Mucopyocele of the maxillary sinus
A 26-year-old male patient reported with a chief complaint of swelling in the left buccal vestibule distal to 28 since last 2 months associated with mild pain when the buccal mucosa is stretched while eating. There was no history of paresthesia or numbness present in the region of chief complaint and no aggravating or relieving factors. No relevant past medical history except the patient gave a history of recurrent sinusitis since last 8 months.\nOn extra-oral examination, slight tenderness was present below the left zygomatic buttress region without any evidence of swelling [].\nIntra-oral examination revealed a solitary soft fluctuant swelling in the buccal vestibule in the region of 27, 28 causing slight obliteration of left buccal vestibule in the same region. Borders of the swelling were not well-defined. Overlying mucosa was found to be normal and the temperature of the swelling was not raised [Figures and ]. The swelling was slightly tender on palpation. Interesting findings was firm digital pressure on the intraoral swelling resulted in greenish yellow pus discharge from the nose associated with fetid odor. There was no draining sinus in the region of swelling and 27, 28 were slight tender on percussion with distal periodontal pocket with 28. On the basis of case history and clinical findings, a provisional diagnosis of chronic periodontal abscess in relation with 27, 28 were made. Chronic infected sinusitis of the left maxillary sinus and infected cyst of the left maxillary sinus were considered as differential diagnosis.\nIntra-oral periapical radiograph of 27, 28 region, topographic occlusal view of maxilla (left side) and orthopentamogram(OPG) shows periodontal ligament(PDL) space widening with 27 in the apical 1/3rd, loss of lamina dura in apical 1/3rd of 28 mesially and complete loss of lamina dura distally and also shows rarefaction in adjacent alveolar bone [Figure –]. Postero-anterior(PA) waters view shows complete opacification of the left maxillary sinus []. OPG and PA water's view were less informative to give proper diagnosis and to judge the extent of the pathology thus computer tomography (CT) scan was advised.\nAxial section (soft-tissue window) of CT [] shows complete obliteration of the left maxillary sinus with soft-tissue density mass which is protruding posteriorly and causing complete destruction of the postero-lateral wall of the maxillary sinus, obliteration of pterygomaxillary fissure and intact anterior and medial wall []. The soft-tissue expansile mass, which is protruding from the sinus, is well-defined roughly round having smooth borders without cortication. There is a slight obliteration of left nasal cavity. Coronal section of C.T. [Figure and ] shows complete opacification of the left maxillary sinus with destruction of the floor of the sinus laterally, causing the protrusion of the mass laterally. CT scan diagnosis was suggestive of benign expansile and destructive lesion of left maxillary sinus.\nThe patient underwent an incisional biopsy of the lesion under local anesthesia, which was approached by a mucosal incision in the upper buccal vestibule. The incised lesion was submitted for histopathological examination. Histopathological report suggestive of infected mucocele of maxillary sinus (mucopyocele).\nSurgical excisions of the entire lesion were carried out under local anesthesia. Patient recovery was uneventful and was kept under follow-up for next 6 months and no fresh complaints were observed.