Case Report: Juvenile Nasopharyngeal Angiofibroma and a Call for Communication Continued from page 5
report confirmed nasopharyngeal angiofibroma. He is 18 months postsurgery without complications or signs of recurrence. Discussion Diagnosis of rare entities such as this will depend on thorough history and physical examination and consideration of a broad differential. After the initial examination, partnering with our subspecialty colleagues becomes imperative for ongoing patient discussion and education. In our case, the patient was referred to otolaryngology as a precaution with low initial clinical suspicion for JNA. Communication requires participation by all parties; therefore, subspecialists must welcome patients sent as a precaution. Once a diagnosis is confirmed, successful management will depend upon the ability between providers to coordinate and optimize
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an individualized treatment plan to reduce operative blood loss and minimize the chances of recurrence. The mean time from initial symptom(s) to diagnosis has been estimated to be 14 months, a significant amount of time for the rapidly evolving adolescent4. The mental, physical, and social impact of 14 months of potentially embarrassing symptoms and uncertainty cannot be understated. The diagnosis of a tumor, although benign, is likely to add stress at an often-insecure age. In conclusion, JNA is a diagnostic challenge that requires scrutinization of a complete history and physical examination to determine when further investigation of epistaxis is warranted. The position and nature of the tumor as well as the literature suggest that the optimal method for management requires an interdisciplinary approach.
Reference List 1. Martins MBB, de Lima FVF, Mendonça CA, de Jesus EPF, Santos ACG, Barreto VMP, et al. Nasopharyngeal angiofibroma: Our experience and literature review. Int Arch Otorhinolaryngol. 2013 Jan;17(1):14–9. 2. M cInerny TK, Adam HM, Campbell DE, DeWitt TG, Foy JM, Kamat DM. American Academy of Pediatrics textbook of pediatric care. 2nd ed. Washington: American Academy Of Pediatrics; 2017. 3. Shaw KN, Bachur RG. Fleisher & Ludwigs textbook of pediatric emergency medicine. 7th ed. Philadelphia: Wolters Kluwer; 2016. 4. Paris J, Guelfucci B, Moulin G, Zanaret M, Triglia JM. Diagnosis and treatment of juvenile nasopharyngeal angiofibroma. Eur Arch Otorhinolaryngol. 2001 Mar;258(3):120–4.
