A Case of Juvenile Angiofibroma Confined to the Vidian Canal and Sphenoid Sinus

Abstract

Objective: In this descriptive case we highlight the need for vigilance in investigating patients with typical demographic but without clinical signs of juvenile angiofibroma on nasendoscopy. We also examine the management of these cases where there is intimate relationship to the optic nerve and carotid artery. Method: We use case records, correspondences, radiological investigations, radiographic images, and intraoperative images and videos to outline the disparity between clinical signs and pathology in this individual case. Results: The CT imaging of this patient demonstrates intracanulicular juvenile angiofibroma within the vidian canal without an intranasal component. This was safely but incompletely removed via an endonasal approach with preoperative embolization. Surveillance imaging allowed detection of residual tumor, which may be removed via a mid-facial degloving approach at a subsequent procedure. Conclusion: Vigilance should be exercised when assessing and investigating patients with subtle signs and symptoms but typical demographic for intra-nasal juvenile angiofibroma. Safe endoscopic removal after embolization can be performed with open surgery reserved for residual or recurrences noted on surveillance imaging.