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Clinical Challenge
September 24, 2020

A Painful Right Maxillary Swelling

Author Affiliations
  • 1Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
  • 2Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
  • 3Department of Pathology and Laboratory Medicine, University Hospitals Cleveland Medical Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio
JAMA Otolaryngol Head Neck Surg. 2021;147(1):93-94. doi:10.1001/jamaoto.2020.2967

A 19-year-old woman with no noteworthy medical issues or surgical history presented to the oral and maxillofacial surgery clinic with a 3-month history of right-sided maxillary pain and swelling. The patient denied any drainage from the site but reported worsening swelling and pain over the past several weeks. On physical examination, there was noted intraoral swelling involving the buccal and palatal aspects of the posterior maxilla. The lesion was soft and fluctuant with no appreciable drainage. The patient’s history was notable for an 8-year history of right maxillary first premolar impaction. Findings from computed tomography of the head demonstrated a relatively spherical 4-cm growth of the right anterior maxilla abutting the maxillary sinus and orbital floors, and enclosing an impacted premolar at the superior margin of the growth (Figure, A). There was no proptosis or visual field changes associated with the lesion. An incisional biopsy was performed via an intraoral approach, and results demonstrated a thickly encapsulated proliferation of odontogenic epithelial cells with pseudoglandular elements (Figure, B and C). Following diagnostic confirmation, the patient was taken to the operating room, and a midface (Weber-Ferguson) incision was used to access the maxillary lesion for complete removal.

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