An endoscopic endonasal prelacrimal recess-maxillary sinus approach for giant schwannoma of the pterygopalatine fossa in children

Primary tumors of the pterygopalatine fossa in children are rare, and most are schwannomas. These types of tumors usually present with vague and nonspecific radiologic characteristics and it’s difficult to diagnose preoperatively. The radiologic characteristics of different kinds of tumors were discussed and analyzed. Magnetic resonance images combined with CT angiography can provide very important information to confirm tumor characteristics before operation, especially enhanced MRI. The pterygopalatine fossa is so deep that it’s challenging to reach through traditional operative approaches, and typical approaches may also cause great trauma. Endoscopic endonasal micro-invasion approaches have gradually been adopted for lesions of the pterygopalatine fossa, including those through the pterygoid process, the middle meatus, the middle meatus combined with a Caldwell-Luc incision, and the prelacrimal recess-maxillary sinus. A prelacrimal recess-maxillary sinus approach has the advantages of being short and direct, causing less trauma, offering safety and face protection, reserving the nasal structure and function, being easy to repair and review, and allowing for a second operation.