Case Details

Oral Medicine and Radiology Dental Materials

Indian Dental Network posted a case

almost 2 years ago

Chronic Maxillary Sinusitis Caused by Denture Lining Material

Courtesy: Tsutomu Sugiura, Kazuhiko Yamamoto, Chie Nakashima, Kazuhiro Murakami, Yumiko Matsusue

An 80-year-old female was referred to the Department of Oral and Maxillofacial Surgery, Narakasuga Hospital because of pus discharge from an oroantral fistula at the right posterior maxilla. The right upper second molar had been extracted 43 days before because of chronic periodontitis. She noticed swelling of the right cheek, purulent rhinorrhea, and discharge through the oroantral fistula 20 days before. She was prescribed antibiotics for seven days by her family doctor. The cheek swelling improved, but the discharge through the oroantral fistula persisted. She had a medical history of hypertension and chronic hepatitis C, both of which were well controlled with an angiotensin II receptor blocker, calcium channel blocker, and ursodeoxycholic acid. The right chronic maxillary sinusitis was identified in X-ray findings by her family doctor several years ago. However, it was asymptomatic and was not treated. A physical extra-oral examination was unremarkable. Oral examination revealed an oroantral fistula with a diameter of 3 mm in the posterior alveolar ridge of the right maxilla . By irrigation of the right maxillary sinus through the oroantral fistula, purulent discharge was observed through the fistula.

A panoramic radiograph showed a bone defect at the posterior alveolar ridge of the right maxilla . Computed tomography (CT) showed partial thickening of the mucosal lining and the presence of a hyperdense foreign body with a density of 240 Hounsfield units in the posterior lower part of the right maxillary sinus . The patient was unaware of the presence of the foreign body. Because the upper complete denture was repaired with acrylic resin and relined with silicone soft lining material 36 days before (seven days after the tooth extraction), the foreign body was suspected to be the denture lining material.

Antibiotic therapy with cefditoren pivoxil was conducted for seven days. The oroantral fistula became almost closed. The patient refused to undergo immediate surgical treatment. Low dose macrolide was administered to improve the maxillary sinusitis for a month. However, CT examination showed complete opacification in the maxillary, ethmoid and frontal sinuses on the right side.

The foreign body was removed by endoscopic surgery under general anesthesia 11 weeks after the first visit, and maxillary antrostomy and ethmoidectomy were also performed. First, the maxillary antrostomy was performed. The maxillary sinus was filled with inflamed hypertrophic mucosa and granulation tissue. The foreign body was found and removed endoscopically . After removal of the granulation tissue, markedly inflamed mucous membrane was removed and the residual mucous membrane was irrigated and preserved. Then, anterior ethmoidectomy and revision of the frontal recess were performed. The foreign body was 12 × 6 mm in size, oval in shape, light pink in color, and compatible with silicone soft lining material .

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