Cholesteatoma of the maxillary sinus.A cholesteatoma (epidermoid epidermoid /epi·der·moid/ (-der´moid) 1. pertaining to or resembling the epidermis. 2. epidermoid cyst. ep·i·der·moid adj. Composed of or resembling epidermal tissue. inclusion cyst) is a cystic keratin-filled mass lined with stratified stratified /strat·i·fied/ (strat´i-fid) formed or arranged in layers. strat·i·fied adj. Arranged in the form of layers or strata. squamous epithelium. When these cysts occur in the facial bones, they probably arise from a congenital inclusion rest or a traumatic implantation. (1,2) In the maxillary antrum, invasion of the buccal epithelium via an oral antral fistula has been proposed as a possible etiology of an antral cholesteatoma. The cholesteatoma is often present within a chronically infected sinus. (1) A 57-year-old man came to us with a history of a painless, very slowly growing expansile ex·pan·sile adj. Of, relating to, or capable of expansion. Adj. 1. expansile - (of gases) capable of expansion expandable, expandible, expansible mass in the left maxillary area. Computed tomography (CT) demonstrated a space-occupying process involving and expanding the left maxillary antrum, which contained inhomogenous, low-density, fat-like material (figure). At surgery, the contents of the expansile mass proved to be breakdown products of purulent pu·ru·lent adj. Containing, discharging, or causing the production of pus. Purulent Consisting of or containing pus Mentioned in: Lacrimal Duct Obstruction purulent containing or forming pus. hemorrhagic exudate exudate /ex·u·date/ (eks´u-dat) a fluid with a high content of protein and cellular debris which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. and cholesterol, which had formed cholesteatomatous debris. Several pathologic entities can produce a slowly growing expansile mass in the maxillary sinus, including epidermoid inclusion cysts (as occurred in the case described herein), mucoceles, and odontogenic keratocysts. (1,2) On CT, an epidermoid inclusion cyst can appear as an expansile mass made up of low-density material. On magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. it can demonstrate intermediate to high signal intensity on both T1- and T2-weighted images, depending on the fatty components of the cholesterol material. (1,3) Cholesteatomas of the facial sinuses are rare. Sinus lesions that have been documented as cholesteatomas have been identified in the maxillary, frontal, and ethmoid sinuses. These paranasal cholesteatomas are considered to be embryonic in origin, and they must be distinguished from secondary iatrogenic iatrogenic /iat·ro·gen·ic/ (i-a´tro-jen´ik) resulting from the activity of physicians; said of any adverse condition in a patient resulting from treatment by a physician or surgeon. or posttraumatic epidermoidinclusion cysts. The treatment is surgical with wide resection. (4) References (1.) Som P, Curtin HD. Sinonasal cavities: Cholesteatomas. In: Som P, Curtin HD. Head and Neck Imaging. 4th ed. Vol. 1. St. Louis: Mosby, 2003:244-6. (2.) Storper IS, Newman AN. Cholesteatoma of the maxillary sinus. Arch Otolaryngol Head Neck Surg 1992;118:975-7. (3.) Sani S, Smith A, Leppla DC, et al. Epidermoid cyst of the sphenoid sinus with extension into the sella turcica sella tur·ci·ca n. A saddlelike prominence on the upper surface of the sphenoid bone of the skull, situated in the middle cranial fossa and dividing it into two halves. presenting as pituitary apoplexy: Case report. Surg Neurol 2005;63:394-7. (4.) Vaz F, Callanan V, Leighton S, Risdon RA. Congenital maxillary sinus cholesteatoma. Int J Pediatr Otorhinolaryngol 2000;52:283-6. |
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