Surgical management of an erupted complex odontoma occupying maxillary sinus
A 22-year-old male patient presented with history of pain and swelling in the left cheek region since 6 months, with nasal obstruction, occasional purulent discharge from left nostril associated with foul smell and reported several episodes of oral bleeding. On examination, a diffuse swelling [] in the left cheek measuring approximately 3×4cm, hard in consistency, Immobile with neurosensory deficits. Intraorally, a yellowish white hard mass [] was seen in the region of clinically missing maxillary left first and second molar teeth with palatal as well as buccal expansion obliterating the buccal vestibule. The mucosa around was apparently inflamed with evidence of discharge and bleeding. Left submandibular lymph nodes were palpable, two in number, oval shape (0.5×1 cm), soft, mobile and nontender. Except for partial deafness in the left ear, patient had no significant personal or family history.\nRoutine conventional radiographs and CT scans were obtained [Figures and ]. A 4×3.5-cm irregular radiopaque mass (cotton wool-like appearance) occupied the left posterior maxilla and extended into 2/3rd of maxillary sinus. The first and second molar were impacted, one lying at the orbital floor and other high in the tuberosity region. A provisional diagnosis of odontoma was made. The mass was excised intraorally in piecemeal due to its size []. The teeth were deep inside and an attempt to retrieve them caused severe pain and discomfort to the patient under local anesthesia. Therefore, the wound was closed with the help of collagen sheet supported with an acrylic palatal plate. The collagen sheet failed to aid in healing of the defect, resulting in wound dehiscence []. Two weeks later a palatal island flap was designed and rotated over the dehiscence and closed primarily without tension. Wound healed completely without any postoperative complications []. Histopathologically [] the decalcified section showed haphazard arrangement of dentin and cementum with numerous pulp spaces confirming the diagnosis as complex odontoma. Six months after the surgery the patient was free of symptoms and no postoperative complications were evident. The patient is under follow-up to assess the fate of the impacted teeth [] as there is evidence of them erupting once the odontoma is removed. Patient has been rehabilitated with a removable partial denture replacing the first and second molar (4c) to facilitate masticatory function and also to prevent supraeruption of opposing lower molar teeth.