Schwannomas limited to the infratemporal fossa: Report of two cases

Schwannomas limited to the infratemporal fossa are rare lesions that may also involve the maxillary sinus, the orbit and the retropharyngeal space. We present two cases of schwannoma arising from the extradural divisions of the trigeminal nerve, with corresponding areas of sensory loss. Both patients had been operated for spinal canal schwannomas previously. Complete tumor removal was accomplished in both cases. The schwannoma of the maxillary division was excised using an orbitozygomatic extradural approach. The schwannoma of the mandibular division was excised using a subtemporal-infratemporal approach. Trigeminal nerve function was preserved and complete recovery of function was achieved in each patient. Identification of an infratemporal schwannoma should alert the physician to consider the diagnosis of neurofibromatosis. The literature regarding schwannomas limited to the infratemporal fossa is reviewed.     

Giant tumour of the pterygopalatine fossa

Neurilemmomas are benign and slow growing tumours. Neurilemmomas of the pterygopalatine fossa are rare. In this paper we present a case of schwannoma arising in the pterygopalatine fossa with extension into infratemporal fossa and floor of the orbit. A transantral approach was used for excision of the tumor following which the defect in the floor of the orbit was reconstructed with the help of a temporoparietal flap.     

Atypical angiofibroma of larynx — a case report

Primary extra nasopharyngeal angiofibroma of larynx is a very rare tumour. We here by present a case of angiofibroma of larynx affecting the anterior commissure & subglottic region in larynx-a rare site of involvement.     

Neurofibroma of infratemporal fossa

Neurogenic tumours form a very small percentage of all neoplastic Unions of head and neck region. The histological classifications of benign neurogenic tumours of head and neck include neurofibroma, schwannoma and neuromas. The purpose of this paper is to report a case of neurofibroma involving right infratemporal fossa, pterygopalatine fossa, nasopharynx which was treated surgically through a transmandibular approach. A benign tumour arising in this anatomical position requires a conservative surgical approach for cosmetic reasons, in this case access was provided by mandibular swing, after lateral mandibular osteotomy in front of the angle of mandible. This surgical procedure provided useful access to such a cryptic anatomical region whilst ensuring a satisfactory cosmetic result.     

An unusual foreign body in infratemporal fossa

A rare case of an unusual foreign body (Scooter clutch) in infratemporal fossa in 25 year young boy is reported here along with management and discussion.     

Juvenile ‘Perinasal’ Angiofibroma

The extranasopharyngeal angiofibroma is a separate clinical entity but those involving infratemporal fossa and cheek resemble juvenile nasopharyngeal angiofibroma (JNA) and hence have been labelled as juvenile perinasal angiofibroma (JPA) in this paper. This paper presents a 7th case of JPA and attempts to review the world literature on JPA, along with a proposal of staging the disease. A 16 year male presented with a painless compressible facial swelling since 7 months without any epistaxis or nasal obstruction. Initially a vascular lesion was suspected but JNA without nasal extension was strongly suspected on imaging. A deep trucut biopsy confirmed the histopathology. The vascular enhancement was significant and the tumour was excised through open approach (Weber Fergusson). JPA that can be regarded as a variant of JNA that fails to extend medially. Imaging demonstrates classical JNA findings with a clear nose/nasopharynx. A deep trucut biopsy under control in inpatient settings may sometimes help. JPA presents most commonly in Stage II where an open facial approach preferably following selective preoperative embolization is indicated. Hence with painless compressible (or non-compressible) cheek swelling suspected to be of a vascular etiology, a high degree of clinical suspicion for JPA needs to maintained in order to prevent a misdiagnosis.     

Controversies surrounding human papilloma virus infection, head & neck vs oral cancer, implications for prophylaxis and treatment

Background

The head and neck are two of the most common sites of extranodal non-Hodgkin's lymphoma (NHL). However, primary tumors of the infratemporal fossa are infrequent, and NHL in this region is extremely rare.

