Tumores de Fosa Pterigopalatina: Tipos de abordajes quirúrgicos y complicaciones / Pterygopalatine Fossa Tumors: Types of surgical approaches and complications

INTRODUCCIÓN. La fosa pterigopalatina es una zona anatómica de difícil acceso, que al presentar masas tumorales genera un alto riesgo de morbimortalidad en población juvenil y adulta, que precisa determinar las complicaciones asociadas a cirugía. OBJETIVO. Evaluar los tipos de abordaje quirúrgico, complicaciones e identificar la estirpe histológica de los tumores de fosa pte-rigopalatina. MATERIALES Y MÉTODOS. Estudio transversal retrospectivo. Población y muestra conocida de 29 Historias Clínicas de pacientes con hallazgos de imagen e histopatológico de tumores con invasión a fosa pterigopalatina divididos en dos grupos: A) resección de masa tumoral y B) biopsia de masa tumoral, operados en el Hospital de Especialidades Carlos Andrade Marín en el período de enero 2017 a diciembre de 2020. RESULTADOS. El 82,76% (24; 29) fueron hombres, con promedio de edad de 30,6 años. El 82,76% (24; 29) de las masas tumorales se originaron en nasofaringe; no se reportaron casos primarios. El tumor más frecuente fue el Angio-fibroma Nasofaringeo Juvenil 68,97% (20; 29), seguido por los tumores malignos con el 20,69% (6; 29), siendo usual el carcinoma adenoideo quístico. En el 62,07% (18; 29) el tumor invadió Fosa Infratemporal y en el 44,83% (13; 29) hacia esfenoides. En el grupo A, el abordaje quirúrgico empleado en el 20,83% (5; 24) fue mediante técnica abierta y en el 79,17% (19; 24) con técnica endoscópica, tanto uni 31,58% (6; 19) como multiportal 68,42% (13; 19). La complicación fue la hiposensibilidad facial en el 12,5% (3; 24), todos en abordajes abiertos. CONCLUSIÓN. Se evaluó los tipos abordaje quirúrgico y se identificó la estirpe histológica de los tumores de fosa pterigopalatina

INTRODUCTION. The pterygopalatine fossa is an anatomical area of difficult access, which when presenting tumor masses generates a high risk of morbimortality in the juvenile and adult popula-tion, which needs to determine the complications associated with surgery. OBJECTIVE. To eva-luate the types of surgical approach, complications and identify the histologic type of pterygopala-tine fossa tumors. MATERIALS AND METHODS. Retrospective cross-sectional study. Population and known sample of 29 Clinical Histories of patients with imaging and histopathological findings of tumors with invasion to pterygopalatine fossa divided into two groups: A) resection of tumor mass and B) biopsy of tumor mass, operated at the Carlos Andrade Marín Specialty Hospital in the period from january 2017 to december 2020. RESULTS. The 82,76% (24; 29) were men, with an average age of 30,6 years. 82,76% (24; 29) of the tumor masses originated in nasopharynx; no primary cases were reported. The most frequent tumor was juvenile nasopharyngeal angiofibroma 68,97% (20; 29), followed by malignant tumors with 20,69% (6; 29), being usual the adenoid cystic carcinoma. In 62,07% (18; 29) the tumor invaded the Infratemporal Fossa and in 44,83% (13; 29) into the sphenoid. In group A, the surgical approach used in 20,83% (5; 24) was by open technique and in 79,17% (19; 24) by endoscopic technique, both uni 31,58% (6; 19) and multiportal 68,42% (13; 19). The complication was facial hyposensitivity in 12,5% (3; 24), all in open approaches. CONCLUSION. The types of surgical approach were evaluated and the histologic type of pterygo-palatine fossa tumors was identified.

