A case of malignant growth right maxilla advanced stage.

From Otolaryngology Online

Clinical details:

70 years old male came with complaints of:

Nasal block (right side) - 1 1/2 years duration

Foul smelling discharge from right nose - 1 year

Swelling right side of cheek - 1 year duration

Swelling under right lower lip - 6 months

Clinical photograph of the patient showing right cheek swelling and discharge from right nasal cavity

On examination:

Swelling ++ involving the right maxilla.

Destruction of antero lateral wall of right maxilla ++

Swelling was variable in consistency.

Bony crepitus felt in some areas of anterior wall of maxilla

Vision was normal in the left eye


Foul smelling discharge from right nasal cavity ++

Proliferative mass seen filling the right nasal cavity completely

Intra-oral examination:

Proliferative mass seen involving the bucco gingival sulcus on the right side

Loss of upper dentition on the right side. Edentulous.

Photograph showing growth maxilla

Grmax 4.jpg

CT plain maxilla axial cut showing growth right maxilla eroding anterolateral wall

CT plain nose and paranasal sinuses coronal cut showing mass inside the right maxilla with erosion of palate

Review of Scan images showed:

Extensive growth involving the right maxillary sinus with erosion of its anterolateral, medial and posterior walls. Lateral pterygoid process was found to be eroded as well.


Optimal management modality in patients with advanced malignancies is to alleviate the acute symptoms of the disease. In this patient by debulking the mass and following it up with post op irradiation palliation could be achieved to a certain extent.

Ideal surgical management in this patient:

Total maxillectomy right with total removal of palate.

The patient was taken up for surgery i.e. total maxillectomy combined with total excision of hard palate. Temporary obturator was used to fill up the defect caused by removal of right maxilla.

Surgical steps:

General anesthesia was used.

Tracheostomy was performed

Weber Ferguson incision was used to expose the right maxilla

Figure showing Weber Ferguson incision marked

Photo showing the patient after removal of maxilla

Photo showing gutta percha prosthesis in positions after maxillectomy