Glomus Tumor of the Pterygopalatine Fossa: A Rare Case Report
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CLINICAL REPORT
Glomus Tumor of the Pterygopalatine Fossa: A Rare Case Report Pankaj Chauhan1 • Trilok C. Guleria2 • R. S. Minhas1 • Suresh Thakur3 Mahender Singh1 • Kavana Soni4
•
Received: 2 August 2020 / Accepted: 23 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract 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.
rare. Surgery of the PPF is difficult because the space is well bounded and hard to explore. But due to technological advances in endoscopic surgery, the lesions of PPF usually removed by endoscopic-assisted surgery. It provide better visualization, reduce surgical risk and less postoperative morbidity [2]. This report presents a case of glomus tumor right PPF in a 65 years old female patient who underwent endoscopic surgery for the tumor.
Keywords Pterygopalatine fossa Glomus Transnasal-transmaxillary Embolization
Case Report Introduction The pterygopalatine fossa (PPF) is a challenging space due to its important vital relations, like the skull base and the orbit, but also due to the vascular and nervous elements that pass through it. Pathological processes in this anatomical space are uncommon [1]. Pterygopalatine fossa usually involved secondarily by direct extension from adjacent structures. Glomus tumor of the PPF is extremely
& Trilok C. Guleria [email protected] 1
Department of Otolaryngology Head and Neck Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2
Department of Otolaryngology Head and Neck Surgery, Dr Radhakrishnan Govt. Medical College, Hamirpur, Himachal Pradesh, India
3
Department of Radiodiagnosis and Imaging, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
4
Consultant Pathologist, Dr. Lal Path Labs Ltd, Rohini, New Delhi, India
A 65-years old female patient presented to ENT OPD with complaints of right sided progressive nasal obstruction and intermittent bleed for the past 6 months. Anterior rhinoscopy revealed grayish polypoidal mass in the right nasal cavity. It bled easily on manipulation, and hence intranasal biopsy was not performed. There was no history of associated co-morbid conditions i.e. hypertension, diabetes mellitus, chronic kidney disease etc. Her routine blood investigations were within normal limits. A contrast enhanced computed tomography (CECT) scan of the nose and paranasal sinuses demonstrated a 3 9 2 cm sized heterogenous soft tissue density in the right pterygopalatine fossa (PPF) that was widening the adjacent bony structures extending laterally to masticator space through pterygomaxillary fissure (PMF) and medially to nasal cavity via sphenopalatine foramen. (Fig. 1) Computed tomography (CT) angiography revealed that the tumor received blood supply directly from
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