Cholesterol granuloma of the maxillary sinus

Abstract

Cholesterol granuloma (CG) is a foreign body reaction to the deposition of cholesterol crystals, usually found in association to chronic middle ear diseases, being highly uncommon in the paranasal sinuses. This article reports a case of CG in the maxillary sinus of a 22-year-old man, manifesting as a swelling on the right maxilla associated with pain and nasal obstruction. Computed tomography (CT) imaging showed complete opacification of the right maxillary sinus with cortical bone expansion and destruction. Incisional biopsy showed a solid mass filling the sinus and histological examination showed foreign body reaction to cholesterol crystals. The microscopic findings associated to tooth vitality, CT images and absence of a cavity during the surgical procedure were compatible with the diagnosis of CG of the maxillary sinus. Complete surgical excision of the mass under general anesthesia was suggested, but the patient did not return to conclude the treatment. CG must be included in differential diagnosis of diseases that cause opacification on the paranasal sinuses, especially sinusitis, and cystic and tumoral lesions.

Cholesterol Granuloma in Odontogenic Cyst: An Enigmatic Lesion

“…Almada et al [10] reported that there are chances of primarily or secondarily inflamed odontogenic lesions that exhibit foreign body reaction to cholesterol crystals in their capsule and could extend to maxillary sinuses due to anatomical continuity. Yamazaki et al [9] reported that CG seems to be one of the driving forces for growth of jaw cysts, especially those with inflammatory background.…”

Cholesterol granuloma in the wall of dentigerous cyst

“…6 It can develop in a variety of body areas such as: the middle ear (most common site), mastoid process, testis, lungs, apex of temporal bone pyramid and paranasal sinuses. 7 Unlike cholesterol granuloma, development of ameloblastoma or even squamous cell carcinoma within dentigerous cysts have been previously reported. 8,9 The incidence of cholesterol crystals is reported as highest in inflammatory cysts, particularly in radicular cysts, while the lowest incidence is reported for cysts of non-inflammatory origin such as odontogenic keratocyst.…”

Modified Lothrop (Draf III) procedure for the treatment of a recurrent orbitofrontal cholesterol granuloma: A case report

“…3 Obstructed drainage and impaired ventilation are considered significant etiological factors. 4 Cholesterol granulomas most commonly develop in the mastoid portion of the temporal bone and middle ear. 5 Here, we report a rare case involving an elderly man with a cholesterol granuloma in the right orbitofrontal region that possibly developed after facial trauma.…”