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Clinical Records
Introduction
Infratemporal fossa schwannomas are extremely rare, benign, encapsulated tumours that originate from the nerve sheath of the maxillary or mandibular branch of the trigeminal nerve and are limited to the infratemporal fossa.1-3Early symptoms of infratemporal fossa schwannomas are often subtle, and the majority of the tumours become quite large before being diagnosed.1-5The treatment of choice for infratemporal fossa schwannoma is surgical removal, particularly when the tumour begins to be symptomatic. Surgical access to the infratemporal fossa is challenging, as this area is deeply seated.
Infratemporal fossa schwannomas have traditionally required an extensive approach, such as the middle fossa extradural approach, infratemporal fossa extradural approach, transmaxillary approach, transmandibular approach or transcervical approach. However, these approaches may cause complications, including cosmetic problems, facial nerve dysfunction, hearing loss and dental malocclusion.
Because of the significant morbidity associated with these approaches to the infratemporal fossa, less invasive alternatives have been sought. We report two cases of infratemporal fossa schwannoma which were completely resected using mini-invasive approaches. The first case was surgically removed using a preauricular subtemporal approach and the second one using a purely endoscopic transnasal approach. There were no intra-operative or post-operative complications or morbidities in either case.
Case reports
Case one
The first case concerns a 49-year-old female patient referred to the otology clinic for the management of right-sided, persistent otitis media with effusion. She complained of right-sided aural fullness and hearing loss.
Otoscopic examination revealed right otitis media with effusion. The head and neck examination, which included nasopharyngeal endoscopy, was unremarkable except for mild diminution of sensation in the distribution of the right mandibular nerve. A cranial computed tomography scan demonstrated a well-circumscribed, homogeneously enhancing mass in the right infratemporal fossa with widening of the foramen ovale. Magnetic resonance imaging (MRI) revealed a 3 cm discrete, well-circumscribed mass, which was hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging, with slight enhancement after gadolinium injection. The mass did not invade the temporal fossa and there was no extension into the nasopharynx (Figure 1).
Fig. 1
Radiological investigation findings for case 1. (a) Axial computed tomography scan, showing a mass in the infratemporal fossa (arrow); notice the compression of the...