Case Report: Dextra Maxillary Sinusitis with Bilateral Concha Hypertrophy

Abstract

Maxillary sinusitis is a common inflammatory condition of the paranasal sinuses that may be exacerbated by anatomical variations such as turbinate hypertrophy and dental pathology. We report a 15-year-old female presenting with 11 weeks of foul-smelling rhinorrhea, post-nasal drip, right facial pain and headache, intermittent fever, cough, nasal obstruction, dyspnea, and nausea. Examination revealed bilateral inferior turbinate hypertrophy and hyperemia with mucopurulent discharge at both middle meatuses, post-nasal drip, and caries of the right maxillary second molar. Vital signs were stable and systemic findings were unremarkable except for maxillary sinus tenderness on the right. Non-contrast paranasal sinus CT demonstrated a well-defined hypodense lesion with mucosal thickening in the right maxillary sinus, patent osteomeatal complex, and bilateral turbinate enlargement, consistent with right maxillary sinusitis with bilateral concha hypertrophy and suspected dentogenic contribution. The working diagnosis was supported by endoscopic findings, with allergic and vasomotor rhinitis considered as differentials. Management included Functional Endoscopic Sinus Surgery (FESS) to restore drainage and mucociliary function, adjunctive pharmacotherapy (azithromycin, ambroxol, ibuprofen, and decongestant), saline nasal irrigation, and counseling on trigger avoidance and head-elevated sleep. This case underscores the importance of careful endoscopic and radiologic evaluation to identify anatomical and odontogenic factors in adolescent maxillary sinusitis and highlights FESS combined with optimized medical therapy as an effective strategy to prevent chronicity and complications.