular tumors---open approaches. Otolaryngol Clin North Am. 49(3):777-90, 2016
                                                                                          8. Snyderman CH et al: Endoscopic management of vascular sinonasal tumors, including angiofibroma. Otolaryngol Clin North Am. 49(3):791-807, 2016
                                                                                          9. Alshaikh NA et al: Juvenile nasopharyngeal angiofibroma staging: an overview. Ear Nose Throat J. 94(6):E12-22, 2015
                                                                                          10. Huang Y et al: Surgical management of juvenile nasopharyngeal angiofibroma: analysis of 162 cases 1995-2012. Laryngoscope. 124(8):1942-6, 2014
                                                                                          11. Boghani Z et al: Juvenile nasopharyngeal angiofibroma: a systematic review and comparison of endoscopic, endoscopic-assisted, and open resection in 1047 cases. Laryngoscope. 123(4):859-69, 2013
                                                                                          12. Leong SC: A systematic review of surgical outcomes for advanced juvenile nasopharyngeal angiofibroma with intracranial involvement. Laryngoscope. 123(5):1125-31, 2013
                                                                                          13. Yi Z et al: Nasopharyngeal angiofibroma: a concise classification system and appropriate treatment options. Am J Otolaryngol. 34(2):133-41, 2013
                                                                                          14. Bleier BS et al: Current management of juvenile nasopharyngeal angiofibroma: a tertiary center experience 1999-2007. Am J Rhinol Allergy. 23(3):328-30, 2009
                                                                                          15. Carrillo JF et al: Juvenile nasopharyngeal angiofibroma: clinical factors associated with recurrence, and proposal of a staging system. J Surg Oncol. 98(2):75-80, 2008
                                                                                          16. Danesi G et al: Juvenile nasopharyngeal angiofibroma: evaluation and surgical management of advanced disease. Otolaryngol Head Neck Surg. 138(5):581-6, 2008
                                                                                          17. Spielmann PM et al: Juvenile nasopharyngeal angiofibroma: spontaneous resolution. Ear Nose Throat J. 87(9):521-3, 2008
                                                                                          18. Kania RE et al: Early postoperative CT scanning for juvenile nasopharyngeal angiofibroma: detection of residual disease. AJNR Am J Neuroradiol. 26(1):82-8, 2005
                                                                                          19. Mann WJ et al: Juvenile angiofibromas: changing surgical concept over the last 20 years. Laryngoscope. 114(2):291-3, 2004
                                                                                          20. Wormald PJ et al: Endoscopic removal of juvenile angiofibromas. Otolaryngol Head Neck Surg. 129(6): 684-91, 2003
                                                                                          21. Jones BV et al: Magnetic resonance imaging of the pediatric head and neck. Top Magn Reson Imaging. 10(6): 348-61, 1999
                                                                                          22. Davis KR: Embolization of epistaxis and juvenile nasopharyngeal angiofibromas. AJR Am J Roentgenol. 148(1):209-18, 1987