Endoscopy ; Humans ; Pterygopalatine Fossa ; surgery

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

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

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

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

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

Pleomorphic adenoma is the most common benign tumor of the salivary gland. It occurs mainly in the major salivary gland, but it can be originated from any minor salivary glands and upper airway. Pleomorphic adenoma arising in the maxillary sinus is extremely rare. Recently, we have experienced a huge pleomorphic adenoma originated in the maxillary sinus. The patient was 64 years old woman and the tumor in the left maxillary sinus extended to the infratemporal fossa, pterygopalatine fossa, and parapharyngeal space through destructed maxillary sinus bony wall. Surgical resection was performed via midfacial degloving approach and the result of surgery was successful. We report this case with the review of literature.
Adenoma, Pleomorphic* ; Female ; Humans ; Maxillary Sinus* ; Middle Aged ; Pterygopalatine Fossa ; Salivary Glands ; Salivary Glands, Minor

Angiofibromas are rare histologically benign tumors that predominantly affect adolescent males and account for approximately 0.5% of all neoplasms of the head and neck. Although angiofibromas are histologically benign, but locally invasive. These tumors are highly vascular and associated with extension to the nose, paranasal sinus, pterygomaxillary fossa, infratemporal fossa, intracranium, and neck. The morbidity and mortality associated with these tumors are related to its prominent vascularity and its propensity for aggressive local growth. Pre-operative embolization is useful for reducing intraoperative blood loss and the risk of incomplete excision of the tumor. These tumors virtually arise from the nasopharynx in the region of the sphenopalatine foramen and pterygopalatine fossa. We present a unique case of an angiofibroma limited to the left parapharyngeal space, without involvement of the sphenopalatine foramen or nasopharynx. We treated this case with transparotid-cervical approach after pre-operative embolization.
Adolescent ; Angiofibroma* ; Head ; Head and Neck Neoplasms ; Humans ; Male ; Mortality ; Nasopharynx ; Neck ; Nose ; Pterygopalatine Fossa

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

Schwannoma, also referred to as neurilemmoma, is an encapsulated benign soft tissue tumor arising from the schwann cells of the nerve sheath. Although 25 to 45% of schwannomas arise in the head and neck region, pterygopalatine fossa is the rarest sites of involvement with only 23 cases reported in the medical literature. It is usually seen in the second and fifth decades, but sex or racial predilection has not been noted. Clinical features of this tumor are dependent on the involved anatomical site, nerve of origin, and compression of adjacent structures. The differential diagnosis of masses in pterygopalatine fossa includes angiofibroma, fibrous histiocytoma, malignant melanoma, lymphoma, and low-grade rhabdomyosarcoma. The treatment of choice is that the tumor is completely removed with careful preservation of its nerve. Recently, the authors experienced a case of schwannoma arising in pterygopalatine fossa, which was removed with transantral approach. Hence, we report a rare case with a review of literature.
Angiofibroma ; Diagnosis, Differential ; Head ; Histiocytoma, Malignant Fibrous ; Lymphoma ; Melanoma ; Neck ; Neurilemmoma ; Pterygopalatine Fossa ; Rhabdomyosarcoma ; Schwann Cells