LAUSR

CLINICAL REPORT In August, 2016, a 64-year-old woman presented with swelling of the maxilla. She had 1st noticed increase swelling of the maxilla about 2 years earlier and visited a physician at a general hospital. As there was no improvement of symptoms was achieved, the patient was referred to our hospital with a painless hard mass of 25 20 mm, normal mucosal color, and bone-like at the base of the left palate (Fig. 1A). Medical history included hypothyroidism. Panorama X-ray films showed a well-defined round border to the maxillary sinus of the mass (Fig. 1B). Computed tomography (CT) showed a well-defined round radiopaque region and revealed a mixed density mass at the base of the left maxilla (Fig. 2A). The interior showed heterogeneous ossification and calcification, but it was not infiltration and the nasal mucosa was preserved even though it protruded to the nasal cavity side (Fig. 2B). Magnetic resonance imaging showed a uniform contrast effect of low signal at T1-weighted image (Fig. 2C) and high signal at T2-weighted image of the maxilla (Fig. 2D). Blood examination revealed no abnormalities. Initial clinical diagnosis was the fibrous dysplasia or maxillary osteoma. The biopsy of the lesion in September yielded a histopathologic diagnosis of hemangioma. In November 2016, we performed tumor excision under general anesthesia. We made a Y incision directly above the maxillary bone tumor and elevated a mucosal flap. There was no adhesion with the oral mucosa or nasal mucosa and the internal part comprised crude trabecular bone tissue; therefore, it could be separated from the bone. We excised the entire tumor and curetted the bone, sutured the mucosa, applied tetracycline hydrochloride ointment gauze, and applied pressure with a splint (Fig. 3B). The biopsy specimen showed formation of mature bone, fibrosis, and dilation and proliferation of blood vessels around the site. Histopathologic analysis revealed cavernous hemangioma in the maxillary bone (Fig. 3C, D). There was no bone exposure, but a punctiform oronasal fistula was observed (Fig. 4A).