An asymptomatic foreign body in a maxillary sinus ostium.

A 68-year-old woman was referred to us with recurring right sinusitis and right facial discomfort that had responded poorly to long-term medical treatment. Computed tomography (CT) of the sinuses detected chronic tight maxillary and ethmoid sinusitis in addition to a metallic foreign body in the left maxillary sinus. The foreign body appeared to be in the area of the natural ostium of the left maxillary sinus (figure, A). The patient had no history of left facial discomfort or left sinus symptoms. Of note was the history of the patient's extensive dental work, which included the placement of dental implants 12 years earlier.

The patient underwent right functional endoscopic sinus surgery for drainage purposes. At the same time, endoscopic exploration of the left maxillary sinus was carried out by first identifying the left uncinate process (figure, B) and then by removing the left uncinate process via a retrograde approach (1) with a microdebrider (figure, C). The foreign body was found to be embedded in the natural ostium of the left maxillary sinus. The natural ostium was enlarged posteriorly and inferiorly, which allowed us to remove the foreign body. It appeared to be a post used for dental reconstruction (figure, D). The patient had an uneventful postoperative course.

In the maxillary sinus, mucociliary clearance is always directed toward the natural ostium. (2) It is interesting to note that the foreign body in this patient had traveled and lodged in the natural ostium. Its presence was asymptomatic, however, because it did not completely obstruct the natural ostium. Maxillary sinus infections have frequently been described as being caused by dental problems. (3) Some of these problems occur when a foreign body of dental origin causes an obstruction of the natural ostium of the maxillary sinus.

The finding of an asymptomatic metallic dental foreign body embedded in a maxillary sinus for many years is not a common occurrence.

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References

(1.) Christmas DA, Yanagisawa E, Joe JK Transnasal endoscopic identification of the natural ostium of the maxillary sinus: A retrograde approach. Ear Nose Throat J 1998:77:454-5.

(2.) Hilding AC. Experimental sinus surgery: Effects of operation windows on normal sinuses. Ann Otol Rhinol Laryngol 1941; 50:379-392.

(3.) Lin PT, Bukachevsky R, Blake M. Management of odontogenic sinusitis with persistent oro-antral fistula Ear Nose Throat J 1991:70:488-90.

From the Department of Otolaryngology, University of South Florida College of Medicine. Tampa, and Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante); and the Section of Otolaryngology, Hospital of St. Raphael, New Haven, Conn., the Section of Otolaryngology. Yale University School of Medicine, New Haven, and the Southern New England Ear, Nose, and Throat and Facial Plastic Surgery Group, New Haven (Dr. Yanagisawa).