While the treatment of chronic odontogenic maxillary sinusitis is based on clear rules the management of acute purulent sinusitis of dental origin may produce a therapeutic dilemma. Often necessary additional drainage through the inferior nasal meatus or an oroantral fistula can cause further damage and promote chronic sinusitis. An alternative temporary drainage to the vestibular space is advised, which might avoid these problems. Keywords: odontogenic maxillary sinusitis, maxillary sinus, empyema, oroantral fistula, drainage, mucociliary clearance