Surgical treatment of odontogenic myxoma and facial deformity in the same procedure
A 25-year-old female patient was referred to our department with a chronic headache. Patient's first diagnosis hypothesis was sinusitis and she had previously been referred to an otolaryngologist. Waters’ radiograph was performed, which demonstrated a limited radiopacity area into the right maxillary sinus. The patient's medical history was unremarkable. On physical examination, the patient was healthy, without swelling. The mucosa overlying the area of the lesion was the same color and texture as the surrounding mucosa. The sensory examination of the maxillary branch of the trigeminal nerve was normal bilaterally. Furthermore, she had aesthetic concerns about her high smile. Facial and cephalometrical examination revealed an excessively facial height and an excessive incisal and gingival display upon smiling. She was diagnosed with vertical maxillary excess and Class I malocclusion []. Initially, the patient was treated for third molar extraction 7 years ago; in this panoramic radiograph, was observed a discrete radiopacity area in the left maxillary sinus. It was probably an early stage of the lesion.\nA biopsy was taken with a Caldwell-Luc approach; histological result show abundant myxoid stroma with collagen fibrils presenting a diagnosis of OM.\nThe treatment planned was Le Fort I osteotomy with down-fracture to remove the tumor with segmental maxillectomy and 5 mm superior maxillary repositioning for better occlusion and facial esthetic.\nSurgery was performed under general anesthesia and nasal endotracheal intubation. Pre-orthognathic surgical models, radiographs, computed tomography face, photographs and biomodels were obtained before the surgery []. When the maxilla was down fractured, the tumor mass was visualized in the right maxillary sinus with four teeth involved in the lesion, which were removed. After the segmental maxillectomy, maxillary segment was stabilized with plate and screw in the anterior area on the right side and fixation on the anterior and posterior maxillary buttress on the left side. No intermaxillary fixation was used and it was not necessary turbinectomy.\nThe 3 years follow-up show satisfaction for the occlusal and esthetic result and the patient is disease-free []. A removable dental prosthesis without functional or aesthetic compromise is used [].