Aetiology:

• Age–
• Usually occurs in the 2nd decade.
• Sex–
• Exclusively common in males.

Theories of origin:

• Hormonal Theory: Angiofibromas are hormone dependent tumors due to estrogen and androgen imbalance.
• Hamartomatous Theory: It suggests of proliferation of vascular aberrant erectile tissue under hormonal influence.

• 4. Ringertz: Tumor arise from periosteum of the nasal vault.
• 5. Som and Neffson: Inequalities in the growth of bones forming skull base results in hypertrophy of the underlying periosteum.
• 6. Bensch and Ewing: Tumor arises from the embryonic fibrocartilage between basi-occiput and basi-sphenoid.
• 7. Brunner: Tumor arises from conjoined pharyngobasilar and buccopharyngeal fascia.
• 8. Osborn: He suggested that this tumor is either a hamartoma or residues of fetal erectile tissue under hormonal influences.
• 9. Girgis and Fahmy: They suggested the presence of paragangliomatous tissue around the terminal part of maxillary artery in the pterygopalatine fossa.

Pathogenesis:

The tumour usually arises from the sphenopalatine foramen or the posterior wall of the nasal cavity with adjoining superolateral wall. The blood vessels are devoid of tunica media, hence the bleeding is torrential.

Blood supply:

Major arterial supply is from the ipsilateral internal maxillary artery. Collateral supply is from the ascending pharyngeal artery and branches of internal carotid artery.

CT scan PNS showing mass in nasal cavity, nasopharynx, pterygopalatine fossa with distortion of nasal septum, medial and posterior wall of maxillary antrum.

Symptoms-

• Nasal obstruction.
• Epistaxis.
• Facial swelling.
• Eustachian tube blockage.
• Rhinolalia.

Treatment:

1) Surgical excision by:

• Transnasal maxillary approach
• Transpalatal approach (Wilson’s approach)
• Lateral Rhinotomy
• Sublabial mid-facial degloving approach
• Infratemporal fossa approach
• Transmaxillary approach (Le fort-I)

• Maxillary swing
• Endoscopic resection
• Combined approaches:

• Combined craniofacial approaches
• Combined transpalatal and sublabial (Sardana’s approach)
• Combined transoral and transnasal endoscopic approach (recent concept)

Pre-operative embolization of the tumor drastically reduces the intra-operative hemorrhage
2)Radiation therapy is usually palliative.