Endoscopic removal of a dental implant displaced into the maxillary sinus: A case presentation and a review of the literature / Arcüregbe diszlokált fogimplantátum eltávolítása endoszkópos ellenorzéssel: Esetismertetés a szakirodalom tükrében

Összefoglaló. Az utóbbi idoben egyre gyakoribbá vált fogászati implantáció egyik nem kívánt szövodménye az arcüregbe került implantátum, amely a maxilla molaris, esetenként praemolaris régiójának implantációjakor fordulhat elo. Ennek oka lehet a kúpsugaras komputertomográfia nélküli, azaz nem megfelelo tervezés, fennálló arcüreggyulladás és -ventilációs probléma, kevés, puha csont, a fúrási vagy implantátumbehelyezési sebészi gyakorlat hiánya, észre nem vett membránperforáció arcüreg-csontfeltöltés esetén. Esetünkben implantáció elott a beteg szájsebész orvosa kúpsugaras komputertomográfia alapján sinusventilációs zavart és arcüreggyulladást véleményezett. Az arcüreggyulladás funkcionális endoszkópos sinussebészeti mutéttel történo kezelését és gyógyulását követoen két lépésben, eloször arcüreg-csontfeltöltést, majd 6 hónappal késobb implantációt végeztek. 4 hónap panasz- és tünetmentes gyógyulást követoen az implantátumfeltárás elott derült fény az arcüregbe került implantátumra, amelyet funkcionális endoszkópos sinussebészeti eljárással, transnasalis (Lothrop) és intraoralis behatolás kombinációjával távolítottunk el. Az implantátumok arcüregbe kerülésének gyakorisága továbbra is ismeretlen, a szakirodalomban kb. 70 közölt esetrol tudunk; a leggyakrabban egy-egy implantátummal kapcsolatban születnek cikkek, ami az összes beültetett implantátum számához képest elenyészo. Az arcüregben lévo szabad implantátum arcüreggyulladást okoz, eltávolítása szükséges, kötelezo. A sinus hátsó részében elhelyezkedo implantátum esetén elsosorban funkcionális endoszkópos sinussebészeti eljárás javasolt. Az elso recessusban lévo implantátum eltávolítására a legjobbnak a praelacrimalis recessusból végzett korszeru behatolás tunik. Tradicionális transoralis/Luc-Caldwell-féle behatolást a friss sinuslift utáni gyulladt csontexcochleatio esetén javasolunk, illetve ha fennálló oroantralis fistulát is zárnunk kell. Orv Hetil. 2022; 163(13): 527-531. Summary. Accidental implant displacement into the maxillary sinus is often due to inappropriate surgical planning or technique, unrecognised sinus disease, failure to recognise low residual bone quality and quantity during implant-supported maxillary molars and premolars rehabilitation. Secondary implant migration can be attributed to the risk of failing osteointegration due to unnoticed sinus membrane rupture during surgery, incomplete soft tissue closure over the implant's site, preexistent sinus ventilation problems. In this study, we present the case of a patient with a symptomless preexistent sinus infection, which had been treated with functional endoscopic sinus surgery. After the healing period, the following two-stage procedures were performed: 1) maxillary sinus bone augmentation, 2) 6 months later dental implant placement, based on a routine orthopantomogram. At the end of the 4-month planned healing period, the implant displacement was noticed in the sinus cavity. The implant was removed with a combination of endoscopic surgery, transnasal and transoral Luc-Caldwell approach. The possible reasons for displaced implant into the sinus cavity, the treatment decision tree and lessons we learned, updated by the international literature, are discussed. Our recommendation for displaced implant removal is primarily transnasal under general anaesthesia. In the case of the implant in the anterior recess of the maxillary sinus, the functional endoscopic sinus surgery through the prelacrimal recess approach seems to be the preferred approach. A transoral approach should be the chosen method in the case of present oro-anthral fistulae or recent sinus bone graft, when the infected graft should also be removed. Orv Hetil. 2022; 163(13): 527-533.

Cloud-Based Multicenter Data Collection and Epidemiologic Analysis of Bisphosphonate-Related Osteonecrosis of the Jaws in a Central European Population.

