Endoscopic Extraction of a Foreign Body From the Maxillary Sinus

7/28/2019 Endoscopic Extraction of a Foreign Body From the Maxillary Sinus

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Endoscopic Extraction of a Foreign Body from theMaxillary Sinus

1. Natsuki Sugiura, MD1,2

2. Kentaro Ochi, MD1,2

3. Yasushi Komatsuzaki, MD1,2

1. 1Kanagawa City, Kanagawa, Japan2. 2Department of Otolaryngology, St Marianna University School of Medicine.1. Reprint requests: Kentaro Ochi, MD, Department of Otolaryngology, St Marianna University

Toyoko Hospital, 3-435, Kosugi-cho, Nakahara-ku, Kawasaki City, Japan 211-0063; e-mail,

[email protected].

A foreign body in the maxillary sinus is a rare finding. Possible causes are injury or accident and

dental procedures.1 Classically, the Caldwell-Luc procedure, which involves opening the anterior wall

of the maxillary sinus, has been performed to extract the maxillary foreign body. Recent

developments in diagnostic and surgical techniques using nasal and sinus endoscopy have provided

much less invasive methods for visualization of the internal structure of the sinuses. We report the

case of the foreign body of the maxillary sinus that was successfully extracted through the inferior

meatal window under endoscopic observation via a small hole at the canine fossa.

CASE REPORT

A 33-year-old man presented to the outpatient clinic of the St Marianna University Toyoko Hospital

with a 2- to 3-year history of an occasional heavy feeling on his left cheek. He had a history of

dental treatment in his youth. Plain sinus films demonstrated a radiodense, loop-shaped foreign

Management of a maxillary sinus foreign body (dentalbur).

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Case report

A 28-year-old woman underwent the extraction of tooth 14 for a periapical abscess that was

unresponsive to antibiotics. During the extraction procedure, the tooth roots were fractured. While a

power dental tool was being used to extract the roots, the patient heard a snap, and it was noted that the

dental tool broke. After the dentist failed to complete the tooth extraction, the patient was sent to the

emergency room at Upstate Medical University for an otolaryngologic evaluation. Our examination

revealed that the patient was anxious but otherwise healthy. Fractured tooth roots were visualized in

tooth socket 14, but no obvious oroantral fistula was seen. No bleeding or discharge from the socket

was noted. The patient had no sinus tenderness or nasal discharge. Anteroposteriorand lateral

radiographs of the sinuses (figure 1) revealed a foreign body in the left maxillary sinus.

The patient was started on clindamycin and taken to the operating room, where we performed a left

Caldwell-Luc procedure. No fistula was visible intraoperatively, but the foreign body, a dental bur, was

found and removed from the left maxillary sinus (figure 2). The patient was discharged from the hospital

the following day, and her tooth extraction--with closure of the oroantral fistula--was completed 2 days

later at her dentist's office. She has recovered completely from both procedures.

Discussion

The natural history of foreign bodies in the paranasal sinuses is only anecdotal and is not truly known.

(7) Reported sequelae include chronic sinusitis, cutaneous fistula, rhinolith formation, and chronic pain.

(7) Likewise, metallic foreign bodies have been associated with malignancy, (8) and when the metal is

lead, there is concern for an increased risk of lead poisoning, particularly in children. (7) For these

reasons, removal of metallic foreign bodies is indicated. (9)

The classical surgical technique for removal of foreign bodies in the maxillary sinus is the Caldwell-Luc

procedure, (9) which involves opening the anterior wall of the maxillary sinus. Recently, technologic

advances have made possible the use of an endoscopic approach for the removal of these foreign

bodies. (1,7,9) Reported advantages of the endoscopic approach, when compared with the Caldwell-Lucprocedure, include less invasiveness and decreased associated morbidity, decreased risk of tooth root

injury, and the ability to fully visualize the sinus. (1,7,9) Despite these advantages, open approaches are

better suited for the removal of larger objects or those located anteriorly in the sinus. (7) In our case, we

chose the open approach because of the size of the retained dental bur.

