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Clinical Problem Solving: Radiology
Aug 2011

Radiology Quiz Case 2

Author Affiliations
 

SECTION EDITOR: C. DOUGLAS PHILLIPS, MD

Arch Otolaryngol Head Neck Surg. 2011;137(8):824. doi:10.1001/archoto.2011.124-a

A healthy 24-year-old woman presented with a 3-month history of left-sided facial pain and pressure, nasal congestion, and tooth sensitivity. She reported intermittent morning-time facial swelling. She denied headaches, epistaxis, sinusitis, facial trauma, or surgery. All of her wisdom teeth had been removed except the one in the left maxilla, which “never dropped.” Physical examination revealed hypesthesia in the left cranial nerve V2 distribution. Nasoendoscopy showed a medialized middle turbinate on the left side, with soft tissue bulging from the middle meatus. Computed tomography (CT) demonstrated an expansile 3.2 × 3.3-cm mass in the left maxillary sinus containing a well-formed tooth along the anterolateral wall. There was dehiscence of the medial and lateral walls of the maxillary sinus and the orbital floor. The left nasal passage was partially obliterated, with effacement of the middle and inferior turbinates. The left ostiomeatal complex was obscured. The remaining paranasal sinuses appeared clear (Figure 1 and Figure 2).

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