Contribución al Estudio Descriptivo del Foramen y Canal Palatino Mayor / Contribution to the Descriptive Study of the Foramen and Greater Palatine Canal

RESUMEN: El foramen y canal palatino mayor (FPM y CPM) comunican boca con fosa pterigopalatina. El conocimiento adecuado de su morfología, permite el abordaje anestésico del nervio maxilar. En el vivo, el FPM está recubierto por una mucosa gruesa, debido a esto los puntos de referencia óseos y dentarios son importantes para ubicar el sitio de punción. Se ha descrito gran variabilidad en cuanto a la etnia, posición, forma, diámetros, longitudes y permeabilidad. Este estudio tuvo como objetivo describir éstas características en cráneos de adultos chilenos. Se utilizaron 31 cráneos de ambos sexos. En los paladares se determinó; forma, largo, profundidad y ancho. En los FPM se consideró su forma, diámetros y localización. En los CPM se registró su permeabilidad y su coincidencia con la forma del FPM. Los registros se realizaron con cámara digital, compás de precisión, caliper digital, compas tridimensional de Korkhaus y sonda metálica. Los resultados muestran un predominio de la forma cuadrada del paladar por sobre las formas triangular y redondeada. Las mediciones de su largo, ancho y profundidad indican diferencias por sexo y por etnia. La forma del FPM no muestra diferencia por sexo, primando la forma ovalada por sobre la fusiforme y la redondeada. La posición de este mismo foramen tampoco muestra diferencias sexuales, primando la posición frente al tercer molar superior, seguida por la posición frente al espacio entre segundo y tercer molar superior y por último frente al 2do molar superior. Las dimensiones del FPM son mayores en individuos masculinos. Los CPM se observaron en su totalidad permeables y los FPM no siempre coincidieron en forma con la sección transversal del CPM. Estos resultados y su comparación con la literatura indican variaciones importantes, lo que impide establecer directrices objetivas a la técnica anestésica que utiliza esta vía anatómica.

ABSTRACT: The greater palatine foramen and canal (GPF and GPC) communicate with the pterygopalatine fossa. The adequate knowledge of its morphology allows the anesthetic approach of the maxillary nerve. In vivo, the GPF is covered by a thick mucosa, therefore, the bone and dental reference points are important to locate the puncture site. Great variability has been described in terms of ethnicity, position, shape, diameters, lengths and permeability. The objective of this study was to describe these characteristics in skulls of Chilean adults. 31 skulls of both sexes were used. In the palates shape, length, depth and width were determined. In the GPF its shape, diameters and location were considered. In the GPC, their permeability and their coincidence with the shape of the GPF were recorded. The records were made with digital camera, precision compass, digital caliper, Korkhaus three-dimensional compass and metallic probe. The results show a predominance of the square shape of the palate over the triangular and rounded forms. The measurements of its length, width and depth indicate differences by sex and ethnicity. The shape of the GPF shows no difference by sex, with the oval shape prevailing over the fusiform and the rounded. The position of this same foramen also shows no sexual differences, with the position prevailing against the upper third molar, followed by the position in front of the space between the upper second and third molars and finally against the upper 2-molar. The dimensions of GPF are greater in male individuals. The GPC were found to be entirely permeable and the GPF did not always coincide in form with the cross section of the GPC. These results and their comparison with the literature indicate important variations, which prevents establishing objective guidelines for the anesthetic technique used in these cases.

Extirpation of primary malignancies in the pterygopalatine and infratemporal fossa via modified maxillary swing approach / 中华口腔医学杂志

Five patients with primary malignancies in the pterygopalatine fossa (PPF) and infra temporal fossa (ITF) were enrolled in this retrospective study between January 2012 and January 2018. After malignancies proven by biopsy and evaluation with CT and MRI scan, all patients received modified maxillary swing (MMS) approach for extirpation of malignant tumors in the PPF and ITF under general anesthesia. En bloc resection with wide surgical margins was successfully performed in all cases. Negative margins were observed in 4 cases and positive margins were found in one patient with adenoid cystic carcinoma who received postoperative radiotherapy. The most common complication was facial numbness. During the follow-up period (range 12 to 57 months), one patient suffered from recurrence while others did not. The advantages of MMS include wide surgical field, full exposure and easy manipulation. The MMS approach is expected to become an standard method for monobloc resection of malignancies in the PPF and ITF.

