Radiopaque tumor in the maxillary sinus—A possible osteoma

RADIOPAQUE TUMOR IN THE MAXILLARY A. POSSIBLE OSTEOMA

SINUS-

Case Report

A

~~-YF;AR-OTJ~ white man was referred to onr office because of a suspected oroantral

fistula.

Case History.--In 1910 the patient had an upper left first molar extracted, at which time the dentist punctured the sinus wall, causing an oroantral fistula. The drainThe sinus continued to drain for four years following the extraction. age then stopped and the sinus became asymptomatic.

Clinical Examination.-l’he patient was edentlxlous in the upper arch. Through the pears since 1910 all his remaining teeth had been extracted. In the upper left first molar area the mucobuccal fold showed a depression about 3 mm. in dia.meter and 3 mm. deep. On probing t.he area a hard mass was discovered. There was no oroantral ventilat,ion. Maxillary sinus and dental roentgenograms were taken.

Roentgenographic

Examination,-The dental I,oentgenogralns showed a On examination of the maxillary sinus roentdense area in the maxillary sinus. genograms, a large bony mass was seen in the left maxillary antrum, almost ent,irely filling it. It appeared to be attached to the medial wall of t,he antrum and probably occluded the meatus. The bony mass was separated from the roof, the lateral wall, and the floor of the sinus. There was an intervening air space of several millimeters noted. There was no bony erosion of the previously mentioned walls of the maxillary sinus. Of the various possibilities an osteoma appears to be most likely. Ossifying fibroma was thought of and ruled out because they usually obliterate the exostosis maxillary sinus and cause asymmetry of the face. Osteocartilaginous presents a homogenous texture on roentgcnograghic examina.tion, and the posFrom the roen tgenographic sibilitv of a calcified cyst was decided to be unlikely. evidence it appeared that the lesion may be an osteoma, as most osteomas arise from the pcriosteum of a bony wall, are attached hy a pedicle, and are usually dne to a stimulation. Course.--On consultation with an otolaryngolugist it was decided to leave the area intact because t,he patient suffered no symptoms from it, and because of his age. It was decided to follow the lesion by s-ray every six mont,hs to note an,v change in the area. The patient was opposed t0 21 biopsy. 1:54:;

1544

S. S. FARE

Fig.

Fig. Fig. l.- -Dental Fig. 2.- -Dental

roentgenogram roentgenogram

Fig. t.-Lateral

1.

2.

with w’obe against tumor. showing suspected area in the maxillary

view of the maxillary

dnus showing

tumor.

sin IUS.

RADIOI’AQUE

Fig.

4.-Anteroposterior

TUMOR

IN MAXILLARY

view of the maxillary

sinus

1545

SINUS

showing

tumor.

Summary 1. A case is reported of a possible osteoma in the left maxillary sinus of a 61-year-old man. 2. This was discovered. on clinical and rocntgenographic examination of the area, A past history of an oroantral fistula following a tooth extraction in this area was obtained. 3. As no biopsy was taken the diagnosis of a definite type of tumor cannot be established.

References Thoma, Kurt I-1.: oral Surgery, St. Louis, 1945, The C. V. Mosby Company. Surgery of Oral and Facial Diseases and Malformations, Brown, George Van Ingen: delphia, 1938, Lea & Febigw. 6333 WILSHIRE

BOULEVARD.

Phila-