• Users Online: 99
  • Print this page
  • Email this page


 
 
Table of Contents
CASE REPORT
Year : 2019  |  Volume : 21  |  Issue : 2  |  Page : 52-54

Tooth in maxillary sinus, less than what commonly anticipated


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 Submission22-Feb-2019
Date of Decision16-Mar-2019
Date of Acceptance13-May-2019
Date of Web Publication22-Oct-2019

Correspondence Address:
Dr. Mohammed Alwabili
Unaizah College of Medicine, Qassim University, P.O. 314, Buraydah 51411
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SJOH.SJOH_8_19

Rights and Permissions
  Abstract 


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 Top


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

Click here to view
Figure 2: Computed tomography-peripheral nervous system in different window characterizing the location and size of the foreign object

Click here to view


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

Click here to view



  Discussion Top


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.[1],[2],[3] One of the reasons is because, in fact, it is a rare complication[1],[3] 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%,[4] 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.[2]

Most of the reported cases in the literature of a tooth in maxillary sinus regardless of its etiology have symptomatic presentation.[5] Symptoms can vary from recurrent or chronic rhinosinusitis,[6] sepsis, nasolacrimal duct obstruction, osteomeatal complex obstruction,[7] headache, and facial paresthesia.[6] In addition, facial swelling, epiphora, and orbital proptosis have been reported.[5] Such condition can be asymptomatic and detected incidentally during radiological examination, however, less common than counter symptomatic presentation.[8]

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.[9] 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.[9] 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.[8]

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.[10] 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[11] 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.[10] 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.[10],[12]


  Conclusion Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tamer Y, Pektas ZO. Accidental displacement of mandibular third molar roots into the pterygomandibular space. Niger J Clin Pract 2018;21:1075-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Lee D, Ishii S, Yakushiji N. Displacement of maxillary third molar into the lateral pharyngeal space. J Oral Maxillofac Surg 2013;71:1653-7.  Back to cited text no. 2
    
3.
Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am 2007;19:117-28, vii.  Back to cited text no. 3
    
4.
Pasqualini D, Erniani F, Coscia D, Pomatto E, Mela F. Third molar extraction. Current trends. Minerva Stomatol 2002;51:411-24, 424-9.  Back to cited text no. 4
    
5.
Kayabasşoğlu G, Karaman M, Kaymaz R, Nacar A. A rare entity causing chronic snusitis: Ectopic tooth in maxillary sinus. Eur J Gen Med 2015;12:1.  Back to cited text no. 5
    
6.
Weber BP, Kempf HG, Mayer R, Braunschweig R. Ectopic teeth in the area of the paranasal sinuses. HNO 1993;41:317-20.  Back to cited text no. 6
    
7.
Jude R, Horowitz J, Loree T. A case report. Ectopic molars that cause osteomeatal complex obstruction. J Am Dent Assoc 1995;126:1655-7.  Back to cited text no. 7
    
8.
Beriat GK. Ectopic molar tooth in the maxillary sinus: A case report. Clin Dent Res 2011;35:35-40.  Back to cited text no. 8
    
9.
Bodner L, Tovi F, Bar-Ziv J. Teeth in the maxillary sinus – Imaging and management. J Laryngol Otol 1997;111:820-4.  Back to cited text no. 9
    
10.
Barbieri D, Capparè P, Gastaldi G, Trimarchi M. Ectopic tooth involving the orbital floor and infraorbital nerve. J Osseointegration 2017;9:323-5.  Back to cited text no. 10
    
11.
Damm M, Quante G, Jungehuelsing M, Stennert E. Impact of functional endoscopic sinus surgery on symptoms and quality of life in chronic rhinosinusitis. Laryngoscope 2002;112:310-5.  Back to cited text no. 11
    
12.
Costa F, Robiony M, Toro C, Sembronio S, Politi M. Endoscopically assisted procedure for removal of a foreign body from the maxillary sinus and contemporary endodontic surgical treatment of the tooth. Head Face Med 2006;2:37.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed174    
    Printed22    
    Emailed0    
    PDF Downloaded40    
    Comments [Add]    

Recommend this journal