Clinical study of the removal of infratemporal fossa and pterygopalatine fossa foreign bodies using a trans-oral approach / 口腔疾病防治

Objective @#To summarize the clinical experience of removing infratemporal fossa and pterygopalatine fossa foreign bodies via a trans-oral approach. @* Methods@#The clinical data of 9 patients with foreign bodies in the infratemporal fossa and pterygopalatine fossa hospitalized from March 2008 to June 2017 were analyzed retrospectively. Among these cases, 4 were flying injuries, 2 were falling injuries, 2 were traffic injuries and 1 was an iatrogenic syringe injury. Foreign bodies were divided into the following categories: 3 cases of wood from branches, 3 cases of iron filings, 2 cases of broken glass, and one case of a broken syringe needle. Before surgery, all subjects underwent spiral CT three-dimensional reconstruction and CT angiography examinations. After accurately determining the relationship between the foreign body and the internal and external carotid arteries and their branches, patients underwent an operation under general anesthesia to remove the foreign body via a trans-oral approach. In addition, patients participated in mouth opening training for one week. Then, patients were followed for 1 to 6 months. Foreign bodies were removed completely in all 9 patients.@*Results@#Foreign bodies were independently located in the pterygopalatine fossa in 2 cases and in the in fratemporal fossa in 3 cases. There were 4 cases of foreign bodies located in both the infratemporal fossa and the pterygopalatine fossa. All 9 patients had the foreign bodies completely removed and were discharged one week after surgery. They were followed for 1 to 6 months. Their mouth opening and occlusion were normal, without any complications.@*Conclusion @#Spiral CT, 3D reconstruction and CT angiography examinations are necessary and important for accurate pre-operation positioning. It is feasible to remove foreign bodies in the infratemporal fossa and pterygopalatine fossa via a trans-oral approach.

A Study of Resection of Pterygopalatine Fossa Tumor by Transnasal Recessed Approach under Nasal Endoscope / 医学研究杂志

Objective To analyze and discuss the surgical outcome and complications of resection of pterygopalatine fossa tumor along the lateral wall of maxillary sinus.Methods Nine patients with pterygopalatine fossa tumors received from March 2012 to June 2015 were treated by transnasal endoscopic approach to resect the pterygopalatine fossa tumors by transnasal recess-maxillary sinus approach.Surgery used general anesthesia,while controlling intraoperative hypotension in patients.The CT and MRI examinations of the sinuses were performed before operation,and the patients were followed up regularly.Results All of the patients underwent successful operation.The pterygopalatine fossa tumors were cleared once,and were discharged after 6-12 days.Although there were 2 patients with mild facial paralysis of the maxillary nerve in 3-24 months of follow-up,there was no serious complication or recurrence.Conclusion The removal of pterygopalatine fossa tumors by transnasal endoscopic approach can safely and effectively remove the tumor tissue and preserve the integrity of the lateral wall of the nasal cavity,minimize facial trauma and nasal cavity function.It is a complication less,low recurrence rate,rapid recovery of the new minimally invasive approach,it is worth to promote the use of clinical.

Endoscopic endonasal approach for mass resection of the pterygopalatine fossa

OBJECTIVES: Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa. METHOD: We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations. A total of 13 patients underwent surgery via the endoscopic endonasal approach for pterygopalatine fossa masses from 2014 to 2016. This case group consisted of 12 benign tumors (10 juvenile nasopharyngeal angiofibromas and two schwannomas) and one malignant tumor. RESULTS: No recurrent tumor developed during the follow-up period. One residual tumor (juvenile nasopharyngeal angiofibroma) that remained in the cavernous sinus was stable. There were no significant complications. Typical sequelae included hypesthesia of the maxillary nerve, trismus, and dry eye syndrome. CONCLUSION: The low frequency of complications together with the high efficacy of resection support the use of the endoscopic endonasal approach as a feasible, safe, and beneficial technique for the management of masses in the pterygopalatine fossa.

Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy

The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block has been used for a long time for treating headaches of varying etiologies. For anesthesiologists, treating postdural puncture headaches (PDPH) has always been challenging. The epidural block patch (EBP) was the only option until researchers explored the role of the SPG block as a relatively simple and effective way to treat PDPH. Also, since the existing evidence proving the efficacy of the SPG block in PDPH is scarce, the block cannot be offered to all patients. EBP can be still considered if an SPG block is not able to alleviate pain due to PDPH.

Application of thin-section computed tomographic images in measurement of safe range from foramen rotundum to siphon of internal carotid artery for operation through pterygopalatine fossa / 吉林大学学报(医学版)

Objective:To measure the safe range from the foramen rotundum to the siphon of internal carotid artery using three-dimensional reconstruction technique, and to provide guidance for operation through pterygopalatine fossa.Methods:The skulls of 121 volunteers were scanned to get the final results with thin-section computed tomographic images.The position of the siphon of internal carotid artery (point A)and foramen rotundum (pointB)were ascertained.Three-dimensional reconstruction technique was used to build a coordinate system paralleled to the frankfort horizontal plane and the nasal septum plane.The coordinate system took point A as the coordinate origin.Point C and point D were the projections of point A in two planes parallel with frankfort horizontal plane and nasal septum plane which included point B.The distances of AC,AB,and BC were measured. The angles of the line went through A and B to the three planes were also measured.Results:The distance of AC was measured as 13.22 (3.79)mm (range,8.33 - 105.67 mm;95%CI:8.55 - 21.39 mm).The angle to the sagittal plane was measured as 33.54 (9.23)° (range,5.38- 66.58°;95%CI:30.88 - 34.20°). The angle to the coronal plane was measured as 53.17 (10.48)°(range,5.60-75.02°;95%CI:51.29-55.06°).The angle to the horizontal plane was measured as 9.43 (12.91 ) mm (range,- 28.44 - 82.22;95% CI:7.11 - 11.76 ). Conclusion:The safety distance from foramen rotundum to the siphon of internal carotid artery in the operation through pterygopalatine fossa (PPF) under nasoendoscope is obtained by thin-section computed tomographic images.

Pterygopalatine fossa infiltration: A radio-anatomic study among adult patients in a tertiary private hospital

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> As   a   guide   to   the   clinical   practice   of   infiltration   of   local   anesthesia   into   the pterygopalatine fossa via the greater palatine canal, this study sought to determine and record the  mean  CT  scan  measurements  of  the  following:  1)  palatal  mucosal  thickness,  2)  length  and width  of  greater  palatine  canal,  and  3)  length  and  width  of  pterygopalatine  fossa  among  adult patients in a private tertiary hospital in Quezon City.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective, Descriptive Study<br /><strong>Setting:</strong> Tertiary Private Hospital<br /><strong>Subjects:</strong> Paranasal Sinus (PNS) CT Scans of 113 adult patients from January 2014 to May 2014 were reviewed and evaluated. Excluded were images with pathology that distorted the anatomy of the sinuses and surrounding structures.<br /><strong>RESULTS:</strong> Our study showed average CT scan measurements of 5.98 mm palatal mucosal thickness, 16.99  mm  greater  palatine  canal  length,  18.75  mm  pterygopalatine  fossa  length,  2.37  mm greater palatine canal width and 2.58 mm pterygopalatine fossa width. Comparison of average measurements  by  sex  was  not  statistically  significant.  There  was  statistical  significance  when comparing the right palatal mucosal thickness of 5.86 mm with the left which was 6.11 mm with p-value of 0.001. Comparison between the length of the right pterygopalatine fossa of 18.48 mm with the  left side at 19.01 mm showed statistical significance with p-value of 0.01.<br /><strong>CONCLUSION:</strong> As the average measurement of the mucosal palatal thickness combined with the length of the greater palatine canal was 22.97 mm, we recommend bending the needle 23 mm from  the  tip  in  a  45  degree  angle  for  adult  patients  who  will  undergo  sinus surgery,  control  of posterior epistaxis, trigeminal nerve block and minor oral cavity surgeries.</p>

