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.