Caption: Figure 2: Enhancing soft tissue mass arising from nasopharynx, destroying pterygoid plates
and extending to infratemporal fossa.
Confirming the elongated pterygoid hamulus radiographically, a reasonable anatomic postulation could have been existed: (1) soft palate mucosa may have been thin and friable than usual; (2) soft palate mucosa may have been much closer than usual to a rather normally located hamulus making it vulnerable to any frictional trauma ; and (3) asymmetry of the Pterygoid plates
After destroying the pterygoid plates
, the tumour extend to pterygopalatine fossa winding round the posterior surface of maxilla through pterygomaxillary fissure, thus entering the cheek.
Imaging revealed diffuse sinus opacification and a Le Fort type I complexfracture involving the maxilla, pterygoid plates
, clivus, and right nasal bridge.
The pterygoid plates
arise laterally and medially from the inferior surface of the side of the body and from the root of the greater wing.
The mean distances between the JF and the medial and lateral pterygoid plates
and the vomer were greater on the right side than the left side.
The skulls were washed and their bases were closely observed in regards with the pterygoid plates
of sphenoid, for the presence of ossified pterygospinous bars and foramina.
Tumor causing bone erosion or destruction including extension into the hard palate and/or middle nasal meatus, except extension to posterior wall of maxillary sinus and pterygoid plates
is a T2 stage tumor.
Axial and coronal computed tomography (CT) images of the maxillofacial bones (Figures 2 and 3) demonstrate extensive cortical destruction, osteosclerosis, cortical thickening, and fragmentation of the right maxilla, which extends into the frontal process of the zygomatic bone and pterygoid plates
. The anterior wall of the maxillary sinus, as well as the palatine process, are mildly depressed, and the lateral and medial walls of the sinus are fragmented, with several bony sequestra present within the sinus cavity.
A wide local excision involving the soft palate, right posterior maxilla and right pterygoid plates
and right temporoparietal galeal flap reconstruction was performed with 500 ml estimated blood loss.
The pneumatization of the sphenoid sinus can vary from total non-pneumatization to hyperpneumatization including clinoid processes, sphenoid wings and pterygoid plates
. In our study, we found absent pneumatization 2.5%, conchal type in 2.5%, presellar type in 22.5% and sellar in 72.5%.
On computed tomography (CT) with intravenous contrast, a large, soft-tissue nasopharyngeal mass with extension into and erosion of the sphenoid sinus walls, pterygoid plates
, and sella turcica and protrusion into the middle cranial fossa was found (figures 1 and 2).