Antrolith: radiological diagnosis and surgical treatment – presentation of clinical cases

Abstract

Introduction: Antrolith is a pathological calcified mass located in the paranasal sinuses, commonly in the maxillary sinus. When it is found in the vicinity or into the nasal cavity, it is also called rhinolith. In most of the cases, antroliths are incidentally identified through dental patients’ radiological examination. This fact underlines the need of antroliths’ detection in radiographs even by the general dentist. Objective: This paper aims to discuss the clinical and radiological diagnosis of antrolith, as well as its therapeutic methods, through the presentation of two clinical cases. Materials – Methods: Clinical cases, diagnosed with dental panoramic radiographs, radiographs of paranasal sinuses (Water’s view) and cone beam computed tomography (CBCT), are presented. Moreover, there has been conducted a review of the recent literature with scientific papers published in databases PubMed and Google Scholar. Results: Antrolith is usually an asymptomatic clinical feature, but painful symptomatology is rarely observed. Radiologically, it is mainly diagnosed with accuracy using orthopantomography and CBCT. As a pathological mass, antrolith should be differentiated from dental dysplasias, inflammatory calcifications, foreign bodies, even neoplasms in case of sizeable antroliths. The treatment choices of antroliths, depending on the severity of every clinical case, include frequent medical observation without any intervention or surgical excision techniques, most commonly the endoscopic sinus surgery or the removal through intraoral access. This article refers to two clinical cases of antroliths, one asymptomatic and one painful case, with all the diagnostic and management methodology being discussed. Conclusions: The radiological diagnosis of antroliths in conjunction with the endoscopic sinus surgery for its removal provide with the opportunity to treat and relieve patients with painful symptomatology. It is important not to be missed by the general dentist, as it may appear incidentally when evaluating panoramic radiographs. The assessment of antroliths is crucial for the differential diagnosis and its therapeutic management requires cooperation with a specialist.