Outpatient retrieval of foreign bodies dislocated in the maxillary sinus

ABSTRACT

Computer-guided implant surgery represents a technological evolution capable of offering clinicians and patients great benefits.

The advent of digital technologies has enabled the creation of operating protocols that, starting from clinical and radiological diagnoses, allow the formulation and implementation of  , reliable and predictable  , reducing the incidence of surgical and prosthetic complications.

The ability to overlay Dicom data from CBCT and STL from oral scans or laboratory models allows for a careful analysis of the patient’s anatomy and planning the ideal implant position.

In the case of maxillary rehabilitations characterised by and pneumatisation of the maxillary sinus, controlling the implant position allows for  of the risks of complications and possible dislocation of the implants   the sinus itself.

The possibility of using surgical templates for guided positioning allows for a reduction in the incidence of such complications, especially during maxillary sinus lift interventions  access or rehabilitations with inclined implants positioned  on the maxillary sinus (All-on 4).

On the other hand, in case of poor design, lack of primary stability of the implants or incorrect preparation of the receiving site, accidental dislocation of implants into the maxillary sinus may occur. In other cases, foreign bodies are represented by:  tooth roots, endodontic materials or other. These situations must be resolved quickly by removing the foreign body to prevent the onset of maxillary sinusitis.

Surgical indications: The classic technique used in these cases is endoscopic. This is effective but involves significant patient discomfort due to hospitalization and the need for general anesthesia. In 2002, Professor Biglioli proposed a technique for the removal of foreign bodies lodged in the maxillary sinus that can be performed on an outpatient basis under local anesthesia. Twenty years of experience have demonstrated its effectiveness, with negligible morbidity and complications.

Surgical technique: Immediately after the foreign body has been dislodged into the maxillary sinus, a flap is created to access the maxillary sinus using a mucosal hinge at the upper edge. This allows for a clear view of the interior of the cavity and easy removal of the object that has slipped into the sinus. The flap is then repositioned and, thanks to its vascularization, quickly ossifies. If surgery is performed after the foreign body has dislodged into the maxillary sinus, a cone beam CT scan must be performed shortly before the surgical procedure to rule out the presence of sinusitis or the possibility that the implant has been transported by mucociliary transport to the most cranial portion of the sinus, or even further.

Videos and photographs facilitate the description of the proposed surgical technique.

Presentation of clinical cases: typical cases of application in implantology and oral surgery are illustrated.

Discussion: ample time is allotted for participants’ questions and answers.