RESUMO
BACKGROUND: Implant protrusion into the nasal and maxillary sinuses presents a challenge in cases of severely resorbed maxillae. AIM: The aim of this study was to evaluate the clinical and radiographic effects of BECES® implant penetration depth into the nasal and maxillary sinuses. SETTING AND DESIGN: This was an observational study conducted in a tertiary institution. MATERIALS AND METHODS: Forty-nine BECES® implants were inserted into the maxilla of patients who presented with severely resorbed ridges but no history of sinusitis. Forty-five implants protruded into the sinus cavities. Patients were examined clinically and radiographically at 1 week and 3, 6, 12, and 18 months after insertion. Maxillary sinus health, survival and success rates, and peri-implant health were assessed using the plaque index (PI), calculus index, modified gingival index (MGI), and probing pocket depth (PPD). STATISTICAL ANALYSIS: Wilcoxon signed-rank test and Mann-Whitney test were used in this study. RESULTS: Four (8.16%) of the 45 implants that penetrated the cavities reached the sinus floor without disrupting the membrane; the penetration depth was ≥4 mm in 20 implants (44.44%) and <4 mm in 25 (55.56%). No patient showed clinical or radiographic signs of sinusitis during the observation period. There were significant differences in the PI, MGI, and PPD values between baseline and the 18-month follow-up with no association with the penetration depth. All implants showed radiographically direct bone-to-implant contact. Where the implant tip barely reached the sinus floor, the membrane healed uneventfully while when deeply penetrating the sinus, the membrane healed around the implant but did not cover the tip. All prostheses and implants survived during the observation period. CONCLUSION: Penetration depth of polished implants with cortical engagement into the maxillary sinus or the floor of the nose does not negatively affect implant survival, the success rate of the treatment, nor peri-implant soft-tissue health. It also does not provoke the development of sinusitis.
RESUMO
BACKGROUND: Facial necrotizing fasciitis is extremely rare. Most of the cases reported in literature are related to dental, sinus, tonsillar and salivary glands causes, but rarely as consequence of skin infection. We report a unique case of lower lip cellulitis, which was initially misdiagnosed as angioedema and subsequently progressed into lower lip necrotizing fasciitis. CASE PRESENTATION: This is a case report of necrotizing fasciitis involving the lower lip as a consequence of infected skin acne in a 19 year old black female. The patient had been diagnosed earlier as a case of angioedema by a physician and treated accordingly. She was mildly anemic, hyponatremic and hypokalemic. Treatment was started immediately by incision, drainage and full debridement of the whole necrotic tissue. Triple antibiotic therapy was administered and daily irrigation and dressing were performed until full recovery. Complete healing occurred within a month by secondary intention. CONCLUSION: This case demonstrates the misdiagnosis of a lip swelling leading to the development of labiofacial necrotizing fasciitis, a serious and life threatening condition. Lip angioedema is a common condition; however, lip fasciitis is rare. A broad differential diagnosis in case of lower lip swelling is essential to avoid inappropriate treatment delay.
