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Endoscopically assisted procedure for removal of a foreign body from the maxillary sinus and contemporary endodontic surgical treatment of the tooth
© Costa et al; licensee BioMed Central Ltd. 2006
Received: 15 May 2006
Accepted: 08 November 2006
Published: 08 November 2006
There have been reports on the migration of teeth or implants into the maxillary sinus. We know of only one report on the migration of a gutta-percha point that had been used to fill a root canal into the ethmoid sinus. We report such a case treated with an endoscopically assisted procedure for removal of the foreign body and contemporary endodontic surgical treatment of the tooth.
A 33-year-old woman was seen for a chronic pain in the region of tooth 26 in June 2005. She had treatment to the root canal of her left upper first molar in 2002. The patient's history indicated also previous symptoms in the last two years of maxillary sinusitis including tenderness in the left infraorbital region and nasal stuffiness.
Removal of foreign bodies through an endonasal endoscopic approach is the treatment of choice . Endoscopically assisted Caldwell-Luc procedure for removal of a surgical bur from the maxillary sinus was also described . There has been no previous report about endoscopic removal of a filling agent migrated from the root canal into the maxillary sinus. Migration through the maxillary sinus of a gutta percha point into the ethmoid sinus was described . In our case, as in the case previously described, it is most likely that the endodontic cement went from the roots of the upper left first molar to the natural ostium by the action of the cilia that continue to clear mucus toward the natural ostium.
It is possible that the foreign body dislocated near the maxillary natural ostium created an antral inflammation of the overlying mucosa and a disturbance in the clearence of the maxillary sinus. This fact with the concomitant hypertrophy of the inferior turbinates may explain the patient's previous symptoms of maxillary sinusitis including tenderness in the left infraorbital region and nasal stuffiness.
In this case a small bone window in the lateral wall of the maxillary sinus was performed in order to obtain a contemporary endodontic surgical treatment of the upper first left molar roots. This report shows how contemporary removal of a foreign body from the maxillary sinus and treatment of the odontogenic source may be obtained through a minimally invasive endoscopically assisted access to the maxillary sinus.
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