Intranasal endoscopic prelacrimal recess approach to sinonasal juvenile ossifying fibroma.

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 1a and 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 1c and 1d]. Pathological finding was ossifying fibroma [Figure 2]. During the 6 months follow‐up, there was no recurrence or complications.