Extensive Maxillary Odontogenic Myxoma With Orbital Involvement Requiring Hemimaxillectomy and Microvascular Reconstruction.

BACKGROUND

Odontogenic myxoma (OM) is a benign but locally aggressive neoplasm derived from odontogenic ectomesenchyme. Although most commonly encountered in the mandible of younger patients, maxillary lesions can demonstrate more aggressive behavior due to proximity to critical structures.

CASE PRESENTATION: A 48-year-old man presented with a 1-year history of progressive nasal obstruction, epistaxis, and facial swelling. Imaging revealed a large expansile mass of the left maxilla with destruction of the orbital floor and extension into adjacent paranasal sinuses. Initial biopsy suggested Schneiderian papilloma; however, tertiary pathologic review confirmed odontogenic myxoma. The patient underwent left hemimaxillectomy with immediate reconstruction using a fibula osteocutaneous free flap and a patient-specific titanium orbital floor implant.

RESULTS

The postoperative course was uneventful. At 5-month follow-up, the patient demonstrated preserved ocular function without diplopia, symmetric midfacial contour, stable occlusion, and no radiographic evidence of recurrence.

CONCLUSION

Maxillary odontogenic myxoma may present atypically in older patients with extensive sinonasal and orbital involvement. Complete surgical resection with immediate microvascular reconstruction enables effective disease control and restoration of function in extensive midfacial defects.