Maxillary fungal sinusitis secondary to extrusion of endodontic gutta percha points.

To cite: Adams M, Bailie N. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2015-210193 DESCRIPTION A 48-year-old woman was referred to otolaryngology with frontal headaches and mid-facial pain. CT scans of the paranasal sinuses revealed opacity in the left maxillary sinus suspicious for fungal sinusitis. Of note, a small linear opacity was seen in the middle of this mass (figure 1). The patient underwent a left middle meatal antrostomy, clearance of maxillary mycetoma and anterior ethmoidectomy. At the time of surgery, inspissated tan coloured concretions consistent with fungal infection were removed from the maxillary sinus. Fungal hyphae were confirmed using special stains. Identification of fungal species was not carried out in keeping with institutional policy. Two small rod-like plastic foreign bodies, measuring 8 mm in length and 0.5 mm in diameter, were embedded within the fungal ball (figure 2). On discussion with the patient after surgery, she reported previous root canal surgery to a left upper molar. She was advised to consult her dental practitioner who confirmed that two endodontic gutta percha (GP) points were missing. The affected tooth had periapical disease involving the floor of the maxillary sinus and the patient was referred to maxillofacial surgery to have this addressed. The CT scan and clinical photograph highlight the potential overlap between dental and sinus pathology. GP points may be identified incidentally within the sinus or can present with either fungal or acute bacterial sinusitis. Maxillary sinus infection due to extrusion of GP points is likely to require surgical intervention from both an ENT (ear, nose and throat) and dental surgeon.