Iatrogenic foreign bodies in the maxillary synus: between malpraxis and medico-legal consequences

Abstract

Objectives: Due to the continuous development of invasive dental procedures, presently we encounter a permanent growing of medical complications, like protrusion of foreign bodies into the maxillary sinus during therapeutic maneuvers on the superior dental arch. Plus that we can find neglected foreign bodies in the maxillary sinuses after ENT surgical procedures. With this clinical study we evaluated the most frequent etiology of the iatrogenic foreign bodies of the maxillary sinus, the improper surgical maneuvers that can lead to protrusion of foreign bodies, and the complications produced by these.<br/> Material and methods: We performed a prospective clinical study on 49 consecutive patients with various types of foreign bodies of the maxillary sinus admitted in our Department between January 2010 - January 2013. In all cases we performed craniofacial CT scans and dental panoramic radiography. The removal of the foreign bodies was performed surgically.<br/> Results: Most common foreign bodies encountered were dental implants (19 patients, representing 38.77%), followed by amalgam fragments (14 patients, 28.57%), Guttapercha points (5 patients, 10.20%), pieces of gauze used for nasal or sinusal packing (4 patients, 8.16%), tooth fragments (3 patients, 6.12%), dental burr (2 patients, 4.08%), Kerr needles (2 patients, 4.08%). The complications encountered were: acute or chronic rhinosinusitis (37 patients 75.51%), with 11 cases of fungal colonization proved at histopathological exam, and the rest of 26 rhinosinusitis patients with bacterial infection, 12 cases of oro-antral fistula (24.29%), 1 case of orbital abscess, 1 case of malar abscess.<br/> Conclusion: Most of the cases of iatrogenic foreign bodies in the maxillary sinus are due to inadequate dental treatments. Dental implants and root canal fillings materials are the most frequent iatrogenic FB inserted into the maxillary sinus. Untreated, they can produce inflammatory – infective sinus pathology, like bacterial or fungal sinusitis, or even abscesses of the surrounding structures.