Pterygopalatine Fossa Research Articles

Comparative analysis of the impact of selected anesthesia methods on the cognitive function of patients undergoing ophthalmic surgery

Background: Anesthesiologists should not only save patient’s life as a process, but also enable the patient to recover his/her social life after surgery, given increased longevity, high social activity throughout life, and increased use of technical equipment in everyday life. Purpose: To assess central nervous system (CNS) changes in patients undergoing penetrating keratoplasty in order to optimize the choice of anesthesia technique, while taking into account the impact of general anesthesia on postoperative cognitive functions. Material and Methods: We employed neuropsychological tests such as Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Luria’s test to examine the cognitive function of patients before surgery and 6 hours, 24 hours, 7 days and 21 days after surgery. Results: On the basis of comparative analysis of the impact of selected anesthesia methods on cognitive function of patients undergoing surgery (penetrating keratoplasty), we concluded that a combination of regional anesthesia (pterygopalatine fossa blockade), dexmedetomidine infusion (0.3 µg/kg) and general analgesia (maintenance in an oxygen/sevoflurane mixture) with exclusion of Sibazon 0.5% had the shortest and the least profound impact on the cognitive function. Conclusion: On the basis of comparative analysis of the impact of selected anesthesia methods on cognitive function of patients undergoing penetrating keratoplasty, we concluded that a combination of regional anesthesia (pterygopalatine fossa blockade), dexmedetomidine infusion (0.3 µg/kg) and general analgesia (maintenance in an oxygen/sevoflurane mixture) with removal of Sibazon 0.5% from premedication and presence of a reduced amount of fentanyl used during anesthesia had the shortest (with a mean duration of a day) and the least profound impact on cognitive state in patients undergoing ophthalmic surgery.

Image findings of anti-neutrophil cytoplasmic antibody-associated vasculitis involving the skull base

To investigate computed tomography (CT) and magnetic resonance imaging (MRI) features of skull bases involving anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). A retrospective review was undertaken to identify an institutional historical cohort of 17 patients with confirmed AAV who underwent CT or MRI and had skull base involvement between 2002 and 2021. Two radiologists reviewed the extent and features of the lesions, bone changes, and other MRI findings. A total of 17 patients (12 men; mean age ± standard deviation, 46.5±17.1 years) were selected. AAV presented as infiltrative lesions with involvement at various sites. Most cases involved the paranasal sinuses (PNS; 88%, 15/17), nasopharynx (88%, 15/17), pterygopalatine fossa (82%, 14/17), and parapharyngeal space (82%, 14/17), frequently accompanied by mucosal irregularity of the PNS and nasopharynx (71%, 12/17). Central skull base and temporal bone involvement were seen in 53% (9/17) and 38% (6/16) of cases, respectively. On T1-weighted imaging (WI) and T2WI MRI, all lesions (15/15) showed predominant signal iso-intensity to grey matter. Although radiological findings of AAV are non-specific and skull base involvement is less common, AAV may be considered if infiltrative lesions predominantly involving the PNS, nasopharynx, pterygopalatine fossa, and parapharyngeal space with combined bone changes of skull base are seen.

Orbitocranial Penetration of Ball Bearing Gun Trauma: A Prospective Human Cadaveric Study.

Objective We completed a prospective human cadaveric study to determine the ability of a ball bearing (BB) pellet to penetrate the orbit and/or surrounding structures. Methods A single trained sergeant officer discharged an alloy steel air rifle to eight cadaver orbits from four adult human cadaver heads. Five BB pellets each were aimed at three locations (caruncle, upper eyelid, or lower eyelid) at 10 cm and 1 m, and then less specifically, at the orbital region for 3- and 5-m distances. Computed tomography (CT) of the cadaver heads was performed. Final locations of BB pellets are divided into three categories: intracranial, surrounding orbital structures including the pterygopalatine fossa and infratemporal fossa, and orbit. Results Of 40 BB pellets, 37 penetrated soft tissue and were visualized on CT: 19 (51%) rested in the intracranial space, 17 (46%) in surrounding orbital structures, and 1 (3%) within the orbit. The deepest position of a pellet was in the parietal lobe, and most superficial location anterior to the frontal bone. Pellets discharged from 1 m were more likely to rest in the intracranial space compared with those from 10 cm ( p < 0.001), 3 m ( p = 0.011), and 5 m ( p = 0.004). The distance of discharge was associated with final pellet location ( p = 0.001). Conclusion BB guns should be considered dangerous and potentially deadly when aimed at the orbit. Although the thick calvarium can protect the intracranial space from BB penetration, the orbit may be a vulnerable entry point with relatively low resistance, allowing penetration of the intracranial and periorbital spaces.

