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Clinical Problem Solving: Pathology
May 2013

Pathology Quiz Case 2

JAMA Otolaryngol Head Neck Surg. 2013;139(5):529. doi:10.1001/jamaoto.2013.2864a

An 11-year-old girl was referred to our institution with an 18-month history of a right facial mass, accompanied by ipsilateral nasal obstruction. She had undergone 2 surgical procedures for removal of the mass prior to referral, 1 via an endoscopic approach and 1 via a sublabial approach. She presented 4 months following her most recent surgical procedure, with physical examination revealing expansion of the maxilla, mild proptosis of the right eye, and an intraoral polypoid mass protruding through the posterior aspect of her previous sublabial incision. Nasal endoscopy revealed a mass emanating from the maxillary sinus and filling the middle meatus. Coronal computed tomography with soft-tissue windows shows an approximately 6-cm expansile mass centered within the right maxillary sinus, with gross local invasion through the orbital floor, into the nasal cavity, and through the posterolateral maxillary sinus wall (Figure 1). Surgical resection was performed through a combined endoscopic, sublabial, and transconjunctival approach.

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