PMC7306543_01
(a, b) Photograph of the patient, showing diffuse swelling at left side of face causing facial asymmetry and pressure symptoms on left eye.
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Initially, two months back the swelling was asymptomatic, it was smaller in size, but it gradually enlarged to the present size and extended to the floor of the orbit, causing facial deformity and pain (Fig. 1).
Pre-operative intra-oral view showing tumor extension.
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Intraoral examination revealed diffuse swelling in the left maxilla, extending from the midline to the posterior molars area and expanding laterally to involve the buccal vestibule and the cheek (Fig. 2).
3D volume reconstructed CT showing expansile large lesion in maxilla and left orbit.
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Computed tomography revealed a very large well- defined radiolucent expansile unilocular lesion in the left maxilla with perforation to the floor of the orbit (Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7).
Coronal cuts demonstrating a large well-defined radiolucent expansile unilocular lesion.
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Computed tomography revealed a very large well- defined radiolucent expansile unilocular lesion in the left maxilla with perforation to the floor of the orbit (Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7).
Axial cuts showing destruction of the maxilla and the extensions of the tumor causing severe disfigurement to the child's face.
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Computed tomography revealed a very large well- defined radiolucent expansile unilocular lesion in the left maxilla with perforation to the floor of the orbit (Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7).
Intraoperative exposure through weber ferguson's incison before resection.
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As the lesion was very extensive, the entire tumor has been removed using an extraoral incision (Weber Ferguson) (Fig. 8, Fig. 9), After tumor exposure lesion appeared to be extending from midline till pterygoid plates on the left side and superiorly to the floor of the orbit. partial maxillectomy performed with removal of the floor of orbit with 1 cm safety margins from all directions using surgical saw and osteotomes. immediate reconstruction using the buccal pad of fat (Fig. 10, Fig. 11) was done.
Intra-operative field after resection.
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As the lesion was very extensive, the entire tumor has been removed using an extraoral incision (Weber Ferguson) (Fig. 8, Fig. 9), After tumor exposure lesion appeared to be extending from midline till pterygoid plates on the left side and superiorly to the floor of the orbit. partial maxillectomy performed with removal of the floor of orbit with 1 cm safety margins from all directions using surgical saw and osteotomes. immediate reconstruction using the buccal pad of fat (Fig. 10, Fig. 11) was done.
One year follow up with remaining 3 mm fistula in the palate which will be addressed later.
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The patient was followed up for one year and showed excellent healing and good functional and esthetic outcome. (Fig. 12) only 3 mm fistula remains in the palate which will be addressed later in a simple operation with no evidence of complication or recurrence.