A 39-year-old woman with a 13-year history of progressive headache of intensity and, two years before admission to our institution, with right nasal obstruction and anosmia.
Throughout his illness he presented progressive proptosis of the right eye, along with diplopia in the extreme look.
Physical examination revealed right proptosis, mild facial palsy due to increased volume in the ipsilateral cheek.
Septal closure showed left convexity and a tumoral lesion in the right choanal area.
Neurological examination was normal.
Computed tomography (CT) showed a hypodense, ovoid lesion, occupying the infratemporal fossa. The sinus was also managed caudally with the right parapharyngeal and fossa floor, causing compression and rostral dorsal displacement.
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Magnetic resonance imaging (MRI) revealed hypointense on T1-weighted sequences and hyperintense on T2-weighted sequences, intensely enhanced with gadolinium.
Its edges appeared well defined and, in addition to the already written displacements of CT, it was evident molding of the soft and hard palate and nasal septum.
We also observed thinning and deformity of the middle floor, which made it difficult to determine whether the lesion originated in that area or was an extension from the infratemporal fossa.
Therefore, the probable diagnoses were neurinoma and sinus inverted papilloma.
The patient underwent surgery by sublabial incision with transmaxillary centrofacial intercartilagenous approach, replenishment of the myocutaneous flap and transmaxillary approach.
A grayish-colored, poorly vascularized tumour of encapsulated consistency (such as hull cloth) displacing neighboring structures was found.
Intracranial resection was performed without incidents.
Histopathological study revealed malignancy.
The postoperative course was uneventful and after three months the patient is asymptomatic with marked improvement of proptosis.
The control CT scan showed complete excision of the lesion.