Transpterygoid Approach to a Dermoid Cyst in Pterygopalatine Fossa

Objective: To describe a case of dermoid cyst arising from the pterygopalatine fossa and review the literature. Methods: We report a case of a 23-year-old man who suffered a car accident 2 years before otolaryngologic attendance. He had one episode of generalized tonic-clonic seizure and developed a reduction of visual acuity of the left side after the accident. Neurologic investigation was performed and magnetic resonance imaging revealed an incidental finding of a heterogeneous ovoid lesion in the pterygopalatine fossa, hyperintense on T2-weighted imaging. Results:  Endoscopic sinus surgery with transpterygoid approach was performed. The ovoid lesion was noted in the pterygopalatine fossa. Puncture for intraoperative evaluation showed a transparent thick fluid. Surprisingly, hair and sebaceous glands were found inside the cyst capsule. The cyst was excised completely. Histologic examination revealed a dermoid cyst. The patient currently has no evidence of recurrence at 1 year postoperatively. Conclusion:  This unique case is a rare report of a dermoid cyst incidentally diagnosed. An endoscopic transnasal transpterygoid approach may be performed to treat successfully this kind of lesion. Although rare, it should be considered in the differential diagnosis of expansive lesions in the pterygopalatine fossa, including schwannoma, angiofibroma, esthesioneuroblastoma, osteochondroma, cholesterol granuloma, hemangioma, lymphoma, and osteoma...

A study of the anatomical variations in the position of the greater palatine foramen in adult human skulls and its clinical significance / Variaciones anatómicas en la posición del foramen palatino mayor en cráneos humanos adultos y su significación clínica

Pain is a common distressing symptom in dental practice. Depending upon the cases, different techniques are used to relieve pain. One of these is peripheral trigeminal nerve block. Peripheral trigeminal nerve block anaesthesia has proved to be an effective and convenient way to anaesthetise large regions of oral and maxillofacial complex. This block can be intraoral or extra oral. The intraoral route is through the greater palatine foramen in which the dental surgeons enter into the pterygopalatine fossa, where the maxillary nerve is situated. The morphological variations in the position of greater palatine foramen may be of clinical importance in the administration of local anaesthesia and in palatal surgery. In the present study, the distance of greater palatine foramen from the median palatine suture, and from the posterior border of hard palate have been noted, and the position of greater palatine foramen relative to the maxillary molars, as well as the direction of the foramen have been examined.

El dolor es un síntoma común y preocupante en la práctica dental. Dependiendo de los casos, diferentes técnicas se utilizan para aliviar el dolor. Una de ellas es el bloqueo periférico del nervio trigémino. Esta, ha demostrado ser una forma eficaz y conveniente para anestesiar grandes regiones del complejo oral y maxilofacial. Este bloqueo puede ser intraoral o extraoral. La vía intraoral es a través del foramen palatino mayor en la cual se ingresa en la fosa pterigopalatina, donde se encuentra el nervio maxilar. Las variaciones morfológicas en la posición del foramen palatino mayor puede ser de importancia clínica en la administración de anestesia local y en la cirugía del paladar. En el presente estudio, se examinó la distancia del foramen palatino mayor desde la sutura palatina mediana y el margen posterior del paladar duro, y su posición relativa a los molares superiores, así como la dirección del foramen palatino mayor.

Invasive intracranial aspergillosis spread by the pterygopalatine fossa in an immunocompetent patient

Aspergillosis of the central nervous system (CNS) is an uncommon infection, mainly found in immunocompromised patients but rarely seen among immunocompetent patients. Herein we describe a 57 year-old immunocompetent man who suffered intracranial aspergillosis spread by the pterygopalatine fossa (PPF) following a tooth extraction. Based on magnetic resonance imaging (MRI) characteristics, in this report we focus on the spreading routes of CNS aspergillosis via communicative structures of the PPF, the relationship between clinical manifestations and the locations of the lesion, and propose a therapeutic strategy to improve the prognosis.

