CLINICAL STUDY
Removal of the Dental Implant Displaced Into the
Maxillary Sinus Through the Inferior Nasal Meatus via
Transnasal Endoscopy
Tingting Jin, MD, Yan Wang, DDS, MD, Shihao Li, MD, Qian Cai, MD,y
and Zhiquan Huang, MD, PhD
Abstract: Worldwide, the reconstruction of the posterior edentu-
lous maxilla with dental implants has become a common practice in
clinical settings. However, the poor bone condition in this area is
sometimes accompanied by complications. Dental implant dis-
placement into the maxillary sinus is viewed as a rare complication.
A case of a 72-year-old man in whom an endoscopic technique was
used to remove a dental implant that had been mistakenly planted
into the maxillary sinus was reported in this study. The authors
approached the sinus through the inferior nasal meatus, and the
dental implant was removed through the widened ostium. The
endoscopic surgical approach described in this study is reliable
and minimally invasive for removing residual roots displaced into
the maxillary sinus. Therefore, it has been concluded that this
clinical procedure is worth using.
Key Words: Dental implant, maxillary sinus, transnasal
endoscopy
(J Craniofac Surg 2019;30: 1178–1179)
CLINICAL REPORT
A 72-year-old man was referred to us with a mistakenly
implanted dental implant in his right maxillary sinus. He
had the implant inserted for the right upper 2nd molar 4 months
ago. The right cheek had started to swell and serous discharge had
developed from the implant site had developed 1 month ago. His
dentist suspected the right maxillary sinusitis was caused by the
dental implant, and a panoramic radiograph was immediately
performed, which revealed the presence of a metallic foreign body
in the right maxillary sinus, that was believed to be the dental
implant (Fig. 1). A computed tomography (CT) examination further
located the position of the dental implant (Fig. 2). After eliminating
some contraindications, surgery was arranged for him.
From the Department of Oral and Maxillofacial Surgery; and yDepartment
Otolaryngology-Head and Neck, Sun Yat-sen Memorial Hospital, Sun
Yat-sen University, Guangzhou, China.
Received October 22, 2018.
Accepted for publication November 18, 2018.
Address correspondence and reprint requests to Zhiquan Huang, MD, PhD,
Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial
Hospital, Sun Yat-sen University, 107th Yanjiang Xi Road, Guangzhou,
Guangdong 510120, China; E-mail: zhiquanhuang1978@126.com
The authors report no conflicts of interest.
Copyright # 2019 by Mutaz B. Habal, MD
ISSN: 1049-2275
DOI: 10.1097/SCS.0000000000005263
1178 The Journal of Craniofacial Surgery  Volume 30, Number 4, June 2019
Copyright © 2019 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
After general anesthesia through orotracheal intubation and
disinfection procedures, the nasal endoscope was inserted into the
right nasal cavity. Under the guidance of 708 endoscope, the
electric cutting suction enters the inferior nasal meatus of the right
nasal cavity. Meanwhile, we observed a small amount of pus in
the opening of inferior nasal meatus. Then, the detecting head and
the attractor of the 708 endoscope were inserted through the
widened ostium to reach the operative region such that the
endoscope could better show the dental implant (Fig. 3). A small
hole to the anterior maxillary wall was made and the implant
approximately 5 mm was immediately located and grasped with
the tip of the attractor. During the surgery, irrigation of the sinus
with sterile normal saline was performed to maintain a clear
visual field and to clean up any remaining infectious materials
after using the tip of the attractor to remove the implant via the
nasal endoscope. In this case, the sinus irrigation was effective.
Finally, the maxillary sinus was filled in with a piece of absorb-
able hemostatic cotton.
After the surgery, nasal decongestants and antibiotics were
prescribed and the recovery was satisfactory. The patient remained
in the hospital for approximately 3 days with small amount of
swelling and pain on the right side of his maxillofacial region but no
loss of sensation. After 3 days, the patient was approved for
discharged. After 2 weeks, nasopharyngeal fiberscope results
showed that the sinus ostium healed well and no remaining secre-
tions were found any more (Fig. 4).
DISCUSSION
The low density of the maxilla, along with severe atrophy of
maxillary bone and a lack of surgical experience can easily lead
to maxillary sinus complications.1 Moreover, the application of
excessive force during dental installation is considered somewhat
related to the mistaken placement of a dental implant into the
maxillary sinus.2 As the panoramic radiograph exhibited in this
case, the maxillary bone was severely atrophic. Perhaps the
patient’s dentist should avoid choosing such a position when
placing an implant. Before implantation, the dentist should have
carried an assessment of the implant area and carefully addressed
this issue.
FIGURE 1. A panoramic radiograph showing the metallic foreign body
apparently located within the bottom part of the maxillary sinus.
The Journal of Craniofacial Surgery  Volume 30, Number 4, June 2019
FIGURE 2. A computed tomography scan showing the more accurate position
of the dental implant and maxillary sinus inflammation.
