A massive sinonasal psammomatoid variant of juvenile ossifying fibroma: Report of a rare entity
A 20-year-old female patient reported with a painless progressive swelling in the left cheek region and difficulty in breathing since 1 year. Past medical history revealed that the patient underwent surgery in a private dental clinic 5 years back for the impacted tooth 23 which was associated with pathology. She had no noteworthy family history. Gross facial asymmetry was noted on left side of the face. The swelling was 6 × 4 cm in size approximately extending anteroposteriorly from ala of the nose to 5 cm from tragus of the ear on the left side. Nasal polyp was seen in the left nostril with obliteration of left ala of the nose [].\nIntraoral examination presented a swelling extending anteroposteriorly from the distal aspect of 21 to mesial aspect of 26; medially till the mid palatine raphe and laterally the buccal vestibule was obliterated and the swelling extended from 21 to 26. On palpation, the swelling was hard in consistency with no fluctuation.\nParanasal sinus (PNS) X-ray revealed haziness in the left maxillary sinus. Computed tomography (CT) scan confirmed well-defined mixed radiolucent and radiopaque areas with calcifications extending superoinferiorly from infraorbital rim to alveolus and anteroposteriorly from the nasal septum to post zygomatic buttress on left side [].\nHistopathological examination of incisional biopsy revealed connective tissue stroma with numerous spherical/irregular ossifications interspersed with cellular fibrous tissue []. The ossifications showed peripheral brush border surrounded by an eosinophilic rimming []. Haemorrhagic areas were also seen. The constellation of clinical, radiological, and histopathological features of this lesion supported an interpretation of psammomatoid variant of JOF.\nUnder general anesthesia, a Weber-Ferguson incision was given to expose the complete lesion. Subtotal maxillectomy was performed and the tumor mass along with nasal and ethmoidal polyps were removed with the help of a chisel and mallet. After complete removal of the mass, borders were carefully osteotomized to avoid the chances of recurrence []. The excised specimen was sent for histopathological examination [] and the diagnosis of PsJOF was confirmed. Postoperative facial appearance and oral function were satisfactory. Follow-up examination of the patient showed no signs of recurrence.