Congenital maxillary sinus cholesteatoma

Epidermoid Cyst of the Maxillary Sinus: A Case Report and Literature Review

Epidermoid cysts are rare benign lesions that can derive from abnormally situated ectodermal tissue during embryological development or from implanted epithelium after trauma or surgery. In the oral and maxillofacial regions, epidermoid cysts usually develop in the floor of the mouth and rarely in other sites. We describe a rare case of an epidermoid cyst arising in the right maxillary sinus. A 29-year-old man with a known diagnosis of Marfan syndrome presented with progressive swelling and tenderness in the right buccal region, mimicking facial cellulitis, and refractory to medical treatment. Computed tomography scan showed a cystic lesion extending widely into the right maxillary sinus. The cyst was successfully removed with a medial maxillectomy through inferior antrostomy approach under general anesthesia. Histological examination confirmed the diagnosis of an epidermoid cyst, showing a cystic wall lined with a thin layer of keratinizing squamous epithelium and fibroma connective tissue infiltrated with inflammatory cells, with no skin appendages. There has been no evidence of recurrence during the 4 year follow-up. We also conduct a review of the English literature for the reported cases of maxillary epidermoid cyst.

Nasal sinuses cholesteatoma: case series and review of the English literature

BACKGROUND

Nasal sinus cholesteatomas are uncommon slow-growing lesions that are frequently misdiagnosed preoperatively. They can develop due to embryologic remnants or iatrogenic factors (surgical trauma or nasal sinus trauma). In addition, they can cause bone destruction resulting in intracranial or intraorbital complications as well as malignant change if neglected. Complete surgical removal is a must with strict postoperative follow-up.

MATERIALS AND METHODS

Three cases of nasal sinus cholesteatoma are reported. The first case was found inside the ethmoidal sinus, the second in the frontal sinus, and the third was found inside a concha bullosa. In all three cases, a wide endoscopic surgical excision was performed. Due to the lateral extension of the lesion, frontal sinus trephine was also used in the case of frontal sinus nasal cholesteatoma. In addition, a review of the English literature for the reported cases of nasal sinus cholesteatomas was conducted.

RESULTS

There were no reported recurrence or residual during strict postoperative follow-up for 2 years (by endoscopic examination and diffusion-weighted MRI with delayed postcontrast T1 images). A review of the English literature revealed 42 cases of nasal sinuses cholesteatomas (including the present three cases) (17 in the frontal sinus, 15 in the maxillary sinus, 5 in the ethmoid sinus, 3 in the sphenoid sinus, and 2 in a concha bullosa).

CONCLUSIONS

Although nasal sinus cholesteatomas are uncommon, they must be considered in the differential diagnosis of slow-growing nasal sinuses lesions. Preoperative CT scan and diffusion-weighted MRI are essential for proper diagnosis and to exclude other similar lesions, such as nasal sinus mucoceles, cholesterol granuloma, or neoplastic lesions. Wide complete surgical excision is necessary to avoid recurrence and facilitate postoperative follow-up. As with ear cholesteatoma, strict postoperative follow-up is required to detect recurrence or residual early and is performed by endoscopic examination, diffusion-weighted MRI, and delayed post-gadolinium T1 images.

Sphenoid Sinus Cholesteatoma-Complications and Skull Base Osteomyelitis: Case Report and Review of Literature

Introduction:

Cholesteatoma of the paranasal sinuses is uncommon. Its clinical characteristics are an expanding growth of the affected paranasal sinuses consisting of keratinizing squamous epithelium with bony wall destruction. Among involved paranasal sinuses, sphenoid sinus cholesteatoma is the least common.

Case presentation:

An 82-year-old female diabetic patient presented with subacute onset of fever after experiencing chronic progressive headaches for more than 20 years. Nasal endoscopy found purulent discharge from left sphenoethmoidal recess. Computed tomography (CT) scan of the paranasal sinus showed soft tissue lesions that totally filled the left sphenoid sinus with posterior and inferior wall destruction. There was no evidence of connection to the left mastoid cavity.

Management and outcome:

Left sphenoidotomy was performed. Histopathology revealed cholesteatoma. Two months after surgery, she became worse and CT showed extensive skull base destruction. The patient underwent bilateral sphenoidectomy and craniotomy with surgical debridement of osteomyelitis of the skull base. She received long-term intravenous ertapenam and sitafloxacin for treating drug-resistant Klebsiella infection. The osteomyelitis could not be controlled, and she died.

Discussion:

Progressive headache can be caused by an uncommon disease such as sphenoid sinus cholesteatoma, which is a surgical condition. Complicating osteomyelitis of the skull base requires extensive debridement surgery and should be anticipated.

Epidermoids of the Paranasal Sinuses and Beyond: Endoscopic Management

Background

Epidermoid tumors of the craniofacial skeleton are uncommon, with the exception of acquired cholesteatoma of the temporal bone. These lesions may be primary embryologic in origin or, less frequently, may be iatrogenic or posttraumatic.

Methods

We report three cases of unusually encountered epidermoids, all of which were managed by endoscopic marsupialization via paranasal sinus approaches. We also review the pathophysiology and clinical presentation of these rare entities.

