ABSTRACT
INTRODUCTION: Schwannomas are well-differentiated, benign tumours that originate from the Schwann cells of nerve sheaths. They constitute 25-45% of all the head and neck tumours and can cause significant morbidity depending on the site of origin. The pterygopalatine fossa is the rarest site of involvement, with only a few cases reported in the literature. CASE PRESENTATION: This is the case of a 46-year-old male who presented with a twelve [12] month history of left-sided facial pain and progressive swelling. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large soft tissue lesion located in the left pterygopalatine fossa (PPF). Surgical management is presented, and technical details of the repair are discussed. At one year follow-up, there were no signs of recurrence, and the cosmetic outcome was satisfactory. DISCUSSION: This case is one of a handful of reported cases of PPF schwannomas in the English literature. Although a significant percentage of schwannomas arise in the head and neck region, the pterygopalatine fossa is the rarest site of involvement. Due to its clinically inaccessible location and complex connections, the pterygopalatine fossa can act as a natural conduit for the spread of inflammatory and neoplastic diseases in the head and neck. CONCLUSION: Currently, the endoscopic endonasal approach (EEA) is preferred due to its safety and good oncologic outcome. There is also decreased morbidity as it is minimally invasive. Furthermore, surgeons embarking on the EEA should be equipped with an image guidance system and be trained in advanced endoscopic techniques. However, the open approach remains a reliable and proven surgical method to treat large tumours located within this intricate and inaccessible area.