Odontogenic Maxillary Sinusitis: A Case Report of Interdisciplinary Care in the Context of an ORL Emergency.

Odontogenic maxillary sinusitis (OMS) represents an important cause of unilateral sinus disease and can lead to persistent symptoms and repeated courses of antibiotics if unrecognized. Prompt identification of a dental source is essential to prevent chronicity and avoid unnecessary interventions. We report the case of a 40-year-old woman who presented with a 3-week history of persistent right maxillary sinus pain, unresponsive to two antibiotic prescriptions. On examination, she had a buccal collection in the upper right maxilla, close to a previous Caldwell-Luc surgical window. She did not present any signs of general condition deterioration. A contrast-enhanced CT scan (single-bolus iodinated contrast) demonstrated a complete opacification of the right maxillary sinus, leading to a diagnosis of obstructive maxillary sinusitis. A transfer into the eye-nose-throat (ORL) and cervicofacial surgery department was decided, in order to perform a middle meatal antrostomy. At the scheduled 2-week ORL follow-up, the patient reported gradual recurrence of symptoms, including pain and a sensation of heaviness in the right maxilla. Examination revealed persistent pus in the right maxillary sinus. As the presence of causal teeth was the most probable reason for this recurrence, the patient was admitted into the oral medicine department of the hospital for dental examination and radiography. A periapical infection, associated with root fracture, was revealed on Tooth #16 and treated with tooth extraction. The symptoms improved in the next following weeks. This case highlights the value of oral and craniofacial radiographies in a coordinated dental and ORL approach for the treatment of refractory maxillary sinusitis. Moreover, clinicians should maintain suspicion for odontogenic sources in unilateral sinusitis to optimize patient outcomes and reduce diagnosis errance.