This chapter discusses juvenile nasopharyngeal angiofibroma (JNA), which is one of the most surgically challenging tumors in the head and neck region. JNA occurs almost exclusively in young males, where the most common age group is 10 to 18 years, with an average age of around 14 years. The tumor is most commonly believed to arise at the site where the sphenoidal process of the palatine bone articulates with the base of the sphenoid and the horizontal ala of the vomer. A primary, non-operated tumor has a definite pattern of adherence to surrounding structures from which it takes parasitic blood supply. The tumor usually originates where the palatine bone articulates with the body of the sphenoid to form the sphenopalatine foramen. As the nasopharyngeal component enlarges, it begins to block the posterior choana of the opposite nostril and may also cause the soft palate to bulge downwards. Surgery is the primary modality of management of JNA.