DISCUSSION
We encountered a case of Gardner syndrome with odontogenic sinusitis.
Many patients with GS are asymptomatic, and diagnosis is based on
incidental findings or family history. Patients with GS may exhibit
tooth abnormalities such as excess teeth, impacted teeth (delayed tooth
eruption), and odontoma, in addition to osteoma2.
Odontoma is usually asymptomatic; however, reports of infected odontoma
exist3. GS with odontogenic sinusitis is rare. As far
as we are aware, there are no similar case reports. In our patient, two
upper left maxillary teeth formed an odontoma, which got infected,
leading to odontogenic sinusitis.
Osteoma occurs in 46%–93% of patients with GS, which is 4–20 times
more frequent than in the general population. It most commonly occurs at
the outer cortex of the skull, mandible, and frontal
sinus2. While a single osteoma might be accidently
identified in clinical practice settings, GS should be suspected if
three or more osteomas are found2. Treatment is not
indicated for osteoma, but surgery may be required for mandibular
dyskinesia or cosmesis2.
If left untreated, patients with FAP will develop colorectal
cancer4, which is the leading cause of death in this
population5. Prophylactic colectomy is a reliable
treatment; however, surgery is recommended for patients in their 20s. In
GS, because of the mutation in APC , which is a tumor-suppressor
gene, complications such as gastric cancer, duodenal cancer, thyroid
cancer, and malignant dental tumors may occur, in addition to colon
cancer. Desmoid tumors also greatly influence the
prognosis4,5. Therefore, full-body examination and
long-term follow-up are required.
An otolaryngologist may see a patient with GS presenting nasal and
buccal symptoms such as sinusitis and a dental infection. GS should be
suspected if characteristic findings—including multiple osteomas of
the skull and facial bones, excess teeth, impacted teeth, and
odontomas—are observed. Eliciting a family history and examining the
whole body, including the colon, can contribute to early diagnosis and
treatment, potentially improving the patient’s prognosis.