PMC9731383_01
Clinical and imaging aspects. A - front view showing ocular dystopia; B - infero-superior view, highlighting the expansive aspect of the lesion; C - CT axial section, showing a mixed unilocular lesion; D - CT sagittal section, showing the preservation of the anterior and posterior cortices.
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It was firm on palpation (Figures 1A, B). The computed tomography showed a multilocular well-defined, predominantly hypodense, expanding lesion located in the left side of the frontal sinus, with a consequent increase in the ipsilateral orbital cone (Figure 1C and 1D).
Surgical and histopathological aspects. A - Coronal surgical access; B - Surgical site after curettage and peripheral osteotomy; C - Histopathological examination (HE, 100X) showing a hypercellular stroma and multiple intermingled calcified structures; D - Histopathological examination (HE, 200X) emphasizing the psammomatoid bodies.
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Coronal access and osteotomy of the anterior wall of the frontal bone were performed for adequate lesion exposure (Figure 2A). As the lesion was well-circumscribed with a clear cleavage plane, it was possible to perform complete excision through curettage and peripheral osteotomy (Figure 2B). The collected specimen was submitted to histological analysis, which showed a cellular stroma, without mitotic activity or cellular atypia, in addition to multiple rounded calcified structures (Figure 2C). These structures were concentric, basophilic, and lamellar with eosinophilic rimming and were found throughout the lesion (Figure 2D).
Planning and rehabilitation. A - Postoperative appearance after the first surgical intervention showing concavity with a noticeable aesthetic defect; B - Planning guided by CT; C - Polymethylmethacrylate implant (scale bar = 2,5 cm); D - Implant fixed with plates and screws from the fixation system1.5.
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As the lesion removal resulted in a concave unfavorable aesthetic defect (Figure 3A), a reconstructing rehabilitation plan was carried out through 3D prototyping (Figure 3B). Thus, guided by the CT image, a customized polymethylmethacrylate implant was performed (Figure 3C). The implant was positioned and fixed in the surgical site with several titanium plates and screws from the 1.5 fixation system (Figure 3D).
Final postoperative period (06 months). A - Frontal view with significant improvement in aesthetic appearance, but with slight remaining ocular dystopia; B - Inferior-superior view.
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The initial postoperative period showed significant aesthetic improvement (Figures 4A, B), with a slight degree of remaining ocular dystopia.