Angiofibroma of Nasopharynx

The patient, a male University student, aged 19, was referred in January, igSg, complaining of left nasal obstruction with some mucoid discharge. These symptoms had been present for seven months and were more pronounced when motor cycling. He had in fact noticed their appearance only after he had acquired his motor cycle, and he wondered if they might be due to this new activity. There were no special features, such as sneezing, suggestive of allergy. This young man was slimly built, with a fair complexion and red hair. Anterior rhinosocopy showed a slight septal deflection to the right and a moderate degree of generalized mucosal congestion. On posterior rhinoscopy a typical appearance of enlargement of the posterior end of the left inferior _turbinate was noted. X-ray of the sinuses demonstrated gross mucosal thickening of the left antrum, the other sinuses being reported as clear. Left antral lavage was negative. An attempt was made to reduce what then appeared to be inflammatory oedema of the posterior end of the turbinate with a cautery point passed along the left side of the nose. When the patient returned for review ten days later he reported that he felt less obstructed but the appearance on posterior rhinoscopy did not show any material difference. Operative reduction of the enlarged posterior end was advised, but the patient was strongly opposed to the idea of any operative procedure. He was asked to reconsider his decision as the left airway was extremely restricted. A month later mirror examination revealed complete obstruction of the left choana, and he then agreed to operation during the Easter vacation. A lateral X-ray of the nasopharynx was taken before admission to exclude the possibility of some pathological condition other than that of the simple diagnosis reached. The radiological report was: "No abnormality seen in the nasopharynx or in the neck. Soft tissue opacities in the nasal cavities may be due to swollen turbinates." Nevertheless the case was marked for operation under general anaesthesia in view of the size of the swelling and its rapid enlargement since it had come under observation. Subsequent events proved that this was a fortunate decision.