Medical Science: Updates and Prospects Vol. 12

Odontogenic sinusitis is a maxillary sinus disease that can arise from dental and maxillofacial pathology and may be difficult to distinguish from rhinogenic sinusitis when clinical signs are non-specific. This case report describes a 38-year-old man who presented with a swollen right cheek, pain and rhinorrhoea of 15 days’ duration. The patient had previously received antibiotic therapy from an otolaryngologist without remission and was referred for assessment of a possible odontogenic cause. Orthopantomography showed displacement of the upper right third molar into the maxillary sinus by a cystic lesion. Computed tomography confirmed a cystic lesion involving bone. The dentigerous cyst and ectopic third molar were surgically removed under local anaesthesia, followed by postoperative treatment with amoxicillin/clavulanic acid and ibuprofen as required. Histopathological examination confirmed an inflamed dentigerous cyst. The patient had no postoperative complications and remained asymptomatic during seven months of follow-up. Follow-up orthopantomography and computed tomography demonstrated extensive abnormal bony occupation of the maxillary sinus. Subsequent biopsy and histopathological analysis confirmed fibrous dysplasia, which was managed conservatively with regular follow-up. The report presents the clinical course, diagnostic imaging, operative management and follow-up findings, while considering how coexisting odontogenic and fibro-osseous pathology may affect interpretation of unilateral sinus disease. This case illustrates the diagnostic complexity of unilateral maxillary sinus disease when odontogenic infection, an ectopic tooth, a dentigerous cyst and an osseous lesion coexist. It also emphasises the value of detailed dental assessment, three-dimensional imaging, histopathological confirmation and postoperative radiological surveillance in identifying lesions that may be overlooked at initial presentation.