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Cholesteatoma of the maxillary sinus.

A cholesteatoma (epidermoid inclusion cyst) is a cystic keratin-filled mass lined with stratified 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 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 hemorrhagic exudate 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 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 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 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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Title Annotation:IMAGING CLINIC
Author:Robertson, Hugh
Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:Dec 1, 2005
Words:369
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