CT paranasal sinuses
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Erosion and irregularities of the lamina dura of right maxillary 2nd and 3rd molar teeth. Hypo-dense lesion (about 15 mm) is seen surrounding the roots of the right maxillary 2nd molar tooth as well as the bucco-distal root of the right maxillary first molar tooth. Bony defect involving the floor of the maxillary sinus averaging 3 mm above the diseased 2nd maxillary molar tooth. The maxillary 3rd molar tooth is defective with lost crown.
Moderate circumferential mucosal thickening of the right maxillary sinus with frothy secretions and obliteration of the right ostio-meatal unit. This is associated with thickening of the maxillary sinus walls.
Features are in favor of peri-apical abscess involving the right maxillary molars notably the second with associated oro-antral fistula and odontogenic right maxillary sinusitis. An oro-antral fistula is abnormal communication between the paranasal sinuses and the oral cavity. It usually follows tooth extraction, radiotherapy or paranasal wall osteomyelitis. Here, only alveolar process cavity showed osteomyelitis changes and communicating with the right maxillary cavity with intra-alveolar sinus. So, alveolo-sinusal fistula subtype is suggested.