Exclusive Endonasal Endoscopic Removal of an Old, Retained, Displaced Tooth Fragment Causing Isolated, Refractory,...

Inadvertent displacement of tooth fragments into the maxillary sinus is a known complication of dental extraction that can be managed instantaneously or soon thereafter through conventional techniques like Caldwell-Luc, alveolar crestal, and lateral approaches. However, if the event remains unidentified or ignored, recalcitrant sinus infection and intra-sinus tooth migration may result. The situation can then be difficult to investigate and treat.This report illustrates using a nasal endoscope in an exclusive endonasal approach in a 28-year-old man to extract an undiagnosed, retained tooth fragment displaced into the maxillary sinus during a dental extraction procedure four years ago, resulting in refractory, isolated chronic maxillary sinusitis. The effect of delayed diagnosis on clinical presentation and surgical decision-making, and the hurdles encountered at surgery, are discussed. Otolaryngologists require a high index of suspicion of a retained, infected tooth as the etiology of maxillary sinusitis. Conventional techniques provide limited surgical field and may be unsuitable in florid sinusitis, when the tooth migrates along the upstream mucociliary beat, and when the oro-antral fistula heals. In contrast, an exclusive endonasal endoscopic approach through middle meatal antrostomy is less invasive and provides wider exposure, but is seldom practiced and documented. Dealing with a grossly infected sinus and an intra-sinus tooth at an unpredictable depth is challenging. The benefits of endoscope-guided access being increasingly recognized in oro-dental interventions, this paper calls for a liaison between oral-maxillofacial surgeons and otolaryngologists in dealing with unforeseen complications related to maxillary sinus and the dentition at its floor.

The online version contains supplementary material available at 10.1007/s12070-025-05490-9.