Endoscopic Medial Maxillectomy for Infected Dental Implants

Abstract

Objective: Chronic maxillary sinusitis of dental origin (CMSDO) is a known complication of osseointegrated dental implants. Treatment of CMSDO currently involves antibiotics, steroids, and nasal irrigation. When medical management has failed, standard of care is removal of the dental implant. We propose performing endoscopic medical maxillectomy (EMM) as an alternative therapy. Method: Single center retrospective chart review on five patients with recalcitrant maxillary sinusitis secondary to dental implants into the maxillary sinus that were subsequently treated with EMM. Review included preoperative symptoms and SNOT-20 scores, medical treatment, computed tomography findings, intraoperative findings, postoperative medical management, postoperative symptoms, and SNOT-20 scores. Results: All 5 patients underwent endoscopic medial maxillectomy, postoperative culture-directed antimicrobial therapy, oral steroids, and nasal irrigation. The patients were followed postoperatively from a period of 3 months to 2 years. All 5 patients demonstrated complete resolution of symptoms of chronic sinusitis and did not require removal of the osseointegrated dental implants. Conclusion: Endoscopic medial maxillectomy provides a safe treatment option for CMSDO due to osseointegrated dental implants that have failed maximal medical therapy. Based on our series, we propose EMM as a viable alternative for those patients who have traditionally required implant removal as definitive therapy.