Case Report-Management of Pansinusitis with Periorbital Cellulitis Complicating External Sinus Lifting Procedure
Member of International Association of Maxillofacial Surgeons; ICMFS; Pan Arab Association of Oral and Maxillofacial Surgeons, Saudi Arabia
*Corresponding author: Nasser Al-Alami, Member of International Association of Maxillofacial Surgeons; ICMFS; Pan Arab Association of Oral and Maxillofacial Surgeons, Saudi Arabia.
Citation: Al-Alami N. (2022) Case Report-Management of Pansinusitis with Periorbital Cellulitis Complicating External Sinus Lifting Procedure. J Oral Med and Dent Res. 3(2):1-06.
Received: December 13, 2022 | Published: December 26, 2022
Copyright© 2022 by Al-Alami N. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Perforation of the maxillary sinus membrane is a common complication during sinus lifting procedures (10-40%). Maxillary sinusitis might result and displacement of the graft material may be a contributing factor. Antibiotic Regimes with removal of the implants perforating the sinus have been used for management of sinusitis with immediate or late replacement of the dental implants. Patient with recurrent severe maxillary, ethmoid and frontal sinusitis attended our center complaining from periorbital cellulitis. She visited multiple ENT clinics for several months with limited improvement on antibiotics and nasal decongestants but the infection was severe and recurrent. CT scan revealed titanium membrane displacement into the maxillary sinus. Drainage was done intraorally and removal of the titanium membrane. She had history of External sinus lifting procedure right side 9 years ago for placement of 3 implants to replace upper posterior teeth. Patient insisted not to remove the implants being stable and essential for her chewing.
She accepted any treatment not involving removal of dental implants without warranty on the result. After curettage of infected bone graft and granulation tissue, sinus membrane was elevated and PRF used to fill the space above the implant apices. The infection resolved completely within 10 days. Follow up of the patient for more than 60 months did not show any recurrence. CT Scan taken after one year shows formation of bony partition between the implants and the maxillary sinus.
Figure 1: External sinus lifting procedure right side.
Figure 2: Periorbital cellulitis.
Drainage was done intraorally and removal of the titanium membrane but infection recurred when patient stopped antibiotics. Treatment plan was discussed with the patient and she refused the traditional treatment to remove the 3 dental implants penetrating the maxillary sinus right side. On the other hand, this case was considered life threatening as periorbital cellulitis can lead to cavernous sinus thrombosis, meningitis, brain abscess and death. An alternative solution was approved by the patient to perform curettage of the infected bone graft and Granulation tissue in the maxillary sinus right side, elevation of the perforated Schneiderian membrane and use of PRF membrane to isolate the dental implant apices from the perforated Schneiderian membrane and maxillary sinus to promote healing. This approach is unique and no high expectations were given to the patient about the success although improvement was anticipated. After 7 days of oral antibiotic Avalox (Moxifloxacin 400mg OD) patient was ready for the procedure. The maxillary sinus was irrigated using diluted antiseptic solution with curettage of infected bone graft and granulation tissue. PRF membranes used to fill the space between the dental implants and the Schneiderian membrane. No collagen membrane used to avoid any unwanted reaction. The plan was to eliminate source of infection and to provide a sort of isolation between the dental implants and the maxillary sinus right side in Figure 3-5.