Metastatic involvement of the maxillary antrum from an uncommon source

Maxillary swellings may be caused by a variety of aetiologies, however, metastatic involvement of the maxilla remains uncommon, with metastases accounting for only 1–3% of all malignant neoplasms in the oral region.1^,2 Identification of metastases by adequate histology is essential in determining further treatment as, in around 30% of cases, the oral lesion is the first sign of disease.3 This puts an onus of responsibility on primary dental care practitioners to recognize key clinical and radiographic features and have a low threshold of suspicion for presentation that might suggest such pathology.

A 65-year-old man presented to his general dental practitioner with a large palatal swelling measuring approximately 2 cm by 2.5 cm and confined to the right side of the hard palate. On examination, the swelling appeared firm on palpation, painless and pulsatile, with normal overlying oral mucosa. In association with this, the patient had begun to develop mobility of adjacent teeth in the upper right quadrant over the preceding weeks. Clinical examination revealed increased mobility of UR6, UR5, UR4 and UR3, despite there being no mobility of the dentition in any other quadrant. An orthopantomogram (OPT) was taken (Figure 1) which revealed a uniform enlargement of the right maxillary sinus with evidence of significant alveolar resorption in comparison to the contralateral side. There was accompanying evidence of root resorption of the adjacent teeth with no signs of displacement.