Extensive Maxillary Odontogenic Myxoma With Orbital Involvement Requiring Hemimaxillectomy and Microvascular...

Area of Science:

• Oral and Maxillofacial Surgery
• Head and Neck Oncology
• Pathology

Background:

• Odontogenic myxoma (OM) is a benign, locally aggressive neoplasm originating from odontogenic ectomesenchyme.
• While typically found in the mandible of younger individuals, maxillary OM can exhibit aggressive behavior due to anatomical proximity to critical structures.

Purpose of the Study:

• To report an atypical case of maxillary odontogenic myxoma in an older patient with extensive sinonasal and orbital involvement.
• To highlight the effectiveness of surgical management and microvascular reconstruction for such extensive defects.

Main Methods:

• A 48-year-old male presented with a year-long history of nasal obstruction, epistaxis, and facial swelling.
• Imaging revealed a large left maxillary mass with orbital floor destruction and paranasal sinus extension.
• Diagnosis of odontogenic myxoma was confirmed after initial misdiagnosis, followed by left hemimaxillectomy and fibula osteocutaneous free flap reconstruction with a patient-specific orbital implant.

Main Results:

• The patient experienced an uneventful postoperative recovery.
• At 5-month follow-up, ocular function was preserved, midfacial contour was symmetric, occlusion was stable, and no recurrence was observed radiographically.

Conclusions:

• Maxillary odontogenic myxoma can present atypically in older patients, involving extensive sinonasal and orbital structures.
• Complete surgical resection combined with immediate microvascular reconstruction is crucial for effective disease control and functional restoration in extensive midfacial defects.