Endoscopic findings of dental implant found in the infundibulum showing the mucociliary clearance of the maxillary sinus

Abstract

Significance statement: A 53-year-old man with left facial pain was referred to our hospital. Nasal endoscopy revealed a purulent discharge at the left middle meatus and bulging of the uncinate process. Computed tomography demonstrated that the dental implant was blocking the left maxillary ostium. Functional endoscopic sinus surgery was performed under general anesthesia. After removal of the uncinate process, a yellowish purulent discharge in the left maxillary sinus discharged from the maxillary sinus. The presence of the dental implant in the infundibulum shows the direction of mucociliary clearance from the nasal sinus. This case indicates how our sinus clears a foreign body, and the direction in which the foreign body is removed.

A 53-year-old man with left facial pain was referred to our hospital. He had been fitted with a dental implant on the left upper molar tooth 4 months previously and had hyperlipidemia 2 years earlier. Nasal endoscopy revealed a purulent discharge at the left middle meatus and bulging of the uncinate process. Coronal and axial computed tomography (CT) demonstrated that the dental implant was blocking the left maxillary ostium (Figures 1A and 1B). Functional endoscopic sinus surgery was performed under general anesthesia. After removal of the uncinate process, a yellowish purulent discharge in the left maxillary sinus discharged from the maxillary sinus. After suctioning of the discharge, the dental implant was found in the infundibulum of the maxillary sinus (Figure 2A) and removed (Figure 2B).

Figure 1.

Coronal (A) and axial (B) computed tomography (CT) showing the dental implant obstructing the infundibulum of the maxillary sinus.

Figure 2.

(A) Dental implant present in the infundibulum of the maxillary sinus. (B) Dental implant removed from infundibulum had dimensions of 1.0 x .3 cm.

When a foreign body is deposited in the sinus, the mucociliary clearance system removes it from our body. The direction of mucociliary clearance is from the nasal cavity to the nasopharynx. In the maxillary sinus, the direction is from the base of the maxillary sinus to its natural ostium. ¹ In this case, the dental implant moved below the maxillary sinus through it and moved toward the ostium. However, it was too large to pass the infundibulum, so it blocked the natural ostium of the maxillary sinus causing acute maxillary sinusitis.

The presence of the dental implant in the infundibulum shows the direction of mucociliary clearance from the nasal sinus.