|Year : 2016 | Volume
| Issue : 1 | Page : 61-63
The role of endoscopic sinus surgery in maxillary sinus foreign body removal
Birjit Singh Oinam, Jiten Singh Ningombam, Sobita Devi Puyam, Sudhiranjan Thingbaijam
Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Imphal, Manipur, India
|Date of Web Publication||5-Feb-2016|
Jiten Singh Ningombam
Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Imphal - 795 004, Manipur
Source of Support: None, Conflict of Interest: None
Extraction of impacted third molars is a common surgical procedure performed by oral surgeons and dentist. Dislodgement of the molar tooth into the maxillary sinus cavity can occur during the procedure. It comprises 0.6-3.8% of iatrogenic foreign body entrapment in the paranasal sinus. We report an unusual case of impacted maxillary third molar tooth that was accidentally displaced into the maxillary sinus during extraction and remained almost 1 year without any symptoms and removed via endoscopic sinus surgery.
Keywords: Dislodged molar tooth, Endoscopic sinus surgery, Maxillary sinus
|How to cite this article:|
Oinam BS, Ningombam JS, Puyam SD, Thingbaijam S. The role of endoscopic sinus surgery in maxillary sinus foreign body removal. J Med Soc 2016;30:61-3
|How to cite this URL:|
Oinam BS, Ningombam JS, Puyam SD, Thingbaijam S. The role of endoscopic sinus surgery in maxillary sinus foreign body removal. J Med Soc [serial online] 2016 [cited 2019 Dec 13];30:61-3. Available from: http://www.jmedsoc.org/text.asp?2016/30/1/61/175856
| Introduction|| |
Foreign body in the maxillary sinus is observed rarely but can occur commonly after car accidents, firearm injury, psychiatric disorder, or iatrogenic in a surgical procedure. Accidental dislodgement of impacted maxillary third molars into the maxillary sinus may occur during extraction. The presence of a tooth inside the sinus may lead to complications such as infection, and thus its surgical removal is strongly recommended.  This report describes the endoscopic removal of an unusual case of impacted maxillary third molar tooth (crown with a part of root) that was accidentally displaced into the maxillary sinus during extraction and remained almost 1 year without any symptoms.
| Case Report|| |
A 40-year-old male came to our outpatient department with the history of dislodgement of the right upper last molar tooth into the right maxillary sinus following failed extraction about 1 year back. There was no history of epistaxis, foul smelling nasal discharge, nasal blockade, headache, and fever. Physical and otorhinolaryngological examinations did not reveal any other abnormality. Routine investigations were within normal. X-ray paranasal sinus showed a radio-opaque shadow in the right maxillary sinus [Figure 1]. Computed tomography (CT) scan of paranasal sinuses revealed a radiodense shadow inside the right maxillary sinus [Figure 2]. In the operation theater, the patient was placed in the supine position. Under general anesthesia, uncinectomy was performed and the maxillary ostium was widened using 0° endoscope. Then, 30° endoscope was used to visualize the inside of the right maxillary sinus. The molar tooth representing the crown and part of the root was found inside the maxillary sinus [Figure 3]. With the help of a curved ball probe, the tooth was dislodged from the surrounding tissue and removed using curved blakesley cup forceps [Figure 4]. After the surgery, the right nostril was packed with ribbon gauze soaked with soframycin ointment. The nasal pack was removed on the first postoperative day, and the patient was discharged on the following day. The postoperative course was uneventful. He was treated with antibiotics, analgesics, and nasal saline sprays for 5 days. Postoperative examination of the nasal cavity after 2 weeks was apparently normal, and a postoperative X-ray paranasal sinus did not reveal any foreign body in the right maxillary sinus.
|Figure 1: X-ray paranasal sinus showing a radio-opaque shadow (tooth) in the right maxillary sinus|
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|Figure 2: Computed tomography scan of paranasal sinuses revealed a radiodense shadow inside the right maxillary sinus|
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| Discussion|| |
Surgical removal of impacted upper third molars is a common procedure routinely carried out in dental offices. It is associated with moderate incidence of complications (around 10%), which may be fractures of the maxillary tuberosity and accidental displacement of the tooth into the infratemporal fossa or maxillary sinus. Because of their proximity to the upper teeth, the maxillary sinuses are the most important paranasal sinuses in dentistry. Excessive apical force during the use of elevators and incorrect surgical technique are the most usual causes of these accidents which is more with less experienced surgeons than trained experienced surgeons.
