Journal of the Louisiana State Medical Society
Juvenile Ossifying Fibroma of the Middle Turbinate
John Carter, MD; Ryan Winters, MD; Christina Yang, MD; Hugo St. Hilaire, DDS, MD; Kimsey Rodriguez, MD
Juvenile ossifying fibroma is a rare, benign tumor that may present in the sinonasal area but has never been described arising from the middle turbinate. The lesion’s locally aggressive behavior and close proximity to orbit and anterior skull base create a significant challenge for the patient and practitioner. This is a case presentation of a 7-year-old female with an invasive recurrent juvenile ossifying fibroma arising from the middle turbinate.
INTRODUCTION Juvenile ossifying fibroma is a benign osseous neoplasm that most commonly presents in the pediatric population at less than 15 years of age. These masses present in the craniofacial skeleton and are most often recognized in the paranasal sinuses, maxilla, or orbit. In contrast to their adult counterpart, ossifying fibroma, these lesions tend to be more locally aggressive. Their nonspecific radiographic appear- ance and locally invasive nature may create a challenge for the practitioner. This is the first described case report of a juvenile ossifying fibroma of the middle turbinate.
CASE REPORT A 7-year-old female with an unremarkable medical history presented to the pediatric otolaryngology clinic with a 10-month history of gradually increasing proptosis and lateral displacement of the left eye. She had headaches, seasonal allergies, and nasal obstruction but denied vision changes, retro-orbital pain, or purulent rhinorrhea. Aside from proptosis, ophthalmologic examwas normal. Clinical examvia anterior rhinoscopy and nasal endoscopy revealed clear secretions and markedly enlarged inferior turbinates obstructing both nasal cavities. With decongestion, the left nasal exam was notable for a large, firm, mucosa-covered
Figure 1b: Axial view highlights the involvement of the middle turbinate.
Figure 1a: Computed tomography of the sinuses (coronal view, bone window). Left-sided mass (3.6 x 2.4 x 3.5 cm) with a radiopaque focus at the anterior aspect of a concha bullosa, immediately opposite the ostium of an opacified maxillary sinus.
100 J La State Med Soc VOL 166 May/June 2014
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