The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

+90 850 321 50 00

Juvenile Nasopharyngeal Angiofibroma (JNA)

Locally aggressive but benign vascular tumor of the nasopharynx affecting almost exclusively adolescent males, presenting with recurrent severe epistaxis and progressive nasal obstruction, requiring preoperative embolization and complete endoscopic or open surgical resection.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our KBB (Kulak Burun Boğaz) department. Book Appointment →

What is Juvenile Nasopharyngeal Angiofibroma (JNA)?

Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign neoplasm composed of vascular and fibrous tissue, but it is locally aggressive due to its tendency for bony erosion and extension along skull base foramina. It originates from the sphenopalatine foramen / pterygopalatine fossa region. JNA almost exclusively affects adolescent males, suggesting hormonal (androgen) influence on growth.

The tumor extends through the sphenopalatine foramen into the nasal cavity and nasopharynx, then into the pterygopalatine fossa via vidian canal, then to the infratemporal fossa, orbit (through inferior orbital fissure), middle cranial fossa (through foramen rotundum and superior orbital fissure), and cavernous sinus. Vascular supply is mainly from the internal maxillary artery (sphenopalatine and descending palatine branches), but advanced lesions may recruit feeders from the internal carotid artery system.

Diagnosis relies on contrast-enhanced MRI (intense enhancement, flow voids, anterior bowing of posterior maxillary wall — Holman-Miller sign), CT (bony remodeling, foraminal widening), and angiography (hypervascular blush). Biopsy is contraindicated. Staging systems include Radkowski, Andrews-Fisch, and University of Pittsburgh. Treatment is preoperative selective transarterial embolization 24-72 hours before resection (reduces bleeding by 60-90%), followed by endoscopic resection (for stages I-IIIa) or combined endoscopic-open or transmaxillary approach for advanced lesions. Recurrence (15-30%) requires long-term MRI surveillance for 5+ years.

Symptoms

Recurrent severe unilateral epistaxis (often profuse and difficult to control)
Progressive unilateral nasal obstruction
Nasopharyngeal mass (vascular, lobulated)
Conductive hearing loss (Eustachian tube obstruction)
Facial swelling, cheek fullness (infratemporal fossa extension)
Proptosis, diplopia, vision changes (orbital/intracranial extension)
Headache, cranial nerve palsies in advanced disease

Risk Factors

Adolescent male (almost exclusive — peak age 10-25 years)
Suspected androgen-dependent growth (hormonal influence)
Familial adenomatous polyposis (rare association)
Genetic predisposition (β-catenin gene mutations described)
No clear environmental or behavioral risk factors
Extremely rare in females (case reports only, often atypical)
Geographic clustering reported (India, Egypt) without confirmed cause

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrent severe nasal bleeding in adolescent boy (especially if unilateral)
  • Progressive unilateral nasal blockage in young male
  • Hearing loss with serous otitis media in adolescent
  • Cheek swelling or facial asymmetry without trauma
  • Eye symptoms (proptosis, double vision) with nasal complaints
  • Any nasopharyngeal mass identified on examination
  • Family history of JNA or familial polyposis with new ENT symptoms

Treatment Methods

01
Preoperative selective transarterial embolization 24-72 hours before surgery (gold standard)
02
Endoscopic transnasal resection for Radkowski stages I-IIIa
03
Combined endoscopic-open (transpalatal, transmaxillary, infratemporal) approach for advanced disease
04
Avoid biopsy — high risk of catastrophic bleeding
05
Hormonal therapy (flutamide) considered for unresectable cases (limited evidence)
06
Radiotherapy reserved for unresectable, recurrent, or intracranial extension (risk of secondary malignancy)
07
Long-term postoperative MRI surveillance every 6-12 months for 5 years (15-30% recurrence)

Which Department to Visit?

You can visit our KBB (Kulak Burun Boğaz) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About KBB (Kulak Burun Boğaz) Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Book AppointmentContact Us

Related Health Topics

Other articles from the same department you may want to explore.

Anaemia

Dahiliye (İç Hastalıkları)

Anaemia is a low haemoglobin level that reduces oxygen delivery, causing fatigue, pallor, and shortness of breath. It is not a disease itself but a sign of many underlying conditions. Most cases are correctable with appropriate diagnosis and treatment.

Iron Deficiency Anaemia

Dahiliye (İç Hastalıkları)

Iron deficiency anaemia develops when dietary intake, absorption, or losses create an iron shortfall, most often affecting women and children. Identifying the underlying cause is the core of management, alongside iron replacement.

Vitamin B12 Deficiency

Dahiliye (İç Hastalıkları)

Vitamin B12 deficiency can cause megaloblastic anaemia, neurological symptoms, and cognitive impairment. Early treatment with intramuscular or oral B12 largely prevents irreversible complications.

Hypertension (High Blood Pressure) Management

Dahiliye (İç Hastalıkları)

Hypertension is often called the silent killer because it progresses symptom-free for years and can damage the heart, brain, kidneys, and eyes. Regular monitoring, lifestyle change, and evidence-based drug therapy dramatically reduce cardiovascular risk.

Chronic Kidney Disease

Dahiliye (İç Hastalıkları)

Chronic kidney disease is one of the most common complications of chronic conditions such as diabetes and hypertension, and can be silent in its early stages.

Hepatitis B (HBV)

Dahiliye (İç Hastalıkları)

Hepatitis B is a DNA virus infection causing acute and chronic hepatitis with risk of cirrhosis and hepatocellular carcinoma; diagnosis integrates HBsAg, HBeAg, anti-HBc, and HBV DNA with management based on disease phase using nucleos(t)ide analogues (entecavir, tenofovir) and universal infant vaccination.

Hepatitis C (HCV)

Dahiliye (İç Hastalıkları)

Hepatitis C is an RNA virus causing chronic hepatitis that may progress to cirrhosis and hepatocellular carcinoma; modern direct-acting antiviral (DAA) pangenotypic regimens (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) achieve sustained virologic response over 95% in 8–12 weeks with universal adult screening and cure for nearly all patients.

Fatty Liver Disease

Dahiliye (İç Hastalıkları)

Non-alcoholic fatty liver disease (NAFLD) is closely related to obesity and metabolic syndrome and is largely reversible with early treatment.

Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.