Chronic maxillary sinusitis associated with an unusual foreign body: a case report

Area of Science:

• Otolaryngology
• Oral and Maxillofacial Surgery
• Radiology

Background:

• Foreign bodies in the maxillary sinus are uncommon, often resulting from dental procedures and leading to chronic sinusitis.
• Oroantral fistulas, frequently a consequence of dental interventions, serve as a primary pathway for foreign body introduction.
• Non-dental foreign bodies are rarely reported, making their diagnosis and management challenging.

Observation:

• A 24-year-old male presented with unilateral chronic maxillary sinusitis.
• CT imaging revealed a wooden toothpick within the left maxillary sinus, extending from the sinus floor to the orbital base.
• The patient had a prior history of an upper second premolar tooth extraction.

Findings:

• The foreign body, identified as a wooden toothpick, was surgically removed using the Caldwell-Luc procedure.
• Endoscopic removal was not feasible due to the toothpick's size and position.
• No active oroantral fistula was detected during surgery, suggesting prior resolution or insertion through a healed fistula.

Implications:

• This case highlights the importance of considering non-dental foreign bodies, such as toothpicks, in the differential diagnosis of chronic maxillary sinusitis.
• The Caldwell-Luc procedure remains a viable option for managing complex cases where endoscopic approaches are insufficient.
• Understanding potential pathways, including healed oroantral fistulas, is crucial for accurate diagnosis and treatment planning.