Open access in solitary nasosinusal neurofibroma.

Abstract

BACKGROUND:

Neurofibroma is a benign tumor originating from Schwann cells, characterized by its asymptomatic course, initially with slow progressive growth. It is a rare disease in the head and neck, reported in less than 4% of cases.

CLINICAL CASE:

A 23-year-old female patient whose condition began in 2019 with symptoms of right nasal obstruction, right hyaline rhinorrhea, and progressive enlargement of the right malar region. Computed tomography and magnetic resonance imaging revealed a lesion in the right maxillary sinus. Open access was decided due to the size of the lesion with submental orotracheal bypass, infraorbital, sublabial, and Lefort 1 access, without aesthetic deformity, with postoperative monitoring for right xerophthalmia and hypoesthesia of the right malar region, without major complications or recurrence.

CONCLUSIONS:

Solitary neurofibroma is uncommon in the nasosinusal tract. Open access was performed for surgical excision, with minimal cosmetic deformity, in addition to reconstruction of the orbital floor.

CLINICAL CASE

A 23-year-old female patient with no chronic degenerative diseases attended an outpatient consultation at the Otolaryngology Department of the High Specialty Medical Unit, Specialty Hospital 14, Adolfo Ruiz Cortines National Medical Center, Veracruz, of the Mexican Social Security Institute, in July 2022. Her condition began in 2019 with slowly progressive hyposmia, anosmia, mild tension headache, right nasal obstruction, ipsilateral facial fullness, and right hyaline rhinorrhea, for which she received multiple treatments due to suspected allergy. Almost three years later, she detected a slowly progressive increase in volume in the right malar region, with a stony consistency, without changes in color or temperature. At that time, a simple computed tomography scan revealed a homogeneous isodense image in the right nasal cavity, in the nasal area of Cotle III to V, with well-defined edges that obstructed the ostium of the right maxillary sinus and extended to the right maxillary sinus, occupying it entirely and thinning the floor of the right orbit. It showed a homogeneous isodense image in the anterior and posterior ethmoid cells on the right side. The diagnostic impression was a nasal tumor under investigation with right ethmoid-maxillary sinusitis, with no other symptoms. T1-weighted MRI revealed a round isointense lesion measuring 50.71 x 43.91 mm, with defined edges in the right maxillary sinus, partially encompassing the cavity.The diagnostic impression was of a nasal tumor under investigation with right ethmoid-maxillary sinusitis, with no other symptoms. T1-weighted magnetic resonance imaging revealed a round isointense lesion measuring 50.71 x 43.91 mm, with defined edges in the right maxillary sinus, partially encompassing the right eye socket, the right anterior and posterior ethmoid cells, and the right nasal cavity. Figure 1 T2 showed a well-defined isointense lesion in the right nasal cavity that encompassed the ipsilateral maxillary sinus, displacing adjacent structures, without loss of the intracranial interface. Figure 2 Preoperative laboratory studies: hemoglobin 12.3 mg/dL, hematocrit 37%, leukocytes 7.62, platelets 330,000, absolute neutrophils 5.67, glucose 95, thrombin time 11.3, and prothrombin time 30.8.

Based on clinical and imaging studies, open surgical treatment was chosen in consultation with the maxillofacial surgeon. The symptoms were exacerbated by evidence of right serous otitis media. The patient underwent surgery in December 2022 with orotracheal intubation to submental bypass (Figure 3), sublabial (Figure 4) and infraorbital (Figure 5) access, Lefort 1 (Figure 6). It was then fixed with screws and osteosynthesis plates, and the orbital floor was reconstructed with titanium mesh. A well-defined, pale pink, firm lesion was found (Figure 7). During the operation, 300 cc were obtained, and no blood transfusion was required. The entire lesion was resected and sent for pathological examination with hematoxylin and eosin staining, with a definitive diagnosis of neurofibroma. Cells with rounded fusiform nuclei with blunt edges and dense chromatin were observed, consistent with Verocay bodies, without pleomorphism or mitosis, alternating with fibroblasts of normal morphology and dense collagen deposits (Figure 8) and positive immunohistochemistry for beta-catenin, SOX10, calretinin, and S100. In post-surgical assessments, the patient reported dental pain, right xerophthalmia, and right malar hypoesthesia, but with good progress after medical and surgical treatment. She denied hyposmia, nasal obstruction, epistaxis, visual disturbances, and cosmetic alterations. She was discharged from the service one year later. She denied hyposmia, nasal obstruction, epistaxis, visual disturbances, and cosmetic alterations. She was discharged from the service one year later. A plain computed tomography scan of the nose and paranasal sinuses revealed the titanium plate in the floor of the orbit (Figure 9).

Stephanie Jessica Varela Tapia,1 Alejandro Jiménez García2

1 Third-year resident in Otolaryngology and Head and Neck Surgery.

2 Certified specialist in Otolaryngology and Head and Neck Surgery.

High Specialty Medical Unit, Specialty Hospital 14, Adolfo Ruiz Cortines National Medical Center, Mexican Social Security Institute, Veracruz, Mexico

To download the complete research, click below:

Page 175

https://www.smorlccc.org/wp-content/uploads/2025/10/Otorrino3_2025CA.pdf