Grand Rounds Vol 8 pages 43–45 Speciality: ENT; Head and neck surgery Article Type: Case Report DOI: 10.1102/1470-5206.2008.0015 ß 2008 e-MED Ltd Unilateral chronic rhinosinusitis Z. Ahmad, C. Repanos and N. Swanborough Department of Otolaryngology, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK Corresponding address: Z. Ahmad, Department of Otolaryngology, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK. E-mail: zeeshan.ahmad@doctors.org.uk Date accepted for publication 24 September 2008 Abstract Foreign bodies within the para-nasal sinuses are a reported cause of chronic unilateral rhinosinusitis. The most commonly cited cause is of dental origin. One previously reported case cited a foreign body from the repair of an orbital blow-out fracture. Suspicion of a sinugenic foreign body cause may only be aroused by a thorough history and examination, usually confirmed by imaging. We report a case of 57-year-old man was referred to ENT with persistent right nasal blockage and catarrh for over a decade. It transpired that he had previously had surgery using a silastic graft for a blow-out fracture. This is only the second reported case in the world literature of recurrent sinusitis from a graft placed to repair an orbital blow-out. A history of significant facial injuries should be considered and then actively investigated in unilateral chronic rhinosinusitis. The advent of ultra-low dose sinus computed tomography scans may encourage a more inquisitive surgeon to further investigate rhinosinusitis with imaging. Keywords Silastic graft; blow-out fracture; unilateral chronic rhinosinusitis; foreign body; nasal blockage. Introduction Foreign bodies within the para-nasal sinuses are a reported cause of chronic unilateral rhinosinusitis. The most commonly cited cause is of dental origin. [1] One previously reported case cited a foreign body from the repair of an orbital blow-out fracture. Several cases of implants and endodontic materials have also been reported. [1–18] Suspicion of a sinugenic foreign body cause may only be aroused by a thorough history and examination and can usually be confirmed by imaging. We report a case of a 57-year-old man referred to ENT with persistent right nasal blockage and catarrh for over a decade. Case report A 57-year-old man was referred to ENT with persistent right nasal blockage and catarrh for over a decade. He was noted to have been in a road traffic accident 18 years previously and sustained facial fractures. This paper is available online at http://www.grandrounds-e-med.com. In the event of a change in the URL address, please use the DOI provided to locate the paper.