Odontogenic Sinusitis: Endoscopic Management of this Iatrogenic Entity

Odontogenic maxillary sinusitis (OMS) is a condition presenting to both the dental and otolaryngologic practitioner. Common causes of OMS include dental implants, displacement of a maxillary tooth root tip during extraction, migration of materials used in root canal therapy or graft material in sinus lift procedure. A 68-year-old male patient presented with complaints of repeated episodes of sinusitis for about 3 months which was not responding to conservative management. He had undergone multiple dental procedures 5 months back. Limited cut CT Paranasal Sinus form peripheral centre was suggestive of bilateral maxillary sinusitis along with multiple radio-opaque foreign bodies in bilateral maxillary sinus. With suspicion of extrusion of dental filling material into the maxilla, patient was posted for endoscopic sinus surgery. Surgery revealed the debris to be free floating in left but fixed to right maxilla. In view of the osseointegrated debris a review of the CT scan plate was done which divulged in situ metal dental implants. This suggested that patient underwent maxillary lift with dental implant placement with subsequent extrusion of bone graft material into maxillary sinus. About 60% of iatrogenic sinusitis are consequent to dental treatments. All patients presenting with recalcitrant rhinosinusitis and history of dental treatment should be suspected for iatrogenic sinusitis and evaluated with CT. Once the diagnosis is confirmed endoscopic removal of the foreign body must be done. Great care must be taken during dental treatment not to accidentally introduce a foreign body into the antrum.