PMC5512413_01
Preoperative photograph showing diffuse swelling on the right side of infraorbital region without obliteration of nasolabial fold
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F1
On extraoral examination, a swelling of about 30 mm x 22 mm was present in the right maxillary region which was oval involving the lower eyelid and obliteration of the nasolabial fold [Figure 1].
Intraoral photograph showing minimal or no swelling in the intraoral region
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F2
On intraoral examination [Figure 2], tenderness was elicited in the right vestibule between the canine region and buccal frenum of the maxilla.
(a) Orthopantomograph showing extension of the radiolucent lesion on the right maxillary region (black arrows). (b) Computed tomography shows extension and measurements of the lesion on the right side. Computed tomography also shows eroded orbital floor on the right side (black arrow) in contrast to the normal orbital floor on the right side (white arrow). (c) Axial computed tomography showing the lesion occupying the right maxillary sinus (black arrow)
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F3
Computed tomographic scan revealed two well-circumscribed lesions present in the anterior maxilla and the maxillary sinus region measuring 2.24 cm x 1.90 cm and 3.71 cm x 2.71 cm, respectively, [Figure 3a and b] and occupying the right maxillary sinus [Figure 3c]. The roof of the sinus was completely eroded due to the lesion along with the infraorbital rim but not penetrating into the orbital tissues and the cavity [Figure 3b].
Intraoperative photograph showing spillage of keratin material during incision
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F4
White keratinaceous material exudated from the anterior incisional area [Figure 4].
Intraoperative photograph showing the enucleated cystic lining mass from the right maxillary sinus
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F5
The other cystic lesion in the right maxilla was enucleated by blunt dissection [Figures 5-7] to prevent damage to the orbital contents as there was no bony separation between the right orbital tissue and the sinus lesional area.
Intraoperative photograph after enucleation/curettage showing a large bony defect
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F6
The other cystic lesion in the right maxilla was enucleated by blunt dissection [Figures 5-7] to prevent damage to the orbital contents as there was no bony separation between the right orbital tissue and the sinus lesional area.
Gross specimen of the enucleated cyst
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F7
The other cystic lesion in the right maxilla was enucleated by blunt dissection [Figures 5-7] to prevent damage to the orbital contents as there was no bony separation between the right orbital tissue and the sinus lesional area.
Palisading basal layer with parakeratinized surface epithelium of 6-8 cell thickness and flat epithelial connective tissue junction (H and E, x400)
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F8
These features were suggestive of KCOT [Figure 8].