Jonathan Dennis, Vlasios Oktseleglou

A 35 year old male attended Accident and Emergency department with the complaint of a significant mass in his mouth which was stated to have spontaneously appeared following a vigorous sneezing episode. This event occurred 4 days after the surgical removal of the upper left third molar under local anaesthetic. The lesion protruded grossly into the mouth and interfered with the occlusion leading to the patient stopping oral intake. The lesion was non reducible and was removed under local anaesthetic. The extraction socket was then closed by primary closure and the patient started on an antral regime. Clinical photographs were taken prior to excision and of the specimen post excision. Histopathology returned as ciliated pseudostratified columnar epithelium which confirms the diagnosis of sinus herniation. The patient was followed up in clinic over a year period and had an uneventful recovery with the exception of a prolonged course of treatment. Learning points from this include the need to appropriately assess extraction sockets after an extraction to determine if an oro-antral communication has occurred and how to manage it appropriately. The different methods will be covered in this topic. Whilst rare, sinus herniation is a known complication and this case demonstrates it very well.

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