Infiltrative odontogenic myxoma of the posterior maxilla: Report of a case
A 25-year-old female was referred to our service for the evaluation of a painless swelling on the right mid-facial region with rapid evolution since one month. Extra-oral examination revealed a diffuse swelling with respect to right mid-facial region that was firm and non tender on palpation causing significant facial asymmetry. Intra-oral examination revealed a firm, non tender swelling expanding the buccal cortex of right maxilla extending from the right first molar to third molar obliterating the buccal vestibule [Figure and ]. No palpable cervical lymphadenopathy was present.\nMaxillary occlusal view revealed radiolucent lesion with respect to right maxillary posterior region with interlaced bony trabeculae resulting in a multilocular spider web appearance; on basis of which a working diagnosis of odontogenic myxoma was made. Further to delineate the extent of the lesion, a computed tomography (CT) scan was carried out. CT scan (axial and coronal views) demonstrated a hypodense ill-defined expansile lesion of the right maxilla with expansion and thinning of the overlying buccal cortex and involvement of the right maxillary antrum. Destruction of the bony margins of medial and lateral walls of the right maxillary antrum, with extension into the nasal cavity resulting in the partial occlusion of the nasal passage was evident. CT scan also revealed destruction of the bony margin of posterior wall of the right maxillary antrum and lateral pterygoid plate. Right infra-orbital margin was seen pushed upwards with erosion of the medial wall of the orbit [Figure and ]. Irregular calcific strands were evident within the lesion [].\nSubsequently, an incisional biopsy was performed and the specimen was submitted for the histopathological examination. The specimen appeared macroscopically as soft gelatinous yellowish white mass with cut surface exhibiting characteristic slimy appearance. Light microscopic examination of the sections stained with H-E revealed spindle and stellate shaped fibroblastic cells set in a myxoid background with delicate haphazardly arranged collagen fibers interspersed with a variable number of tiny capillaries []. Few areas show isolated foci of residual bone []. Odontogenic islands, binucleated cells, cellular pleomorphism and mitotic figures were not appreciated. The histopathological features were consistent with the diagnosis of odontogenic myxoma. The tumor was surgically excised with partial enbloc resection of the maxilla. The postoperative course was uneventful. The patient has since been kept on regular follow-up, and treatment planning for dental rehabilitation is currently underway.