Maxillary Sinusitis After Sinus Lift Due to Gemella morbillorum

Abstract

Sinus lift is a predictable procedure for increasing alveolar bone height in the posterosuperior alveolar regions to allow oral prosthetic rehabilitation. Several complications have been documented in the literature and vary from sinus membrane perforation to maxillary rhinosinusitis. The authors present a case of Gemella morbillorum acute sinusitis after sinus lift surgery. The purpose of this report is to describe the surgical and pharmacological management of a patient allergic to penicillin.

Rational Prophylactic Antibiotic Selection for Sinus Elevation Surgery

“…It should be noted that, in addition to amoxicillin/clavulanate 1,4,7 and doxycycline, 38 practitioners have used perioperative amoxicillin, 2,3,36-38 clindamycin, 2,3,7,12,16 cephalosporins, 1,6,11 metronidazole, 12,16 tetracycline, 12,38 clarithromycin, 10 and levofloxacin 10 for SES or as treatment for postoperative sinus graft infection. For SES, perioperative antibiotics have been delivered locally, 3,16,38 orally, [1][2][3][4]6,7,[10][11][12]16,[36][37][38] or intravenously. 4,6,7,10 Although direct evidence to validate amoxicillin/clavulanate and doxycycline as optimal medications for antibiotic prophylaxis before SES does not exist, these agents are justified in the setting of SES based on established principles of anti-infective therapy, available data on the target microbial profile, and target bacteria antibiotic susceptibility.…”

“…5,8,[17][18][19][20][21][22][23][24][25][26][27][30][31][32][33][34][35] Studies that merely reported use of perioperative antibiotics for SES or associated postsurgical complications were excluded, as these reports neither provided rationale for antibiotic selection nor sought to specifically justify use of one antibiotic over another. [1][2][3][4]6,7,[10][11][12]14,16,[36][37][38]…”

“…‒ Physicians recognize dental procedures and sinus surgery as predisposing factors for acute bacterial rhinosinusitis (ABRS) . Even so, patients are not uniformly susceptible to postoperative sinus infection . Factors that have been associated with increased risk of acute infection following SES include smoking, immunocompromised status, uncontrolled diabetes, chronic sinusitis, and alcohol abuse .…”

“…Unfortunately, postoperative sinus infection risk assessment criteria have not been defined and validated. Accordingly, studies investigating SES outcomes predominantly report use of a perioperative antibiotic ( Table ) . However, practitioners have not achieved consensus on the most appropriate perioperative SES antibiotic regimen, and widely accepted guidelines do not exist.…”

“…8 Even so, patients are not uniformly susceptible to postoperative sinus infection. 6,[9][10][11][12][13] Factors that have been associated with increased risk of acute infection following SES include smoking, immunocompromised status, uncontrolled diabetes, chronic sinusitis, and alcohol abuse. 6,9,13 Additionally, lack of proper aseptic surgical technique, unfavorable osteomeatal anatomy, and impaired sinus drainage may also increase postsurgical infection risk 1,8,[11][12][13] and jeopardize therapeutic outcomes.…”