International Journal of Health Sciences and Research Vol.10; Issue: 8; August 2020 Website: www.ijhsr.org Case Report ISSN: 2249-9571 International Journal of Health Sciences and Research (www.ijhsr.org) 284 Vol.10; Issue: 8; August 2020 Proptosis: An Unusual Chief Complaint of Juvenile Nasopharyngeal Angiofibroma Andrew Charles Gomez Junior 1 , Mohamad Hazri Bin Hamal 2 1 Resident trainee in Otorhinolaryngology, University Malaya Medical Center, Lembah Pantai, 59100, Kuala Lumpur, Malaysia 2 Consultant Otorhinolaryngologist, Hospital Ampang, Jalan Mewah Utara, Pandan Mewah Ampang 68000 Selangor Darul Ehsan, Malaysia Corresponding Author: Andrew Charles Gomez Junior ABSTRACT Juvenile nasopharyngeal angiofibroma is an uncommon, benign, fibrovascular tumor that almost exclusively affects adolescent males . We report a case of a 19 year old gentleman who presented to a tertiary center with gradual right proptosis and was diagnosed with a juvenile nasal angiofibroma. Keywords:- Juvenile Nasopharyngeal Angiofibroma, Benign, Proptosis INTRODUCTION Juvenile nasopharyngeal angiofibroma is an uncommon, benign, fibrovascular tumor that almost exclusively affects adolescent males. [1] With their propensity to present with recurrent episodes of profuse epistaxis, these tumors are often a challenge for surgeons. In most cases, diagnosis is based on clinical grounds and does not require a tissue biopsy. The diagnosis can however be a challenge in cases where the characteristic symptoms of recurrent epistaxis and nasal obstruction are not present. CASE REPORT Figure 1 A 19 year old, gentleman was admitted with a chief complaint of right proptosis for 3 months duration. The patient also complained of right sided blurring of vision for one year, and 1 episode of right- sided epistaxis 2 months prior and frontal headache for the preceding 2 weeks. He denied a history of nasal blockage or neck swellings. Review of systems was unremarkable. On examination there was obvious right eye proptosis (Figure 1). Nasoendoscopy revealed a pink, fleshy mass occupying the right nasal cavity, pushing the nasal septum to the left. On the basis of the age of presentation and nasoendoscopic findings a contrast enhanced Computer tomography of the paranasal sinuses and brain was undertaken. This revealed an aggressive, highly vascular, nasal tumor within the epicenter of the nasal cavity (Figure 2) eroding the floor of the anterior cranial fossa and cribriform plates, bilateral sphenoid sinuses with intracranial and orbital extension. The mass obliterates the right pterygopalatine and bilateral sphenopalatine fossas. Magnetic resonance imaging with angiography showed intradural extension and the right maxillary