This article has Open Peer Review reports available.
Fatty tissue within the maxillary sinus: a rare finding.
© Stręk et al; licensee BioMed Central Ltd. 2006
Received: 24 February 2006
Accepted: 04 September 2006
Published: 04 September 2006
We report a rare case of fatty tissue within the maxillary sinus in a 21-years-old woman, with a history of several previous punctures of the maxillary sinus.
Clinical data of the patient was analysed retrospectively. The patient presented with symptoms of left-sided chronic maxillary sinusitis and had undergone several punctures of the left maxillary sinus 18 months earlier. Subsequent to one of the procedures an acute pain in the left orbit lasting a couple of days was noted. Left endoscopic transnasal antrotomy was performed. The maxillary sinus was filled with polypous, chronically inflamed mucous membrane. Upon its removal, the maxillary roof was identified as drawn downwards and covered with normal mucous membrane. Upon dissection of the membrane, adipose tissue filling the zygomatic recess of the sinus was identified and subsequently removed. The maxillary roof was unchanged. Histopatologic examination confirmed the material to be adipose tissue. No short or long term sequelae occurred.
Adipose tissue can be found in the maxillary sinus most commonly when penetrating from surrounding locations. It is our hypothesis that in the reported patient it penetrated from the orbit to the maxillary sinus following puncture. It seems that a hole in the maxillary sinus roof, about 1 mm in diameter, caused by the needle, may have been a portal of entry for the adipose tissue into the maxillary sinus. The discussed case suggests particular care be taken in performing puncture of the maxillary sinus.
Orbital content herniation into the maxillary sinus is relatively frequent in orbital floor fractures . Soft tissues (inferior rectus muscle and orbital fat) penetrate through the cracks in the orbital floor which results in limited eye movements and diplopia . Magnetic resonance imaging (MRI) is able to demonstrate orbital floor fractures as sensitively as computed tomography (CT), but CT is superior to MRI in showing small and associated fractures; therefore CT remains the imaging modality of choice in the case of orbital fractures and dehiscences [1, 2]. Both MRI and CT are not effective in differentiating adipose tissue from oedematous mucous membrane lining the maxillary sinus. We describe and discuss a case of adipose tissue found in the maxillary sinus that might have penetrated from the orbit into the sinus following a diagnostic puncture. Such a case has not previously been reported.
Adipose tissue can be found in the maxillary sinus either when penetrating from surrounding locations or in rare cases of fat and adipose tissue tumours [3, 4]. In a study of 256 non-epithelial neoplasms involving the nasal cavity, paranasal sinuses and nasopharynx, reported by Fu et al.  only two lesions were classified as adipose tissue tumours (one lipoma and one liposarcoma) . However, a lipoma of the maxillary sinus could be a relevant differential diagnosis for the presented case. Normal fat fills the bucca in front of the lateral wall of the maxillary sinus  but in young individuals the bone is thick enough and not yet pneumatized so it prevents soft tissue from penetrating into the sinus cavity through dehiscences. In the presented patient none of the punctures were performed through the lateral sinus wall. Adipose tissue is a usual finding in the pterygopalatine fossa . In orbital floor fractures, orbital adipose tissue penetrates into the maxillary sinus  through relatively large cracks. The amount of fatty tissue found in the maxillary sinus of our patient correlated with the degree of enophthalmos. It is our hypothesis that the fatty tissue could have penetrated from the orbit into the maxillary sinus through the aperture caused by the puncture needle. Puncture of the maxillary sinus is considered the gold standard for diagnosing bacterial maxillary sinusitis . It is usually performed via the inferior nasal meatus and the needle should be directed at such an angle so as not to interfere with the roof of the maxillary sinus . In the reported patient, the needle could have perforated the superior sinus wall. Data from the available literature and our own experience prove that in lamina papyracea dehiscences or iatrogenic defects subsequent herniation of orbital content into the ethmoids also occurs , suggesting that orbital adipose tissue has a tendency to penetrate into surrounding locations. It seems that even a hole of about 1 mm in diameter caused by the needle might have been a portal of entry for the adipose tissue into the maxillary sinus, before the aperture healed. CT scans performed in our patient prior to surgery did not disclose any dehiscence but even low-thickness slices of the CT scan may not detect such a small aperture. It might, however, have healed during the period between the puncture and surgery.
Adipose tissue can be found in the maxillary sinus most commonly when penetrating from surrounding locations. It is our hypothesis that in the reported patient it penetrated from the orbit to the maxillary sinus. The discussed case suggests particular care should be taken in performing puncture of the maxillary sinus.
Written consent was obtained from the patient for publication of the study.
- Freund M, Hahnel S, Sartor K: The value of magnetic resonance imaging in the diagnosis of orbital floor fractures. Eur Radiol. 2002, 12: 1127-1133. 10.1007/s00330-001-1167-3.View ArticlePubMedGoogle Scholar
- Meyers RM, Valvassori G: Interpretation of anatomic variations of computed tomography scans of the sinuses: a surgeon's perspective. Laryngoscope. 1998, 108: 422-425. 10.1097/00005537-199803000-00020.View ArticlePubMedGoogle Scholar
- Grigoriu V, Stefaniu A: Orbital fibrolipoma involving the maxillary sinus. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Otorinolaringol. 1980, 25: 285-287.PubMedGoogle Scholar
- Kater W, Neubert J, Herrmann G: Angiolipoma of the maxillary sinus as a cause of recurring sinusitis-like symptoms. Dtsch Z Mund Kiefer Gesichtschir. 1991, 15: 38-41.PubMedGoogle Scholar
- Fu YS, Perzin KH: Non-epithelial tumors of the nasal cavity, paranasal sinuses and nasopharynx: a clinicopathologyic study. VIII. Adipose tissue tumors (lipoma and liposarcoma). Cancer. 1977, 40: 1314-1317. 10.1002/1097-0142(197709)40:3<1314::AID-CNCR2820400348>3.0.CO;2-O.View ArticlePubMedGoogle Scholar
- Mao J, Gao JH, Yan H, Ballinger JR: Susceptibility artifact reduction in fat suppression. Magn Reson Med. 1995, 33: 582-587.View ArticlePubMedGoogle Scholar
- Daniels DL, Rauschning W, Lovas J, Williams AL, Haughton VM: Pterygopalatine fossa: computed tomographic studies. Radiology. 1983, 149: 511-516.View ArticlePubMedGoogle Scholar
- Joniau S, Vlaminck S, Van Landuyt H, Kuhweide R, Dick C: Microbiology of sinus puncture versus middle meatal aspiration in acute bacterial maxillary sinusitis. Am J Rhinol. 2005, 19: 135-140.PubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.