Endoscopic trans nasal excision of pterygopalatine fossa schwannoma: case report and review of literature
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20204645Keywords:
Pterygopalatine fossa, Schwannomas, Endoscopic excisionAbstract
The pterygopalatine fossa is a difficult area for surgical access and lesions in this area traditionally advocated open external trans maxillary approaches. With endoscopic techniques, it is possible to not only access and explore this area but also plan complete excision of lesions in the pterygopalatine fossa. We present a case report of a 26-year-old lady with complaints of pain in the area of the left cheek for 6 months. She had no other co-morbidities. On clinical examination, no abnormality was detected. Radiological examination with magnetic resonance imaging showed a lesion possibly a schwannoma in the left pterygopalatine fossa behind the left maxillary sinus. Complete excision was achieved using trans nasal endoscopic technique through the left maxillary sinus. Histopathological examination confirmed the diagnosis of schwannoma. Post-operative period was uneventful and she was free from any pain and neurological symptoms on subsequent follow up. Schwannomas in the pterygopalatine fossa are rare entities. Endoscopic techniques are safe and effective in accessing the pterygopalatine fossa for excision of lesions situated in this area. This technique obviates the need for external facial incisions or intra oral incisions and helps in good surgical outcomes and quick healing and recovery.
References
DelGaudio JM. Endoscopic transnasal approach to the pterygopalatine fossa. Arch Otolaryngol Head Neck Surg. 2003;129(4):441-6.
Plzák J, Kratochvil V, Kešner A, Šurda P, Vlasák A, Zvěřina E. Endoscopic endonasal approach for mass resection of the pterygopalatine fossa. Clinic. 2017;72(9):554-61.
Xue Z, Liu J, Bi ZY, Yi ZQ, Bao SD, Liu PN et al, Evolution of transmaxillary approach to tumors in pterygopalatine fossa and infratemporal fossa: anatomic simulation and clinical practice. Chin Med J. 2019;132(7):798.
Pasquini E, Sciarretta V, Farneti G, Ippolito A, Mazzatenta D, Frank G. Endoscopic endonasal approach for the treatment of benign schwannoma of the sinonasal tract and pterygopalatine fossa. Am J Rhinol. 2002;16(2):113-8.
Robitaille Y, Seemayer TA, El Deiry A. Peripheral nerve tumors involving paranasal sinuses: a case report and review of the literature. Canc. 1975;35(4):1254-8.
Perzin KH, Panyu H, Wechter S. Nonepithelial tumors of the nasal cavity, paranasal sinuses and nasopharynx. A clinicopathologic study. XII: Schwann cell tumors (neurilemoma, neurofibroma, malignant schwannoma). Canc. 1982;50(10):2193-202.
Dublin AB, Dedo HH, Bridger WH. Intranasal schwannoma: magnetic resonance and computed tomography appearance. Am J Otolaryngol. 1995;16(4):251-4.
Som PM, Shapiro MD, Biller HF, Sasaki C, Lawson W. Sinonasal tumors and inflammatory tissues: differentiation with MR imaging. Radiol. 1988;167(3):803-8.
Alfieri A, Jho HD, Schettino R, Tschabitscher M. Endoscopic endonasal approach to the pterygopalatine fossa: anatomic study. Neurosurg. 2003;52(2):374-80.
Battaglia P, Turri–Zanoni M, Lepera D, Sica E, Karligkiotis A, Dallan I et al, Endoscopic transnasal approaches to pterygopalatine fossa tumors. Head Neck. 2016;38(S1):E214-20.
