An unusual presentation of osteoblastoma of the maxilla: A case report
A 17-year-old Hispanic female was admitted to the Stony Brook University School of Dental Medicine for an emergency visit with a chief complaint of dull pain of the left posterior maxilla. Physical examination found a bony swelling located buccal to the left maxillary molars. No erythema, edema, or purulent discharge was noted. Panoramic radiography revealed a moderately defined granular radiopaque area in the periapical region of the left maxillary molars with superior displacement of the sinus floor (). No peripheral radiolucent rim was noted on the panoramic radiograph. For further investigation of the lesion, bone algorithm multidetector computed tomography(MDCT) was performed. The MDCT images also revealed a moderately defined granular hyper-attenuating area in the region of the left maxillary molars. Superior displacement of the left maxillary sinus floor, supero-posterior displacement of the left maxillary third molar, and external apical root resorption of the first and second molars were also appreciated. The entity was confluent with the lamina dura of the affected teeth; however, the periodontal ligament space remained intact. Of note were a thin hypo-attenuating rim, partially surrounding the central portion of the lesion at the antero-medial periphery, and a small area of possible buccal dehiscence adjacent to the left maxillary second molar (). Based on clinical and radiographic features, a preliminary differential diagnosis of osteoblastoma, fibrous dysplasia and cemento-ossifying fibroma was considered. Although unlikely, a remote possibility of osteosarcoma was considered as well. The patient, however, failed to attend her follow-up appointment for further examination.\nThe patient was then referred back to the authors' institution from a private oral and maxillofacial surgery office 13 months after the initial visit. An incisional biopsy had been performed by the referring physician and a histopathologic examination was done prior to readmittance. A histopathologic examination of the specimen revealed well-vascularized fibrous connective tissue containing a tumor composed of osteoid trabeculae surrounded by plump osteoblasts and scattered osteoclasts (). Osteoblast bridges between the bone trabeculae in several areas were also noted. Based on these features, a histolpathologic diagnosis of osteoblastoma was made.\nComplete excision of the tumor was performed via left partial maxillectomy with localized mucoperiosteal advancement flap under general anesthesia (). A histopathologic examination of the surgical specimen showed the histopathologic features of the previous incisional biopsy, and final diagnosis of osteoblastoma was made. The postoperative course was uneventful other than postoperative pain and nasal congestion, which eventually resolved by 4 weeks postoperatively. The patient was last seen 1 year after surgery and showed no sign of recurrence on both clinical and radiologic examinations ().