Chronic Maxillary Sinusitis Secondary to a Retained Wooden Foreign Body: A Case Report.

Abstract

Background: Retained wooden foreign bodies in the maxillary sinus, particularly with prolonged latency, pose significant diagnostic, and therapeutic challenges due to their low radiodensity and resemblance to fungal infections on imaging. This case highlights the role of electromagnetic navigation-guided endoscopic sinus surgery (ENG-ESS) in managing complex long-latency foreign bodies.

Case presentation: A 31-year-old man presented with recurrent right infraorbital abscesses and facial swelling for over a year and was initially misdiagnosed with fungal sinusitis. Conventional treatments, including multiple abscess drainage and endoscopic sinus fenestration, failed to resolve the symptoms. Imaging revealed a high-density maxillary sinus shadow, which was later identified as a 4.5 cm wooden fragment retained for 5 years post-trauma. The initial endoscopic removal of a smaller fragment provided transient relief. ENG-ESS subsequently localized and removed the residual migratory fragment extending to the orbital wall, leading to complete resolution of the infection.

Conclusion: This case underscores the diagnostic pitfalls of wooden foreign bodies and advocates for integrating trauma history with advanced imaging. ENG-ESS demonstrated superior precision in navigating complex anatomy and reducing the risk and complications of residual foreign bodies. We propose a trauma history dynamic imaging-navigation surgery framework for long-latency refractory cases.