Relationship between volume of pterygopalatine fossa and block anesthesia of maxillary nerve: a pilot study / Relación entre el volumen de la fosa pterigopalatina y la anestesia troncular del nervio maxilar: un estudio piloto

Block anesthesia of maxillary nerve 9BAMN) is achieved by depositing anesthesia through greater palatine canal into the pterygopalatine fossa. Authors differ in the amount of anesthesia to be administered and the rate of complications (diplopia and hematomas), Coronado et al., (2008), measured the size of the pterygopalatine fossa finding an average of 1.2 ml, suggesting that amount of anesthesia for BAMN. The aim of this study is to compare the effectiveness of low doses of 1.2 ml (LD)versus traditional dose of 1.8 m. (TD) of anesthesia for BAMN and its adverse effects. A quasi experimental exploratory clinical study was performed involving 82 patients where the anesthetic technique was suitable for tooth extraction procedure; patients were randomized in LD and TD groups, 2 percent lidocaine with 1:50.000 epinephrine was used. Demographic (sex and age), clinical (tooth for extraction and anesthetic dose) as well as anatomical variables (upper facial and cranial index) were recorded. The anesthetic success (AS) was defined as the possibility to perform the tooth extraction with no pain or minimal pain as measured by visual analogue scale (VAS). For statistical analysis chi-square and t test (p <0.05) were used. The results show that the pain and AS were 2.93 and 61.67 percent in LD group and 3.09 and 59.09 percent in TD group respectively, there were 6 cases of diplopia with no significant statistical difference between groups.

El bloqueo troncular del nervio maxilar (BTNM) se logra depositando anestesia vía canal palatino mayor en la fosa pterigopalatina. Los autores difieren en la cantidad de anestesia a depositar y la tasa de complicaciones asociadas (diplopía y hematomas). Coronado et al. (2008) midió el volumen de la fosa pterigopalatina encontrando un promedio de 1,2ml, sugiriendo dicha cantidad de anestesia para el BTNM. El objetivo del presente trabajo es comparar la eficacia de dosis bajas de 1,2ml (DB) versus dosis tradicional de 1,8ml (DT) de anestesia para el BTNM y sus efectos adversos. Se realizó un estudio clínico cuasiexperimental de carácter exploratorio, participaron 82 pacientes donde la técnica anestésica estaba indicada para un procedimiento de exodoncia, los que fueron aleatorizados en los grupos DB y DT, administrándoles lidocaína al 2 por ciento con 1:50.000 de epinefrina. Se registraron variables demográficas (sexo y edad), clínicas (pieza a extraer y dosis administrada) y anatómicas (índices facial superior y craneal). El éxito anestésico (EA) se definió como la posibilidad de realizar la exodoncia con nulo o mínimo dolor, medido con escala visual análoga (EVA). En el análisis estadístico se utilizaron los tests de chi cuadrado y t de student (p<0,05). Los resultados muestran que el dolor y el EA en el grupo DB fueron de 2,93 y 61,67 por ciento y en el DT de 3,09 y 59,09 por ciento respectivamente, hubo 6 casos de diplopía sin diferencias estadísticamente significativas entre ambos grupos.

A Case of Chronic Invasive Fungal Sinusitis Invading Pterygopalatine Fossa / 대한이비인후과학회지

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.

Relationship between pterygopalatine fossa volume and cephalic and upper facial indexes / Relación entre el volumen de la fosa pterigopalatina y los índices cefálico y facial superior

The maxilary nerve can be block in the pterygopalatine fossa, entering from oral cavity via greater palatine canal. The aim of this study was to analyse the volume of the pterygopalatine fossa and its relationship with upper facial height and cephalic indexes. In 71 human adults skulls, without sex distinction, was determined the volume of the pterygopalatine fossa and cephalic and upper facial height indexes. Through a t test (p < 0.05) were compared the average volume between cephalic and facial types. The average volume of the pterygopalatine fossa was 1.2 mi (DS 0.297), were not found differences according to the cephalic or facial type.

