by Premier Hospitals | January 22, 2024 |
Pterygopalatine Fossa Tumour' refers to a tumour situated in a small space behind the upper jaw, known as the Pterygopalatine Fossa. This area contains important structures like nerves, blood vessels, and connective tissues. Tumours in this fossa can vary, ranging from benign to malignant, and may originate from different tissues, influencing symptoms, treatment options, and prognosis.
Due to the complex anatomy and delicate structures in the Pterygopalatine Fossa, surgical management often involves specialised techniques such as swing maxillotomy. This surgical approach improves access to the fossa by temporarily moving the upper jaw away from the skull, providing better visibility and flexibility during the procedure.
In this article, we present the management of an uncommon caseâa left pterygopalatine fossa tumour in one of our patients. Our skilled medical team at Premier Hospital, Hyderabad, addressed this challenge adeptly, utilising the swing maxillotomy technique alongside gross total excision.
The patient, a 26-year-old female, presented with a persistent complaint of left cheek pain endured for a year. Over the last two months, the pain escalated, leading her to seek medical attention. Notably, she experienced tingling and numbness in the left cheek, adding complexity to her condition.
The team at Premier Hospital, led by a neurosurgeon, conducted a series of tests to comprehensively evaluate the nature of her symptoms. These tests included MRI of the brain and paranasal sinuses and CT imaging of the paranasal sinuses. These investigations played a crucial role in uncovering the details of the left pterygopalatine fossa tumour and guiding the subsequent course of management.
Upon initial examination, the patient presented with good health, maintaining a fair general condition and displaying no fever or abnormalities in vital signs. Importantly, there were no apparent focal neurological deficits observed.
Further evaluation through MRI of the brain and paranasal sinuses, along with CT imaging of the paranasal sinuses, revealed compelling evidence. The scans depicted a well-enhancing lesion in the left pterygopalatine fossa, with its lateral margins extending toward the left Internal Carotid Artery (ICA). This radiological evidence suggested the possibility of a Schwannoma, potentially originating from the V2 branch of the left maxillary nerve.
The diagnostic findings unveiled by the imaging studies served as crucial pieces in unravelling the nature and extent of the left pterygopalatine fossa tumour.
The patient, presenting with a year-long history of left cheek pain intensifying over the last two months, accompanied by tingling and numbness, underwent a diagnostic journey that culminated in revealing a well-enhancing lesion in the left pterygopalatine fossa, extending towards the left Internal Carotid Arteryâsuggestive of a potential Schwannoma arising from the V2 branch of the left maxillary nerve.
Subsequently, a Weber Ferguson incision paved the way for a left swing maxillotomy, enabling the meticulous gross total excision of the tumour on October 26, 2023. Postoperatively, the patient exhibited swift mobilisation the next day, initiating Ryleâs tube feeding and clear oral fluids.
The surgical intervention for the left pterygopalatine fossa tumour comprised a series of meticulous steps, ensuring both precision and efficacy.
Guiding the intricate surgical procedure for the left pterygopalatine fossa tumour was Dr. Mamindla Ravi Kumar, a seasoned Senior Consultant Neurosurgeon specialising in brain and spine surgery. With an impressive academic background encompassing an MBBS, MS, and M.Ch from NIMS, Dr. Kumar's expertise is further augmented by fellowships in Endospine from France and UBE spine surgery.
Additionally, his proficiency in Skull Base Surgery, acquired through a fellowship at MS Ramaiah and WSBF, underscores a commitment to continuous learning and staying abreast of cutting-edge techniques. Dr. Kumar's leadership in this case not only reflects his comprehensive skill set but also his dedication to providing optimal patient care in the intricate realm of neurosurgery.
In navigating the complexities of neurosurgery, particularly in addressing rare cases like the pterygopalatine fossa tumour, a delicate blend of expertise, precision, and innovative techniques is paramount. Premier Hospital, Hyderabad stands as a beacon of excellence, emphasizing tailored approaches such as the swing maxillotomy technique. The commitment to optimal patient care is evident in the hospital's team of top-notch medical professionals, making it a multi-speciality hospital of choice in Hyderabad.