Results

The first patient is a 60-year-old man with a congenital epidermoid of the petrous apex removed via an endoscopic transsphenoid approach assisted by image-guided surgical navigation with CT/MRA merge. The second case is a 48-year-old woman with a history of trauma found to have a mass in the pterygopalatine space. An endoscopic transmaxillary approach was used to ligate the internal maxillary artery and marsupialize the cyst into the maxillary sinus. The third patient is a 22-year-old woman with a supraorbital ethmoid epidermoid tumor discovered intraoperatively during surgery for a presumed mucocele. This patient also had a known history of trauma. The cyst was marsupialized into the adjacent frontal sinus. Image-guided surgical navigation using CT was performed in the latter two cases. All patients are free of recurrence with follow-up ranging from 14 to 26 months.

Conclusion

With advancements in endoscopic techniques, including the use of image guidance, many of these relatively uncommon lesions can be managed by minimally invasive approaches via the paranasal sinuses.

Cholesteatoma of Maxillary Sinus: What Is the Best Surgical Approach?

Cholesteatoma is a relatively common disease entity within the middle ear or mastoid cavity but cholesteatoma of the paranasal sinuses is a rare diseases entity, especially in the maxillary sinus. As the authors recently experienced a patient of maxillary sinus cholesteatoma, the authors tried to review all the literatures previously reported on the "Cholesteatoma of the maxillary sinus." The aim of this study was to describe authors' recent experience and review previously reported patients of cholesteatoma of the maxillary sinus. Additionally, it is to describe the clinical features focusing on the computed tomography findings and to elucidate which approach may be best for complete excision. The authors thoroughly reviewed 10 patient reports written in English regarding the cholesteatoma of maxillary sinus which have been published since the 1980s. Based on authors' review, the authors suggest some conclusions. First, the diagnosis of cholesteatoma, although rare, should be considered for any slowly expansile lesion of the maxillary sinus. Second, there was no specific computed tomography finding that was helpful for the diagnosis of maxillary sinus cholesteatoma. Last, the surgical approach to cholesteatoma of the maxillary sinus should be chosen to allow visibility and complete removal according to the size, location, and extent of diseases.

Cholesteatoma of the maxillary sinus: a case report and review of the literature

Cholesteatoma is a relatively common disease entity within the middle ear cavity, but it is rarely found in the paranasal sinuses. We describe a rare case of cholesteatoma in the maxillary sinus of an elderly man presenting with recurrent sinus infections and nasal obstruction refractory to medical treatment. The patient was treated using functional endoscopic sinus surgery with successful removal of the cholesteatoma. He has no recurrence of the cholesteotoma at a 13year follow-up. We review the literature and history on maxillary cholesteatomas and discuss the theories on the pathogenesis of cholesteatoma formation. We propose functional endoscopic sinus surgery with maxillary antrostomy and marsupialization of the cholesteatoma as a primary treatment option for a maxillary cholesteatoma.

Cholesteatoma of the nose and maxillary and ethmoid sinuses: a rare complication of palatal surgery

A 10-year-old boy presented with a complaint of a left-sided nasal obstruction with an associated foul-smelling discharge. Physical examination and anterior rhinoscopy revealed that a whitish, friable mass had completely filled the left nasal cavity. On computed tomography, a soft-tissue mass was seen filling the cavity and extending to the paranasal sinuses with bone erosion. A biopsy of the mass suggested that it represented a cholesteatoma. The lesion was removed via nasal endoscopy, and histopathology confirmed the diagnosis of a cholesteatoma. No recurrence was noted during 6 months of follow-up. Cholesteatoma of the paranasal sinuses is a rare entity, as only a few dozen cases have been reported in the literature.

Removal of frontal sinus keratoma solely via endoscopic sinus surgery

OBJECTIVES

To present a patient with a frontal sinus keratoma removed solely via endoscopic sinus surgery, including presentation of characteristic computed tomography and magnetic resonance images; to discuss the differential diagnosis of this condition; and to report the current knowledge on and treatment of frontal sinus keratoma.

CASE REPORT

A 53-year-old man presented to our department with a 10-month history of rhinorrhoea and postnasal drip. After computed tomography and magnetic resonance imaging studies, the patient underwent surgery utilising a modified Lothrop procedure. An extensive soft tissue lesion was removed from the frontal sinus. Histological examination revealed a lamellated cluster of keratinous material. The pathological diagnosis was keratoma of the frontal sinus. There was no recurrence of keratoma over a two-year follow-up period.

CONCLUSIONS

Following review of the English language literature, we believe this case report to represent the first successful application of a modified endoscopic Lothrop procedure for resection of an extensive frontal sinus keratoma. Thus, the applications of endoscopic sinus surgery may be expanded to include frontal sinus keratoma removal.

Aetiopathology of maxillary swelling--a 3-year prospective study

A wide variety of lesions and not necessarily a malignant tumour can cause maxillary swelling. Non-specificity of clinical and radiological features of these maxillary lesions makes their diagnosis difficult. Review of literature adds a little regarding the aetiopathological distribution of the various lesions causing maxillary swelling. We present our finding regarding the relative distribution of various conditions causing maxillary swelling. The awareness of the spectrum of pathology related to maxillary swelling is essential for correct diagnosis and treatment. Forty-eight patients who presented with a swelling of the maxilla to our hospital between May 1998 and April 2001 were prospectively studied regarding the clinical presentations, radiological features and histological findings. Maxillary swelling was found to be caused by malignant tumours in 54.2%, benign neoplasms in 22.9% and non-neoplastic lesions in 22.9%. Overall squamous cell carcinoma (22.9%) was the commonest lesion, tumour of vascular origin was the commonest benign neoplasm and odontogenic cyst was the commonest among the non-neoplastic lesions.