Occult massive ossifying fibroma of maxilla extending into the maxillary antrum – A rare case report

Aim: The aim of this study was to report a peculiar case of massive ossifying fibroma which had an occult presentation, occupying the maxillary antrum. Background: Ossifying fibroma is a slow-growing benign fibro-osseous lesion that most commonly affects the mandible (70–80%). When it involves the maxilla, it is more extensive. It may affect the nasal cavity, and thereby causing nasal blockage and breathing difficulty even without extensive asymmetry. Case Description: The patient complained of swelling in the left upper posterior teeth region for the past 6 months. A history of nasal blockade and difficulty in breathing was present. Deviation of tip of the nose was evident without gross facial asymmetry. Intraorally, the swelling extended buccopalatally, crossing the midline with smooth surface. Radiological investigation revealed mixed radiolucency and radiopacity with distinct borders with apical root resorption of involved teeth and bicortical expansion was evident. The extent of the lesion involved the entire left maxillary antrum, airway of the nasal cavity, and pushing the nasal septum to the contralateral side. Surgical enucleated was performed. Conclusion: Six months postoperatively, the patient showed uneventful healing with evidence of bone formation with relief from symptoms. Surgical enucleation has demonstrated a good prognosis in this case, as ossifying fibromas are encapsulated and well demarcated from surrounding tissues. Clinical Significance: This case report documents a peculiar case of extensive ossifying fibroma of the maxilla, involving the sinus that hinders breathing and showing minimal asymmetry. Prompt diagnosis and treatment have proven effective with no complications postoperatively.