Endoscopic transnasal prelacrimal recess approach for adenomatoid odontogenic tumor in the maxillary sinus: a case report

Adenomatoid odontogenic tumor (AOT) is a rare, benign odontogenic neoplasm that primarily affects young individuals, shows a female predilection, and is commonly associated with impacted teeth. Although typically localized to the anterior maxilla, AOT can occasionally arise in atypical sites, including the maxillary sinus, where it may lead to osseous destruction and displacement of adjacent teeth. This case report describes a rare presentation of AOT involving the maxillary sinus and highlights the diagnostic and surgical considerations associated with this atypical location. A 23-year-old woman presented with a six-month history of persistent left-sided nasal obstruction accompanied by headaches. Clinical examination revealed displacement of deciduous teeth and left nasal cavity expansion. Computed tomography (CT) showed a well-circumscribed lesion in the left maxillary sinus, with clustered punctate calcifications, displacement of an impacted canine, and adjacent root resorption. Based on this combination of odontogenic imaging features, AOT was considered the leading preoperative diagnosis. The tumor was excised via an endoscopic transnasal prelacrimal recess approach. Intraoperatively, destruction of the bony walls of the maxillary sinus was noted, and an ectopic tooth was removed together with the tumor. Histopathology confirmed the diagnosis of AOT. The patient had an uneventful postoperative recovery, with no clinically evident complications during the available follow-up period. At the six-month follow-up, nasal endoscopy and repeat CT demonstrated a well-epithelialized sinus cavity and a patent sinus ostium, with no evidence of residual or recurrent lesion during the available short-term follow-up. Although benign, AOT can pose diagnostic challenges due to its radiographic overlap with other odontogenic lesions. The present case highlights the necessity of including AOT in the differential diagnosis of maxillary sinus lesions, particularly in young patients. The endoscopic transnasal prelacrimal recess approach may be a feasible option for selected maxillary sinus AOTs, offering direct endoscopic access while avoiding external incisions. Early recognition, complete excision, and long-term follow-up remain important for monitoring late recurrence.