Case presentation

We present a case of a 41-year-old female that presented with swelling in the right preauricular region that had persisted for the past two years. The patient was diagnosed as having a small lymphocytic NHL. She initially underwent chemo-radiation but reported relapse. The tumor was excised and again the patient underwent chemotherapy. The patient remained symptomatic and developed a second primary squamous cell carcinoma in the right retromolar trigone.

Discussion and conclusion

We discussed NHL with an emphasis on extranodal manifestations. Extranodal NHL that is limited to a single site can be managed by surgery and regular follow up. To the best of our knowledge, this is only the second case of primary NHL of the infratemporal fossa to be reported in the literature.     

Facial translocation approach to infratemporal fossa and cranial base in extensive angiofibroma: A review of 7 cases

Angiofibroma extending to infratemporal fossa, orbit and middle cranial fossa is a difficult problem for a surgeon to tackle. Traditional extracranial excision with radiotherapy for the intracranial extension was practiced for a long time with variable results. Different approaches to remove such a tumour are described but most of them are not free from resultant morbidity in the form of facial asymmetry and incomplete tumour removal. Facial translocation approach facilitates complete tumour removal without cutting through the tumour thereby reducing per-operative blood loss. It also avoids facial asymmetry as the zygomatico-orbito-maxillary bony complex is replaced after the tumour removal. We present a review of seven cases with the results. The surgical steps, advantages, disadvantages and the complications are discussed.     

Angiofibroma arising from nasal septum in adult male—A rare occurence

Angiofibroma is an unique problem faced by the otolaryngologist, due to its recurrence, occurence in a rather inaccessible area and troublesome bleeding during excision. It’s commonly known to arise from nasopharynx in adolescent males but extra nasopharyngeal extensions are not uncommon. Herewith we are presnting an extremely rare case of angiofibroma arising from the nasal septum in an adult male. To the best of our knowledge septal angiofibroma has not been reported in the relevant literature yet. The clinical features and management of this case are discussed in this paper.     

Schwannoma of the sino-nasal tract: a rare clinico-pathological entity revisited

Schwannomas are benign neoplasms arising from Schwann cells of the peripheral, cranial and autonomic nerves. We report a case of schwannoma in the sino-nasal tract, a very rare site of tumour origin with unusual pseudoangiomatous histopathological changes, which we came across in a 22 years male with progressive nasal obstruction.     

Roentgen Diagnosis of Naso-pharyngeal Masses*

The roentgen features of nasopharyngeal angio-fibromas, malignant tumours and antro-choanal polypi are described. Techniques employed are lateral skiagram of nasopharynx, submentovertical view, Water's projection and contrast naso-pharyngography. The value of Water's view to show lateral displacement of the coronoid process and the submento-vertical view to show widening of infratemporal fossa and inferior orbital fissure as signs of extra-pharyngeal extension of angiofibromas are discussed. A case of cylindroma is reported. Contrast nasopharyngography is advocated in cases with unexplained otologic symptoms and cranial nerve palsies. Contrast nasopharyngography provides a permanent record of tumour regarding size and position before and after treatment. This procedure done post-operatively documents the extra-pharyngeal extensions of angiofibromas.     

Recurrent inverted papilloma with intracranial and temporal fossa involvement: A case report and review of the literature

Inverted papilloma (IP) is a rare nasosinusal benign tumour, with epithelium surface inversion to inside the stroma. Extension to intracranial temporal fossa and middle ear has been reported in few cases in the literature. This involvement may be derived from either direct extension from sinonasal cavity via the Eustachian tube or primary middle ear involvement secondary to metaplastic changes of the middle ear mucosa. Here, we report a case of inverted papilloma in a male patient, with multiple recurrences, middle ear and intracranial involvement into the temporal fossa with posterior development of malignancy. This patient had received multiple surgeries and radiotherapy but despite of that, his disease recurred several times. As a conclusion, inverted papilloma is a benign tumour with an aggressive course, tendency to recurrence and progression to malignancy. Intracranial and temporal fossa involvements are rare and the treatment depends of the symptoms and the severity of the disease.     

