A 32-year-old male from Kolkata presented with a rapidly progressive massive right-sided facial swelling with gross facial asymmetry and progressive difficulty in swallowing for the past one year. Clinical examination revealed an approximately 8x10cm diffuse, firm, non-tender swelling over the right side of the face. The skin over the swelling was stretched with restricted mouth opening. The delay in seeking medical attention was attributed to the prevailing COVID restrictions in the country.
A CT scan of the paranasal sinuses with 3D reconstruction demonstrated a large expansile lytic lesion, centred within the right maxillary sinus boundaries with anatomical extension into the right infratemporal fossa too. A biopsy of the lesion was then undertaken, which was suggestive of ameloblastoma. Ameloblastoma is a locally aggressive benign tumour affecting the mandible and less commonly the maxilla. “As per medical literature, solid ameloblastomas rarely affects maxillary bone. Maxillary ameloblastomas also are notorious in secondarily invading through the nasal and paranasal sinuses, giving rise to increased morbidity and discomfort to the patients in day to day activities,” explained ProfDr Sanjeev Mohanty, Senior Consultant and Head, Institute of ENT, Head & Neck Surgery.
After a thorough surgical planning, a modified Denker’s endoscopic transnasal surgery with access to the infratemporal fossa was contemplated, with an informed consent obtained from patient to convert it to open approach if need be. However, a purposeful endonasal approach was performed by the surgeon, Dr Mohanty, to excise the tumour completely with disease-free margins all around. Coblation system and powered instrumentation were used with good hemostasis intraoperatively.
The post-operative period was uneventful and confirmed intact vision and normal mouth opening. Repeat CT scan done three weeks postoperatively showed no evidence of recurrent or residual lesion. Speaking about the kind of advanced technology available at MGM Healthcare, Dr Mohanty said, “A happy patient with enviable postoperative outcomes indeed. Innovative endoscopic surgical techniques in modern medicine, available at MGM Healthcare, have resulted in a less radical surgery with lowered complications in safe hands, especially in skull base surgery.”