Pulp necrosis during septorhinoplasty

Abstract

Bony manipulation near the nasal spine or maxillary crest trimming can predispose teeth to injury during septorhinoplasty, especially when there is an aberrant vascular supply or a highly situated root apex in the premaxilla. Prospective cross-sectional study. A prospective cross-sectional study was carried out on 438 teeth (maxillary incisors and canines) that were supposedly affected and 73 control teeth (mandibular lateral incisors) in 73 candidates of septorhinoplasty before and after surgery to determine the frequency of pulp necrosis using electrical, heat, and cold pulpal tests. Those with difficult intubation, history of root canals or orthodontic procedures, history of dental trauma, or a positive preoperative test were excluded from the study. Patients were followed up 2 weeks, 3 months, and 6 months postoperatively, and test results were compared before and at three intervals after the surgery. Seventy-three consecutive patients, including 11 males and 62 females, met the study criteria. Septoplasty with anterior maxillary crest trimming and anterior nasal spine manipulation was performed in 63 and 52 cases, respectively. Only 10 cases underwent septoplasty without manipulation of the maxillary crest or the anterior nasal spine. Based on pulp testing, no case of pulp necrosis was seen during the 6-month follow-up. Considering there are very few reports of dental problems during septorhinoplasty, it is an unlikely cause of serious dental complications such as pulp necrosis. An abnormal anatomy might be a good explanation for rare cases.