Juvenile nasopharyngeal angiofibroma is a benign, vascular tumour that primarily occurs in adolescent males. Despite its benign nature, aggressive growth patterns can cause potential life-threatening complications. Juvenile nasopharyngeal angiofibroma is normally unilateral, originating from the sphenopalatine artery, but bilateral symptoms can occur if a large tumour extends to the contralateral side of the nasopharynx. This paper presents the first reported case of true bilateral extensive juvenile nasopharyngeal angiofibroma involving clinically challenging pre-surgical planning and surgical strategy.

A 21-year-old male presented with increasing bilateral nasal obstruction and discharge. Examination revealed tumours bilaterally and imaging demonstrated non-contiguous tumours. Pre-operative angiography showed strictly ipsilateral vascular supplies requiring bilateral embolisation. Radical removal performed as one-step, computer-assisted functional endoscopic sinus surgery was performed. The follow-up period was uncomplicated.

This case illustrates the importance of suspecting bilateral juvenile nasopharyngeal angiofibroma in patients presenting with bilateral symptoms. Our management, including successful pre-operative planning, enabled one-step total removal of both tumours and rapid patient recovery.

Pregnancy-associated pyogenic granuloma (pregnancy tumour) is not uncommon. However, control of severe bleeding associated with the lesion by transarterial embolisation has never been reported.

We report the case of a 33-year-old pregnant woman (34 weeks gestation) who presented with a pregnancy-associated pyogenic granuloma of the mandibular gingiva with a life-threatening haemorrhage. The bleeding stopped soon after transarterial micro-embolisation and regressed after one month; thus, no further surgical excision was needed. The patient was free of post-operative wound pain and infection, and there was no recurrence after one year of follow up.

In general, surgical excision is the first treatment choice for pregnancy tumours. However, it is limited by the risk of marked deformity or incomplete excision when large lesions or difficult surgical areas are encountered. For large tumours, transarterial embolisation may be a safer alternative.

To report a rare case of delayed endovascular coil extrusion following embolisation of a lingual artery pseudoaneurysm.

A 23-year-old woman presented with dysphagia and odynophagia 11 months after having experienced massive post-tonsillectomy haemorrhage. At that time, the bleeding had been stopped by embolisation of a lingual artery pseudoaneurysm and the external carotid artery. Clinical examination at admission showed extrusion of the embolisation coils in the lateral lower pharyngeal wall. The coils were removed under general anaesthesia in the presence of an interventional radiologist. The procedure and post-operative period were without complication and no bleeding was observed. The dysphagia and pain disappeared and the subsequent seven-month follow-up period was uneventful.

Although selective embolisation is a safe and effective treatment for severe post-tonsillectomy haemorrhage, the possibility of delayed coil extrusion should be kept in mind.

(1) To highlight the significance of carotid artery pseudoaneurysm as a rare complication following neck dissection, and (2) to suggest endovascular coiling as management, in the presence of infection, previous radiotherapy and a grafted blood supply.

A 66-year-old man diagnosed with squamous cell carcinoma of the hypopharynx and upper oesophagus underwent pharyngolaryngectomy with reconstruction of a neo-pharynx using a free jejunal graft. The patient had previously received radiotherapy for a soft palate squamous cell carcinoma. Two months after surgery, computed tomography demonstrated a bilobed pseudoaneurysm of the left external carotid artery just distal to the arterial branch supplying the jejunal graft. This mycotic pseudoaneurysm was successfully treated with endovascular coiling, while maintaining the patency of the superior thyroid artery supplying the jejunal graft anastomosis.

In this patient, endovascular coiling of the external carotid artery was considered to be the only definitive treatment for a life-threatening mycotic pseudoaneurysm.