An unusual case of maxillary sinus foreign body through oroantral fistula

Introduction: Foreign bodies are common seen in ENT practice. The most commonly involved sites are nasal cavities, ears, and pharynx. Foreign bodies may be introduced willingly by the patient or by accident. Voluntary placement of Foreign Bodies occurs mostly in children. Paranasal sinus foreign bodies are rarely seen, and most of them are introduced accidentally or iatrogenically .This paper reports a case of chronic sinusitis secondary to the insertion of multiple foreign bodies in the maxillary sinus. Case Report: A 9 year old female child presented to the Out Patient Department, brought by her parents, with complaints of recurrent left sided nasal blockage since 1 year. Patient had complaints of recurrent rhinitis with multiple episodes of nasal blockage with difficulty in nasal breathing especially while sleeping, cacosmia with mucoid and mucopurulent nasal discharge. The symptoms resolved with medications but recurred. A CT Scan was adviced which showed presence of polyp arising from the maxillary sinus with widening of the osteomeatal complex and the polyp extending posteriorly towards the posterior choana. Oral cavity examination did not reveal presence of oroantral fistula. patient was posted for Functional Endoscopic Sinus Surgery. Multiple wooden foreign bodies were found in the middle meatus protruding out from the maxillary sinus ostium which were removed. Conclusion:In a case of unilateral sinusitis or polyposis not responding to any drug regimen, possibility of foreign body should be kept in mind. An oroantral fistula can be an important cause for the foreign body in the maxillary sinus. A preoperative CT Scan is an excellent way for diagnosis and planning management of the patient. Functional Endoscopic Sinus surgery is now the most preferred approach for removal of nasal foreign bodies but Caldwell luc approach should be kept in mind should the need arise.