Treatment of dental implant-related maxillary sinusitis with functional endoscopic sinus surgery in combination with an intra-oral approach
Identifieur interne : 001E59 ( Pmc/Corpus ); précédent : 001E58; suivant : 001E60Treatment of dental implant-related maxillary sinusitis with functional endoscopic sinus surgery in combination with an intra-oral approach
Auteurs : Ki-Young Nam ; Jong-Bae KimSource :
- Journal of the Korean Association of Oral and Maxillofacial Surgeons [ 2234-7550 ] ; 2014.
Abstract
The present report describes the case of a patient who underwent maxillary sinusitis right after dental implant installation with sinus lifting. Computed tomography scan revealed a dental implant (#16) was protruded inside the right maxillary sinus and confirmed the obstruction of ostium. A symptom remission was gained with the dual approaches combined by functional endoscopic sinus surgery and an intra-oral approach. Fully recovered function and healing of sinus were identified after 10 months follow-up. We report the case of sinusitis caused by protrusion of implants with sinus floor lift procedures and propose that practitioners should be aware of the possible its complications and management.
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DOI: 10.5125/jkaoms.2014.40.2.87
PubMed: 24868506
PubMed Central: 4028795
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Treatment of dental implant-related maxillary sinusitis with functional endoscopic sinus surgery in combination with an intra-oral approach</title><author><name sortKey="Nam, Ki Young" sort="Nam, Ki Young" uniqKey="Nam K" first="Ki-Young" last="Nam">Ki-Young Nam</name><affiliation><nlm:aff id="A1">Department of Dentistry, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.</nlm:aff></affiliation></author><author><name sortKey="Kim, Jong Bae" sort="Kim, Jong Bae" uniqKey="Kim J" first="Jong-Bae" last="Kim">Jong-Bae Kim</name><affiliation><nlm:aff id="A1">Department of Dentistry, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24868506</idno><idno type="pmc">4028795</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028795</idno><idno type="RBID">PMC:4028795</idno><idno type="doi">10.5125/jkaoms.2014.40.2.87</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">001E59</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001E59</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Treatment of dental implant-related maxillary sinusitis with functional endoscopic sinus surgery in combination with an intra-oral approach</title><author><name sortKey="Nam, Ki Young" sort="Nam, Ki Young" uniqKey="Nam K" first="Ki-Young" last="Nam">Ki-Young Nam</name><affiliation><nlm:aff id="A1">Department of Dentistry, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.</nlm:aff></affiliation></author><author><name sortKey="Kim, Jong Bae" sort="Kim, Jong Bae" uniqKey="Kim J" first="Jong-Bae" last="Kim">Jong-Bae Kim</name><affiliation><nlm:aff id="A1">Department of Dentistry, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of the Korean Association of Oral and Maxillofacial Surgeons</title><idno type="ISSN">2234-7550</idno><idno type="eISSN">2234-5930</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>The present report describes the case of a patient who underwent maxillary sinusitis right after dental implant installation with sinus lifting. Computed tomography scan revealed a dental implant (#16) was protruded inside the right maxillary sinus and confirmed the obstruction of ostium. A symptom remission was gained with the dual approaches combined by functional endoscopic sinus surgery and an intra-oral approach. Fully recovered function and healing of sinus were identified after 10 months follow-up. We report the case of sinusitis caused by protrusion of implants with sinus floor lift procedures and propose that practitioners should be aware of the possible its complications and management.