Section 3

A child presents with recurrent epistaxis and unilateral nasal obstruction. A CT scan is requested as an outpatient and on the report the Holman-Miller sign is described. 

What is the Holman-Miller sign?

Anterior bowing of the posterior wall of the maxillary antrum

What is the most likely diagnosis?

Right juvenile nasoangiofibroma

Anatomically where does this arise?

The tumor originates in the lateral wall of the nasal cavity, close to the superior border of the sphenopalatine foramen.

Name a staging system for this condition?

  • Radkowski staging system
  • Andrews-Fisch staging system
  • Sessions staging system

List two other investigations you would request?

  • MRI scan
  • Angiography

What is the circulating blood volume in a child?

80ml/kg

Describe the treatment for this condition?

Surgical resection with preoperative embolisation

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