PMC9484961_01
Non-contrast CT paranasal sinuses, bony windows: Top left (sagittal), Top right (coronal), Bottom left (axial) demonstrating 4 x 2 x 5 mm sclerotic, radio-opaque density anteriorly in the left maxillary sinus. The NLD and infraorbital foramen are noted within the red circle. The bottom right (coronal) figure shows lobulated mucosal thickening surrounding the left ostiomeatal unit with occlusion. No periapical lucencies or other radiologic stigmata of endodontic or periodontal disease were present. No osteitis or significant maxillary sinus opacification was observed as the CT was performed within 5 days of the initial dental procedure, and it was organised by the dental team to confirm the existence of the foreign body when the patient had begun to develop headaches but before reporting nasal discharge and infective symptoms. As there was no concern for complicated sinusitis and operative anatomy was already detailed in the initial CT, a repeat CT was not indicated when the patient's nasal obstruction and sinofacial pain were worsening.
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fig2
CT paranasal sinuses with fine slices, arranged by the dental team on day 5 postdental extraction, once headache started to develop, demonstrated a 4 x 2 x 5 m sclerotic density placed anteromedially in the left maxillary sinus with mucosal thickening obstructing the ostiomeatal unit (Figure 2).
Endoscopic view of nasal cavity. (a) Monopolar diathermy is used to create mucosal incision anterior to the head of the IT; and (b) mucosal incision is extended to the floor of the nasal cavity, allowing a mucoperiosteal flap to be raised.
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fig3
She underwent the prelacrimal maxillary window approach with removal of the dental foreign body and preservation of the IT and NLD (Figures 3-5).
(a) Skeletonization of the NLD. (b) Burr used to commence the prelacrimal medial maxillectomy anterior to the NLD and IT. (c) Bony removal of the lateral nasal wall to access the maxillary sinus. (d) Instrumentation through the prelacrimal window into the maxillary sinus.
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fig4
She underwent the prelacrimal maxillary window approach with removal of the dental foreign body and preservation of the IT and NLD (Figures 3-5).
(a) Endoscopic view of the prelacrimal maxillary window accessing the anterior maxillary sinus. (b) Identification and retrieval of the displaced tooth root through the PLWA.
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fig5
She underwent the prelacrimal maxillary window approach with removal of the dental foreign body and preservation of the IT and NLD (Figures 3-5).