Naifa L. Busaidy, MD, Kamal F. Busaidy, BDS, FDSRCS, Sai-Ching Jim Yeung, MD, PhD

Disclosures

February 28, 2005

Case Presentation

A 45-year-old man presented with a swelling in his left upper jaw. The mass had been present for approximately 3 months and was continuing to grow. He denied pain, fever, or weight loss, and there was no prior history of trauma. He reported occasional bleeding from the area of the swelling.

The review of systems was significant for vague, intermittent abdominal pain and constipation for 2 years. He also reported an increase in frequency of urination, which he attributed to increased thirst during the summer months.

The past medical history was significant for nephrolithiasis 1 year previously. No specific investigation or treatment was initiated at that time. He worked as a dry cleaner and had been a cigarette smoker for 20 years. He denied any exposure to radiation. His mother had been diagnosed with breast cancer. There was no history of kidney stones, other cancer, or diabetes mellitus in the family.

The physical examination was notable for blood pressure of 149/90 mm Hg. He had noticeable fullness over his left maxilla with flattening of his nasolabial fold (Figure 1). The mass was firm, without erythema or increased warmth. Examination of the oral cavity showed displaced upper teeth on the left side, with a nontender, firm mass in the maxilla (Figures 2 and 3). The deep tendon reflexes were minimally exaggerated. The remainder of the examination was within normal limits.

Note the flattening of the left nasolabial fold (arrow).

Intraoral view showing expansion of the left maxilla and displacement of teeth.

Intraoral view showing maxillary expansion extending across midline of palate. Note also the central ulceration.

Question

What is the differential diagnosis?

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