Sir, a 28-year-old patient was referred to the maxillofacial department regarding a possible fracture of the left infra-orbital rim. On attendance he gave a history of tripping and falling whilst under the influence of alcohol and injuring his face on a metal triangular sign. Unusually his concern was mainly that he may have a foreign body in his cheek wound.

On examination there was a small healing laceration on the left cheek with mild oedema and tenderness associated and there was reduced sensation in the V2 inferior orbital branch distribution. The remaining clinical examination was entirely normal. Radiographic evaluation from the time of incident revealed an unusually-shaped radiolucency in the upper left quadrant, which may have previously been missed due to the patient's anterior crowns (Fig. 1).

Figure 1
figure 1

OM view showing unusual radiolucency associated with the upper left lateral incisor and canine crowns

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On review, an unusual radiographic appearance was noted on the occipito-mental views and prompted further investigation, consisting of a lateral cepholgram (Fig. 2). This revealed a bullet shaped object in the maxillary sinus, approximately 10 mm length with comminution of the anterior maxillary wall. At this point the patient gave a slightly altered history including being caught up in an altercation involving a firearm. Given the history of ongoing pain and discomfort in this region, the decision was made for the foreign body to be removed. This was achieved using a Caldwell-Luc procedure and the foreign body was successfully removed under general anaesthetic. The patient's post-operative recovery was uneventful.

Figure 2
figure 2

Lateral cephlogram showing a foreign body within the maxillary sinus

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