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Lee, Jk" uniqKey="Lee J">JK Lee</name></author><author><name sortKey="Um, Hs" uniqKey="Um H">HS Um</name></author><author><name sortKey="Chang, Bs" uniqKey="Chang B">BS Chang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ueda, M" uniqKey="Ueda M">M Ueda</name></author><author><name sortKey="Kaneda, T" uniqKey="Kaneda T">T Kaneda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Quiney, Re" uniqKey="Quiney R">RE Quiney</name></author><author><name sortKey="Brimble, E" uniqKey="Brimble E">E Brimble</name></author><author><name sortKey="Hodge, M" uniqKey="Hodge M">M Hodge</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Galindo, P" uniqKey="Galindo P">P Galindo</name></author><author><name sortKey="Sanchez Fernandez, E" uniqKey="Sanchez Fernandez E">E Sánchez-Fernández</name></author><author><name sortKey="Avila, G" uniqKey="Avila G">G Avila</name></author><author><name sortKey="Cutando, A" uniqKey="Cutando A">A Cutando</name></author><author><name sortKey="Fernandez, Je" uniqKey="Fernandez J">JE Fernandez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Felisati, G" uniqKey="Felisati G">G Felisati</name></author><author><name sortKey="Lozza, P" uniqKey="Lozza P">P Lozza</name></author><author><name sortKey="Chiapasco, M" uniqKey="Chiapasco M">M Chiapasco</name></author><author><name sortKey="Borloni, R" uniqKey="Borloni R">R Borloni</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, Yw" uniqKey="Chen Y">YW Chen</name></author><author><name sortKey="Huang, Cc" uniqKey="Huang C">CC Huang</name></author><author><name sortKey="Chang, Ph" uniqKey="Chang P">PH Chang</name></author><author><name sortKey="Chen, Cw" uniqKey="Chen C">CW Chen</name></author><author><name sortKey="Wu, Cc" uniqKey="Wu C">CC Wu</name></author><author><name sortKey="Fu, Ch" uniqKey="Fu C">CH Fu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chiapasco, M" uniqKey="Chiapasco M">M Chiapasco</name></author><author><name sortKey="Felisati, G" uniqKey="Felisati G">G Felisati</name></author><author><name sortKey="Zaniboni, M" uniqKey="Zaniboni M">M Zaniboni</name></author><author><name sortKey="Pipolo, C" uniqKey="Pipolo C">C Pipolo</name></author><author><name sortKey="Borloni, R" uniqKey="Borloni R">R Borloni</name></author><author><name sortKey="Lozza, P" uniqKey="Lozza P">P Lozza</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Timmenga, Nm" uniqKey="Timmenga N">NM Timmenga</name></author><author><name sortKey="Raghoebar, Gm" uniqKey="Raghoebar G">GM Raghoebar</name></author><author><name sortKey="Van Weissenbruch, R" uniqKey="Van Weissenbruch R">R van Weissenbruch</name></author><author><name sortKey="Vissink, A" uniqKey="Vissink A">A Vissink</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pignataro, L" uniqKey="Pignataro L">L Pignataro</name></author><author><name sortKey="Mantovani, M" uniqKey="Mantovani M">M Mantovani</name></author><author><name sortKey="Torretta, S" uniqKey="Torretta S">S Torretta</name></author><author><name sortKey="Felisati, G" uniqKey="Felisati G">G Felisati</name></author><author><name sortKey="Sambataro, G" uniqKey="Sambataro G">G Sambataro</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yang, Sn" uniqKey="Yang S">SN Yang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Raghoebar, Gm" uniqKey="Raghoebar G">GM Raghoebar</name></author><author><name sortKey="Van Weissenbruch, R" uniqKey="Van Weissenbruch R">R van Weissenbruch</name></author><author><name sortKey="Vissink, A" uniqKey="Vissink A">A Vissink</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Korean Assoc Oral Maxillofac Surg</journal-id><journal-id journal-id-type="iso-abbrev">J Korean Assoc Oral Maxillofac Surg</journal-id><journal-id journal-id-type="publisher-id">JKAOMS</journal-id><journal-title-group><journal-title>Journal of the Korean Association of Oral and Maxillofacial Surgeons</journal-title></journal-title-group><issn pub-type="ppub">2234-7550</issn><issn pub-type="epub">2234-5930</issn><publisher><publisher-name>The Korean Association of Oral and Maxillofacial Surgeons</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24868506</article-id><article-id pub-id-type="pmc">4028795</article-id><article-id pub-id-type="doi">10.5125/jkaoms.2014.40.2.87</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Treatment of dental implant-related maxillary sinusitis with functional endoscopic sinus surgery in combination with an intra-oral approach</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Nam</surname><given-names>Ki-Young</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Jong-Bae</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib></contrib-group><aff id="A1">Department of Dentistry, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.