Posterior fossa solitary fibrous tumour: report of a fetal case and review of the literature

We report a case of solitary fibrous tumour (SFT) involving the posterior fossa in a fetus of 25 weeks’ gestation. SFT is a rare mesenchymal neoplasm, arising in various locations including the meninges. After disclosure of severe ventriculomegaly and posterior fossa mass measuring 45 mm in diameter, termination of pregnancy was performed in accordance with French legislation. Our neuropathological study revealed a tumour covered by meninges, with severe compression of the cerebellum and the brain stem. Microscopically, the tumour was highly cellular, made of packed small fusiform cells with branching vasculature and consistent expression of CD34. No extraneurological lesion was noted. Except cysts and vascular malformations, posterior fossa tumours have been exceptionally reported in fetuses. SFT was distinguished from hemangiopericytoma. In spite of the fact these tumours share many similarities, some criteria such as the staining pattern for CD34 instead indicated a SFT. Histology was distinctive of hemangioblastoma and primitive neuroectodermal tumour. The prognosis of solitary fibrous tumour, which is usually a benign tumour, was there worsened by the precocity of the onset and the local invasion causing disruption of the cerebellum, compression of the brain stem and severe ventriculomegaly.     

Nasal hemangiopericytoma

Haemangiopericytoma is rare tumour of vascular tissue. It’s pathological behaviour is variable. It arises from pericytes of Zimmermann. Although one fourth of cases are reported from head and neck region, nasal haemangiopericytoma is very rare. Because of rarity of condition, one case of nasal haemangiopericytoma arising from nasal septum is reported.     

Fibrolipoma of the nasopharynx in a child

Besides angiofibroma, benign tumours of the nasopharynx are in general rare. A true lipoma of the nasopharynx is rarely reported. Fibrolipoma in a child is a very rare tumour and is hence reported.     

Neurilemmoma of cervical sympathetic chain

Neurilemmoma of the cervical sympathetic chain is a rare nerve tumour. Less than 40 confirmed cases have been reported in the literature.1 2 Sometimes they can he mistaken as carotid body tumour but usual presentation of these lesions is an asymptomatic neck mass. Because of the rarity of the tumour we report another case of neurilemmoma arising from cervical sympathetic chain in a 19 years old male.     

Schwannoma of submandibular region

Tumours of the nerve sheath origin in the head and neck are not common. Schwannomas are rare. Only a few cases have been reported so far. We report a rare case of Schwannoma of Submandibular region arising from the lingual nerve.     

Solitary fibrous tumor of the infratemporal fossa: A case report

First described as a pleural neoplasm, the solitary fibrous tumor (fibrous mesothelioma) has been reported in a number of extrapulmonary sites, including the Head-Neck region. In the Head-Neck region, it has been described in the sinonasal tract, epiglottis, parapharyngeal, retropharyngeal spaces, parotid and infratemporal fossa. We present the second case of solitary fibrous tumor of infratemporal fossa described in world literature. A complete excision was achieved by transmaxillary approach.     

Carotid body tumour

A case of carotid body tumour (paraganglioma) which is both unusual and highly vascular, arising from the carotid body is reported. The patient was a 68-year-old female with a right submandibular swelling. The initial pathological diagnosis was obtained from the incisional biopsy. Carotid angiography revealed the feeding vessels arising only from the external carotid artery. The tumour was completely removed and no evidence of recurrence could be found 2-years postoperatively.     

Giant supraglottic schwannoma

Schwannomas arising from the supraglottis are uncommon, if not rare. They are known to arise from the head and neck region but oropharyngeal presentation is not often seen. Few cases of pedunculated schwannoma arising from the aryepiglottic fold presenting as giant tumours in the oropharynx have been reported so far. The tumour in this case has been excised via intraoral approach, with nil residual morbidity. A follow up period of one year was uneventful without any recurrence.