Tuberculosis of the maxillary sinus manifesting as a facial abscess. (Original Article).

Abstract

Tuberculosis of the maxillary sinus is rare. Likewise, an acute onset that necessitates incision and drainage is also very uncommon. We report the case of a 15-year-old girl who came to us with an abscess on the left side of her face. She was found to have tuberculosis of the left maxillary antrum.

Introduction

Tuberculosis of the maxillary sinus is nearly always secondary to pulmonary or extrapulmonary tuberculosis. The infection reaches the sinus either via the bloodstream or by direct extension. (1)

There are essentially two types of pathology seen in sinonasal tuberculosis. The first type features infection of the submucosa only. The antrum is filled with polyps and thickened mucosa, which has a pale and boggy appearance. Purulent discharge is minimal, which makes a clinical diagnosis difficult. This form of sinonasal tuberculosis is more common than the second type, which is characterized by bony involvement and fistula formation. The latter form is more aggressive and more difficult to treat.

In this article, we describe a case of tuberculosis of the maxillary sinus that manifested as a facial abscess.

Case report

A 15-year-old girl came to the outpatient department with a 3-month history of a discharging sinus in the left infraorbital region. She had an abscess on the left side of her face, where incision and drainage had been performed 3 months earlier. She had been on oral antibiotics for more than 1 month, but the discharge persisted. Computed tomography (CT) revealed the presence of a soft-tissue swelling over the maxilla, along with osteomyelitic changes in the anterolateral and superior walls of the maxilla that involved the floor and lateral wall of the orbit (figure 1).

We performed surgery via a left sublabial approach and removed granulation tissue from the anterior wall of the maxillary antrum and inflammatory tissue from the antrum. These specimens were sent for histopathologic analysis. Microscopic examination detected both necrotizing and non-necrotizing granulomas in the subepithelial and intertrabecular areas (figure 2). Acid-fast staining detected a few bacilli. Special stains for fungus were negative. A chest x-ray found no evidence of tuberculosis. A test for human immunodeficiency virus was nonreactive.

The patient was started on antitubercular treatment, and the infraorbital sinus discharge resolved in 1 week. She remained on antitubercular treatment for 9 months. At 18 months of follow-up, the sinus had healed and the patient remained asymptomatic.

Discussion

Shukla et al reported a case of tuberculosis of the maxillary sinus that also featured a tubercular abscess in the brain. (2) Jam et al reported that orbital involvement can manifest as epiphora and a deterioration of vision. (3) Immigrants with negative chest x-rays might harbor tuberculosis in extrapulmonary sites; Ellis reported a case of maxillary sinus tuberculosis in an immigrant who entered the United States. (4) Only rarely has maxillary sinus tuberculosis been associated with a carcinoma. (5)

In an era when a plethora of very effective antitubercular chemotherapeutic agents is available, this case of acute maxillary sinus tuberculosis serves as a reminder that the disease is still very active in Third World countries.

From the Department of Otolaryngology (Dr. Jha and Dr. Deka) and the Department of Pathology (Dr. Sharma), All-India Institute of Medical Sciences, New Delhi.

Reprint requests: Dr. Devanand Jha, Assistant Professor, Department of Otolaryngology, AIIMS, New Delhi 110029, India. Phone: [phone]; fax: [phone] or [phone]; e-mail: [e-mail]

References

(1.) Page JR, Jash DK. Tuberculosis of the nose and paranasal sinuses. J Laryngol Otol 1974;88:579-83.

(2.) Shukla GK, Dayal D, Chabra DK. Tuberculosis of maxillary sinus. J Laryngol Otol 1972;86:747-54.

(3.) Jam MR, Chundawat HS, Batra V. Tuberculosis of the maxillary antrum and of the orbit. Indian J Ophthalmol 1979;27:18-20.

(4.) Ellis JG. Extrapulmonary tuberculosis in immigrants [letter]. Lancet 1979;1:621.

(5.) Vrat V, Saharia PS, Nayyer M. Co-existing tuberculosis and malignancy in the maxillary sinus. J Laryngol Otol 1985;99:397-8.