</aff><author-notes><corresp>Corresponding author: Ki-Young Nam. Department of Dentistry, Keimyung University Dongsan Medical Center, 56, Dalseong-ro, Jung-gu, Daegu 700-712, Korea. TEL: +82-53-250-7805, FAX: +82-53-250-7802, <email>nkyp@dsmc.or.kr</email></corresp></author-notes><pub-date pub-type="ppub"><month>4</month><year>2014</year></pub-date><pub-date pub-type="epub"><day>28</day><month>4</month><year>2014</year></pub-date><volume>40</volume><issue>2</issue><fpage>87</fpage><lpage>90</lpage><history><date date-type="received"><day>28</day><month>2</month><year>2014</year></date><date date-type="rev-recd"><day>14</day><month>4</month><year>2014</year></date><date date-type="accepted"><day>16</day><month>4</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2014 The Korean Association of Oral and Maxillofacial Surgeons. All rights reserved.</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>The present report describes the case of a patient who underwent maxillary sinusitis right after dental implant installation with sinus lifting. Computed tomography scan revealed a dental implant (#16) was protruded inside the right maxillary sinus and confirmed the obstruction of ostium. A symptom remission was gained with the dual approaches combined by functional endoscopic sinus surgery and an intra-oral approach. Fully recovered function and healing of sinus were identified after 10 months follow-up. We report the case of sinusitis caused by protrusion of implants with sinus floor lift procedures and propose that practitioners should be aware of the possible its complications and management.</p></abstract><kwd-group><kwd>Maxillary sinusitis</kwd><kwd>Dental implants</kwd><kwd>Endoscopy</kwd></kwd-group></article-meta></front><body><sec><title>I. Introduction</title><p>Rehabilitation of masticatory function after dental implants are placed in the partial or full edentulous area has become routine; however, implantation can occasionally be compromised by anatomical limitations as well as the status of alveolar bone and surrounding soft tissue. Implantation around the posterior maxilla area is often challenging because of alveolar bone resorption, sinus pneumatization or other reasons<xref rid="B1" ref-type="bibr">1</xref>. To overcome these problems, maxillary sinus lifting and sinus bone grafting are often recommended, although these procedures have uncommon complications such as maxillary sinusitis and infection. Inadequate maxillary bone thickness, along with poor surgical planning and lack of experience, is also associated with protrusion of implants into the maxillary sinus<xref rid="B2" ref-type="bibr">2</xref>,<xref rid="B3" ref-type="bibr">3</xref> or grafting material migration to the paranasal sinuses (PNS)<xref rid="B4" ref-type="bibr">4</xref>,<xref rid="B5" ref-type="bibr">5</xref>. Generally, intraoral approaches such as Caldwell-Luc approach, inferior meatal osteotomy or oro-antral fistula closure have been popular options for the treatment of post-op sequelae. However, these techniques have been insufficient for full recovery of maxillary sinus function. For complete recovery of maxillary sinus function and rapid resolution of sinusitis, functional endoscopic sinus surgery (FESS) is recommended, which is favored over the Caldwell-Luc approach because of positive outcomes such as shorter hospital stay and lower morbidity<xref rid="B6" ref-type="bibr">6</xref>. We report a case of maxillary sinusitis related to failed osteotome sinus elevation technique as well as successful management with FESS in combination with an intra-oral approach.</p></sec><sec><title>II. Case Report</title><p>A 39-year-old female was referred to our dental department due to considerable pain in the right zygoma area with headache in the right temporal region. The patient had a history of extraction of #16 approximately 5 months prior due to a vertical crack, and underwent single dental implant installation with the osteotome technique for #16 in a local dental clinic 3 days prior to presentation. Panoramic view revealed that the single implant was protruding into the right maxillary sinus and the radiopacity of the sinus was increased.