Objective: Bisphosphonate-related osteonecrosis of the jaws is considered to be a rare but severe complication of bisphosphonate therapy. To understand this condition better, data collection is essential. Although the number of scientific papers about this subject is large, to date only a few multicenter reports have been published. Study design: We present a novel cloud-based data collection system for the evaluation of the risk factors of bisphosphonate-related osteonecrosis of the jaws. Web-based questionnaire and database have been set up and made available to voluntary researchers and clinicians in oral and maxillofacial surgery in Hungary and Slovakia. Results: To date, fifteen colleagues from eight maxillofacial units have joined the study. Data of 180 patients have been recorded. Collected data were statistically analysed and evaluated from an epidemiological point of view. Conclusions: Authors consider cloud-based multicenter data collection a useful tool that allows for real-time collaboration between users, facilitates fast data entry and analysis, and thus considerably contributes to widening our knowledge of bisphosphonate-related osteonecrosis of the jaws.

Modified procedure for secondary facial rehabilitation following total bilateral irreversible peripheral facial palsy.

We present the case of a middle-aged gentleman who developed total bilateral irreversible peripheral facial palsy over a period of 10 years, starting with palsy of the marginal mandibular and buccal branches of the facial nerve and progressing to the zygomatic and temporal branches. The patient did not develop any other neurological symptoms, and all neurological and other tests have remained negative over the last 10 years. Dripping of saliva and inability to close the mouth necessitated reanimation of the perioral region with the help of a fascia lata graft fixed to the fascia of the masseter muscles. The increasing lagophthalmos and associated eye problems were alleviated with a temporal muscle transposition combined with a lengthening procedure using the temporal fascia, passed through the upper and lower eyelids and hooked around the medial canthal ligament. The fascia strips were sutured not to the canthal ligament itself, but to each other, thereby placing equal self-adjusted tension on the upper and lower eyelids. Both operations were successful and improved eating and eye closure functions, allowing resolution of the eye symptoms.

Do we need three-dimensional computed tomography in maxillofacial surgery?

In a retrospective clinical study (2000-2003), 121 patients' radiographs and computed tomography scans were reviewed to establish the clinical value of three-dimensional computed tomography. Eighty patients had computed tomography scans; 48 had three-dimensional computed tomography scans for diagnosing facial fractures, 3 for diagnosing temporomandibular joint ankylosis, 1 for tumor with bone destruction, and 1 for a mandibular cyst. It is concluded that axial, coronal, and three-dimensional computed tomography is of crucial importance and should be mandatory for all suspected comminuted and displaced midface fractures instead of plain radiographs. Three-dimensional computed tomography is also recommended for comminuted mandibular fractures and temporomandibular joint ankylosis. Three-dimensional computed tomography is not recommended for the diagnosis of minimally displaced fractures.

Blow-out fracture of the orbital floor in early childhood.

Because of the anatomy of the developing bones in early childhood, blow-out fractures are rare before the age of 8 years. We present two cases where after a fall, computed tomography examinations revealed a blow-out fracture of the left orbital floor in a 12-month-old child and 27-month-old child. Because no associated symptoms were noted, both cases were managed conservatively.

Etiology and patterns of facial fractures in the United Arab Emirates.

A retrospective study on facial fractures was carried out in the Department of Oral and Maxillofacial Surgery at Tawam Hospital (Al Ain, United Arab Emirates) between January 1, 1998 and December 31, 2001. The study included 144 patients with a mean age of 26.5 years; the most frequently injured patients belonged to the 16- to 20-year-old age group. The male predilection was 83%. Road traffic accident was the most common causative factor (59%), followed by falls (21.5%), accidents where camels were involved (5.5%), work- and sport-related accidents (4.8% and 4.8%, respectively), and assault (4.1%). A total of 53.4% of the patients suffered isolated mandibular fractures, 32.6% had isolated midface fractures, and 13.8% had combined midface and mandibular fractures. Associated injuries were noted in 22.2% of the patients. The number of patients treated increased from 28.3 (1990-1995) to 36 (1998-2001) on an annual average; a reduction in isolated nasal fractures and associated injuries, including facial lacerations, was noted with no change in age or etiology predilection. Sufficient data could not be obtained to determine if the favorable results with the associated injuries were a result of the effect of a compulsory seat belt law introduced on June 1, 1998, but the increasing number of maxillofacial injuries suggests that the seat belt law is ignored in this country.