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Stomatologija, Baltic Dental and Maxillofacial Journal, 18: 128-32, 2016
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SUMMARY
,QWURGXFWLRQThe present article reports the late removal of a wisdom tooth displaced into
the maxillary sinus associated with the curettage of the adjacent infection tissue, under general
anesthesia.
&DVHGHVFULSWLRQ A male patient, 42 years-old, was forwarded to remove a right wisdom
tooth which was displaced into the right maxillary sinus for 10 months. The patient reported that
the tooth was tried to be removed using odontosection in two moments without any success.
Since then, the patient has been having (applicants) episodes of sinusitis. It had been planned
to remove the tooth and the cleaning of the right maxillary sinus. The surgical procedure was
done through the Caldwell-Luc access, followed by the removal of the dental fragments which
were into the maxillary sinus and curettage of the cavity in order to remove the granulation
tissue, associated to copious irrigation.
&RQFOXVLRQ The surgical removal of the tooth displaced into the maxillary sinus associated
with the sinus curettage was successfully achieved, solving the patient complaints.
.H\ZRUGV maxillary sinus, third molar, case study, oral surgery, intraoperative complication.
INTRODUCTION
The most frequent procedure conducted by and thus its surgical removal is strongly recom-
the oral maxillofacial surgeons are the surgically mended (7).
removal of third molars (1). The complication rates 7KHPD[LOODU\VLQXVLWLVLVDQLQDPPDWRU\DQG
associated with this procedure are between 2.6% to or infectious process originating by bacterial, fungal
30.9% (2, 3). Referring to the superior third molars, or viral infection developed in the maxillary sinus.
complications could occur, mainly, the tuberosity It can be presented in isolation or associated with
fracture, root fracture, oroantral comunication and processes that affect one or more adjacent sinuses
displacement of the tooth into the adjacent paranasal (8). From the total, cases of maxillary sinusitis, ap-
structures (1, 4). Third molars displaced into the proximately 1012% are exclusively sinusitis of the
maxillary sinus have been related to 0.6% to 3.8% home tooth (9, 10).
of frequency in literature (5). Acute bacterial sinusitis usually occurs follow-
The maxillary sinus is a pyramid shaped cav- ing an upper respiratory infection that results in the
ity with its base adjacent to the nasal wall and apex obstruction of the osteomeatal complex, impaired
pointing to the zygoma. The average dimensions of mucociliary clearance and overproduction of secre-
the adult sinus are 2.5 to 3.5cm wide, 3.6 to 4.5cm tions. Among the signs and symptoms that use to in-
high, and 3.8 to 4.5cm deep. Anteriorly, it extends crease the likelihood of a correct diagnosis of acute
WR WKH FDQLQH DQG SUHPRODU DUHD 7KH VLQXV RRU sinusitis are double sickening (biphasic illness),
XVXDOO\KDVLWVPRVWLQIHULRUSRLQWQHDUWRWKHUVW pain with unilateral prominence, purulent rhinorrhea
molar region (6). The presence of a tooth inside the by history, purulent secretions in the nasal cavity
sinus may lead to complications such as infection, on examination, a lack of response to decongestant
or antihistamine therapy, facial pain above or be-
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low both eyes on leaning forward, and maxillary
VLW\RI3DUDQi8)35%UD]LO
toothache. The term double sickening refers to
$GGUHVVFRUUHVSRQGHQFHWR%UXQR7RFKHWWR3ULPR+RVSLWDO;9 patients who start with a cold and begin to improve,
6HUYLoR %XFR0D[LOR)DFLDO 5XD ;9 GH 1RYHPEUR &(3
&XULWLED3DUDQi%UD]LO only to have the congestion and discomfort returned
(PDLODGGUHVVEUXQRSULPR#\DKRRFRPEU 7UDGLWLRQDOO\VLQXVLWLVKDVEHHQFODVVLHGE\
128 Stomatologija, Baltic Dental and Maxillofacial Journal, 2016, Vol. 18, No. 4
CASE REPORT B. T. Primo et al.
