Nodular fasciitis is a rare, benign tumor of mesenchymal fibroblasts arising from the deep fascia or bony periostium and presents as a mass in the subcutaneous tissues. Due to its rapid growth, it may mimic a malignant lesion. In children, the myxoid type of nodular fasciitis (also termed infiltrative fasciitis, pseudosarcomatous fasciitis, or pseudosarcomatous fibromatosis) is most common with involvement of the head and neck. To date, four cases of nodular fasciitis specifically involving the maxilla have been reported, only one of which includes a description of the surgical approach. This case report describes a 16-month-old female with nodular fasciitis of the nasolabial groove arising from the maxilla. The objective is to discuss and illustrate the imaging appearance of this rare maxillary location of myxoid fasciitis and to describe the successful resection of the mass utilizing the midfacial degloving approach. Introduction Nodular fasciitis is a rare, benign tumor of fibroblastic growth that most often presents in patients between 20 and 40 years of age but may also affect children [123]. While the specific cause for nodular fasciitis is unknown, it is thought to be part of a spectrum of “quasi-neoplastic” lesions [4]. Interestingly, but of unknown significance, is the fact that a history of trauma has been reported to precede the occurrence of the lesion in some cases [5]. In addition to the relationship with trauma, chromosomal abnormalities have been described and may suggest a neoplastic origin [6]. The misdiagnosis as a sarcoma stems from the rapid growth, mitotic activity, and numerous spindle cells [1]. The exact rate of occurrence is unknown because of the common misdiagnosis as a sarcoma [4]. Case Report A 16-month-old girl presented to our children’s tertiary referral center with a rapidly enlarging mass that had been present for 2 weeks. The patient had no pain, fever or epiphora. The parents did not recall any specific trauma (major or minor) recently involving the child’s face. The past medical history was unremarkable and development was age appropriate.Physical exam revealed an overall healthy and active 16-month-old child with a firm 2.0 cm mass obscuring the left nasolabial fold. Anterior rhinoscopy revealed the mass nearly obstructing the left nasal cavity. The mucosa of the nasal cavity and overlying facial skin were uninvolved. The remainder of the physical exam, including the eye exam, was unremarkable.Since the lesion was initially thought to involve the lacrimal sac, the young girl was first seen by ophthalmology. The nasolacrimal duct was probed and flushed intra-operatively, revealing no obstruction. The solid intranasal mass was biopsied, but not resected. The pathology suggested nodular fasciitis (Figure 1).
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