An unusual case of Sinusitis – foreign body in the maxillary antrum

We report a diagnostic challenge relating to a 9‐year persistent oroantral fistula and subsequent insertion of foreign body in the maxillary antrum. An oroantral communication initially occurred following the removal of a maxillary molar. This persisted to form an oroantral fistula which the patient cleaned daily with a cotton wool bud. This ultimately led to a large volume of foreign body being implanted into the maxillary antrum. The patient was largely asymptomatic in the early stages and only attended the dentist when experiencing discomfort. This case is unusual for a number of reasons; first, due to the chronicity of the fistula and second, the method of self‐management that the patient utilised which involved daily cleaning of the fistula with a cotton bud. There are likely to have been a number of factors contributing to the delay in presentation including a lack of symptoms, preconceptions about visiting the dentist and a lack of understanding regarding the expected post‐operative healing process. This case highlights the crucial role of dentists in providing clear and comprehensive post‐operative instructions, while ensuring patients understand the need for appropriate follow‐up. Dentists should recognise that patients will often have pre‐conceived ideas or anxieties about dental treatment and may only attend if in pain, preferring to self‐manage their symptoms if possible. This case also considers difficulties in diagnosing oral pathology with unusual aetiology. Foreign body was not initially considered, and it highlights the importance of detailed history taking and thinking laterally when formulating a differential diagnosis.