Clinical Problem Solving
March 2015

A Rapidly Enlarging Maxillary Lesion

Author Affiliations
  • 1University of Florida College of Medicine, Gainesville
  • 2Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville
  • 3Department of Otolaryngology–Head and Neck Surgery, University of Florida College of Medicine, Gainesville

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JAMA Otolaryngol Head Neck Surg. 2015;141(3):287-288. doi:10.1001/jamaoto.2014.3486

A teenage girl was seen at the emergency department after several months of sinus pressure and facial swelling and several weeks of external deviation of her nasal septum. On examination, a left nasal mass was noted. Computed tomographic (CT) scans without and with contrast showed a heterogeneous mass with solid and cystic components completely opacifying the left maxillary sinus (Figure, A and B, respectively). The mass eroded the orbital floor, medial and posterior maxillary walls, and anterior ethmoid air cells. There was no extension beyond the cribriform plate. Mild left-sided proptosis was noted, with displacement of the inferior rectus but no muscle invasion. The left maxillary alveolar ridge and several molar roots were involved. Bony changes were consistent with remodeling and thinning. Magnetic resonance imaging was unavailable because the patient had braces. Biopsy and tissue analysis demonstrated a spindle cell process in a patternless arrangement with clinically significant multinucleated giant cells (Figure, C). The tissue specimen showed rare mitotic activity and lacked cytologic atypia. The mass was removed using a microdebrider and Tru-cut forceps. Curved olive-tip suction was placed between the maxillary sinus walls, nasal cavity, and anterior aspect of the mass. The tumor was collapsed in and removed in 5 portions; the largest measured 7.0 × 4.0 × 2.0 cm. The most firm, fibrotic portion of the tumor, centered on the posterior maxillary wall, was removed en bloc through identification of a fibrous dissection plane between the tumor and periosteum overlying the pterygopalatine space. At the 5-month follow-up the patient was stable and asymptomatic and showed no evidence of recurrence following excision and left maxillectomy.

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