Chennai: A 32-year-old male from Kolkata was found with a rapidly progressive massive right-sided facial swelling with gross facial asymmetry and progressive difficulty in swallowing for the past one year.
Clinical examination revealed an approximately 8x10cm diffuse, firm, non-tender swelling over the right side of the face.
The skin over the swelling was stretched with restricted mouth opening. The delay in seeking medical attention was attributed to the prevailing Covid restrictions in the country.
A CT scan of the paranasal sinuses with 3D reconstruction demonstrated a large expansile lytic lesion, centred within the right maxillary sinus boundaries with anatomical extension into the right infratemporal fossa too. A biopsy of the lesion was then undertaken, which was suggestive of ameloblastoma.
“As per medical literature, solid ameloblastomas rarely affects maxillary bone. Maxillary ameloblastomas also are notorious in secondarily invading through the nasal and paranasal sinuses, giving rise to increased morbidity and discomfort to the patients in day to day activities,” explained Prof Dr Sanjeev Mohanty, senior consultant and head, Institute of ENT, Head & Neck Surgery at MGM Healthcare, Chennai.
After a thorough surgical planning, a modified Denkerās endoscopic transnasal surgery with access to the infratemporal fossa was contemplated, with an informed consent obtained from patient to convert it to open approach if need be. However, a purposeful endonasal approach was performed by Dr Mohanty to excise the tumour completely with disease-free margins all around. Coblation system and powered instrumentation were used with good hemostasis intraoperatively.