A term used to describe a calcification in a sinus.

The maxillary sinuses are located on either side of the nose. When debris, mucus, or other materials accumulate in these sinuses, they can form a hard mass called antrolith or sinus calculus.

Really, I thought – this is news to me, or did I forget it in Radiology and Oral Medicine 30 years ago.

The presentation of an antrolith may vary depending on its size and location within the sinus. Small antroliths may be asymptomatic and go unnoticed, while larger ones can lead to symptoms and complications.

Symptoms of an antrolith may include:

  1. Facial pain or pressure: Due to pressure buildup within the sinus.
  2. Headache: Often in the area of the affected sinus.
  3. Nasal Congestion: Difficulty breathing through the affected nostril.
  4. Pus or Discharge: If the antrolith leads to a sinus infection (sinusitis).
  5. Foul-smelling Breath: Due to the presence of stagnant debris in the sinus.

What Causes Antroliths?

The exact cause of antroliths (sinus calculi) is not entirely clear. However, they are thought to form as a result of the following factors:

  1. Stagnation of Mucus and Debris: The maxillary sinuses produce mucus, which normally drains into the nasal passages through small openings called ostia. When these ostia become blocked or narrowed due to inflammation, allergies, infections, or anatomical factors, the mucus can accumulate and stagnate in the sinus cavities. Over time, this stagnant mucus can harden and form antroliths
  2. Infections: Sinus infections (sinusitis) can accumulate pus and debris within the sinuses. Chronic or recurrent sinusitis can contribute to the formation of antroliths.
  3. Foreign Bodies: Occasionally, foreign objects or materials can accidentally enter the sinuses and serve as a nucleus around which antroliths may form.
  4. Dental Issues: In some cases, dental problems such as dental infections or complications after dental procedures can contribute to developing Antroliths i.e. a root or object in the sinus
  5. Environmental Exposures: Exposure to certain environmental factors, such as pollutants or irritants, can contribute to chronic sinus inflammation, which may increase the likelihood of antrolith formation.

It’s important to note that while these factors are associated with antra information, not everyone with sinus issues will develop antroliths. Antroliths are relatively uncommon and are considered a less frequent complication of sinusitis or sinus-related conditions.

Diagnosis of an antrolith is typically made using imaging techniques such as a sinus X-ray or CBCT scan. Once diagnosed, the appropriate treatment will depend on symptoms and patient wishes.

Treatment options for antrolith may include – and as a dentist, we should know the options and when and where to refer.

  1. Observation: If the antrolith is small, asymptomatic, and not causing any issues, a doctor may recommend a wait-and-see approach. Regular check-ups and imaging might be advised to monitor any changes or potential growth.
  2. Nasal Irrigation: For small antroliths causing mild symptoms or discomfort, nasal irrigation with saline solution can be tried. This technique involves rinsing the nasal passages to help dislodge and remove debris or mucus.
  3. Medical Management: If there are associated symptoms like sinusitis (sinus infection), a doctor may prescribe antibiotics or other medications to manage the infection and reduce inflammation.
  4. Endoscopic Sinus Surgery: Endoscopic sinus surgery may be recommended in larger or symptomatic antroliths cases or when conservative treatments have failed. This minimally invasive procedure involves using a thin, flexible tube with a camera (endoscope) to remove the antrolith and clear any obstructions in the sinus passages. This approach is often preferred as it allows for a quicker recovery and less scarring compared to traditional open surgery.
  5. Functional Endoscopic Sinus Surgery (FESS): FESS is an endoscopic sinus surgery performed to improve the drainage of the sinuses. It can treat chronic sinusitis and remove antroliths while preserving the natural anatomy of the sinuses.
  6. Caldwell-Luc Procedure: In rare cases where other methods are not feasible or have failed, the Caldwell-Luc procedure may be considered. This open surgical procedure involves creating a small window in the maxillary sinus to access and removes the antrolith.

So as a dentist, look out for them.

Referral to an ENT Specialist may be required, or simple observation.

From tomorrow, I’ll be looking out for them as well, all in the surgery.

As a patient, it may be worth considering if you have a sign or symptom that does not appear to improve.

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