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In the discussion about the juvenile nasopharyngeal

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angiofibroma, I mentioned that these are usually

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presenting with epistaxis in a young male.

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In fact, it is like 95% males and very few

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females that have juvenile nasopharyngeal.

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Angiofibroma in and of itself

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is actually pretty common.

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60% of the population have an episode in their lifetime.

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Many of these do not require medical care.

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Only 6% are brought to medical attention of those 6%.

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Another 6% will get interventional treatment

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where they require embolization of a blood

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vessel that may be the source of the epistaxis.

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Most of the time, the epistaxis is secondary

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to a branch of the external carotid artery.

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Or the sphenopalatine artery, or a branch of the internal

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maxillary artery where you have particles that are used

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to block the offending vessel, and you don't need to do

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it permanently with the particles if you get it to stop.

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And with packing, usually you're able to have

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the patient be relieved of the epistaxis.

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So occasionally there will be sources where it

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requires bilateral internal maxillary artery.

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Facial artery or ascending pharyngeal particle

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embolization to get the bleeding to stop.

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The underlying etiology must be addressed.

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And in point of fact, with juvenile nasopharyngeal

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angiofibroma prior to surgery, a lot of times

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those patients get preoperative embolization.

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But you also wanna rule out vascular malformations,

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venous vascular malformations, arterial venous

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fistulas, for example, or any erosive mass.

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That is growing into these blood vessels.

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Another common finding that we

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see in our imaging armamentarium.

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Is nasal septal perforation in the

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emergency room at Johns Hopkins Hospital.

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I would say maybe 10% of those patients

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floating through the emergency room and getting

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a head CT have nasal septal perforation.

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And this is because in East Baltimore there is a lot

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of drug use that may lead to nasal septal erosion.

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This is most commonly cocaine sniffing,

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but it can be inhalation of heroin.

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So a lot of different things are potentially

2:29

a source of nasal septal perforation.

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Here you see a patient who has nasal septal

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perforation, and the etiology here was sarcoidosis

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within the differential diagnosis of nasal

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septal regions and nasal septal perforation.

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We also have syphilis and we have

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leprosy, and we have Wegener's disease.

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All of these may cause nasal

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septal perforation with regard to sarcoidosis.

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56 00:02:55,810 --> 00:02:58,480 We're gonna look for noncaveating granulomas.

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This may be indistinguishable

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because Wegener's may have granulomas.

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This is, you know, granulomas, angiitis, the new term.

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Look for orbital and intracranial disease

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associated with either sarcoidosis.

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Or Wegener's where you may have

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inflammation that affects both of them.

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Another thing that can occur in this location

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is IgG-related inflammatory disease, usually

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affecting more commonly the orbits as a differential

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diagnosis of orbital pseudotumor, but it may

3:29

also affect the sino-nasal cavity, a little

3:32

less likely to cause nasal septal perforation.