April fools' 2012: maxillary tettigoniidaosis

Case contributed by Frank Gaillard
Diagnosis not applicable


Prior history of medial maxillary antrostomy. Woke up on April 1st 2012 with a buzzing sensation in the left side of the nose after falling asleep in his yard.

Patient Data

Age: 85 years
Gender: Male

This case is fictitious and the described condition is not a real diagnosis. The images in this case have been digitally altered. The case was originally published as one of Radiopaedia.org's April Fools' cases

Facial x-rays


Best seen on frontal view, but also visible on lateral projection, is the faint outline of an insect in the left maxillary antrum, lying on the posterior wall. 

Cricket outline colored in. 

Tettigoniidae photograph (Image exists in the public domain. Source: http://en.wikipedia.org/wiki/File:Tettigoniidae_front-side_view.JPG)

Case Discussion

Endoscopic examination subsequently extracted parts of a cricket, which had presumably crawled into the patient's nose while he slept and into his maxillary antrum via the antrostomy. 

The insect was later identified by University of Melbourne entomologist Dr Ishihara Rorschach as belonging to the Tettigoniidae family (known in America as katydids and in England and Australia as bush-crickets). 

Dr Rorschach believes this case supports the hypothesis, gaining acceptance in evolutionary entomological circles, that the extreme ostiomeatal narrowness unique to diurnal primates evolved to prevent insectuous paranasal sinus inhabitation during nocturnal recumbency [1]. This is further supported by the observation made in 1956 by Owlman et al of absence of such structures in Tryanhavasnoozus bugupschnoz (also known as the Indonesian polyphasic sleeping spider monkey) who sleeps no more than 12 minutes at a time [2].

Medical disclaimer

This case was presented as the case of the day on April 1st 2012, and as you have hopefully worked out by now is entirely fictional.

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