El nervio maxilar puede ser bloqueado en la fosa pterigopalatina, ingresando desde la cavidad oral vía canal palatino mayor. El objetivo de este estudio fue analizar el volumen de la fosa y su relación con los índices cefálico y facial superior. Se utilizaron 71 cráneos humanos adultos, sin distinción de sexo. Se determinó el volumen de la fosa pterigopalatina y los índices cefálico y facial superior. Mediante una prueba t (p < 0.05) se compararon las medias del volumen entre los tipos cefálicos y faciales. El volumen medio de la fosa fue de 1.2 mi (DS 0.297), no se encontraron diferencias de acuerdo al tipo cefálico o facial.

A Case of Schwannoma Arising in Pterygopalatine Fossa / 대한이비인후과학회지

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.

Applied anatomy for management of pterygopalatine fossa lesions via endoscopic transnasal approach / 第二军医大学学报

Objective:To provide anatomic data for management of pterygopalatine fossa lesions via endoscopic transnasal approach.Methods: Fifteen(30 sides) formalin-preserved human skulls were subjected to microsurgical dissection to evaluate the exposure scopes of 3 different endoscopic surgery approaches: endonasal middle meatal transpalatine approach,endonasal middle meatal transantral approach,and endonasal inferior turbinectomy transantral approach.Meanwhile,20(40 sides) dry skulls were dissected and the related measurements were obtained.Results: The 3 approaches allowed for different exposure of the pterygopalatine fossa structure.The mean distances from foramen rotundum to anterior nasal spur,superior orbital fissure,and optic canal were(61.86?3.67)mm,(3.56?0.75) mm,and(11.23?1.24) mm,respectively.Conclusion: The 3 endoscopic approaches are safe and effective for resection of different pterygopalatine fossa lesions and foramen rotundum serves as a landmark for safe management of the pterygopalatine fossa.

A Case of Malignant Fibrous Histiocytoma of the Pterygopalatine Fossa / 대한이비인후과학회지

Although there are some reports of malignant fibrous histiocytoma arising from the head and neck region, there has been no reports on the case originating from pterygopalatine fossa. We experienced a case of 29-year old male patient who visited our hospital with complaints of trismus, periorbital swelling and altered sensation on the left zygomatic area. On physical examination, he showed hypertrophic left middle turbinate, retracted ear drum, and swollen posterior wall of the nasopharynx. On computed tomography, he also showed a low density lesion originating from pterygopalatine fossa. Based on these findings, he was diagnosed with malignant fibrous histiocytoma originating from pterygopalatine fossa. and underwent radical maxillectomy, marginal mandibulectomy, radical neck dissection, and tracheotomy.

TOPOGRAPHY AND MORPHOMETRY OF THE STRUCTURES OF THE PTERYGOPALATINE FOSSA IN KOREANS

Maxillary osteotomy(LeFort I, II, III) is a commonly performed maxillary surgical procedure for the correction of dentofacial deformities. Maxillary osteotomy necessitate seperation of the skeleton of the middle third of the face from its posterior attachments to the cranium. With conventional techniques, an osteotome is placed between the maxilla and pterygoid plates and tapped medially and anteriorly to separate the pterygomaxillary junction. To separate the pterygomaxillary junction safely, knowledge on the anatomical structures of the pterygopalatine fossa area is very important to surgeons. So, to clarify the anatomical structures as it relates to the surgical approach of the pterygomaxillary junction area, Korean skulls (male 110 sides, female 44 sides) were used. And 30 sides of Korean hemisectioned heads were dissected to study about the anatomical and surgical structures of the pterygopalatine fossa area. Suggestions are given regarding the prevention of the complication during the maxillary osteotomy. Results of the studies indicate that with regard to the course of the maxillary artery and the morphology of the pterygomaxillary junction, pterygomaxillary dysjunction would be safely done with pterygomaxillary osteotome of 15mm width in Koreans. And osteotomy should be angled inferiorly from the zygomaticomaxillary crest. This will minimize the risk of the damaging the pterygopalatine fossa area because the mean distance form the inferior border of the pterygomaxillary junction to the furcation of the descending palatine artery was 24.8mm.

A Case of Neurofibroma of the Orbit and Pterygopalatine Fossa

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.