Chronic maxillary sinusitis, odontogenic origin
Findings:
Mild to moderate circumferential mucosal thickening involves the left maxillary sinus with no obstruction of the osteomeatal complex. The walls of the left maxillary sinus are thickened and sclerotic most compatible with chronic inflammatory disease. Periapical cysts are associated with teeth numbers 14 and 15 with small dehiscences in the floor of the maxillary sinus considered likely. Very minimal mucosal thickening extends along the floor of the right maxillary sinus. The sphenoid sinuses are clear. There is moderate rightward deviation of the nasal septum with nasal spur indenting the inferior turbinate. A small leftward projecting nasal spur is present.
Discussion:
The presence of maxillary sinus mucosal thickening should prompt a search for an underlying etiology. It is not uncommon to have chronic odontogenic infection that manifests as a well circumscribed lucency, a radicular or periapical cyst, surrounding the roots of a carious or cracked tooth. When the periapical cyst ruptures into the lumen of the maxillary sinus, chronic sinusitis will result, whcih will result in remodeling and reactive thickening of the sinus walls. An infected tooth in the mandible will cause a simlar periapical cyst which may either fistulize to the oral cavity or leak into the adjacent soft tissues causing a deep neck/face infection with possible abscess. The treatment for this process includes extraction of the offending tooth and antibiotics. If the chronically infected maxillary tooth is not recognized, conservative treatment of the reactive sinusitis will fail.
Case prepared in part by Josh Hall, UC undergraduate