Suspected Acute Sinusitis and Foreign Body on Evaluation of a Periapical Infection

A 62-year-old male was referred by a general dentist who noted an acute periapical infection associated with tooth #30. The patient was concerned about his sinuses and pain. During full-volume review, the radiologist noted a linear high-density entity suggestive of a foreign object of non-odontogenic origin (versus detached bone), along with bilateral maxillary sinus findings suggestive of acute sinusitis and a perforation in the cartilaginous nasal septum. The radiologist noted that the suspected acute sinusitis is a likely source of the patient's pain and that the suspected foreign body may contribute as well.

Referral to an otolaryngologist was recommended for clinical evaluation of the sinus and nasal findings, along with a clinical history covering prior nasal foreign bodies, trauma or surgery, and chronic intranasal substance use. The radiologist highlighted the case as an example of the value of full-volume review, of considering non-odontogenic sources of pain, and of using an OMR report to support interdisciplinary care.