While squamous cell carcinoma represents the majority of malignant laryngeal tumors, primary laryngeal lymphoma is exceptionally rare. We present the case of a 78-year-old female with a history of sarcoidosis and remote tobacco use who presented with progressive hoarseness and throat discomfort. Imaging revealed a left supraglottic mass with associated cervical lymphadenopathy. Histopathologic evaluation demonstrated a low-grade B-cell lymphoproliferative disorder involving the supraglottis. This case highlights the importance of maintaining a broad differential diagnosis for persistent dysphonia and underscores the critical role of tissue biopsy in distinguishing malignant lymphoid processes from inflammatory or epithelial pathologies.
Facial nerve schwannoma may present with otological symptoms despite preserved facial nerve function, creating a diagnostic challenge when the lesion involves the middle ear. A 75-year-old man developed aural fullness and hearing loss following craniofacial trauma. Otoscopy revealed a dark reddish retrotympanic mass. Computed tomography demonstrated soft-tissue opacification of the middle ear and mastoid with a tegmen tympani defect, raising suspicion of post-traumatic middle-ear disease with cerebrospinal fluid leakage. Facial function remained normal. Surgical exploration confirmed a dural defect and cerebrospinal fluid leakage but unexpectedly revealed an extensive tumour involving the facial nerve. We performed complete excision, followed by facial nerve reconstruction using a great auricular nerve interposition graft. Histopathological examination confirmed schwannoma. Retrospective review of the pre-operative computed tomography images demonstrated smooth facial-canal expansion and enlargement of the stylomastoid foramen that had been present but not specifically sought or recognised before surgery. This case highlights how coexisting traumatic abnormalities may obscure an underlying facial nerve schwannoma. Careful assessment of the entire facial nerve pathway on temporal bone imaging may provide an important diagnostic clue in patients with an unexplained retrotympanic mass, even when facial function is preserved.
ObjectiveSchwannoma located in the infratemporal fossa (ITF) is a rarely encountered clinical condition, with symptoms that may be minimal. However, ITF is very difficult to reach. This work summarizes our experience with the surgical enucleation of ITF schwannoma using a modified trans-zygomatic approach, with minimal postoperative complications.MethodsA retrospective review of ITF schwannoma cases treated at our tertiary medical institution between August 2019 and November 2024 was undertaken. Data were retrieved from case notes and analyzed.ResultsIn total, three cases were included: two male patients and one female patient. The lesion was on the left side in one case and on the right side in the other two cases. The patients' ages ranged from 33 to 55 years, with average and median ages of 46.7 and 52 years, respectively. The patients had no presenting symptoms, and the lesions were all discovered through imaging inspections. When the zygomatic arch was separated from the masseter muscle, the ITF was clearly exposed, and the mass could be visualized. Then, enucleation within the schwannoma capsule was attempted, and intact removal was achieved in all three cases. There were no postoperative complications in two patients, while one patient developed facial numbness immediately after surgery, which gradually recovered after 3 months. The median follow-up duration was 49 months. No recurrence was documented.ConclusionsModified trans-zygomatic surgical approach could be considered a minimally invasive approach for asymptomatic ITF schwannoma, resulting in minimal postoperative complications. Enucleation achieved both intact mass removal and nerve fiber preservation.