Maxillary Nerve as Landmark for Exposure of the Internal Maxillary Artery in Extracranial-Intracranial Bypass Surgery

To establish a new method for fast exposure of the internal maxillary artery (IMA) during extracranial-intracranial bypass surgery. To explore the positional relationship between the IMA and the maxillary nerve and pterygomaxillary fissure, 11 formalin-fixed cadaveric specimens were dissected. Three bone windows of the middle fossa were created for further analysis. Then the IMA length that could be pulled up above the middle fossa was measured after different degrees of removal of bony structure. The IMA branches under each bone window were also explored in detail. The top of the pterygomaxillary fissure was located 11.50 mm anterolateral to the foramen rotundum. The IMA could be identified just inferior to the infratemporal segment maxillary nerve in all specimens. After drilling of the first bone window, the IMA length that could be pulled above the middle fossa bone was 6.85 mm. After drilling of the second bone window and further mobilization, the IMA length that could be harvested was significantly longer (9.04 mm vs. 6.85 mm; P < 0.001). Removal of the third bone window did not significantly improve the IMA length that could be harvested. The maxillary nerve could be used as a reliable landmark for the exposure of the IMA in the pterygopalatine fossa. With our technique, the IMA could be easily exposed and sufficiently dissected without zygomatic osteotomy and extensive middle fossa floor removal.

Mykola Pirogov’s (1810-1881) illness mystery. Computed tomography and 3D reconstruction of the head of the famous surgeon's mummy

Introduction. It is known that at the age of 70, the outstanding surgeon Mykola Pirogov suffered from pain and a wound of the palate on the right and had problems with eating. He was consulted by well-known doctors M.V. Sklifosovskyi, E. von Wahl, V.F. Grube, E.I. Bohdanovskyi and the famous surgeon T. Billroth, convincing him that the ulcer was benign.On the fourth day after his death, on the initiative of his wife Baroness O.A. von Bistrom, Pirogov's body was embalmed by permission of the church.Case report. In 2018, M.I. Pirogov's body was re-embalmed in Vinnytsia according to the original method by scientists of Vinnytsia National Medical University and the National University of Life and Environmental Sciences of Ukraine.The remains were examined using a 32-slice computer tomograph Siemens "Somatom go. Up" (Germany) with 3D reconstruction of the entire body and the head of great surgeon. According to the protocol, the slices thickness was 0.8 mm, the voltage was 110‒120 kV, the current strength was 30‒230 mA, the thickness of reconstructions was 0.8 to 3.0 mm.Modern technologies made it possible to see destructive changes in the bones of the skull and establish the cause of Mykola Pirogov's illness and death. The 3D reconstructions prove the fact that Pirogov's diagnosis was correct. The existing bone changes indicate widespread malignancy, most likely cancer in the mouth, nasopharynx, and pterygopalatine fossa on the right.Discussion. Natural and anthropogenic mummies are important for history and science, as they can tell us about the health conditions and lifestyle of people in the past.Computed tomography is a non-destructive technique, and is therefore considered the gold standard for studying mummies. This method is also used during the embalming procedure and monitor the degree of preservation of the mummified body. Currently, computed tomography is widely used in mummy research to non-invasively assess the natural or anthropogenic origin, mummification embalming technique, bone and soft tissue preservation parameters, age, constitution, health status, cause of death, post-mortem injuries, etc.Conclusions. The use of computed tomography followed by 3D reconstruction is highly likely to not only predict the future, but also shed light on the mysteries of the past.