The diagnosis of this condition can be made radiologically with plain sinus X-rays taken in Water's view, panoramic radiography, and sometimes CT scans taken in axial and coronal views. The most accepted treatment for accidental tooth displacement into the maxillary sinus is the removal of the dislodged tooth to prevent future infections, preferably during the same surgical procedure, if possible. However, infection is not a certain outcome since sinuses have been observed to be healthy despite the inclusion of foreign material. In this case, the symptoms are not manifested after a long period of 12 months of tooth displacement. Peterson et al. recommend that a tooth dislocated to the maxillary sinus be removed after a period of 4-6 weeks, since there is fibrosis during the initial healing period that can stabilize the tooth, making its positioning firmer. 
The alveolar approach and the Caldwell-Luc operation are two well-documented approaches for the removal of roots displaced into the maxillary antrum. The alveolar approach ensures the immediate removal of the displaced root via the oroantral opening, whereas the Caldwell-Luc operation involves bone removal from the canine fossa to gain access into the maxillary antrum after which the foreign body is removed.  The main advantages of the Caldwell-Luc technique were good visualization functional endoscopic surgery which tries to overcome these drawbacks. Chandrasena et al. and Al Nashawany et al. reported the sole use of the functional endoscopic technique for the retrieval of a root inadvertently displaced into the antrum; a procedure very similar to the approach described in this article. , However, in both the cases, the endoscope was used to remove only the displaced root from the maxillary antrum. In this case, the crown along with a part of the root was removed using the functional endoscopic sinus surgery technique. Hasbini et al., in their report of an endoscopic removal of an ectopic third molar obstructing the osteomeatal complex used this technique is not only removing the tooth but also, in addition, teasing out an associated dentigerous cyst, thereby restoring the patient's normal breathing  of the operative field. Facial asymmetry, nervous lesion, dental pulp devitalization, and oroantral fistulas can occur as complications associated with the procedures. The advantages of functional endoscopic sinus surgery noted in literature include its less invasiveness, decreased the risk of tooth root injury, and ability to fully visualize the antrum; others include a short recovery time and little or no risk of injury to the infraorbital nerve.
| Conclusion|| |
The tooth in the maxillary sinus is a rare condition although it can occur after tooth extraction, commonly upper third molar tooth. The Caldwell-Luc and transalveolar approaches were commonly performed for retrieval of the foreign body lodged into the maxillary sinus. Advances in the endoscopic sinus surgery techniques have changed the approach in such cases. Endoscopic removal has a better surgical field, low morbidity, and less complication. This is the first reported successful retrieval of an intact crown along with the root of a dislodged third molar tooth by endoscopic sinus surgery approach.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Patel M, Down K. Accidental displacement of impacted maxillary third molars. Br Dent J 1994;177:57-9.
Peterson LJ, Ellis E III, Hupp RJ, Tucker RM. Oral Surgery and Maxilofacial Contemporary, Editor: Guanabara Koogan, Rio de Janeiro, Brazil, 3 rd
Chandrasema F, Singh A, Visavadia BG. Removal of a root from the maxillary sinus using functional endoscopic sinus surgery. Br J Oral and Max fac Surg 2010;48:558-9.
Al Nashawany M, Olakunle HO, Kumar R, Alhumaid H, Taha EA, Parvez S, et al
. Endoscopic sinus surgery for the removal of foreign body (root) from the maxillary antrum: Our experience. Case Rep Int 2014;3:1-5.
Hasbini AS, Hadi U, Ghafari J. Endoscopic removal of an ectopic third molar obstructing the osteomeatal complex. Ear Nose Throat J 2001;80:667-70.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]