Adult-onset juvenile nasopharyngeal angiofibroma with delayed adult recurrence managed by revision endoscopic resection and external carotid branch ligation.

Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign but highly vascular skull-base tumor classically seen in adolescent males; adult-onset disease is rare and may be overlooked. Reports of JNA presenting in adulthood with recurrence occurring entirely in adulthood remain scarce. We report a 34-year-old man with recurrent left-sided epistaxis and intermittent nasal obstruction three years after endoscopic resection at age 31 for histologically confirmed JNA. Endoscopy demonstrated a soft mass arising from the left sphenopalatine region. CT showed recurrent disease involving the left nasal cavity, maxillary and sphenoid sinuses, with extension into the sphenopalatine/pterygopalatine fossae and bony erosion (Radkowski IIC). Revision endoscopic coblation-assisted excision with posterior maxillary wall drilling was performed. Significant intraoperative bleeding required selective ligation of external carotid branches (internal maxillary, ascending pharyngeal, and facial arteries) to achieve hemostasis. At 6 months, the patient remained symptom-free.