Endoscopic resection of type D trigeminal schwannoma through nasal sinus approach

Objective: To examine the feasibility and surgical approach of removing type D trigeminal schwannoma through nasal cavity and nasal sinus under endoscope. Methods: Eleven patients with trigeminal schwannoma who were treated in the Department of Otorhinolaryngology, Qilu Hospital of Shandong University from December 2014 to August 2021 were analyzed retrospectively in this study. There were 7 males and 4 females, aged (47.5±13.5) years (range: 12 to 64 years). The neoplasm involved the pterygopalatine fossa, infratemporal fossa, ethmoidal sinus, sphenoid sinus, cavernous sinus, and middle cranial fossa. The size of tumors were between 1.6 cm×2.0 cm×2.0 cm and 5.7 cm×6.0 cm×6.0 cm. Under general anesthesia, the tumors were resected through the transpterygoid approach in 4 cases, through the prelacrimal recess approach in 4 cases, through the extended prelacrimal recess approach in 2 cases, and through the endoscopic medial maxillectomy approach in 1 case. The nasal endoscopy and imaging examination were conducted to detect whether neoplasm recurred or not, and the main clinical symptoms during follow-up. Results: All the surgical procedures were performed under endonasal endoscope, including Gross total resection in 10 patients. The tumor of a 12-year-old patient was not resected completely due to huge tumor size and limited operation space. One patient was accompanied by two other schwannomas located in the occipital region and the ipsilateral parotid gland region originating from the zygomatic branch of the facial nerve, both of which were removed concurrently. After tumor resection, the dura mater of middle cranial fossa was directly exposed in the nasal sinus in 2 cases, including 1 case accompanied by cerebrospinal fluid leakage which was reconstructed by a free mucosal flap obtained from the middle turbinate, the other case was packed by the autologous fat to protect the dura mater. The operation time was (M(IQR)) 180 (160) minutes (range: 120 to 485 minutes). No complications and deaths were observed. No recurrence was observed in the 10 patients with total tumor resection during a 58 (68) months' (range: 10 to 90 months) follow-up. No obvious change was observed in the facial appearance of all patients during the follow-up. Conclusion: Type D trigeminal schwannoma involving pterygopalatine fossa and infratemporal fossa can be removed safely through purely endoscopic endonasal approach by selecting the appropriate approach according to the size and involvement of the tumor.

A radioanatomical study of 3rd segment terminal branches of the maxillary artery in the pterygopalatine fossa

This study describes the clinical anatomical topography and relationship of the terminal branches of the maxillary artery to the bony wall of the maxillary sinus in the pterygopalatine fossa (PPF) to estimate the bleeding risk during surgical interventions. Using contrasted computer tomography records, (i) the route of the maxillary artery in the infratemporal fossa, (ii) the number of the arteries in the critical PPF surgery plane, (iii) the diameter of the largest artery in the area and (iv) its relation to the posterior wall of the maxillary sinus were examined. Furthermore, measurements were extended with (v) the minerality of the bony posterior wall of the maxillary sinus on bone-window images. For statistical analyses Student’s t- and Fisher-test were applied. 50 patients (n = 50, 100 cases including both sides) were examined in this study. The maxillary artery reached the pterygomaxillary fissure on the lateral side of the lateral pterygoid muscle in 56% of the cases (n = 32), in 37% (n = 23) on its medial side and in 7% (n = 4) on both sides. The number of arteries at the level of the Vidian canal in the PPF varied between 1 and 4 with a median of 2. The diameter of the biggest branch was 1.2–4.7 mm, the median diameter was 1.90 mm. In 41% (n = 30) of the cases the biggest artery directly contacted the posterior wall of the maxillary sinus, and the mineral density of the posterior wall was decreased in 14.3% (n = 12) of all investigated cases. The present description and statistical analysis of the vasculature of the PPF optimizes operative planning—like clip size or the type and direction of the surgical approach—in this hidden and deep head/neck region.

Effects of bilateral transmucosal sphenopalatine ganglion block on intraoperative anesthetic requirements and recovery profile in children undergoing palatoplasty under general anesthesia.

