Novel Single-Stage Transcervical Submandibular Approach for a Giant Multicompartmental Pterygopalatine Fossa...

Giant schwannomas originating in the pterygopalatine fossa (PPF) with multicompartmental extension pose a considerable surgical challenge.

This report details the management of a 34-year-old female who presented with progressive facial numbness, dysphagia, and unilateral facial asymmetry secondary to a voluminous PPF schwannoma.

Preoperative imaging characterized a solid-cystic expansile mass with involvement of the maxillary sinus, infratemporal fossa, parapharyngeal space, and the anterolateral craniovertebral junction, including encasement of the internal carotid artery.

Given the tumor's significant lateral and posterior-inferior extension that precluded a purely endoscopic resection, a tailored transcervical submandibular approach was utilized. This open corridor provided direct lateral access, enabling safe proximal vascular control and permitting meticulous neurovascular dissection.

Gross-total resection was ultimately achieved without the need for mandibular osteotomy or transfacial incisions. The patient's postoperative course was uncomplicated, with preservation of neurological function, and follow-up imaging confirmed complete resection.

This case highlights the novel single-stage transcervical submandibular approach as a viable and effective surgical strategy for select, extensive PPF schwannomas with dominant lateral and neurovascular involvement, serves as a critical alternative when endoscopic access is insufficient. To our knowledge, this is the first report of a single-stage transcervical submandibular resection for a multicompartmental PPF schwannoma with such extensive lateral and vascular involvement, unlike previous studies have described multi-staged procedures for similar complex lesions.