Nasopharyngeal angiofibroma.

Based on this patient's history and the imaging studies, all the consultants agree that they are dealing with a juvenile nasopharyngeal angiofibroma. They agree that a biopsy is not necessary. However, angiography would be obtained by 2 physicians (Drs. Seid and Weber). When treating an extensive JNA, the consultants differ in their approaches. One favors a lateral infratemporal fossa approach (Dr. Gantz), but the others favor a combined approach (Drs. Seid and Weber). In this particular case, 2 experts favor resection (Drs. Gantz and Weber), but one would irradiate (Dr. Seid). There is also disagreement regarding the severity of morbidity. Minor problems include conductive hearing loss, paresis of the third division of the fifth cranial nerve (Dr. Gantz), and a transient facial nerve paralysis (Dr. Weber). They are more concerned about the long-range problems from skull-base radiotherapy including brain-stem compromise, pituitary dysfunction, and radiation-induced malignancies. No one suggests chemotherapy or multimodal therapy. Regarding the natural history of JNA, the views range from no spontaneous regression (Dr. Gantz), gradual involution over time (Dr. Seid), or an indolent nature that requires tapering the treatment to the benign nature of the process (Dr. Weber).