CASE DESCRIPTION
Stomatologija, Baltic Dental and Maxillofacial Journal, 2016, Vol. 18, No. 4 129
B. T. Primo et al. CASE REPORT
130 Stomatologija, Baltic Dental and Maxillofacial Journal, 2016, Vol. 18, No. 4
CASE REPORT B. T. Primo et al.
into the maxillary sinus, even with local or general In this particular case, the patient was forwarded
anesthesia, using intraoral access (Caldwell-Luc ac- with the tooth already displaced 10 months ago and
cess) or trough endoscopy (13, 14, 22). For Peterson with complains of chronic sinusitis. The patient was
HWDO, (16) in 2000,, the tooth displaced into the max- followed up with medication without success.
illary sinus should be removed 4 to 6 weeks later, Sinusitis is a common medical problem with
in as much as in this initial healing period occurs a VLJQLFDQWV\PSWRPVWKDWLQWHUIHUHVZLWKSDWLHQWV
EURVLVDURXQGWKHWRRWKZKLFKOHDGVLQWRVWDELOL]D- quality of life as well as loss of work productivity,
tion of the same into a more unmoved position. which presents major medical and social concerns.
Whichever it is the treatment option, the sur- The principles involved in the treatment of chronic
geon must have to be conscious of the anatomic VLQXVLWLVLQYROYHLGHQWLFDWLRQDQGWUHDWLQJWKHXQ-
potential damage. The blood supply to the maxil- derlying causes. Goals of treatment include reduc-
lary sinus is primarily derived from the posterior tion of mucosal edema, reestablishment of sinus
superior alveolar artery and the infraorbital artery, ventilation and eradication of infecting pathogens
both being branches of the maxillary artery. There (25). In this case, the patogenic agent, originating
DUHVLJQLFDQWDQDVWRPRVHVEHWZHHQWKHVHDUWHU- the sinusitis was the tooth displaced into the maxil-
ies in the lateral antral wall. The greater palatine lary sinus, being indicated the surgical removal and
artery also supplies the inferior portion of the sinus curettage of the infectious material. The goal of this
(23). However, because of the blood supplies to the procedure is to restore sinus ventilation and normal
maxillary sinus being from terminal branches of pe- function of the mucociliary clearance system.
ULSKHUDOYHVVHOVVLJQLFDQWKHPRUUKDJHGXULQJWKH
sinus lift procedure is rare. Nerve supply to the sinus CONCLUSIONS
is derived from the superior alveolar branch of the
maxillary (V2) division of the trigeminal nerve (24). The prevention of dental displacement into the
If the professional suspect that the tooth was DGMDFHQWFDYLW\LVREWDLQHGIURPLGHQWLFDWLRQRIWKH
displaced into adjacent space during the surgery is anatomical relationship of the maxillary sinus and
advisable to extend the incision in order to try to nasal cavity, adequate operatory visibility trough
remove it, avoiding another surgery and decreasing YHVWLEXODU DS DQG WLVVXH VHSDUDWLRQ7KH VXUJLFDO
the morbidity. If the professional could not see the removal of the tooth displaced into the maxillary
tooth or judge incapable to remove it at that moment sinus, at this rate, was done with success under gen-
it is wise to abort the surgery and perform the suture eral anesthesia with a drainage and curettage of the
to provide hemostasis, prescribe an antibiotics and infectious process, solving the patient complaints.
the use of nasal descongestant to avoid the accumu-
lation of secretions at the cavity. CONFLICT OF INTEREST
Sverzut HW DO (22) in 2005, stated that the
removal should be accomplished during the same 7KHDXWKRUVGHFODUHWKDWWKH\KDYHQRFRQLFW
procedure but indicated that delayed treatment does of interest
not always precipitate active sinus disease and that Sources of support that require acknowledg-
this asymptomatic interval can last several months. ment: None
REFERENCES
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2007;19:117-28. 6. van den Bergh JP, ten Bruggenkate CM, Disch FJ, Tuinzing
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1986;44:855-9. 9. Brook I. Sinusitis of odontogenic origin. 2WRODU\QJRO+HDG
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Maxilofac 2014;36:78-81. 6XUJ 2007;65:223-8.
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Stomatologija, Baltic Dental and Maxillofacial Journal, 2016, Vol. 18, No. 4 131
B. T. Primo et al. CASE REPORT
Received: 19 11 2014
Accepted for publishing: 28 12 2016
132 Stomatologija, Baltic Dental and Maxillofacial Journal, 2016, Vol. 18, No. 4