Sir, a 42-year-old Caucasian male was referred urgently by his GDP to the Department of Oral & Maxillofacial Surgery. He presented with a ten month history of blocked right nostril, slight epistaxis, pain and tenderness of the teeth in the upper right maxilla. He had previously consulted his GMP who diagnosed sinusitis and a course of antibiotics was prescribed. There was no improvement in his symptoms. The patient then visited his GDP who commenced root canal treatment of the 16 as this tooth was suspected of being responsible for the symptoms. Again, there was no improvement in his symptoms. This led the GDP to take an OPG which showed radio opacity of the right maxillary antrum.

Clinical examination revealed no paraesthesia of the right cheek, no visual problems and no cervical lymphadenopathy. Intraorally the 16 was tender to palpation and the 17 was grade I mobile but not TTP. A CT scan of the sinuses showed soft tissue opacity based within the right maxillary antrum with marked bony remodelling evident and deviation of the nasal septum to the right (Fig. 1). Bony destruction of the medial wall of the maxillary antrum was noted.

Figure 1
figure 1

CT scan of the sinuses

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An incisional biopsy of the right maxillary antrum under general anaesthetic via a Caldwell-luc approach revealed a neuroendocrine carcinoma. The patient underwent a hemi maxillectomy and is currently doing well. Neuroendocrine carcinoma of the paranasal sinuses are extremely rare neoplasms. This tumour was first reported in this site in 1965, and since then there have been only 61 documented cases in the literature.1

The case shows a pattern of tumour presentation that was initially clinically interpreted to indicate an odontogenic infection. It is important that GDPs obtain an accurate history and carry out a thorough examination before making a diagnosis. The GDP in this case has shown that if there is no response or improvement of the patient's symptoms following dental treatment it is imperative that clinicians think again and consider pathology arising from other anatomical structures present in the head and neck.

The patient's GDP is to be congratulated in the management of this case.