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To the Editor: Ossifying fibroma is a benign but rare fibro-osseous tumor in the craniofacial region. Complete resection is the only way to treat it. Here, we reported one case of maxillary juvenile ossifying fibroma operated with intranasal endoscopic prelacrimal recess approach in which nasolacrimal duct (NLD) and inferior turbinate (IT) were spared.  A 9-year-old girl presented left facial asymmetry for 2 months and was hospitalized in the Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital in June 2013. A paranasal sinus computed tomography (CT) scan showed a lesion in left maxillary sinus (MS). No nasal obstruction, rhinorrhea, decreased vision, proptosis or epistaxis was ever complained. No abnormal finding was noted in and out of her nose during the physical examination and nasal endoscopy. Imaging study revealed that the left MS expanded to 2.4 cm × 2.8 cm × 3.0 cm. Soft tissue density was present inside the sinus surrounded with a clear boundary and intact bone wall [Figure ​[Figure1a1a and ​and1b].1b]. Tumor resection was performed with intranasal endoscopic prelacrimal recess approach under general anesthesia. First, we chiseled off the anterior bony portion of the medial wall of the MS to expose the NLD posteriorly and mucosa of MS interiorly. The sinus was filled with a solid, encapsulated and sand like mass, about 2.4 cm × 2.8 cm × 3.0 cm in size. Surrounding bone walls appeared as stalactite, and the surface was rough. Second, the tumor was removed completely. On the 2nd day after operation, the nasal packing was taken away, and the postoperative CT scan was carried out at the same time [Figure ​[Figure1c1c and ​and1d].1d]. Pathological finding was ossifying fibroma [Figure 2]. During the 6 months follow-up, there was no recurrence or complications.    Figure 1  Preoperative paranasal sinus computed tomography (CT) in coronal position (a) and horizontal position (b) showed ossifying fibroma in left maxillary sinus (triangles). Postoperative paranasal sinus CT in coronal position (c) and horizontal position (d) ...      Figure 2  Pathological finding showed ossifying fibroma (HE, original magnification ×200).    For ossifying fibroma, early surgery is necessary to achieve a complete tumor resection. There are many procedures available depending on the involvements of lesion,[1,2] such as midfacial desgloving approach, Denker or modified Dener operation, Caldwell-Luc operation, medial maxillectomy, etc.[3] In all the above procedures, IT and/or NLD is to be sacrificed, and dry nose, epiphora or facial numbness may occur after operation. To improve the quality of life, Zhou et al.[4] introduced intranasal endoscopic prelacrimal recess approach to treating such disease. Without ablation of IT and NLD, the function of the nasal cavity and lacrimal aperture are preserved. Meanwhile, hospital stay can be shortened. This was first reported to use this approach to remove ossifying fibroma in MS. The surgery went smoothly and follow-up results showed no postoperative complications. In short, juvenile ossifying fibroma of MS may be the potential indications for prelacrima recess approach.

Intranasal Endoscopic Prelacrimal Recess Approach to Sinonasal Juvenile Ossifying Fibroma