Where is your maxillary sinus

When dislocation of a tooth to the maxillary sinus is diagnosed, surgical planning to remove it is needed. This report describes a clinical case of a patient whose third molar was iatrogenically dislocated to the interior of the maxillary sinus.

So the clinical conduct and surgery used to resolve this case are presented at the report. A year-old female patient, leucoderma, sought treatment from the Surgery Unit at the Dental Faculty of the Federal University of Sergipe. She had a history of pain and edema in the right side of the genian region after two failed attempts to remove the dental unit DU She brought in a panoramic X-ray taken prior to those two surgeries. During the extraoral clinical exam, intense edema of the left hemiface with signs of infection, excoriation of the labial commissure, hematoma, and a limited ability to open the mouth were observed.

The case was characterized as level 1 seriousness [ 5 ]. On the preoperative X-ray exam, the presence of dental inclusion for DUs 18, 28, 38, and 48 was observed. DU 18 had vertical impaction and intimacy with the maxillary sinus, and DU 28 had mesioangular impaction. DU 38 had horizontal impaction class 2 branch and class B depth , and DU 48 was totally vestibularized with horizontal impaction class 2 branch and class B depth [ 6 ] Figure 1.

A new panoramic X-rays was requested to clarify the diagnosis. One week later, the patient has overcome her infection with new X-rays that showed the presence of tooth 18 in the interior of the maxillary sinus Figure 2. The patient was sent to receive a computed tomography examination of the maxilla by volumetric acquisition to better locate DU 18 Figure 3. After tomography, the surgical planning was conducted. Three surgical procedures were planned to remove DUs 28, 38, and 48, and the displaced DU 18 from the maxillary sinus.

One-week interprocedural interval was applied between the interventions. As prophylactic antibiotic therapy, 2 grams amoxicillin was given to her 1 hour before surgery [ 8 ]. The drugs were injected as preconized at current literature [ 10 ] and the surgical technique for DUs 38 and 48 followed the recommended protocol [ 11 ].

It was taken 10 minutes after applying the alveolar nerve anesthetic before proceeding with the surgery to avoid the need to block the greater palatine nerve [ 12 ]. The surgical technique followed the preconized protocol [ 11 ]. The tooth was removed from the maxillary sinus using the Caldwell Luc operation, which was originally described in the late s as an approach to the maxillary sinus accessing it through the labiogingival sulcus to canine fossa incision. By this technique, there is bone resection of the sinus vestibular wall, which is open and provides access to the removal of the foreign body from the maxillary sinus, and then the sinus must be irrigated and the suture must be made, relaxing at health bone 6, The following postoperative instructions were explained to the patient for each of the surgeries she received.

After the final surgery, a new panoramic X-ray for postoperative evaluation was obtained, and it showed no evidence of any complications Figure 4. Because of their proximity to the upper teeth, the maxillary sinuses are the most important paranasal sinuses in dentistry [ 14 , 15 ]. The close relationship between these anatomical structures requires a surgeon who is sufficiently cautious and sensitive to deal adequately with the case.

Often, the distance between the root apex and the sinus mucosa is showed to be reduced to millimeters, making the transposition of a dental element to the maxillary sinus possible, mostly the upper third molar [ 6 , 16 , 17 ], as can be seen in this report.

According to some authors the present iatrogenic case can be caused by excessive apical force during the use of extractors and incorrect surgical techniques [ 18 , 19 ]. However, in these circumstances, the professionals need to be prudent and cautious in their handling of the case to reduce the trauma caused by the accident and to attain the desired result [ 16 ]. Nevertheless, computed tomography offers the clearest view and a three-dimensional view, which makes it indispensable for the evaluation and proper handling of cases such as the one presented here [ 21 , 22 ].

In the present case, panoramic X-ray and computed tomography were used to determine with precision the location of the translocated tooth. However, in some cases, the procedure can be completed with only panoramic X-rays [ 16 , 23 ]. In cases of accidental dislocation of fragments to the interior of the maxillary sinus, some authors agree that the most acceptable treatment is removal to prevent future infection [ 17 , 24 — 26 ].

However, infection is not a certain outcome since sinuses have been observed to be healthy despite the inclusion of foreign material [ 27 ]. The ideal circumstance is that any dislocated foreign body be taken out during the same surgical procedure in which it was dislodged, if possible. However, the sinus can remain asymptomatic for several months before an acute infection develops. The patient in the present report showed classic signs of an infection caused by dental material inside the right maxillary sinus.

Peterson et al. In the present case, the Caldwell-Luc operating technique was used. Another well-known technique is the transalveolar procedure, but it is only indicated when the already existing opening is larger than the foreign body to be removed [ 19 ]. Normally, it is used only as the first and immediate attempt to recover root remains [ 18 , 30 ]. The advent of endoscopy has also helped with the process of removing small foreign bodies from paranasal cavities [ 6 , 31 ].

It allows sufficient visualization of the surgical field, has low morbidity, and is easily accepted by patients. However, a lack of specialized manpower and the lack of logistical resources available in most public and private services have made routine use of endoscopy impractical [ 16 ].

Moreover, she said that she was very anxious about the surgery to remove the tooth from the maxillary sinus, since previous surgeries on that D. For the other extractions, the patient was calmer. Iatrogenic can occur in various fields of dentistry, even during relatively noninvasive treatments. Therefore, all patients undergoing dental procedures should be told about the risks and possibilities of complications.

In this case, removing the tooth dislocated to the maxillary sinus required a second surgical period. Nonetheless, the professional on this case was able to proceed with X-ray planning, surgery, and appropriate medication.

The best way to avoid dental dislocation to the maxillary sinuses is through careful preoperative evaluation. Before every surgical procedure, dental teams should request the appropriate complementary exams and evaluate whether the professional has the ability to perform the procedure that needs to be done in a sufficiently cautious way.

They also need to make sure that any complications can be resolved, if possible, thereby leaving the patient free from disorders, such as that described in this case report. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview. Academic Editor: Tommaso Lombardi. Received 19 Aug Revised 08 Jan Accepted 13 Jan Published 01 Feb Abstract The maxillary sinus or antrum is the largest of the paranasal sinuses.

Introduction The maxillary sinus, or antrum, is the widest of the paranasal cavities, occupying the entire maxillary body. Figure 1. Figure 2. Figure 3. Computed tomography examination of the maxilla by volumetric acquisition to better locate DU Figure 4. References A. Bellotti, F. Costa, and E. View at: Google Scholar R. Dias, J. Tomeh, D. Pupim, R. Tonin, G. Farah, and A. View at: Google Scholar A.

Bouquet, J. The two maxillary sinuses are located below the cheeks, above the teeth and on the sides of the nose. The maxillary sinuses are shaped like a pyramid and each contain three cavities, which point sideways, inwards, and downwards. The sinuses are small air-filled holes found in the bones of the face. The maxillary sinus drains into the nose through a hole called the ostia. When the ostia becomes clogged, sinusitis can occur. The ostia of the maxillary sinus often clog because the ostia are located near the top of the maxillary sinus, thus making proper drainage difficult.

Maxillary sinusitis or an infection of the maxillary sinus can have the following symptoms: fever, pain or pressure in face near the cheekbones, toothache, and runny nose. Sinusitis is the most common of maxillary sinus illnesses and is usually treated with prescription antibiotics.

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