Surgical Treatment of Amalgam Fillings Causing Iatrogenic Sinusitis

Abstract

Iatrogenic maxillary sinusitis is a rare disease entity that can be fatal if not managed. Thirteen patients (five men and eight women) were referred to our clinic because of chronic iatrogenic maxillary sinusitis. Eight patients presented with a left-side maxillary sinusitis, four patients presented with right-side maxillary sinusitis, and one patient presented with right-side pan sinusitis. The sinusitis was caused by the intrusion of amalgam filling during root treatment of teeth. All of the patients were treated surgically with a Caldwell-Luc approach. In 12 patients, the amalgam was removed with the infected and inflamed maxillary mucosa. In one patient, the amalgam could not be removed with the Caldwell-Luc technique because it was in the deeper part of the root of the molar tooth. Histologic examination revealed four cases of aspergillosis; three cases of papillary and polypoid sinusitis; three cases of nonspecific pseudo-polypoid sinusitis; two cases of hyperplasic polypoid sinusitis; and one case of catarrhal sinusitis. All patients were relieved of their complaints that were related to sinusitis. Radiologically, the maxillary sinuses were clean 1 month after Caldwell-Luc intervention. Iatrogenic maxillary sinusitis should be considered a serious infection. A smear should be taken whenever a foreign body is intruded into the sinus. Foreign bodies can get jammed in the posterior wall of the sinus and can provoke chronic sinusitis with a risk intracranial extension. Hence, the disease should be managed surgically without delay. Furthermore, dentists should be cautious with dental amalgam filling.

Removal of Displaced Foreign Body From the Maxillary Sinus Using Replaceable Bony Windows and Saline Irrigation, Followed by Suctioning of the Foreign Body

“…6 -11 Various surgical methods for the retrieval of foreign bodies have been reported. [1][2][3][4][5][6][7][8][9][10][11] The Caldwell-Luc approach, the lateral window approach, or endoscopic transantral/transnasal surgery are commonly used procedures for the retrieval of foreign bodies. The Caldwell-Luc approach has some disadvantages such as postoperative numbness, paresthesis, facial asymmetry, and dental problems.…”

“…1 Other foreign bodies, such as tooth roots or metallic objects, can migrate into the sinus due to the doctor's inexperience. [2][3][4] Migrated foreign bodies in the sinus can cause significant complications such as inflammatory reactions, sinusitis, and fungal infections, [5][6][7][8] and the dental implant can be displaced into the sphenoidal sinus. 9 To extract displaced foreign bodies from the sinus, the Caldwell-Luc approach or the lateral window approach, combined with endoscopic surgery, antrally or transnasally, have been reported.…”

“…9 To extract displaced foreign bodies from the sinus, the Caldwell-Luc approach or the lateral window approach, combined with endoscopic surgery, antrally or transnasally, have been reported. [5][6][7][8][9][10][11] However, when the Caldwell-Luc or lateral window approach is performed without a sinus graft, the access window may not be replaced by a new bony wall in the lateral wall of the sinus. 12,13 To remove foreign bodies, the use of endoscopy is definitely effective; but this procedure, which requires specific training and equipment, has some disadvantages.…”

Sinusitis maxilar iatrogénica tras la colocación de implantes: A propósito de un caso

“…En 9 de los cuales (5%) se identificaron en el interior del seno, como factor causal claro, distintos cuerpos extraños relacionados con algún tratamiento dental previo. La presencia de distintos objetos y sustancias desplazadas al seno maxilar, como factores irritantes desencadenantes de sinusitis maxilar, está ampliamente registrada: desde amalgama (16,17), gutapercha (18,19), remanentes de tubos de plástico de drenajes previos (20) e incluso agujas de sutura (21). Debido a que estos cuerpos extraños pueden desplazarse por el interior del seno maxilar y fijarse a su pared posterior, con el consiguiente riesgo de extensión intracraneal del proceso infeccioso, y con la dificultad añadida en su extracción del alto riesgo de hemorragia de esta área.…”

Retrieval of Root Fragment in Maxillary Sinus Via Anterolateral Wall of the Sinus to Preserve Alveolar Bone

“…The Caldwell-Luc approach, lateral window approach, and endoscopic approach have been reported. [3][4][5] However, when the Caldwell-Luc approach or the lateral window approach is performed without a sinus graft, the access window may not be replaced by a new bony wall. 6 Although transnasal endoscopic procedure respects the integrity of the sinus, it requires a specific training and equipment.…”