An unusual case of unilateral sinus disease may reveal the presence of a retained foreign body

Introduction: Differential diagnosis of unilateral sinus disease (USD) is important in clinical practice as it can be broad, and for which timely and effective treatment is important. With this report we would like to present a case of a patient with a foreign body retained in the left maxillary sinus for eight years. Presentation of case: A 50-year-old gardener referred to have been injured on the job in 2010. Even though he was wearing his safety helmet with face shield and earmuffs, he had the sensation to have been hit by an object coming from the soil, while he was using his grass trimmer. However, the patient was asymptomatic with no complications. After eight years, the man started experiencing left nasal obstruction associated with purulent discharge and ipsilateral headache. A fetid odor coming from inside the nose and described as “the carcass of a dog” led him to seek medical attention. The patient underwent a functional endoscopic sinus surgery (FESS) with septoplasty and a foreign body, consisting of a metal nail, was retrieved. Discussion: This case highlights a two key learning points. The first one concerns occupational safety measures; full-face shield helmets are the best option and should be employed in order to avoid the penetration of any possibly dangerous materials. Secondly, grass trimmers with more sophisticated designs are required in order to prevent injuries like this. Conclusions: Besides being peculiar because of the onset of clinical symptoms, this case report highlights the importance of full-face shield helmets and certified machinery.