Throbbing Tooth Pain and Eye Swelling — Rare Sinus Carcinoma Uncovered

The patient, a 45-year-old Manhattan Beach resident, presented with throbbing pain in an upper molar that peaked every morning and was accompanied by noticeable swelling around the eye. Over-the-counter pain medications weren't touching it. The pain would ease somewhat as the day went on, but it never fully resolved.

History and Prior Treatment

The referring dentist had noted an abscess and prescribed a 10-day course of antibiotics, which the patient completed. A neighboring tooth had been extracted in January 2023. Despite the antibiotics, the symptoms persisted. On examination, we found a 6+ mm probing pocket on the distal aspect of the molar — deep enough to raise concern, but the real story was on the CBCT.

What the CBCT Showed

The 3D imaging revealed several findings that didn't fit a routine endo-perio presentation: calcification within the canal, furcation involvement, and — most concerning — irregular bone borders with cortical plate erosion. The borders weren't smooth the way you'd expect with a standard infection or cyst. They were ragged and ill-defined, which in rare cases can indicate malignancy.

Our Decision

Rather than rushing to extract, we opened the tooth and placed calcium hydroxide medication. The goal was to give the tooth a chance to respond to treatment. If it healed, we'd have our answer. If it didn't, the non-healing pattern combined with the imaging findings would justify extraction and biopsy for a definitive diagnosis.