|Year : 2019 | Volume
| Issue : 2 | Page : 52-54
Tooth in maxillary sinus, less than what commonly anticipated
Mohammed Alwabili1, Mohammad Aloulah2, Raseel Alsuwaidan3, Ahmed Altuwaijri3
1 Medical Intern, Unaizah Collage of Medicine, Qassim University, Qassim, Saudi Arabia
2 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
3 Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
|Date of Submission||22-Feb-2019|
|Date of Decision||16-Mar-2019|
|Date of Acceptance||13-May-2019|
|Date of Web Publication||22-Oct-2019|
Dr. Mohammed Alwabili
Unaizah College of Medicine, Qassim University, P.O. 314, Buraydah 51411
Source of Support: None, Conflict of Interest: None
The maxillary sinus can be a host of a wide range of different types of foreign bodies as a result of its size and the anatomical relation to multiple different skull compartments. Displacement of maxillary molars to the maxillary sinus can occur, although it is rarely reported and the incidence of such condition is still unknown. Most of reported cases in the literature of a tooth in maxillary sinus regardless of its etiology have symptomatic presentation. Different approaches can be utilized to manage such condition; however, surgical management by functional endoscopic sinus surgery is preferred given its advantages of better sinus aeration and less postoperative complication.
Keywords: Foreign body, functional endoscopic sinus surgery, maxillary sinus, tooth
|How to cite this article:|
Alwabili M, Aloulah M, Alsuwaidan R, Altuwaijri A. Tooth in maxillary sinus, less than what commonly anticipated. Saudi J Otorhinolaryngol Head Neck Surg 2019;21:52-4
|How to cite this URL:|
Alwabili M, Aloulah M, Alsuwaidan R, Altuwaijri A. Tooth in maxillary sinus, less than what commonly anticipated. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2019 [cited 2019 Dec 12];21:52-4. Available from: http://www.sjohns.org/text.asp?2019/21/2/52/269715
| Case Report|| |
We report the case of 35-year-old female who presented to the Otolaryngology Clinic at King Abdulaziz University Hospital in Riyadh, Saudi Arabia, with a complaint of recurrent alternating nasal obstruction more on the left side for 18 months. Furthermore, she was having bilateral frontal headache alongside an occasional postnasal drip and decrease in her sense of smell. On nasoscope examination, a bilateral hypertrophied inferior turbinates, anterior deviated nasal septum to the left side with no apparent polyps or discharge and clear nasopharynx was diagnosed.
For routine preoperative assessment, the patient underwent paranasal sinuses computed tomography (CT) scan with no contrast which showed a soft-tissue radiodensity almost completely specifying the left maxillary sinus, in addition to linear calcific radiodensity noted within the left maxillary sinus [Figure 1] and [Figure 2]. A suspicion of foreign body entrapment was made. In addition, a bilateral hypertrophied turbinates more on the right was observed.
|Figure 1: Computed tomography-peripheral nervous system bone window showing a small area of opacity in the left maxillary sinus|
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|Figure 2: Computed tomography-peripheral nervous system in different window characterizing the location and size of the foreign object|
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Our patient was submitted to undergo limited functional endoscopic sinus surgery (FESS) with right turbinoplasty under general anesthesia. Intraoperatively, we started by left uncinectomy then wide maxillary antrostomy followed by anterior ethmoidectomy for better exposure, and with the aid of a 70° scope, foreign body was seen in the floor of maxillary sinus anteriorly and was taken out by suction. It was surrounded by pus material. After foreign body removal, irrigation and cleaning was done of the maxillary sinus. During exploration of the left maxillary sinus, we extracted what seemed to be an entrapped tooth which was not attached to any sinus wall [Figure 3]. However, it was difficult to identify the type of tooth as it has been worn off. Postoperative course was uneventful, and the patient was able to go home next day with appropriate medications for the rest of her recovery course. Histopathological examination of the extracted body confirms the specimen to be a consistent with tooth material.
|Figure 3: Foreign body after the removal which seems to be a disfigured tooth|
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| Discussion|| |
The maxillary sinus can be a host of a wide range of different types of foreign bodies as a result of its size and its anatomical relation to multiple different skull compartments. Tooth in maxillary sinus has been reported in the literature, however, in relation to different etiological processes. Developmental disturbances, pathological processes, or iatrogenic interventions are usually which result in such findings.
Any foreign body which occupies the free space of sinuses can result in impaired mucociliary movement leading to the potential development of rhinosinusitis symptoms. Such symptoms can impair the patient's quality of life while rendering them unable to respond well to usual rhinosinusitis medical therapy.
Displacement of maxillary molars to the maxillary sinus can occur, although it rarely reported and the incidence of such condition still unknown.,, One of the reasons is because, in fact, it is a rare complication, in addition to the malpractice consideration of leaving a foreign body behind. Iatrogenic displacement of maxillary molar teeth to different adjacent structures can be a complication from maxillofacial procedures, specifically, exodontia procedures; however, complications of such procedure have been reported to be <1.1%, and much more less frequently to happens is the displacement of tooth to maxillary sinus, which is, in fact, less than what would be expected.
Most of the reported cases in the literature of a tooth in maxillary sinus regardless of its etiology have symptomatic presentation. Symptoms can vary from recurrent or chronic rhinosinusitis, sepsis, nasolacrimal duct obstruction, osteomeatal complex obstruction, headache, and facial paresthesia. In addition, facial swelling, epiphora, and orbital proptosis have been reported. Such condition can be asymptomatic and detected incidentally during radiological examination, however, less common than counter symptomatic presentation.
Part of the initial steps in diagnosing such condition is obtaining radiological studies. CT scan without contrast taken in axial and coronal sections has been the tool in localizing and ascertaining the location of such foreign objects. Another less relatively expensive method is by obtaining X-ray Water's view, panoramic radiography, and plain skull radiography. However, CT scan remains the gold standard and superior in paranasal sinuses characterization. In addition, CT scans are of great value in facilitating the preoperative surgical decision and assuring the appropriate surgical approach which will reflect well upon patient prognosis and prevent unwanted complications. Opacity of the tooth will appear as much or equal to bone opacity; however, other differentials can mimic such findings – infections such as tuberous sclerosis, syphilis, or fungi with calcification and other foreign bodies or benign conditions such as osteoma, hemangioma, or calcified polyps. In addition, other malignant conditions such as chondrosarcoma and osteosarcoma which have to be put into considerations.
Management of such condition has been commonly reported in the literature to be done by Caldwell–Luc procedure given its advantage of direct visualization and a wide operating space. Nonetheless, and in comparison with more recent options like FESS, it has many disadvantages such as injury to the anterior superior alveolar nerve during bone removal from the canine fossa which will result in paresthesia of the upper row of anterior teeth. On the other hand, during FESS, the ostium of maxillary sinus can be enlarged to gain access to the target object or area and is less invasive. In addition, FESS can lower the risk of tooth root injury. Furthermore, it has the advantages of quicker recovery and eliminates the risk of infraorbital nerve injury.,
| Conclusion|| |
Displaced tooth in the maxillary sinus is a rare condition and less than what usually expected. Rhinosinusitis picture can result, and interventions such as FESS are the preferred option.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]