Ectopic teeth within the maxillary sinus are rare causes of persistent sinonasal symptoms, often manifesting as chronic sinusitis resistant to standard medical therapy. This report discusses a 53-year-old male presenting with right-sided nasal obstruction, facial pressure, pain, and rhinitis. Despite medical management, including nasal sprays and antibiotics, symptoms persisted. Computed tomography revealed an ectopic tooth embedded in the posterior lateral wall of the right maxillary sinus, a rare contributor to the patient’s refractory sinusitis. Given the failure of medical management and confirmed ectopic tooth, the patient underwent surgical intervention, including septoplasty, turbinoplasty, and right-sided functional endoscopic sinus surgery (FESS), consisting of right maxillary antrostomy, anterior ethmoidectomy, and removal of the ectopic tooth. Intraoperatively, a fully formed tooth was identified within the posterior maxillary sinus wall, with associated muco-pus drainage, indicating chronic inflammation. Ectopic teeth in the maxillary sinus presentations are limited to case reports and case series as outlined by Lambroni et al, Kayabosogolu et al, levin et al and Almomen et al. This case adds to the limited literature and suggests that surgical removal, in select cases, can offer substantial symptomatic relief and restore quality of life. Mohan et. al. suggests that without removal, there is a propensity to form a cyst or tumour and/or the lesion may cause perforation of the orbital floor and obliteration of the nasal cavity. This case highlights the importance of considering ectopic teeth as a rare but treatable cause of persistent maxillary sinusitis when conventional treatments fail. Early identification and surgical removal of ectopic teeth can alleviate symptoms and prevent long-term inflammation. Postoperatively, the patient experienced complete resolution of sinonasal symptoms, demonstrating the potential benefits of timely surgical intervention.