In order to facilitate the comparison with other similar case reports published elsewhere, we have made a search on PubMed database by using the keywords [complex odontoma] and [maxillary sinus]. Eighteen articles on complex odontomas in maxillary sinus were selected, but one did not fully describe the access and thus was excluded . However, the search revealed 18 cases in the period between 1956 and 2022, with one of the articles reporting on two patients. These data are listed in Table I.
The mean age of the patients was 22.21 ± 8.86 years old, ranging from 11 to 48 years. The male:female ratio was 2.2:1. Data demonstrated that intra-sinus complex odontoma is more prevalent on the left side (63.15%), with a mean size of 38 x 34.3 mm. However, there is divergence in the literature as studies report that the majority of these lesions are detected during the second decade of life (mean age of 14 years), with little or no difference between genders .
Although intra-sinus odontoma is not common, the maxillary sinus is a site susceptible to pathologies of odontogenic origin due to its close anatomical relationship with teeth and periodontal tissues . As well as in the present case, odontoma is usually found as an incidental radiographic finding, but the involvement of maxillary sinus should be carefully evaluated and the lesion removed because its growth can lead to local and systemic impairment. Among the possible complications associated to odontoma, one can site deviation or absence of tooth eruption, alveolar bone expansion [7, 8, 11, 14, 16, 18], regional lymphadenopathy [13, 21], nasal obstruction [10, 13, 19, 23], epistaxis, diplopia and sinusitis [10, 24]. Moreover, cystic formation may concomitantly occur, resulting in bone destruction [15, 21].
Different surgical approaches for removal of tumours in the middle third of the face have been described. The Caldwell-Luc technique was first described by George Caldwell in 1893 and Henri Luc in 1897 as a surgical approach for lesions in the maxillary sinus . Such an approach is the most used conventional intraoral technique, in which the lesion is accessed through the anterior and lateral walls of the maxillary sinus. However, conventional techniques are not recommended for large or posterior lesions due to the limited visualisation and consequent impairment of the access to the lesion, which can damage the adjacent structures . Moreover, these approaches also tend to cause bone defects on the sinusal walls, which may not be repaired and thus require reconstruction with donor site for bone grafting. If these osteotomy gaps are extensive, then the overlying soft tissues can collapse into the space normally occupied by those walls .
As an alternative to the conventional surgical approaches, the Le Fort I osteotomy provides better access to lesions located in the posterior region of the maxilla as the lesion’s margins and adjacent bone structures can be visualised. Therefore, this surgical approach allows accurately delineating the osteotomies to be performed, which ensures complete resection of the lesion and prevents relapse consequently [8, 27–29]. It is considered a versatile technique because one can change the horizontal osteotomy level depending on the location of the tumour and its proximity to other structures, such as orbit floor and skull base . Scolozzi & Lombardi  emphasise that this technique is not aimed only at posteriorly located lesions, but also at those involving one or more maxillary walls, thus reducing loss bone.
In addition to the present study, only Armstrong & Bhardwj  and Korpi et al.  reported the use of Le Fort I osteotomy for removal of an intra-sinus complex odontoma. This technique allows better surgical predictability, causes no occlusal alteration and has low rate of post-operative morbidity. The possible complications are the same ones which may occur during the surgical correction of a dento-facial deformity. Hass Junior et al.  performed a systematic review and found that only 8.5% of the patients submitted to Le Fort I osteotomy had a post-operative complication. The most frequent adverse effects include haemorrhage, pulp necrosis, bucco-sinusal fistulas (oro-antral) lesions of nasolacrimal duct and secondary infections [28–31]. In the present case report, there were neither immediate nor long-term complications.