Introduction and Importance: Schwannomas are benign nerve sheath tumors that may arise in deep anatomical regions such as the infratemporal fossa and parapharyngeal space. Their slow growth and nonspecific presentation often delay diagnosis. Ancient schwannoma is a rare histological variant characterized by degenerative changes that may mimic malignancy. Case Presentation: We report the case of a 64-year-old man presenting with progressive left parotid swelling and long-standing hemifacial paresthesia. Imaging revealed a giant infratemporal fossa tumor with parapharyngeal extension. Complete surgical excision was achieved via a superior vestibular approach with maxillo-malar osteotomy. Histopathology confirmed an ancient schwannoma. No recurrence was observed at one-year follow-up. Clinical Discussion: Management of large infratemporal schwannomas remains challenging due to their deep location and proximity to critical neurovascular structures. Surgical approach selection must be individualized according to tumor extension. Conclusion: This case highlights the importance of accurate histopathological diagnosis and tailored surgical planning in the management of giant ancient schwannomas of the infratemporal fossa.
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