Dutta Mainak, Ali Henna, Howlader Debraj, Mallick Ajay
Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Kalyani, NH-34 Connector, Basantapur, Saguna, Nadia, Kalyani, West Bengal India.
Department of Dentistry, All India Institute of Medical Sciences, Kalyani, NH-34 Connector, Basantapur, Saguna, Nadia, Kalyani, West Bengal India.
Indian J Otolaryngol Head Neck Surg. 2025 Jul;77(7):2602-2606. doi: 10.1007/s12070-025-05490-9. Epub 2025 May 13.
Inadvertent displacement of tooth fragments into the maxillary sinus is a known complication of dental extraction that can be managed instantaneously or soon thereafter through conventional techniques like Caldwell-Luc, alveolar crestal, and lateral approaches. However, if the event remains unidentified or ignored, recalcitrant sinus infection and intra-sinus tooth migration may result. The situation can then be difficult to investigate and treat.This report illustrates using a nasal endoscope in an exclusive endonasal approach in a 28-year-old man to extract an undiagnosed, retained tooth fragment displaced into the maxillary sinus during a dental extraction procedure four years ago, resulting in refractory, isolated chronic maxillary sinusitis. The effect of delayed diagnosis on clinical presentation and surgical decision-making, and the hurdles encountered at surgery, are discussed. Otolaryngologists require a high index of suspicion of a retained, infected tooth as the etiology of maxillary sinusitis. Conventional techniques provide limited surgical field and may be unsuitable in florid sinusitis, when the tooth migrates along the upstream mucociliary beat, and when the oro-antral fistula heals. In contrast, an exclusive endonasal endoscopic approach through middle meatal antrostomy is less invasive and provides wider exposure, but is seldom practiced and documented. Dealing with a grossly infected sinus and an intra-sinus tooth at an unpredictable depth is challenging. The benefits of endoscope-guided access being increasingly recognized in oro-dental interventions, this paper calls for a liaison between oral-maxillofacial surgeons and otolaryngologists in dealing with unforeseen complications related to maxillary sinus and the dentition at its floor.
The online version contains supplementary material available at 10.1007/s12070-025-05490-9.
牙碎片意外移位至上颌窦是拔牙已知的并发症，可通过诸如柯-陆氏（Caldwell-Luc）手术、牙槽嵴入路和外侧入路等传统技术立即或在拔牙后不久进行处理。然而，如果该情况未被识别或被忽视，可能会导致顽固的鼻窦感染和窦内牙齿移位。进而这种情况可能难以检查和治疗。本报告阐述了一名28岁男性患者，采用鼻内镜经鼻内入路，取出4年前拔牙过程中移位至上颌窦且当时未被诊断出的残留牙碎片，该碎片导致了难治性、孤立性慢性上颌窦炎。讨论了延迟诊断对临床表现和手术决策的影响，以及手术中遇到的障碍。耳鼻喉科医生需要高度怀疑残留感染牙齿是上颌窦炎的病因。传统技术提供的手术视野有限，当牙齿沿上游黏液纤毛摆动方向移位、存在口腔-鼻窦瘘愈合以及在急性鼻窦炎时可能并不适用。相比之下，经中鼻道上颌窦开窗术的单纯鼻内镜入路侵入性较小且视野更开阔，但很少被实践和记录。处理严重感染的鼻窦和深度不可预测的窦内牙齿具有挑战性。内镜引导下进入在口腔-牙科干预中的益处日益得到认可，本文呼吁口腔颌面外科医生和耳鼻喉科医生在处理与上颌窦及其底部牙列相关的意外并发症时加强合作。
在线版本包含可在10.1007/s12070-025-05490-9获取的补充材料。
