Resection of Extranasopharyngeal Angiofibroma filling the Infratemporal Fossa Using the Facial Dismasking Approach (Case Report)

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  • Ｆａｃｉａｌ　ｄｉａｍａｓｋｉｎｇ法を用いた側頭下窩血管線維腫例
  • リンショウ Facial dismaskingホウ オ モチイタ ソクトウ カカ ケッカン センイシュレイ

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Abstract

We report a rare case of extranasopharyngeal angiofibroma of the infratemporal fossa. A seventeen-year-old man had been aware of a swelling mass in the oral cavity for three years. A large submucosal mass was identified at the right soft palate, but there was no obvious lesion in the nasal cavity or nasopharyngeal space. Computed tomography and magnetic resonance imaging demonstrated that the infratemporal fossa was occupied by a large spindle-shaped mass showing strong enhancement and the foramen ovale had been expanded by the mass. Under a diagnosis of trigeminal schwannoma, surgery was performed via the facial dismasking approach. The mass was parallel to a trigeminal nerve, which was sacrificed, and the lesion was removed completely with an addition of cervical approach. Having lost considerable blood, he received a blood transfusion intraoperatively, however, his postoperative clinical course was uneventful. The mass presented a smooth, elastic, pale appearance, and its histopathological diagnosis was angiofibroma. The origin of the lesion was considered the pterygoid (vidian) canal, which is an unusual site for the origin of angiofibroma. The patient did not demonstrate dysarthria or dysmasesis, and there was no apparent cosmetic complication. The patient is currently free from disease two years after surgery. The facial dismasking approach offers excellent access for excision of a tumor involving the infratemporal fossa.

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