Adenoid cystic carcinoma (ACC) is an uncommon malignant neoplasm that predominantly arises from major and minor salivary glands, accounting for about 1% of head and neck malignancies. ACCs originating from the pterygopalatine fossa (PPF) are extremely rare. In this case report, we present a 77-year-old male patient who experienced a two-year hemi-facial numbness and mild trismus, with intact nasal mucosa. He underwent Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) which revealed opacification of the left PPF with extension to the left infratemporal fossa and osteolytic areas of the sphenoid bone. Histopathology, following blind biopsies, revealed ACC of the PPF, which was subsequently treated with combined therapy (radiotherapy and chemotherapy). Due to their slow and progressive growth, as well as their tendency for perineural invasion, ACCs should always be considered in the differential diagnosis of painless swelling or nerve dysfunction. To our knowledge, this case is the fifth described in the English literature.

Angioleiomyoma (ALM) is a benign neoplasm marked by the presence of blood vessels and smooth muscle cells, commonly located within the subcutaneous or deep dermal layers. Its manifestation in the pterygopalatine fossa is infrequent, thereby posing difficulties in its diagnosis and distinction from other benign tumors within the same anatomical site. In the present case study, an ALM originating in the right pterygopalatine fossa of a 44-year-old female patient was investigated. The patient underwent surgical intervention for the vascular smooth muscle tumor, and there has been no recurrence noted during the postoperative monitoring period.

The pterygopalatine fossa and infratemporal fossa are often approached through an external incision because of their deep facial location, but this can present problems such as facial scarring and deformity. In schwannoma surgery, intraneural dissection is a useful surgical technique for achieving gross total resection while preserving the capsule, including the nerves. For appropriate enucleation and preservation of the functional nerve, it is indispensable to distinguish between the pseudocapsule and the tumor capsule. This case report presents a case of endonasal surgical intervention for an extracranial trigeminal schwannoma employing the tri-port approach and narrow-band imaging.

UNASSIGNED: Granulomatous invasive fungal sinusitis (GIFS) is a rare and life-threatening disease, whereas fungus ball (FB) is the most common form of noninvasive fungal sinusitis. Both GIFS and FB primarily develop in immunocompetent patients, with the former associated with higher mortality and morbidity.
UNASSIGNED: A chart review and review of the literature.
UNASSIGNED: We present the case of a 77-year-old woman with mixed fungal sinusitis who was successfully treated with voriconazole.
UNASSIGNED: GIFS and FB can coexist in extremely rare cases, known as mixed fungal sinusitis; however, the diagnosis and subsequent treatment of mixed fungal sinusitis can be delayed because of a lack of awareness of the underlying concept. Therefore, it is crucial for clinicians to recognize the concept of mixed fungal sinusitis.

Neurosynovial tumors, originating from Schwann cells within nerve sheaths, are benign entities, with 25% to 45% manifesting in the head and neck region. However, occurrences in the pterygopalatine fossa (PPF) are exceptionally rare, and only a handful of cases have been documented. In this report, we present the unique case of a 6-year-old child exhibiting a sizable soft tissue mass in the left PPF, extending into the inferior orbital fissure. The patient underwent successful intranasal endoscopic removal of PPF schwannoma utilizing the prelacrimal recess approach, with postoperative pathology confirming the diagnosis of schwannoma. Schwannomas within the PPF are particularly uncommon, and instances of such tumors in pediatric patients are even more exceptional. This case highlights the diagnostic and therapeutic challenges associated with PPF schwannomas in children, emphasizing the significance of a multidisciplinary approach for optimal management. In addition, a comprehensive literature review is presented to provide insights into the existing knowledge on this rare entity, further contributing to the understanding of pediatric PPF schwannomas.

The pterygopalatine fossa (PPF) is a challenging space and pathological processes in this anatomical space are uncommon. This report presents a case of glomus tumor right PPF in a 65 years old female patient who underwent tumor removal by endoscopic transnasal-transmaxillary approach with preoperative selective embolization of the right internal maxillary artery.

UNASSIGNED: Foreign body (FB) in the nasal cavities is a frequent cause of otolaryngology emergency consultation that sometimes requires surgical treatment. When there is involvement of the posterolateral wall of the maxillary sinus (MS) and of the pterygopalatine fossa (PPF), conventional techniques such as antrostomy and medial endoscopic maxillectomy may not allow sufficient domination of the surgical field.
UNASSIGNED: We report the case of a woman who suffered from intranasal trauma with epistaxis and pain.
UNASSIGNED: A computed tomography scan revealed a metallic FB at the level of the right posterolateral wall of the MS, PPF, and greater wing of the sphenoid bone.
UNASSIGNED: A minimally invasive transnasal endoscopic prelacrimal approach was chosen for its removal.
UNASSIGNED: The postoperative recovery was rapid and without complication.

Background and Objectives: The maxillary sinus hypoplasia (MSH) is an occasional variation of the maxilla, occurring either unilaterally or bilaterally. Previous studies dealing with MSH have not detailed the consequent anatomical changes of the maxilla and adjacent fossae. Materials and Methods: A 58-year-old female case was scanned in Cone Beam Computed Tomography and found to have asymmetrical bilateral MSH, who was then further evaluated anatomically. Results: The maxillary sinuses were hypoplastic and had mild mucosal thickenings. The orbital floors were curved. The uncinate process and the ethmoidal infundibulum were laterally displaced beneath the orbit floor. On each side, the lateral nasal wall protruded within the respective maxillary bone to reach above the vestibular cortical plate of the alveolar process. This expansion of the lateral nasal walls was limited to the premolar and first molar regions. The inferior turbinates were laterally curved. The perpendicular palatine plate was building a postero-lateral nasal wall in front of the pterygopalatine fossa. Conclusions: The classification systems of MSH should be detailed to indicate whether the normal uncinate process is medial or inferior to the orbit. The lateral expansion of the lateral nasal wall in MSH is limited to the anterior part of that wall. The laterally expanded nasal fossa could reach anterior to the pterygopalatine fossa in MSH. Seemingly, CBCT is a better tool than CT to evaluate the detailed anatomy of the modified anatomical structures in MSH; as such, it could be of help in a surgical approach.

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.

Adenotonsillectomies are one of the most common otolaryngologic surgeries performed to alleviate obstructive sleep-disordered breathing and apnea in children. The pain management following adenotonsillectomy continues to be a challenge for both pediatric anesthesiologists and otolaryngologists due to the mortality that stems from the use of opioid pain medications in children who have an increased baseline risk airway obstruction and apnea that is exacerbated by any exposure to opioids. We present a case utilizing bilateral suprazygomatic maxillary nerve (SZMN) blocks or, more accurately, suprazygomatic infratemporal-pterygopalatine fossa injections to achieve opioid-free perioperative analgesia for pediatric adenotonsillectomy with nasal turbinate reduction.