PMC4811067_01
Face asymmetry before surgery.
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A male patient, 2 years and 5 months old, presented at the otorhinolaryngology outpatient clinic with parents complaining of an enlargement and hardening of left maxilla region for 2 weeks (Figure 1).
Coronal axial and sagittal CT: odontogenic myxoma left maxilla.
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A face tomography was completed and revealed a maxillary sinus cyst with odontogenic origin and associated bone erosion (Figure 2).
Surgery steps 2 to 5. *Dental germ removal.
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Therefore, the main diagnosis hypothesis was odontogenic cyst, and the patient was submitted to surgery (Figure 3). Access was obtained through a sublabial incision at anterior left maxilla wall, and a dissection along anatomical planes through the cyst wall covered by a bone capsule was performed (Figure 3(a)). Thereafter, dissection along the cyst limits and identification of bone erosion were performed (Figure 3(b)). Peripheral osteotomies in all the surrounding bone that was in direct contact with the lesion were made, and this bone was removed with a cutter (Figures 3(c) and 3(d)). The cyst had a gelatinous mass characteristic (Figure 3(e)).
Odontogenic myxoma: (a) H&E x10: a lobular and loose myxomatous tumor surrounded by alveolar bone. (b) H&E x20: note the spindle and stellate cells in a myxoid stroma with few collagen fibrils and delicate capillary vasculature.
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It is compounded by a cytologically bland spindled and stellated-shaped cells proliferation in an abundant, loose myxoid stroma that contains few collagen fibrils and delicate vessels (Figure 4).
Immunohistochemical analysis: (a) diffuse positivity for vimentin, (b) focal expression for 1A4 auto control: vessels wall, (c) AE1-AE3 negative, and (d) Ki-67 expression around 5-8% of the nuclei.
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An immunohistochemistry analysis showed a diffuse expression against vimentin antibody, with focal reactivity for muscle-specific actin (Table 1 and Figure 5), favoring fibroblastic proliferation with some myofibroblastic differentiation.
Coronal, axial, and 3D bone reconstruction showing no recurrence of the maxillary lesion.
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