Transpterygoid Approach to a Dermoid Cyst in Pterygopalatine Fossa
15 May 2013
27 June 2013
25 October 2013 (online)
Objective To describe a case of dermoid cyst arising from the pterygopalatine fossa and review the literature.
Methods We report a case of a 23-year-old man who suffered a car accident 2 years before otolaryngologic attendance. He had one episode of generalized tonic-clonic seizure and developed a reduction of visual acuity of the left side after the accident. Neurologic investigation was performed and magnetic resonance imaging revealed an incidental finding of a heterogeneous ovoid lesion in the pterygopalatine fossa, hyperintense on T2-weighted imaging.
Results Endoscopic sinus surgery with transpterygoid approach was performed. The ovoid lesion was noted in the pterygopalatine fossa. Puncture for intraoperative evaluation showed a transparent thick fluid. Surprisingly, hair and sebaceous glands were found inside the cyst capsule. The cyst was excised completely. Histologic examination revealed a dermoid cyst. The patient currently has no evidence of recurrence at 1 year postoperatively.
Conclusion This unique case is a rare report of a dermoid cyst incidentally diagnosed. An endoscopic transnasal transpterygoid approach may be performed to treat successfully this kind of lesion. Although rare, it should be considered in the differential diagnosis of expansive lesions in the pterygopalatine fossa, including schwannoma, angiofibroma, esthesioneuroblastoma, osteochondroma, cholesterol granuloma, hemangioma, lymphoma, and osteoma.
- 1 Yu Q, Wang P, Shi H, Luo J, Sun D. The lesions of the pterygopalatine and infratemporal spaces: computed tomography evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85: 742-751
- 2 Smirniotopoulos JG, Chiechi MV. Teratomas, dermoids, and epidermoids of the head and neck. Radiographics 1995; 15: 1437-1455
- 3 Vrabec JT, Schwaber MK. Dermoid tumor of the middle ear: case report and literature review. Am J Otol 1992; 13: 580-581
- 4 European Position Paper on Endoscopic Management of Tumors of the Nose, Paranasal Sinuses and Skull Base. Rhinology 2010; (Suppl. 22) 1-143
- 5 Snyderman CH, Pant H, Carrau RL, Prevedello D, Gardner P, Kassam AB. What are the limits of endoscopic sinus surgery? The expanded endonasal approach to the skull base. Keio J Med 2009; 58: 152-160
- 6 Uppal HS, D'Souza AR, De R, Irving RM. Dermoid cyst of the infratemporal fossa. J Laryngol Otol 2002; 116: 150-152
- 7 Faye N, Lafitte F, Williams M , et al. The masticator space: from anatomy to pathology. J Neuroradiol 2009; 36: 121-130
- 8 Nishikawa T, Ishida H, Nibu K. A rare spontaneous temporal meningoencephalocele with dehiscence into the pterygoid fossa. Auris Nasus Larynx 2004; 31: 429-431
- 9 Souza RP , et al. Maxillary sinus carcinoma: an analysis of ten cases. Radiol Bras 2006; 39: 397-400
- 10 Seccia V, Lenzi R, Casani AP, Muscatello L. Ectopic olfactory neuroblastoma arising in the pterygopalatine fossa. Otolaryngol Head Neck Surg 2010; 142: 460-461
- 11 Wu W, Hu X, Lei D. Giant osteochondroma derived from pterygoid process of sphenoid. Int J Oral Maxillofac Surg 2007; 36: 959-962
- 12 Weiland DA, Aygun N. An unusual presentation of a cholesterol granuloma in a pneumatized pterygoid process of the sphenoid sinus. Otolaryngol Head Neck Surg 2007; 136: 153-154
- 13 Ghosh A, Saha S, Saha VP, Sadhu A, Chattopadhyay S. Infratemporal fossa myoepithelial carcinoma—a rare case report. Oral Maxillofac Surg 2009; 13: 59-62