Foreign bodies in the maxillary sinus should be removed
because they can cause sinusitis by interrupting mucociliary clear-
ance or causing a tissue reaction.3– 5 According to the literature,
there are 5 different surgical approaches for the removal of dental
implants from the maxillary sinus, including suction of a foreign
body through an oronasal fistula, the classical Caldwell–Luc
procedure (CLP),the ‘‘lateral window,’’ the transoral endoscopic
approach and the transnasal endoscopic procedure.6 –9 Caldwell–
Luc operation has been one of the most favorable classical
approaches to the maxillary sinus due to its ease of access and
rapid recovery of the patient’s symptoms. However, several post-
operative complications exist after CLP, such as postoperative
maxillary cysts and a high rate of relapse of sinus symptoms, which
were thought to be induced by decreased sinus volume resulted
from the inferior osteotomy. All in all, additional intraoral wound is
inevitable for CLP.10 With advancements in endoscopic instrumen-
tation and expertise, minimally invasive endoscopic surgery has
been developed for various indications in the craniomaxillofacial
area.11 Functional endoscopic sinus surgery (FESS) has been more
recommended by rhinologists due to the easy and rapid recovery of
sinus functions, low morbidity, and flexible approaches to the
paranasal sinuses.10 The development of FESS allowed the direct
visualization of the sinuses, which is viewed as a less invasive
surgical procedure. Endoscopic removal is supposed to be mini-
mally invasive with quicker operative time and postoperative
recovery.12 With the transnasal endoscopic approach, bony alveolar
integrity is maintained and further dental implant surgery can be
performed without the need for a sinus lift. Its advantages include
reduced surgical time, less trauma and reduced bleeding, which
often offer a shorter patient recovery time. In this case, the dental
FIGURE 3. Photographs showing the transnasal incision and the removal of
dental implant with transnasal endoscopy.
# 2019 Mutaz B. Habal, MD
Copyright © 2019 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Removal of the Dental Implant Displaced
FIGURE 4. Photographs showing that the sinus ostium is healing without any
complication via nasopharyngeal fiberscope.
implant was located in the middle of the base of the maxillary sinus.
However, the endoscopic nasal approach may not be applicable if
the location of the implant body exceeds the reach of surgical
forceps. Therefore, careful radiographic and CT evaluation are
important before performing this procedure.13 Since the advent
of endoscopic sinus surgery, interdisciplinary cooperation between
specialties has prevailed, such as in this case.
However, even though functional endoscopic sinus surgery
presents extremely limited complications, there are still some
disadvantages of this procedure. This procedure requires surgeon
to have specific training and experience. In some cases where
oroantral communication exists, this procedure should be combined
with the intraoral approach.
In conclusion, the proposed method described here is simple,
and comfortable for the patient. Compared to the classic CLP and
other surgical approaches, endoscopic transnasal removal of dental
implants and other foreign bodies within the maxillary sinus is a
safe, minimally invasive procedure that is worth using.
REFERENCES
1. Adell R, Lekholm UA, Rockler, et al. 15-year study of osseointegrated
implants in the treatment of the edentulous jaw. Int J Oral Surg
1981;10:387–416
2. Varol A, Turker N, Goker K, et al. Endoscopic retrieval of dental
implants from the maxillary sinus. Int J Oral Maxillofac Implants
2006;21:801–804
3. Raghoebar GM, Vissink A. Treatment for an endosseous implant
migrated into the maxillary sinus not causing maxillary sinusitis: case
report. Int J Oral Maxillofac Implants 2003;18:745–749
4. Sugiura N, Ochi K, Komatsuzaki Y. Endoscopic extraction of a for-eign
body from the maxillary sinus. Otolaryngol Head Neck Surg
2004;130:279–280
5. Scorticati MC, Raina G, Federico M. Cluster-like headache
associated to a foreign body in the maxillary sinus. Neurology
2002;59:643–644
6. Pagella F, Emanuelli E, Castelnuovo P. Endoscopic extraction of a metal
foreign body from the maxillary sinus. Laryngoscope 1999;109 (Pt 1):
339–342
7. Chiapasco M, Felisati G, Maccari A, et al. The management of
complications following displacement of oral implants in the paranasal
sinuses: a multicenter clinical report and proposed treatment protocols.
Int J Oral Maxillofac Surg 2009;38:1273–1278
8. Sohn DS, Jung HS, Kim KH, et al. Removal of displaced foreign body
from the maxillary sinus using replaceable bony windows and saline
irrigation, followed by suctioning of the foreign body. Implant Dent
2011;20:112–117
9. Biglioli F, Chiapasco M. An easy access to retrieve dental implants
displaced into the maxillary sinus: the bony window technique. Clin
Oral Implants Res 2014;25:1344–1351
10. Kim SM. The removal of an implant beneath the optic canal by modified
endoscopic-assisted sinus surgery. Eur Arch Otorhinolaryngol
2017;274:1167–1171
11. Huang Z, Huang Z, Zhang D, et al. Endoscopically-assisted operations
in the treatment of odontogenic peripheral osteomyelitis of the posterior
mandible. Br J Oral Maxillofac Surg 2016;54:542–546
12. Matti E, Emanuelli E, Pusateri A, et al. Transnasal endoscopic removal
of dental implants from the maxillary sinus. Int J Oral Maxillofac
Implants 2013;28:905–910
13. Kitamura A, Zeredo JL. Migrated maxillary implant removed via
semilunar hiatus by transnasal endoscope. Implant Dent 2010;19:
16–20
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