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Clinical Challenge
August 2016

Expansile Maxillary Sinus Mass in a Young Child

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill
  • 2Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill
JAMA Otolaryngol Head Neck Surg. 2016;142(8):793-794. doi:10.1001/jamaoto.2015.3789

A young boy presented with a 2-month history of a progressively enlarging right facial mass. The swelling persisted despite a course of oral antibiotics prescribed by the primary care team. His parents denied any recent fevers, night sweats, weight loss, pain, respiratory distress, nasal bleeding, or significant rhinorrhea. The physical examination revealed a right infraorbital and maxillary swelling, with deformity of the right lateral nasal dorsum. The remainder of the physical examination was unremarkable. Flexible fiber-optic sinonasal endoscopy revealed a normal appearance of the nasal mucosa with no obvious obstruction, mass lesion, rhinorrhea, or bleeding. Vision was grossly normal with no diplopia, and sensation of the right cheek was intact. A contrasted maxillofacial computed tomographic (CT) scan and magnetic resonance imaging (MRI) were performed, revealing an expansile right maxillary mass, associated with roots of the upper molar and premolar teeth, with erosion through the anterior maxillary wall and some thinning and displacement of the inferior orbital wall (Figure, A). The lesion was excised via a sublabial approach using both open and endoscopic techniques for better visualization. Histopathologic analysis revealed a bland, monotonous proliferation of stellate spindled cells with a variable extracellular matrix ranging from loose myxoid (Figure, B) to fibromyxoid and collagenous (Figure, C). There was also permeation of adjacent bone marrow spaces (Figure, D).