Primary extracranial meningioma of the maxillary sinus presenting as buccal swelling

Meningiomas are usually benign tumors that originate from the meningothelial arachnoidal cells that are normally found in arachnoid villi of the meninges surrounding the brain and spinal cord. Rarely, these tumors are found extracranially, primarily in the head and neck region. A 14-year-old boy presented with a lesion in the left premolar area of his maxilla that appeared to be a buccal swelling. Computed tomography on bone window setting demonstrated an expansile mass with high density area in the left maxillary sinus. The anterior wall of the maxillary sinus was thinned by the expanding mass. Magnetic resonance imaging revealed the well-circumscribed lesion to be homogeneously and relatively hypointense on T2-weighted imaging. The lesion was weakly enhanced by gadolinium. Imaging study of the lesion revealed a mass with no intracranial extension and no metastasis nests. The mass was removed surgically, and pathological studies showed a fibrous meningioma. Five years have elapsed since this surgical excision, with no evidence of recurrence. Primary meningiomas of the paranasal sinuses may arise from heterotopic meningeal tissues displaced during closure of midline structures during fetal development. Symptoms include progressive exophthalmos, nasal obstruction, and epistaxis. No cases in the maxillary sinus presenting as buccal swelling have been described.