Sphenopalatine ganglion block (SPGB) given as injection provides excellent perioperative analgesia during palatoplasty. Our objectives were to assess the effect of transmucosal SPGB on anesthetic requirements, intraoperative hemodynamics, recovery time, and emergence delirium in children undergoing palatoplasty. This prospective, randomized study was conducted in 30 children with cleft palate undergoing palatoplasty, divided into two equal groups. After induction and intubation, patients in Group B received bilateral SPGB using cotton-tipped applicators soaked in 2% lignocaine, which were passed through both the nares, and the distal tip was positioned just superior to middle turbinate and anterior to pterygopalatine fossa and sphenopalatine ganglion. In Group C, saline-soaked cotton applicators were used. All patients received general anesthesia as per a standardized protocol. Intraoperative heart rate, mean arterial pressure, the requirement of anesthetics, extubation time, and emergence delirium were compared. Compared with Group C, patients in Group B had significantly lower sevoflurane consumption (17.2 ± 2.6 vs. 27.5 ± 5.0mL, P < 0.001) and fentanyl consumption (2.2 ± 0.5 vs. 3.2 ± 0.6 μ/kg, P < 0.001).The extubation time was significantly shorter in Group B (3.9 ± 0.7 vs. 9.5 ± 1.6 minutes, P < 0.001). PAED (Pediatric Anesthesia Emergence Delirium Scale) scores at 5and 10 minutes were significantly higher in Group C (P < 0.001). Intraoperative heart rate was significantly higher in Group C. Group C had significantly higher mean arterial pressure at 15, 60, and 75 minutes. Preoperative, SPGB administered by mucosal application of local anesthetic significantly reduced sevoflurane and fentanyl requirements, with stable hemodynamics, quicker recovery, and less emergence delirium in children undergoing palatoplasty.

Comparison of the feasibility and safety of infrazygomatic and suprazygomatic approaches to pterygopalatine fossa using virtual reality

BackgroundInjections of local anesthetics into pterygopalatine fossa gained popularity for treating acute and chronic facial pain and headaches. Injury of maxillary artery during pterygopalatine fossa injection can result in pseudoaneurysm...

A giant schwannoma at the pterygopalatine fossa – A case report

A giant schwannoma at the pterygopalatine fossa – A case report

Пулевое ранение глотки с фиксацией инородного тела в мягких тканях на уровне основания черепа

Foreign bodies of the ENT organs are one of the most common reasons for visiting an ENT doctor, including referrals for inpatient treatment. The problem of injuries to the head and neck, despite peacetime, is due to the growth of the criminal situation, the availability of traumatic means of self-defense and, at times, their unreasonably frequent use. Bullet wounds of ENT organs are often accompanied by various complications: heavy bleeding; damage to the orbit, pterygopalatine fossa, base of the skull; contusion symptoms and manifestations of shock. Modern technical solutions in otorhinolaryngology, which undoubtedly are navigation systems, allow determining the location of foreign bodies in the head and neck area with an accuracy of up to a millimeter, which is often the only way to safely remove them. The article considers an example of successful removal of a foreign body of the skull base area (metal bullet) in a 27-year-old patient using video endoscopic equipment and navigation system.

Granulomatosis With Polyangiitis Presenting as an Infratemporal Fossa Mass

Granulomatosis with polyangiitis is a rare autoimmune disease that affects small to medium-sized blood vessels throughout the body. Here, we present a case of an infratemporal mass that was the result of granulomatosis with polyangiitis. A 51-year-old male presented to the emergency department due to right cheek and facial pain that he had been experiencing for 2 to 3 months. An MRI revealed a mass within the right infratemporal and pterygopalatine fossae extending into the inferior right orbital fissure along the maxillary division of the trigeminal nerve (V2) and the vidian nerve causing concern for malignancy. Histology from an endoscopic biopsy demonstrated multiple arteries with luminal obliteration with non-necrotizing granulomas. The patient was started on steroids and immunosuppressive therapy, which improved his symptoms and decreased the size of the residual mass. This case illustrates the need for laboratory testing, imaging, and biopsy of the involved tissue in cases where GPA is suspected to prevent treatment delays that could lead to the destruction of vital organs.

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal and Endoscopic-Assisted Transmaxillary Transpterygoid Approaches.

