Ectopic Tooth in the Maxillary Sinus and Chronic Recalcitrant Rhinosinusitis

Introduction: Intramaxillary sinus ectopic tooth associated with a dentigerous cyst is a rare occurrence. Ectopic teeth do not need to be removed if they are asymptomatic. In symptomatic patients a combined approach - Caldwell-Luc and Endoscopic wide medial antrosatomy - can be used to completely excise the dentigerous cyst and ensure adequate drainage of the maxillary sinus.

Material and Methods: Case report and literature review

Results: A 54 year old Caucasian female presented with a few years history of right sided facial pain, nasal obstruction, postnasal drip and hyposmia. She had undergone Endonasal inferior nasal antrostomy / Caldwell luc surgery 10 years ago. Nasal endoscopy revealed mucopurulent discharge in her right middle meatus. The CT scan of her paranasal sinuses revealed bilateral severe mucoperiosteal disease affecting most of her sinuses, a right Haller cell, and also showed evidence of previous sinus surgery. Incidentally, left sided dentigerous cysts and two ectopic teeth were seen in the left maxillary sinus. Even with maximal medical therapy, her symptoms failed to resolve. She underwent septoplasty and right functional endoscopic sinus surgery (FESS). The post-operative recovery was smooth and she reported complete resolution of her symptomatology on the right side. Two months later she developed persistent left sided facial pain associated with maxillary facial swelling. A course of oral antibiotics failed to improve the situation. After consultation with the maxillofacial colleagues, the dentigerous cyst and the ectopic tooth were removed using a combined endoscopic Caldwell-Luc approach. Only the infected ectopic tooth was removed. The other ectopic tooth was left in situ as it was covered by healthy bone. No postoperative complications were encountered. The patient made a good and complete recovery with resolution of her symptoms.

Conclusions: Chronic recalcitrant sinusitis is significantly associated with dental etiology.

A combined approach-FESS/Caldwell Luc provides better access, better visualization and facilitates complete removal of the disease pathology from the maxillary sinus. We recommend the above procedure for recalcitrant maxillary sinusitis of dental origin.

Keywords: ectopic tooth, unilateral, maxillary sinus, recalcitrant chronic rhinosinusitis.