Organized Hematoma in the Maxillary Sinus

Kim, Jae Jin

Abstract

Organized hematoma of the maxillary sinus is a rare, nonneoplastic benign lesion with locally destructive behavior that may mimic a malignancy. Clinically, symptoms do not usually occur while the lesion remains localized to the maxillary sinus. Because there is gradual enlargement of the lesion causing erosion and displacement of the adjacent bony structures, symptoms such as epistaxis, cheek swelling, nasal obstruction, headache, and exophthalmos become manifest. Radiologically, unilateral cases are much more frequent than bilateral, and Waters' view shows complete opacity of the expanded maxillary sinus and some masses. CT scan shows a large heterogeneous enhancing mass causing considerable expansion of the maxillary sinus with bony erosion. On MR imaging, the mass usually has a variable signal intensity on T1- and T2- weighted images, ranging from low to high. After contrast administration, discrete areas of enhancement are present within the mass. Although the disease is essentially benign and nonneoplastic, differential diagnosis from neoplastic disease including malignancy both clinically and radiologically has been always problematic. Accurate preoperative diagnosis of organized hematoma of the maxillary sinus is important to avoid unnecessary extensive surgery, because this condition is curative with a simple, conservative surgical approach and rarely recur. Organized hematoma of the maxillary sinus should be included in the differential diagnosis when patients have recurrent epistaxis, slow-growing mass of the cheek, nasal obstruction, and expansile mass in the maxillary sinus. A 33-year-old man was referred to the department of oral and maxillofacial surgery with a three-month history of slowly growing painful swelling of the left cheek. The mass of the maxillary sinus was resected by a Caldwell-Luc approach. Histopahtoly showed only a fibous encapsulated organized hematoma. To our knowledge, organized hematoma of the maxillary sinus has not been previously described in the Korean literature of the oral and maxillofacial surgery. We report a case of organized hematoma of the maxillary sinus presenting with an enlarging maxillary sinus mass.