背景:神经鞘瘤分化良好,起源于神经鞘的施万细胞的良性肿瘤。它们占所有头颈部肿瘤的25-45%,并可能导致严重的发病率,具体取决于起源部位。翼腭窝是最罕见的受累部位,文献中只有少数病例报道。
方法:这是一名46岁男性患者,有12[12]个月的左侧面部疼痛和进行性肿胀病史。对比增强计算机断层扫描(CT)和磁共振成像(MRI)显示位于左翼腭窝(PPF)的大软组织病变。介绍了手术管理,并讨论了维修的技术细节。在一年的随访中,没有复发的迹象,美容效果令人满意。
结论:该病例是英文文献中报道的少数PPF神经鞘瘤病例之一。尽管相当比例的神经鞘瘤出现在头颈部,翼腭窝是最罕见的受累部位。由于其临床上难以接近的位置和复杂的连接,翼腭窝可以作为炎症和肿瘤疾病在头颈部传播的天然管道。
结论:目前,内镜经鼻入路(EEA)因其安全性和良好的肿瘤学结局而成为首选.发病率也降低,因为它是微创的。此外,进行EEA的外科医生应配备图像引导系统,并接受先进的内窥镜技术培训。然而,开放入路仍然是一种可靠且行之有效的手术方法,可以治疗位于该复杂且无法进入的区域内的大型肿瘤。
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.
CONCLUSIONS: 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.