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Case 215344

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Referral category

Troublesome / painful / cracked tooth (Endodontic)

Region of interest

Upper arch

Referral reason

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Canaray 215344

1. Rarefying osteitis on tooth 18

There is rarefying osteitis surrounding the root of tooth 18. The floor of the right maxillary sinus has been displaced superiorly and is dehiscent, resulting in a possible draining sinus tract into the right maxillary sinus. There is a circumferential dehiscence surrounding tooth 18 at the alveolar crest, which suggests the presence of a second draining sinus tract. These findings suggest that this tooth is devitalized. The presence of an intraoral drainage pathway in addition to a potential drainage pathway into the right maxillary sinus suggests that tooth 18 is not likely the sole cause of the patient's substantial paranasal sinus opacification.

While it is possible that this tooth is a contributory factor to the right maxillary sinusitis, and should be extracted, it does not appear to be the primary source of the complete opacification of the ethmoid and sphenoid sinuses.

2. Severe right maxillary sinusitis

The right maxillary sinus is almost completely opacified. A meniscus is visible in the superior aspect of the sinus, suggesting the sinus is at least partially fluid filled. There is also mucositis of the roof of the right maxillary sinus. The right osteomeatal complex is also opacified. The presence of the air meniscus within the sinus suggests that partial or intermittent drainage of the sinus is occurring either through the osteomeatal complex or though the socket of tooth 18.

3. Opacification in right ethmoid sinuses

The right ethmoid air cells are completely opacified. This has secondarily affected the drainage of the right frontal and sphenoid sinuses.

4. Opacification of right sphenoid sinus: Notify ENT specialist

The sphenoid sinus is partially visualized in this imaging volume. The right aspect of the sphenoid sinus appears opacified. This appearance is suggestive of the presence of sinusitis extending from the right ethmoid air cells and right maxillary sinus. There is also mild mucositis of the left aspect of the sphenoid sinus. Due to the severity of the possible sequelae of sphenoid sinusitis, the patient's ENT specialist should be immediately notified that severe sphenoid sinusitis is present.

5. Opacification of frontal sinus

The frontal sinus is partially visualized. There is opacification of the right aspect of the frontal sinus. This appearance is suggestive of sinusitis, which is also observed in the other paranasal sinuses on the right side. As well a retention pseudocyst is present in the frontal sinus.

6. Retention pseudocyst in left maxillary sinus

A small retention pseudocyst is present along the floor and medial wall of the left maxillary sinus. There is also mild mucosal thickening of the floor of the left maxillary sinus. These represent a non-significant incidental findings.

7. Widened PDL space on tooth 21

The periapical periodontal ligament space on the endodontically-treated tooth 21 is widened. The existing obturation is centrally positioned and extends slightly short of the radiologic apex. This may represent a healed post-treatment appearance with an apical scar or persistent low-grade endodontic pathology. The remaining periradicular bone appears normal. There are no signs of a root fracture.

8. History of apical surgery at tooth 24: persistent buccal bone defect

The root apex of tooth 24 exhibits a blunted appearance, suggestive of a history of apical surgery. The lamina dura around the root apex of tooth 24 appears at least partially reformed. A persistent postsurgical defect is present in the buccal cortex superior to the periapical region of the root of tooth 24. This appearance is suggestive of a healed appearance with a fibrous scar, however clinical correlation is recommended. No unobturated canals are visible. No signs of fracture are present.