Unusual case of odontogenic maxillary sinusitis.

Brimioulle M, Desai K. BMJ Case Rep 2017. doi:10.1136/bcr-2017-220911 Description A 76-year-old woman presented with intermittent infection around the upper right 2 (UR2) area of the maxilla for several years. She also complained of persistent rhinorrhoea and right-sided facial pain. Seven years previously, she had presented with similar right maxillary pain, after undergoing root canal treatment of the UR2, 3 and 4 teeth. An orthopantomogram had shown uptake around the UR2 region (figure 1). There was a suspicion of retained tooth fragment, and she underwent a Caldwell-Luc procedure under local anaesthetic but no tooth fragment was identified at surgery. Examination revealed a sinus draining buccally around UR2 and a fluctuant swelling of the palate. She was tender over the right maxilla. Nasal endoscopy did not demonstrate any purulent discharge from the right middle meatus. A CT scan identified (1) opacification of the sinus, (2) a calcified 7 mm mass of tooth density in the inferior third of the sinus and (3) an oroantral fistula with an expanded area around UR2 consistent with an abscess cavity, confirming the diagnosis of odontogenic maxillary sinusitis (figure 2). The patient was treated with antibiotics and she underwent functional endoscopic sinus surgery, during which a dental root was formally identified and removed from the right maxillary sinus (figure 3). Following this, the patient made a complete recovery. Odontogenic causes account for up to 30%–40% of maxillary sinusitis, the most common being of iatrogenic origin. As demonstrated in this case, without