PMC5771908_01
Facial CT scan using contrast-enhancing agent and showing an osteolytic tumor starting in the right maxillary sinus and measuring 60 x 57 x 55 mm.
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The patient presented with a facial CT scan that showed a large osteolytic tumor of the right maxillary sinus (Fig. 1).
Facial MRI using gadolinium and showing the extension of the tumor to the orbit, the nasal fossa and the oral cavity and the destruction of the right lateral one-third of the palate.
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Within a few days, the tumor had invaded the right nasal fossa and a large part of the oral cavity, inducing a destruction of 1/3 of the oral cavity's roof in its lateral part (hard palate; Fig. 2).
The development of the tumor in the oral cavity and toward the pharynx. We can notice the swelling of the right cheek.
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The growth of the tumor toward the pharynx was so impressive (Fig. 3) that the patient showed rapidly increasing signs of respiratory discomfort and frequent episodes of coughing.
The specimen after the tumor was removed from inside the oral cavity and the pharynx.
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The specimen (Fig. 4) was then sent to the laboratory.
Microscopique picture of the specimen showing a fabric fiber surrounded by inflammatory tissue.
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The histological examination found necrosis, inflammatory tissue, and fabric fibers suggesting the presence of the remains of gauze (Gossypiboma; Fig. 5).
(A) Aspect before the second surgery. (B) Peroperative aspect of the surgical site after the gossypiboma was removed using a submucoperiosteal dissection of the maxillary sinus.
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The complete removal of the tumor was performed using a submucoperiosteal dissection (Fig. 6A and B).
(A) The remaining nasal mucosa was used to create a new upper layer for the palate. The buccal fat pad is dissected. (B) The buccal fat pad was flattened and spread under the new sinus floor mucosa. (C) A mucosal flap was harvested from the cheek above the level of the Stensen's duct to form the oral roof mucosa. Transfixing sutures ensure the good contact between the three layers. (D) Final external aspect with the tumor that has been removed. (E) Continuous sutures ensure a good contact of the oral cavity roof mucosa (picture taken 3 days after the surgery).
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(A) External aspect 6 months after surgery: The right eye ball which was deported upward is returning to its normal position. (B) Oral view of the palate: 6 months after the surgery, the palate is still completely closed.
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Six months after the surgery, the oral cavity's roof is still completely closed (Fig. 8A and B).
Facial MRI performed 6 months after the surgery and showing empty right sinus and nasal fossa. A thickening of the sphenoid sinus mucosa is remaining.
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There is still persistent thickening of the sphenoidal sinus mucosa (Fig. 9).