Organized maxillary hematoma: A rare clinical entity, report of 2 cases and review of the literature

Abstract

The analysis of two cases of organized maxillary hematoma is presented, as a review of the literature on its characteristics and management. IntroductionOrganized hematoma (HO) of the maxilla is a benign, rare, unilateral lesion that is frequently confused with malignancy due to its expansive local destruction at the level of the maxillary, sphenoid, or frontal sinuses [1–3]. Described by first reported by Tadokoro in 1917 [4,5], has been rarely reported in the medical literature (204 reported cases).Some risk factors have been associated with the presence of this pathology, for example: a history of head and neck surgery, hypertension, coagulopathies, end-stage renal disease, and liver cirrhosis [6,7].The etiology is not very clear, but it is believed that the accumulation of blood in the maxillary sinus together with poor ventilation and drainage of the paranasal sinuses can lead to the formation of a hematoma. As part of the healing process, necrosis, fibrosis, and hyalinization occur, leading to the formation of a capsule, thus preventing reabsorption of the hematoma [8].Its most frequent clinical presentation is the existence of epistaxis and nasal obstruction [7], although patients may present pain in the cheeks and headache [9]CT and MRI are critical for diagnosis, although CT can show non-specific findings, especially if there is no contrast study, since the aggressive and invasive nature of the lesion on the bone component can confuse its timely diagnosis [3]It is usually confused with a malignant condition or locally aggressive neoplasia, generating great concern for the patient and the doctor, therefore a high clinical suspicion is essential, accompanied by an accurate preoperative diagnosis and adequate therapeutic planning in this type of case, thus interventions can be avoided. excessive and unnecessary surgical procedures, since a simple conservative functional endoscopic surgery of the paranasal sinuses is generally curative and does not usually present with recurrence.The objective of this report is to describe the clinical evolution and surgical management of two adult patients with this unusual pathology. Study designCase series with literature review. MethodTwo patients with a histopathologic diagnosis of HO were retrospectively reviewed for clinical features, imaging findings, pathologic features, and treatment modalities. ResultsThe 2 cases described includes involvement of the maxillary sinus, the main symptoms were epistaxis associated with nasal obstruction. The patients did not have an important clinical history such as the use of anticoagulants. Computed tomography (CT) of the paranasal sinuses showed expansive masses associated with bone destruction, areas of central hyperattenuation and peripheral hypoattenuation. After surgery, there was no recurrence at 18 and 16 months in any of the cases. A review of the available literature revealed results that were mostly similar to our cases, except for the distribution of sex, since 100% of our population is female and there are no comorbidities associated with the presentation of the pathology. ConclusionsAn organized maxillary hematoma should be included in the differential diagnosis of a unilateral occupying mass of the maxillary sinus with bone destruction. For its diagnosis, an adequate anamnesis and endoscopic examination is opportune, as well as the detailed analysis of the simple and contrasted tomography of the paranasal sinuses accompanied by the postoperative histopathological examination.