Introduction The endoscopic endonasal transpterygoid approach (EETPA) with or without the addition of the endoscopic-assisted sublabial anterior transmaxillary approach (ESTA) has become increasingly utilized for lesions posterior to the pterygopalatine fossa (PPF), including infratemporal fossa (ITF), lateral recess of the sphenoid sinus, Meckel's cave, petrous apex, and parapharyngeal space. The main goal of this study is to develop an educational resource to learn the steps of the EETPA for trainees. Methods EETPA and ESTA were performed in 12 specimens by neurosurgery trainees, under supervision from the senior authors. One EETPA and one ESTA were performed on each specimen on opposite sides. Dissections were supplemented with representative cases. Results After a wide unilateral sphenoidotomy, ethmoidectomy, and partial medial maxillectomy, the anteromedial bone limits of the PPF were identified and drilled out. The pterygoid progress was modularly removed. By enlarging the opening of the posterior and lateral walls of the maxillary sinus through EETPA and ESTA, respectively, the neurovascular and muscular compartments of the PPF and ITF were better identified. The EETPA opens direct corridors to the PPF, medial ITF, middle cranial fossa, cavernous sinus, Meckel's cave, petrous apex, and internal carotid artery. If a more lateral exposure of the ITF is needed, the ESTA is an appropriate addition. Conclusion Despite the steep learning curve of the EETPA, granular knowledge of its surgical anatomy and basic surgical steps are vital for those advancing their learning in complex endoscopic approaches to the ventral skull base when expanding the approach laterally in the coronal plane.

Clinical implications of the anatomical relationships of the pterygopalatine fossa and Vidian canal: an endonasal endoscopic cadaveric study

Objectives: The aim of our study was to describe a surgical access to pterygopalatine fossa and Vidian canal using an endonasal endoscopic approach. We also intend to reveal the anatomical relations of the neurovascular structures in the surgical corridors and to determine the relationships between previously defined reference points in order to prevent surgical complications during surgical access to these regions. Methods: Our study was carried out between October-December 2016 in Cerrahpaşa Faculty of Medicine Microneurosurgery and Neuroanatomy Laboratory. A total of 7 silicon dye-injected cadavers (4 males and 3 females) were studied. 3D images were obtained by photographing the approaches applied to the pterygopalatine fossa and Vidian canal and related anatomical structures. Results: We succeeded in exposing and examining the pterygopalatine fossa and Vidian canal endoscopically in all samples. First, the posterior wall of the maxillary sinus was opened to reach the pterygopalatine fossa. The pterygopalatine fossa was divided into 3 anatomical compartments. The first layer encountered was the periosteum covering the pterygopalatine fossa. After removing the periosteum, the fat layer was revealed. Under the fat layer, the vascular compartment and finally the neural compartment were encountered. Conclusion: Our study revealed three-dimensional anatomical data related to the surgical margins involved in approaches to the pterygopalatine fossa and Vidian canal; and specifically defined various neurovascular structures encountered in these approaches. Our study provides information to decrease potential complications that may develop during endonasal endoscopic surgery. We conclude that as the anatomy of the pterygopalatine fossa and Vidian canal is known in details, the endonasal endoscopic approach is likely to become the standard method to access lesions in these regions.

How I do it:- Endoscopic Reverse Denker's Approach.

Introduction: Endoscopic Denker's approach involves complete exposure of the anterior, inferior and lateral walls of the maxillary sinus providing access to both infratemporal and pterygopalatine fossa. Open approaches to maxillary sinus may lead to a high chance of cranial nerve dysfunction, trismus and wound healing issues. Surgical methods differ based on pathology, exposure, visualization and extent of clearance of the pathology. Method: The technique and surgical steps of Endoscopic Reverse Denker's approach are presented. Results: Critical steps include inferior turbinectomy, uncinectomy, followed by mega middle meatal antrostomy. For exposure drilling is started from the anterior margin of middle meatal antrostomy up to the pyriform aperture anteriorly till the anterior wall of the maxilla is visualized and the nasolacrimal duct can be visualized and transected. This method preserves the pyriform aperture and anterior wall similar to inside-out mastoidectomy tracing the pathology with less bone removal, faster and less morbidity. Conclusion: Endoscopic Reverse Denker's is a 2-handed or 4-handed endoscopic technique for proper exposure, visualization and clearance of the maxillary pathology of the anterolateral and anterior wall. Olfaction is preserved and crusting is less as there is less bone removal with no atrophic nasal changes. It preserves the pyriform aperture thereby preventing alar collapse.

