Sterile abscesses are sometimes a milder form of the same process caused not by germs but by nonliving irritants such as drugs. If an injected drug like penicillin is not absorbe it stays where it was injected and may cause enough irritation to generate a sterile abscess—sterile because there is no infection involved. Signs and symptoms of a maxillary sinus infection can appear suddenly and resolve on their own, or can become chronic and require treatment 2. In addition the unrecognized peri-apical abscess is a cause of failed endoscopic sinus surgery.
Dentists are unable to recognize periapical abscesses reliably with dental X-rays and exam.
In patients with maxillary sinus disease, the teeth should be specifically examined as part of the radiological workup. This case demonstrated a periapical abscess associated with acute sinusitis as an incidental finding in a patient being evaluated for other reasons. Dental abscesses can exert pressure on the root of tooth, which contains the neurovascular bund. Postsurgical changes are noted in the left aspect of the nasal cavity.
There is leftward nasal septal deviation. Small air fluid level in the left maxillary sinus compatible with acute sinusitis.