Squamous cell carcinoma of the pterygopalatine fossa (retroantral space)

A patient developed sensory disturbance and pain in the distribution of the maxillary nerve several months after removal of a statedly benign cutaneous malar lesion. One year later, abducens palsy developed, and computed tomography showed a mass of the pterygopalatine fossa abutting on the superior nasopharynx. Results of examination and multiple biopsies of the nasopharynx were normal. Direct biopsy of the pterygopalatine fossa via a transmaxillary sinus approach revealed squamous cell carcinoma. Extension of malignancy from the adjacent nasopharynx (not detected on biopsy) or sphenoid sinus and perineural spread of an undiagnosed cutaneous squamous cell carcinoma along the maxillary nerve were considered as possibilities. The anatomy of the pterygopalatine fossa and its environs is reviewed with respect to clinical signs of second division trigeminal neuropathy, abducens palsy and diminished ipsilateral tearing.