![]() Grossly the tumour weighed 972.8 g, which according to the best of our knowledge is the largest reported in the English literature. The pterygoid plates were drilled till the Vidian canal. The right pterygoid plate was drilled out as it showed a remnant of the mass. Maxillectomy was done by a standard Weber Fergusson incision, and the entire mass was excised in toto. Access to the right external carotid artery was obtained by making an incision in the neck, to prevent any in advent bleed. The patient was posted for a total Maxillectomy under general anaesthesia. The child tolerated the procedure well and was asymptomatic after the embolization. Embolization of the right and left internal maxillary artery and the right facial artery was then carried out using absorbable gelatin. Right internal maxillary, right facial, right ophthalmic and left internal maxillary arteries were feeders to the tumour. There was exposure keratopathy in cornea of the right eye and features of optic nerve compression.īiopsy of the swelling was taken from the mass protruding from the right nostril under local anaesthesia, which confirmed the diagnosis of ossifying fibroma.Ĭonsidering the large size of the mass, the patient underwent a digital subtraction angiography (DSA) with embolization of the feeding vessels one day prior to planned excision. Examination of the right eye showed eccentric non-axial proptosis, visual acuity restricted to finger counting at a distance of 1 m only. There was a widening of the right upper alveolus and obliteration of the right upper gingivobuccal sulcus by the mass. The patient was breathing with an open mouth, with the widening of the upper incisors. The mass also pushed the nasal septum to the left, causing complete obstruction to the left nostril. The mass extended outside from the right nostril, pushing the lateral nasal wall and vestibule outwards. The skin over the swelling was stretched, with visible dilated veins over the swelling. The swelling was non-tender, with no local rise in temperature hard in consistency. On examination the swelling was of the size 18 cm × 15 cm, extending superiorly to the right eyebrow, displacing the right eye supero-laterally inferiorly till the angle of the mandible medially till the left side of the nasolabial fold and laterally till the right zygomatic arch. The past medical record of the child revealed that two years ago, the patient had undergone a biopsy of the mass at an outside hospital and diagnosed as having fibrous dysplasia. She also gave a history of one episode of epistaxis which required hospital admission and conservative management. At presentation, the patient could only breathe through the mouth due to complete obstruction of both nostrils. There was also a history of progressive nasal obstruction initially in the right nostril, which then went on to involve the left nostril ( Fig. The swelling pushed the right eye outwards and upwards, causing a painless, progressive diminution of vision and watering in the right eye. Case reportĪ12-year-old female child presented to our outpatient department with history of a progressive right sided facial swelling, causing facial deformity and proptosis for the past four years. ![]() The present case is that of a JOF involving the maxilla causing facial deformity, proptosis and visual impairment in a 12-year-old child which was managed successfully by surgical excision via transfacial approach, with review of the literature. Juvenile ossifying fibromas (JOF) are rare, locally aggressive tumours with high potentials of recurrence.
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