Surgical Approach to Rhino-Orbital Mucormycosis using Contrast Enhanced MRI as Roadmap

Introduction Increase in Mucormycosis cases following COVID-19 infection was major concern due to angio-invasive nature causing necrosis. Aggressive surgical resection is necessary to combat this infection. Identifying areas of involvement like orbit, infratemporal fossa and nature of involvement (enhancing or non-enhancing) is best assessed by MRI. Hence, we decided to use MRI as surgical roadmap for disease clearance. Materials and Methods All post-COVID suspected mucormycosis cases based on clinical suspicion underwent MRI and nasal endoscopic biopsy. In MRI we evaluated T1 with contrast and T2 with fat suppression. Once Mucormycosis was confirmed by biopsy, Amphotericin B was started with monitoring of biochemical parameters. Surgical resection till level of viable tissue was reached was done based on MRI findings. Post-operatively patients underwent nasal douching and endoscopic surveillance. Results Our surgical experience shows that maximum patients had to undergo unilateral FESS with modified endoscopic Denker’s approach and opening of pterygopalatine and infratemporal fossa. We conclude that all patients must minimally undergo the above surgery. Endoscopic Denker’s approach allows easy post-operative surveillance. The pterygopalatine and infratemporal fossa is anatomically hidden by posterior wall of maxilla. Since we found more than 50% involvement of these areas, the necessity to open and visualise the areas in our opinion is must in all cases of post-COVID rhino-orbital mucormycosis. Conclusion Post-COVID Rhino-Orbital Mucormycosis requires high index of suspicion. Underrated symptoms like headache, facial pain and facial swelling in post-COVID patients with associated immunocompromised state like diabetes mellitus must be thoroughly investigated by MRI nose, paranasal sinus and orbit. Surgical debridement as dictated by MRI and routine inspection of pterygopalatine and infratemporal fossa should be done.

Effectiveness of sphenopalatine ganglion block for V1 trigeminal neuralgia secondary to herpes zoster. case report

Introduction: Postherpetic V1 branch trigeminal neuralgia (TN) is a different neuralgia of the maxillary and mandibular divisions. This is usually refractory to conventional management since the involvement of the ophthalmic division can produce obvious autonomic symptoms. Few cases have been described, and conventional therapy is usually ineffective. Multimodal analgesic approaches are required in which regional anesthesia is considered an option, in order to optimize the response and improve the patient's quality of life. Methodology: A clinical case of a previously healthy 43-year-old female with a history of facial Herpes Zoster is reported. She presents TN of the left unilateral ophthalmic division for six months of evolution. The characteristic pain is accompanied by autonomic manifestations, refractory to pharmacological treatment. A sphenopalatine ganglion (SPG) block was performed in the pterygopalatine fossa with an infracygomatic approach. The evolution of pain was recorded on the Numerical Visual Analog Scale (VAS) and the quality of life was reported by the Headache Impact Test (HIT-6) scale on days 1, 15, 30, and 90 after the procedure. It was correlated with what was reported in the literature, finding only three cases related to autonomic trigeminal neuralgia (TN), which were treated with radiofrequency. The strongest evidence lies in the use of sphenopalatine ganglion block, radiofrequency ablation, and neurostimulation for cluster headaches. Results: A decrease in pain was reported on the VAS scale from 10/10 to 0/10 after the procedure, which was maintained during the first month without presenting autonomic symptoms. In the third month, VAS 2/10 is recorded, which is accompanied by tears. According to the HIT-6 scale, there was an improvement in quality of life from 69 points (very severe impact) to 36 points (little or no impact). Discussion: In recent studies, the connection of the ophthalmic nerve with the SPG has been found, in such a way that it is a possible explanation of why the SPG block is effective for pain relief in the ophthalmic nerve area in patients with TN. Conclusion: The present case of TN V1, with SPG blockade, showed analgesic efficacy and improvement in the quality of life reported by the patient. Further research with larger cohorts is required to standardize the procedure for such a diagnosis.

