Riding the Mucociliary Escalator: A Risk-Stratified Approach to Maxillary Sinus Foreign Body Management

The management of maxillary sinus (MS) foreign bodies (FBs) currently lacks a standardized framework, leading to inconsistent decision-making regarding observation versus surgery.

This study aimed to identify predictors of spontaneous passage (SP) of MS FBs and propose a risk-stratified management algorithm.

This retrospective cohort study combined one institutional case (conducted at the Hospital of Stomatology, Sun Yat-sen University) with cases from a literature review. Patients with multiple FBs that involved not only the MS or with uncontrolled severe systemic disease were excluded.

The predictor variables were FBs physical characteristics, specifically size (≤5 mm vs > 5 mm), morphology (regular vs irregular), and material composition.

The outcome variable was the clearance method: SP or operative retrieval.

Covariates included sex, age, duration of FBs retention, presence or absence of oroantral communication, clinical symptoms, and sinusitis.

Data were analyzed using Fisher's exact tests for categorical variables, Mann-Whitney U tests for continuous variables, and multivariable log-linear Poisson regression with robust sandwich variance estimators. Significance was set at P < .05.

The sample was composed of 55 subjects (1990 and 2025) with a mean age of 41.0 (SD, 16.6) years and 16 (30.8%) were female. The overall SP frequency was 16.4% (9/55). A shorter retention duration was statistically associated with SP (median: 7 vs 180 days; P < .001), with 50% of SP events occurring within the first week. Foreign body size (≤5 mm) showed a marginal trend toward SP (P = .05). In the multivariable model, only retention duration remained independently significant (adjusted relative risk = 0.95, P = .01), representing a 5% daily decrease in clearance likelihood. Other physical properties were not independently significant (P > .05).

Not all MS FBs constitute surgical emergencies. Spontaneous clearance is tightly restricted to an early opportunity window. Active surveillance may be considered for asymptomatic, small (≤5 mm) objects within the first week, whereas immediate surgical retrieval remains the standard for high-risk objects.