(<xref ref-type="fig" rid="F1">Fig. 1</xref>) Medical therapy was administered, including empirical antibiotics (penicillin, clindamycin), non-steroidal anti-inflammatory drugs, expectorants and antihistamines, which were prescribed to mitigate symptoms; however, the patient showed no improvement after 4 weeks of follow-up, and the persistence of signs and symptoms of discomfort indicated that further investigation was needed. Coronal view computed tomography (CT) revealed definite signs of sinusitis with opacification of the right maxillary sinus as well as ethmoidal sinus, and confirmed that a dental implant was protruding approximately 5 mm into the sinus with a displaced bone fragment from the sinus floor at the apical portion of the implant.(<xref ref-type="fig" rid="F2">Fig. 2</xref>) It was unclear whether bone grafting had been performed. Water's view also revealed increased density and haziness in the right maxillary sinus.(<xref ref-type="fig" rid="F3">Fig. 3</xref>) Based on this evidence of obstruction of the ostium of the right nasal cavity and infection of the mucocele of the right maxillary sinus, we consulted an otolaryngologist and concluded that an intra-oral approach alone would not be sufficient to remove the mucocele and potentially scattered graft particles. Implant removal was also considered because the fixture was loose; therefore, FESS was performed in combination with an intra-oral approach under general anesthesia followed by admission of the patient. The operation was conducted by cooperative team approach, including an oral-maxillofacial surgeon and otolaryngologist. After the endoscope was inserted into the nose, cotton soaked with epinephrine was applied to the middle meatus for 5 minutes, then cotton was removed. The middle turbinate was widely excised so that pus and infected bone graft particles could be flushed from the sinus cavity. The ostium was exposed by removal of the uncinate process in the middle meatus to access to ostium and the ethmoidal sinus. Edematous, hyperplastic nasal mucosa within the sinus was enucleated after the natural ostium was surgically enlarged (<xref ref-type="fig" rid="F4">Fig. 4</xref>), then the sinus was irrigated with normal saline until no additional free-floating particles were observed. During this procedure, removal of the sinus mucosa of the maxillary was not attempted. Implant removal and primary closure of the oro-antral fistula were performed.(<xref ref-type="fig" rid="F5">Fig. 5</xref>) The patient received polyvinyl acetal absorbent nasal packing for 1 week, no complications occurred and symptoms improved gradually over the healing period. The radiopaque phase of the sinus cavity was remarkably decreased in the right maxillary sinus 1 week postoperatively, though mucosal thickening was still observed.(<xref ref-type="fig" rid="F6">Fig. 6</xref>) However, full recovery of the sinus was evidenced on transverse dental CT at the 10-month follow-up visit.(<xref ref-type="fig" rid="F7">Fig. 7</xref>)</p></sec><sec><title>III. Discussion</title><p>In many cases of maxillary sinusitis, dysfunction of mucociliary clearance is a major clinical problem. The stagnation of secretions and obstruction of excretion from and ventilation within the maxillary sinus are predisposing factors for sinus infection<xref rid="B7" ref-type="bibr">7</xref>. The area between middle turbinate and lateral nasal wall often has the anatomical variance; therefore, edema of the mucosa can result in obstruction of the ostium and dysfunction of mucociliary function. Maxillary sinus floor lift has been reported to cause postoperative sinusitis<xref rid="B8" ref-type="bibr">8</xref>. The elevation of the Schneiderian membrane could affect a sinus homeostasis and lead to sinusitis by temporal obstruction of a physiological sinus drainage through the ostio-meatal unit (OMU)<xref rid="B9" ref-type="bibr">9</xref>. Mucosal inflammation caused by misplaced implants can similarly cause mucosal inflammation and stenosis of the OMU with detrimental effects on sinus ventilation. Recommended treatment for dental implant-related sinusitis typically involves surgical restoration for proper drainage and ventilation of the sinus, interrupting the described sequence of events that lead to sinus infection.