Extensive Sinonasal Changes on Routine Exam

A 41-year-old male, new to the referring practice with no previous medical history on file, came in for a routine exam and cleaning. On review of the scan, the radiologist identified extensive sinonasal changes including palatal cleft, septal perforation, turbinate loss, absent ethmoid sinus floor, discontinuous maxillary sinus walls with possible sequestra, collapse of nasal alae, enlarged palatine canals/foramina, and cleft palate. These findings may be suggestive of conditions such as Granulomatosis with polyangiitis (Wegener's granulomatosis), osteonecrosis, or chronic invasive fungal sinusitis. An expedited referral to ENT was recommended. The radiologist noted this degree of pathology is an uncommon finding, particularly in a patient not currently undergoing treatment, and expressed appreciation for the opportunity to bring these changes to the patient's attention.