Minimally Invasive Modified Trans-zygomatic Approach for Enucleation of Asymptomatic Infra-temporal Fossa Schwannoma: A Report of Three Cases and a Review of Literature

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.