</p><p>FESS is a relatively recent surgical procedure used in the treatment of maxillary sinusitis. It widens the OMU to facilitate sinus secretion from the PNS into the nasal cavity, as the patient's normal anatomical structures are preserved<xref rid="B10" ref-type="bibr">10</xref>. FESS is able to treat OMU alterations and remove displaced dental implants, though it does not allow for removal of implants that protrude into the sinus, as in the present case<xref rid="B2" ref-type="bibr">2</xref>. Intraoral approaches are a more suitable method for addressing oro-antral fistulas and removing implants from within the sinus, but they cannot repair OMU alterations and other aspects of sinusitis<xref rid="B7" ref-type="bibr">7</xref>. Simple elimination of the irritating stimulus, such as exposed or displaced implant, could also be considered. Reports in the literature indicated that implant exposure greater than 4 mm from the sinus floor can give rise to sinusitis or rhinosinusitis<xref rid="B11" ref-type="bibr">11</xref>. In this report, the implant fixture was removed due to not only the exposed length (5 mm), but also the significant lack of initial stability.</p><p>Though further studies are needed to evaluate the efficacy of FESS in treating recalcitrant implant-related sinusitis and its ability to prevent recurrence, the combination of FESS and an intra-oral approach should be considered a useful option for the restoration of normal naso-sinus homeostasis<xref rid="B2" ref-type="bibr">2</xref>. The authors report favorable results of this dual approach in the treatment of maxillary sinusitis following implantation with sinus lifting. 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A case report</article-title><source>Int J Oral Maxillofac Surg</source><year>2004</year><volume>33</volume><fpage>312</fpage><lpage>314</lpage><pub-id pub-id-type="pmid">15287319</pub-id></element-citation></ref></ref-list></back><floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1</label><caption><p>Panoramic view taken 5 days after right maxilla sinus bone grafting and #16 implantation revealed dental implant protrusion into the right maxillary sinus.</p></caption><graphic xlink:href="jkaoms-40-87-g001"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Fig. 2</label><caption><p>Paranasal sinuses computed tomography revealed mucosal thickening and opacification with air bubbles in the right maxillary sinus and the protrusion of an implant fixture into the sinus, along with a bony fragment (arrow).</p></caption><graphic xlink:href="jkaoms-40-87-g002"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label><caption><p>Water's view computed tomography revealed increased density and haziness in the right maxillary sinus.</p></caption><graphic xlink:href="jkaoms-40-87-g003"></graphic></fig><fig id="F4" orientation="portrait" position="float"><label>Fig. 4</label><caption><p>Endoscopic view, after uncenectomy and maxillary sinus ostium enlargement.</p></caption><graphic xlink:href="jkaoms-40-87-g004"></graphic></fig><fig id="F5" orientation="portrait" position="float"><label>Fig. 5</label><caption><p>An intra-oral approach allowed for the removal of the mobile dental implant and closure of the oro-antra fistula.</p></caption><graphic xlink:href="jkaoms-40-87-g005"></graphic></fig><fig id="F6" orientation="portrait" position="float"><label>Fig. 6</label><caption><p>Computed tomography revealed that opacification of the right maxillary sinus was decreased 1 week postoperatively. Mucosal thickening of the sinus wall had also decreased.</p></caption><graphic xlink:href="jkaoms-40-87-g006"></graphic></fig><fig id="F7" orientation="portrait" position="float"><label>Fig. 7</label><caption><p>Transverse dental computed tomography scanning revealed complete recovery of the right maxillary sinus with normal mucosal thickness 10 months after surgery.</p></caption><graphic xlink:href="jkaoms-40-87-g007"></graphic></fig></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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