Schwannomas of the Nasopharynx and Pterygopalatine Fossa

We report a rare case of nasopharyngeal schwannoma in a 40-year-old Japanese woman that was successfully excised completely using an endoscopic approach. For contrast, we report a large pterygopalatine fossa schwannoma excised completely using an endoscopic approach in a 73-year-old woman. Schwannomas are benign, well-encapsulated peripheral nerve sheath tumors. They can occur throughout the body with 45% of cases occurring in the head and neck and less than 4% of cases arising in the nasal cavity and paranasal sinuses. Only a handful reportedly originates in the nasopharynx. Nasal schwannomas can have a highly variable presentation and variable histologic and cranial nerves findings, with the most common symptom being progressive unilateral nasal obstruction. Schwannomas are classically radioresistant with treatment based on total tumor excision. The nasopharynx is, however, a notoriously difficult area to access surgically due to its central location, surrounding facial skeleton and skull base, great vessels, and cranial nerves. The traditional surgical approach for this region has been open, including anterior, lateral, and inferior approaches with the anterior approach of lateral rhinotomy as the most common. These approaches, however, provide limited access or significant morbidity, including fistulas, trismus, and cosmetic deformities. Minimally invasive endoscopic resection of this region has been increasingly used as it offers comparable efficacy to open approaches with better visualization, cosmesis, safety, and more rapid healing. In this presentation, the signs and symptoms of nasopharyngeal masses will be reviewed, cranial nerve findings will be discussed, and the varying histologies of schwannoma of the nasal cavity and paranasal region will be detailed.