Maxillary Sinusitis of Odontogenic Origin in Relation to Ectopic 2.8 Associated with Follicular Dentigerous Cyst – Combined Transnasal and Oral Endoscopic Approach: A Case Report

Abstract

Purpose: To describe the management of orosinusal pathology by combined transnasal and oral endoscopy. Methods: The 54-year-old patient underwent a dental and otolaryngological evaluation for left odontogenic maxillary sinusitis in relation to plausible dental follicular cyst of ectopic element 2.8. The symptoms reported at the time of access to the hospital were nasal obstruction and nocturnal rhonchopathy. In the ENT evaluation by videorhinoscopy with rigid optics, complex deviation of the nasal septum was revealed, without any evident formation or pathological secretion. On inspection of the oral cavity, the mucous membranes appeared unscathed. The previously extracted aleveolus of 1.6 was evident. The radiological examination, facial CT, revealed the left maxillary sinus almost completely occupied by a cystic appearance, with thin calcified walls and homogeneous content that had a dental element, probably the 2.8, which fenestrates the vestibular cortex of the lateral wall of the maxillary sinus. This lesion erodes the medial wall of the sinus, obliterating the ostiomeatal complex and imprinting the ipsilateral ethmoidal cells. Biohumoral tests showed normal coagulation parameters, indices of renal function, liver and ionemia. The patient under general anesthesia and oral intubation with a combined intervention of the left anterior FESS, intrasulcular flap from dental elements 2.7 to 2.3 with mesial releasing incision, moderate osteotomy, ectopic 2.8 extraction and enucleation of the cystic lesion with simultaneous closure of the orosinusal communication with advancement of the Bichat fat pad and closure by first intention. In the same session, the ENT moment is carried out transnasally for total left uncinectomy, medium antrostomy with the union of the natural ostium and the accessory ostium. Bilateral lower turbinoplasty with bipolar forceps. The patient was then controlled after 15 days and then six months, showing good healing and no signs of recurrence at the rhinoscopic check on the physical examination of the oral cavity. Results: Based on the clinical and radiological aspect, the diagnosis of a follicular dentigerous cyst (WHO 2017) covered by a multi-layered non-keratinized paving epithelium, with moderate chronic inflammation, including gigantocellular and cholesteric crystals, is reached from the microbiological and histological examination. Necrotic amorphous material coexists including rare hyphae and fungal spores, with mycotic and actinomycotic superinfection. Conclusions: The combined oral and nasal intervention, allowed by the collaboration between the oral surgeon and ENT, has made it possible to shorten the healing time and resolve the pathology without recurrence.