Endoscopy ; Humans ; Pterygopalatine Fossa ; surgery

There are several options for the management of patients with locally recurred nasopharyngeal carcinoma after irradiation. Many patients can benefit from reirradiation but the complications of high dose irradiation for the second time are often severe and unbearable. In some patients, the recurred lesion may persist even after the reirradiation. Obtaining an adequate exposure of the nasopharynx for an oncologic surgical procedure has been challenging because of its surgical inaccessibility. However, improvements in the surgical approaches to the nasopharynx and paranasopharynx have been made in recent years. Two illustrative cases, in which we performed salvage surgery, are presented in this article. Using the maxillary swing approach, we removed the recurrent nasopharyngeal tumor in a 43 year old female patient. The reassembly of the osseous and soft tissues was not difficult and the associated morbidity was acceptable. In a 19 year old male patient, subtemporal-preauricular infratemporal fossa approach was performed with low morbidity for the removal of tumor recurred at the pterygopalatine fossa.
Adult ; Female ; Humans ; Male ; Nasopharynx ; Pterygopalatine Fossa ; Young Adult

Chronic invasive fungal sinusitis is a slowly destructive process that most commonly affects the ethmoid and sphenoid sinus, but may involve any paranasal sinus. The disease typically has a time course over 12 weeks. Pathologically, it is characterized as a dense accumulation of hyphae, occasional vascular invasion and sparse inflammatory reaction with involvement of local structures. Aspergillus fumigates is the most common pathogen. In this report, we present a patient with chronic invasive fungal sinusitis invading pterygopalatine fossa, which was presented as only mild thickening of posterior wall of maxillary sinus at initial CT scan.
Aspergillus ; Humans ; Hyphae ; Maxillary Sinus ; Pterygopalatine Fossa ; Sinusitis ; Sphenoid Sinus

With the increasing use of stereotactic radiosurgery, recent reports have suggested that stereotactic radiosurgery may induce secondary malignancies. While the risk of secondary malignancy after conventional radiotherapy is well known, its development after stereotactic radiosurgery has been reported in only a few cases. Here we present the case of a 56-year-old female with visual disturbance of sudden onset. She underwent trans-sphenoidal surgery for a pituitary adenoma 13 years earlier. Imaging studies revealed a newly developed pituitary mass invading the right carvenous sinus. Gross total resection of the tumor was performed using a trans-sphenoidal and pterygopalatine fossa approach. The histological diagnosis was pituitary epithelioid osteosarcoma. Clinicians should be aware of the rare occurrence of radiation-induced pituitary sarcoma as a potentially fatal late complication of stereotactic radiosurgery.
Diagnosis ; Female ; Humans ; Middle Aged ; Osteosarcoma* ; Pituitary Neoplasms* ; Pterygopalatine Fossa ; Radiosurgery ; Radiotherapy ; Sarcoma

Endoscopy ; methods ; Female ; Humans ; Meningocele ; surgery ; Middle Aged ; Pterygopalatine Fossa ; surgery

In neurofibroma, not only schwann cells but also perineural cell, endoneural cells, and fibroblastoid cells create the tumor mass. Simple, isolated neurofibroma are common in the skin but rare in the eye. Simple isolated neurofibroma of the eye are common in the superior orbit, and a case with an isolated neurofibroma of the orbit and maxillary antrum has been reported. The authors have experienced a 57-year-old male patient who complained exophthalmos on his left eye for 2 years. The neurofibroma of the orbit and pterygopalatine fossa was confirmed and reported with a review of literature.
Exophthalmos ; Humans ; Male ; Maxillary Sinus ; Middle Aged ; Neurofibroma* ; Orbit* ; Pterygopalatine Fossa* ; Schwann Cells ; Skin

The surgical approach to juvenile nasopharyngeal angiofibroma (JNA) is determined by the topographic localization, the extent of the tumor, and the experience of the surgical team.1)2) Current surgical options include lateral rhinotomy, midfacial degloving, transpalatal, infratemporal fossa, and transnasal approaches.2)3) Recently, the transnasal endoscopic surgical approach has sometimes been applied to treat benign tumors such as JNA.1)3)4) Transnasal endoscopic excision of a case of JNA limited to the left posterior nasal cavity, nasopharynx, and anterior pterygopalatine fossa was performed successfully on a 17-year old male patient. An endoscopic follow-up at postoperative two years did not indicate residual tumor or recurrence.
Adolescent ; Angiofibroma* ; Follow-Up Studies ; Humans ; Male ; Nasal Cavity ; Nasopharynx ; Neoplasm, Residual ; Pterygopalatine Fossa ; Recurrence

Cholesterol granuloma is usually found in chronic middle ear disease. However, it rarely occurs in the sinonasal regions and only a few cases have been reported in the literature. The etiology of the sinonasal cholesterol granuloma is not known yet, and the clinical manifestations are variable. The 78-year-old man complained of facial pain and toothache at first visit. The PNS CT had a homogenous isodense mass occupying right spenoid sinus and extending to right pterygopalatine fossa, infratemporal fossa and masticator space. The PNS MRI had characteristically high signal lesion at both T1- and T2-weighted images. The tumor was completely excised via transantral approach. Pathological confirmation was the cholesterol granuloma with fungal infection consistent with Aspergillus species. This patient is followed up without recurrence.
Aged ; Aspergillus ; Cholesterol ; Ear, Middle ; Facial Pain ; Granuloma ; Humans ; Pterygopalatine Fossa ; Recurrence ; Sphenoid Sinus ; Toothache

As an important landmark, the posterolateral wall of maxillary sinus can help to locate numbers of significant signs such as maxillary artery and its branches, maxillary nerve and infraorbital nerve, infratemporal fossa and pterygopalatine fossa etc. in the endoscopic surgery for paranasal sinuses and lateral skull base. This article reviewed related researches about the anatomy and endoscopic surgery of posterolateral wall of maxillary sinus.
Endoscopy ; Humans ; Maxillary Artery ; Maxillary Nerve ; Maxillary Sinus ; anatomy & histology ; Nasal Surgical Procedures ; Pterygopalatine Fossa

OBJECTIVE: To provide morphologic data for the operation of pterygopalatine fossa (PPF) region by measuring the bony landmarks and dissecting vessel and nerve. METHOD: The shape, size and adjacent important structures of PPF were observed in 20 dry skulls (forty sides). Ten (twenty sides) skulls were fixed in 4% paraformaldehyde and their arteries were perfused with red lacteprene. The pterygopalatine fossa was exposed from the middle sagittal section dissected to inner wall of maxillary sinus and PPF and observed the course of trigeminal nerve and arteria maxillaris under the operating microscope. To investigate the related surgical anatomy approaches of the maxillary sinus and pterygopalatine fossa. RESULT: The pterygopalatine fossa shows a long and narrow cleft. PPF communicate with nasal cavity, oral cavity, pharynx, orbit, infratemporal fossa and middle cranial fossa. The pterygopalatine segment of maxillary artery and accompanying vein, the maxillary nerve and sphenopalatine ganglion are the most important structures. There are two layers of tissue in the pterygopalatine fossa, they are nervous layer and vessel layer. CONCLUSION (1) To deal with lesion, the approach of maxillary sinus can de used, the cross point of the upper wall, the inner wall and the back wall can be thought as important landmark. (2) Safe scope could be acquired in endoscopic transnasal surgery in pterygopalatine fossa, pterygoid canal and foramen rotundum could be thought as an important landmark.
Adult ; Humans ; Maxillary Sinus ; anatomy & histology ; surgery ; Pterygopalatine Fossa ; anatomy & histology ; surgery