Foreign body in the maxillary sinus. Considerations on maxillary sinus approaches wound closure

Introduction. Paranasal intra-sinus foreign bodies are often related to wounding agents or to penetrating trauma, as caused by ear crashes. The maxillary sinus is the most often affected region. We present an atypical clinical case of a foreign body in the maxillary sinus. Case report. A 27-year-old male patient, consulted for right facial pain associated to a yellow and fetid nasal discharge. Tooth no. 16 had been extracted five months before. Twenty days after extraction, there was an oro-antral fistula which was closed with surgical dental cement. At consultation, the fistula was patent in the tooth alveolus. A "cone beam" CT scan showed a 2-cm long hyper dense image with well-defined margins within the right maxillary sinus, associated with sinusal mucosa thickening. The diagnosis was an oro-antral fistula complicated by maxillary sinusitis due to a foreign body. The foreign body was removed under general anesthesia and antibiotic therapy, through an antero-lateral antrotomy, and sinus curettage was performed. The anterior cortical wall was fixed with a titanium mini-plate. The fistula was closed with a buccal fat pad. There was no complication during the 24-month follow-up. Discussion. Foreign bodies may be found in the sinuses, especially in the maxillary sinus. They are often of iatrogenic origin. CT scan may confirm the diagnosis. The treatment is surgical removal. (C) 2011. Published by Elsevier Masson SAS.