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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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1. Antrochoanal polyp causing left-sided nasal obstruction and opacification of left maxillary sinus
A polypoid soft tissue mass extends through the enlarged ostium of the left maxillary sinus and into the left middle nasal meatus and through the posterior nasal choana. This reflects the presence of an antrochoanal polyp. The left maxillary sinus is opacified, which reflects the presence of severe mucositis or sinusitis secondary to obstructed antral drainage. Referral to an ENT is indicated for the management of the patient's left-sided nasal obstruction.
2. History of sinus surgery
Enlargement of the ostium of the left maxillary sinus and obliteration of the septae separating the left ethmoidal air cells suggests a history of sinus surgery.
Axial views of maxillary sinuses and nasal cavity
These axial cross-sectional images demonstrate communication of the polyp between the left maxillary sinus ostium and the nasal cavity, as well as extension of this polyp through the posterior nasal choana. The walls of the left maxillary sinus do not demonstrate evidence of chronic changes at this time.
Coronal views of paranasal sinuses and nasal cavity
These coronal cross-sectional images demonstrate enlargement of the ostium of the left maxillary sinus, as well as obliteration of the septae in the region of the left ethmoid air cells. This appearance suggests a history of surgical intervention. The right maxillary sinus, ethmoid air cells, and sphenoid sinus are clear.
Sagittal views of left maxillary sinus and nasal cavity
These sagittal cross-sectional images demonstrate complete opacification of the left maxillary sinus. The sinus floor is intact, and no odontogenic pathology is present. Extension of the polypoid soft tissue mass into the left nasal cavity and herniation through the posterior choana reflects the presence of an antrochoanal polyp.
Normal tooth 22
Tooth 22 appears normal radiographically. No signs of endodontic or periradicular pathology are present. The patient's symptoms are not odontogenic in origin.
Axial views of tooth 22
These axial cross-sectional images demonstrate the normal appearance of the alveolar bone surrounding the root of tooth 22.
Buccolingual views of tooth 22
These buccolingual cross-sectional images demonstrate the intact buccal and palatal cortical plates adjacent to the root of tooth 22. No periapical pathology is present.
Mesiodistal views of tooth 22
These mesiodistal cross-sectional images demonstrate the normal appearance of the periapical and periradicular bone located mesial and distal to the root of tooth 22. There are no radiographic signs of endodontic pathology or root fracture.