Sinonasal Cholesteatoma Presenting Within the Maxillary Sinus: A Case Report

Epidermal inclusion cysts are a common type of benign cutaneous cyst. When located in the mastoid cavity, they are more commonly known as cholesteatomas. However, it is extremely rare to be present within the paranasal sinuses, with 20 known cases involving the maxillary sinus. This is a case presentation of an epidermal inclusion cyst of the maxillary sinus, describing its clinical presentation, identifying pathological correlations, and highlighting the importance of early recognition and management.

A case report.

A retrospective review of the medical records and pathology findings was performed.

A previously healthy 20-year-old male presented with several months of bilateral nasal obstruction refractory to medical therapy. Nasal endoscopy demonstrated a deviated septum and edema of the left middle meatus. Noncontrast computed tomography demonstrated opacification of the left maxillary sinus with bony expansion. Of note, there was the appearance of an ectopic tooth within the posterior aspect of the maxillary sinus. Surgical management included septoplasty and left endoscopic maxillary mega-antrostomy. Histopathologic examination of the left maxillary sinus contents was diagnostic of an epidermal inclusion cyst. There was improvement of symptoms and no recurrence or residual cyst during postoperative follow-up at 6 months.

This case underscores the need to consider the extremely rare entity of an epidermal inclusion cyst within the differential diagnosis for chronic sinusitis and the need for careful review of imaging for surgical planning. Awareness of this presentation will facilitate accurate diagnosis and appropriate management of this rare disease.