Schwannoma at the sinonasal tract and pterygopalatine fossa: Experience at a tertiary care teaching hospital in Eastern India

Abstract Background: Schwannomas are neoplasms that are rarely found in the sinonasal tract and pterygopalatine fossa (PPF). The objective of this study is to evaluate the schwannoma in the sinonasal tract and PPF including its effectiveness of endoscopic surgical excision of the lesion. Methods: This retrospective study was done between March 2018 and April 2022. There were nine cases of benign schwannomas found in the nasal cavity, the nasal ethmoid and the PPF. All patients had undergone endoscopic endonasal removal of the tumour. Results: All the patients successfully underwent endonasal endoscopic excision of the schwannoma from the sinonasal tract and PPF. Out of nine patients, one showed recurrence after 1 year during follow-up check-ups. None of the patients showed any major vascular complications during surgery. At follow-up, one patient presented with a persistent sensory deficit in the facial area. Conclusions: The endonasal endoscopic approach for schwannoma at the sinonasal tract and PPF is a safe and effective method for biopsy and treatment. This approach is highly effective for visualisation and has the potential to reduce complications. Pre-operative imaging is an important step before successful treatment by endoscopic endonasal removal of the schwannoma.

The application of 3-dimensional magnetic resonance imaging in nasopharyngeal carcinoma with pterygopalatine fossa invasion

ObjectThe pterygopalatine fossa (PPF) is a covert neurovascular pathway in the skull base and connects with numerous intracranial and extracranial spaces. The aim of this study was to explore the magnetic resonance imaging (MRI) features of PPF invasion in patients with nasopharyngeal carcinoma (NPC). Material and methodsThe medical records of 88 patients with stage T3 or T4 NPC were retrospectively analyzed. The 3-Dimensional (3D) volumetric images of MRI were reconstructed for the tiny connecting conduits of the invaded PPFs in the NPC patients. The infiltration incidence of conduits and connected further structures were calculated. ResultsForty-six PPFs from 37 patients were invaded by NPC. The proportions of stage T4 NPC and intracranial extension were higher in patients with PPF invasion than that without PPF invasion (P < 0.05). Each connecting conduit of the PPF had corresponding optimal reconstructed orientation based on 3D volumetric MRI images. The first three most common infiltrated conduits were palatovaginal canal, vidian canal and sphenopalatine foramen, which were adjacent to the nasopharynx. Among the conduits connecting with further structures, the most common infiltrated conduit was pterygomaxillary fissure, followed by foramen rotundum and inferior orbital fissure. Furthermore, The NPC lesions involved stage T4 structures via the conduits from 19.6% of the invaded PPFs. ConclusionsThe application of high-quality reconstruction images based on 3D sequence of MRI in NPC patients proved to be feasible and beneficial for the manifestation of the invaded PPFs and connecting conduits.

Histologic Features of a Solitary Fibrous Tumor in the Region of Oral Cavity and Maxillofacial Complex with Recurrence and Distant Metastasis: a Rare Case Report

Abstract Introduction/Objective Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm, and may involve many anatomic locations. Approximately 0.6% of SFTs in the oral cavity and maxillofacial complex may recur and/or develop distant metastasis. Here we report a case of SFT in oral cavity with local recurrence and distant metastasis. Methods/Case Report The patient was a 66-year-old male with a past medical history of left buccal mass status post excision with an unclear diagnosis in a foreign country 6 years ago. He presented with a recurrence of the left buccal mass. Computerized tomography (CT) of the head and chest demonstrated a 9 cm expansile mass centered in the left pterygopalatine fossa and a 1.7 cm mass in left upper lobe of the lung, respectively. Biopsy of the lung mass was performed first and displayed a hypercellular mesenchymal tumor, composed of spindle cells arranged in vague short fascicles, and scant fibrous stroma with thin-walled and staghorn-like vasculature. The tumor cells had mild nuclear atypia with 5 mitoses/10 high power fields. No necrosis is identified. There were trapped benign pneumocytes and bronchial epithelial cells in the tumor. The tumor is positive for CD34, CD99, Bcl-2 and STAT6 immunostains. The large left buccal mass was biopsied later and showed similar morphology. The diagnoses of metastatic SFT in the lung and recurrent SFT were rendered, respectively. Results (if a Case Study enter NA) NA. Conclusion The histologic findings of the recurrent SFT and the pulmonary metastasis are similar in our case. Although marked cellular atypia and necrosis are not observed in either tumor, other features including the large size of recurrent tumor, hypercellularity, and increased mitotic activity are associated with malignant behavior in this report, and warrant the need for long-term follow-up.