Presentations 2020: OMFS

354 - A Case of a Diagnostically Elusive Cystic Lesion of the Maxillary Sinus

E Jones T Collins
Presented by: Emily Jones
Royal Gwent Hospital

This presentation will describe a 19-year-old female who was referred to our OMFS department for removal of an unerupted maxillary left third molar. The patient's main symptoms were pain in this quadrant and slight left infraorbital paraesthesia. Further clinical examination revealed a palpable bony expansion in the maxillary left buccal sulcus with all teeth in this quadrant remaining vital to sensibility testing. A cone beam CT demonstrated a well-defined 5cm cystic lesion occupying the whole of the left maxillary antrum and causing expansion. During surgical exploration and ultimate enucleation there was a macroscopic suggestion of involvement with periapical structures as well as expression of possibly keratinous content. Histological investigation identified an unusual keratinising cystic lesion that was difficult to classify despite three independent opinions. The report highlighted equivocally overlapping features of an odontogenic keratocyst, ameloblastoma and cystic tumour. The conclusion was that it was likely a keratinising cystic lesion of presumptive odontogenic origin with squamous proliferation and daughter cysts. Recurrence risk was noted to be high based on histological features and thus close and long-term clinical review was advised. This presentation will highlight the importance of obtaining a comprehensive history, clinical examination, imaging and histopathology to obtain a diagnosis. Despite significant advances, diagnostically ambiguous cases still present. This is the nature of clinical practice, and such encounters illustrate that further understanding and development is still to be pursued within our scientific community. Therefore, we must ensure a multi-disciplinary team approach with regular clinical follow up to achieve optimum patient care.
Consent Statement: Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian. A copy of the consent form is available for review by the the meeting organisers..

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