[FIGURE 1 OMITTED]

Sinus foreign bodies are not common findings. When they are discovered, however, their removal is

indicated. Often, otolaryngologists are called upon to remove them. Because foreign bodies in the

paranasal sinuses vary in size and location, otolaryngologists must be familiar with the different

approaches for properly removing them.

[FIGURE 2 OMITTED]

References

(1.) Connolly AA, White P. How I do it: Transantral endoscopic removal of maxillary sinus foreign body. J

Otolaryngol 1995;24(1):73-4.
http://medical-dictionary.thefreedictionary.com/anteroposteriorhttp://encyclopedia2.thefreedictionary.com/fistulahttp://medical-dictionary.thefreedictionary.com/sequelaehttp://medical-dictionary.thefreedictionary.com/cutaneoushttp://medical-dictionary.thefreedictionary.com/cutaneoushttp://medical-dictionary.thefreedictionary.com/sequelaehttp://encyclopedia2.thefreedictionary.com/fistulahttp://medical-dictionary.thefreedictionary.com/anteroposterior


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(2.) Gupta AC, Murthy DE Putotu ML. Unusual type of foreign body in the maxillary sinus. J Laryngol

Otol 1990;104(9):718-19.

(3.) Donlon WC. Reamerin the maxillary antrum: A complication of periapical surgery. Oral Surg Oral

Med Oral Pathol 1989;68(1): 122-3.

(4.) Abe K, Beppu K, Shinohara M, Oka M. An iatrogenic foreign body (dental bur) in the maxillary

antrum: A report of two cases. Br Dent J 1992;173(2):63-5.

(5.) Murata H, Kida S, Miura K, et al. A foreign body in the maxillary sinus; report of three cases. Jpn J

Oral Surg 1987;33:1024.

(6.) Kanda T, Ono K, Mizuki H, et al. Two cases of a foreign body in the maxillary sinus. Jpn J Oral Surg

1983;29:1956-60.

(7.) Brinson GM, Senior BA, Yarbrough WG. Endoscopic management of retained airgun projectiles in

the paranasat sinuses. Otolaryngol Head Neck Surg 2004;130(1):25-30.

(8.) Birnmeyer G. [On late sequelae of metallic foreign bodies in the region of the paranasal sinuses.] Z

Laryngol Rhinol Otol 1963; 42:778-85.

(9.) Pagella F, Emanuelli E, Castelnuovo E Endoscopic extraction of a metal foreign body from the

maxillary sinus. Laryngoscope 1999; 109(2 Pt 1):339-42.

Joseph L. Smith II, MD; Precha Emko, MD, FACS

From ENTAssociates of Chester County, Exton. Pennsylvania (Dr. Smith), and the Department of

Otolaryngology and Communication Sciences, Upstate Medical University, Syracuse, New York(Dr. Emko).

Reprint requests: Joseph L. Smith II, MD, ENT Associates of Chester County, 80 W. Welsh Pool Rd.,

Suite 103, Exton, PA 19341. Phone: (610) 363-2532; fax: (610) 363-0210; e-mail: jlsmithii@ yahoo.com
http://encyclopedia2.thefreedictionary.com/reamerhttp://medical-dictionary.thefreedictionary.com/FACShttp://medical-dictionary.thefreedictionary.com/ENThttp://encyclopedia.thefreedictionary.com/Syracuse%2c+New+Yorkhttp://encyclopedia.thefreedictionary.com/Syracuse%2c+New+Yorkhttp://encyclopedia.thefreedictionary.com/Syracuse%2c+New+Yorkhttp://medical-dictionary.thefreedictionary.com/ENThttp://medical-dictionary.thefreedictionary.com/FACShttp://encyclopedia2.thefreedictionary.com/reamer

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Endoscopic Extraction of a Foreign Body From the Maxillary Sinus