Foreign Body of the Maxillary Sinus Predisposing to Fungal Sinusitis in a Diabetic Individual: An Uncommon Presentation

Foreign bodies in the paranasal sinuses are rare, often iatrogenic, with the maxillary sinus being the most commonly affected, typically following dental procedures. This case report discusses a 56-year-old woman with uncontrolled Type 2 Diabetes Mellitus who presented with right eye pain, leading to the incidental discovery of dental screws displaced into her maxillary sinuses. Following thorough Ophthalmology workup, Otorhinolaryngology evaluation and imaging studies, there were multiple screws within the right maxillary sinus and left middle meatus, causing mucosal thickening and inflammation. Notably, a screw was impinging on the orbital floor. Surgical intervention involved a Middle Meatal Antrostomy on the left and a Radical Antrostomy on the right to remove the foreign bodies and extensive fungal debris, later identified as Aspergillus fumigatus. A palatal fistula formed postoperatively was managed with bone wax. Postoperative recovery was uneventful under antibiotic, NSAID, insulin and antihistamine therapy. Long-standing foreign bodies (especially in diabetics) can precipitate fungal infections. Early diagnosis and intervention is crucial to prevent morbidity. The unique aspect of this case was the ophthalmologic presentation due to orbital floor impingement by a migrated dental screw.