Radiology Teaching Files > Case 46326

Contributed by: Jay Jimenez, Radiologist, Carle Clinic Association, Urbana, Illinois, USA.
Patient: 34 year old female
History: 34 year old female with persistant left maxillary sinusitis. History of left upper molar extraction six months prior.

Fig. 1: Extensive inlammatory changes in the left maxillary sinus with air fluid level.

Fig. 2: Bony defect in the floor of the maxillary sinus

Acute upon chronic mucosal membrane inflammatory changes in the left maxillary sinus with an air fluid level noted.

There is a lucent defect in the bony floor of the maxillary sinus that communicates with the alveolar ridge.

Diagnosis: Oroantral Fistula

A complication of maxillary tooth extraction, the oroantral fistula can be a cause of recurrent or persistant maxillary sinus. Imaging findings are that of localized mucosal disease in the affected sinus with demonstration of a bony defect in the floor of the sinus which communicates with the oral cavity. Conservative treatment consists of treating the sinus disease in hopes of spontaneous closure. Often these lesions require surgery for definitve treatment which typically consists of fistula excision and closure with a buccal mucoperiostial flap.

References: Ballenger, JJ. Otorhinolaryngology, Head and Neck Surgery. 15th Ed. Pg. 185.
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Additional Details:

Case Number: 46326Last Updated: 2003-02-15
Anatomy: Face and Neck   Pathology: Iatrogenic
Modality: CTAccess Level: Readable by all users
Keywords: sinusitis, oral antral fistula

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