Diagnosis:

Accurate treatment cannot happen without accurate diagnosis. This case was referred for evaluation and treatment of tooth #2. It was presumed that the large soft tissue swelling was coming from this tooth. As one can plainly see on the 2-dimensional radiograph, tooth #2 does have a lesion associated with its roots. Is this the cause of the large sized swelling in the soft tissue just behind it (clinical photo)? We used the CBCT to reveal complete occlusion of the right maxillary sinus secondary to sinus infection (purple *). The infection has traced the path of least resistance which happened to be the small thickness of bone behind tooth #2. This is why it would seem that this soft tissue swelling is coming from the infected tooth. In fact, the lesion associated with the tooth (green arrows and circle) do not even communicate with the sinus lesion (red arrows and circle). Pretty interesting lesson in diagnosis as we employed all tools available to conclude with a sinus infection being responsible for this patient’s chief complaint, and not the tooth! This case has been referred to an ENT for further evaluation while we have planned to treat the tooth in the future…