Nims Surgeons Remove Cheekbone Tumour Through Eyelid
Doctors use a minimally invasive orbital approach to remove a 3-cm benign tumour without leaving a facial scar.
Neurosurgeons at Nizam’s Institute of Medical Sciences (Nims) have removed a benign tumour lodged deep behind the cheekbone of a 29‑year‑old woman by approaching it through her lower eyelid, avoiding any incision on her face or inside her nose.
The patient had been suffering from headaches in the forehead region for three months. Imaging revealed a 3‑cm schwannoma, a slow‑growing, non‑cancerous tumour arising from the sheath covering a nerve. It had developed from the maxillary nerve, which carries sensation from the cheek, upper lip and upper teeth, doctors said.
The tumour was located in the pterygopalatine fossa, a narrow space behind the cheekbone and below the eye. Conventionally, such tumours are removed through open surgery involving facial incisions and bone cutting, or through endoscopic surgery via the nose, which can disturb nasal structures, said Dr Y. Thirumal Yerragunta, additional professor, Department of Neurosurgery.
On November 4, the team used a transconjunctival approach, making a small incision on the inner surface of the lower eyelid. Working along the floor of the eye socket, surgeons removed a small window of bone and accessed the back wall of the maxillary sinus. An endoscope was used to reach and remove the tumour, guided by neuronavigation, a GPS‑like system showing instrument positions on scans in real time. The procedure lasted six hours.
A post‑operative MRI confirmed complete removal, while lab examination confirmed it was benign. The infraorbital nerve supplying sensation to the cheek and upper lip was preserved. The patient’s vision and eye movements remained normal. She was discharged on the fourth day after surgery. The procedure was performed free under the Rajiv Aarogyasri scheme.
According to the Nims team, medical literature describes the orbital route in anatomical studies and biopsies, but no published report exists of complete removal of such a tumour through this approach. The team believes this is the first such case reported. “The orbital route gave us a short, direct corridor to the tumour without a single facial incision,” Dr Yerragunta said, cautioning that the technique is not suitable for every patient and requires careful planning with neurosurgeons, ophthalmologists and anaesthetists.
The patient’s husband said the family had feared a major facial operation but she returned home without a scar and with normal sensation. The neurosurgery team comprised Dr Yerragunta, Dr Ramnath Reddy Kanala, Dr Murali Krishna Bethanbhatla and Dr Umamaheshwar Edulla, with neuro anaesthetists Dr M. Srilatha and Dr Sapna Nikhar. Dr Modini led the ophthalmology team from Sarojini Devi Eye Hospital.
Patients with similar complaints can consult the NIMS Neurosurgery OPD at Punjagutta from Monday to Saturday, between 8 am and 2 pm, doctors said.
