The Tooth in the Maxillary Sinus as a Complication During Extraction of the Upper Wisdom Tooth

Abstract

Svi udžbenici oralne kirurgije spominju među mogućim komplikacijama tijekom vađenja zuba i uguravanje korijena zuba ili cijeloga zuba u maksilarni sinus. Dok je prva komplikacija razmjerno česta, i s njom se oralni kirurzi susreću gotovo danomice, uguravanje cijeloga zuba u maksilarni sinus nije uobičajena komplikacija. Dva slučaja umnjaka u maksilarnome sinusu primljena su prošle godine na liječenje u Klinički zavod za oralnu kirurgiju KB “Dubrava”, Zagreb. U oba se slučaja radilo o komplikaciji nastaloj za vrijeme alveotomije gornjih retiniranih umnjaka. U oba slučaja zubi su skliznuli u sinus za vrijeme rada Beinovom polugom. Pacijenti su hospitalizirani i nakon potrebne obradbe u općoj su anesteziji provedene ekstirpacije zuba pristupom kroz facijalnu stjenku. Nakon što su odstranjeni zubi, izvršene su tamponade dna sinusa jodoformnom gazom koja je izvedena u usta u prednjem dijelu reza i odstranjena treći dan nakon zahvata. Pošto su odstranjeni šavovi, pacijenti su nadzirani do prestanka objektivnih i subjektivnih smetnji i time je liječenje bilo završeno. Primjeri se pokazuju kako bi se upozorilo da se komplikacija, za koju se obično misli da postoji samo u knjigama, može dogoditi svakome od nas. U tome smislu savjetujemo opreznu upotrebu klijeπta samo u slučajevima kada je zub moguće obuhvatiti preko ekvatora njegove krune, a s određenim ogradama umjesto Beinove poluge preporučujemo bilo koju od parnih poluga koje obično upotrebljavamo u donjoj čeljusti za vađenje korjenova donjih višekorijenskih zuba.All textbooks on oral surgery mention the pushing of the tooth root or the whole tooth into the maxillary sinus as one of the possible complications during tooth extraction. While the first complication is relatively frequent and oral surgeons come across it almost every day, pushing of the whole tooth into the maxillary sinus is an uncommon complication. Two cases of the wisdom tooth in the maxillary sinus were admitted last year for treatment in the Clinical Department of Oral Surgery. Both cases were complications which occurred during alveotomy of upper impacted wisdom teeth. In both cases the teeth had slid into the sinus during work with Bein\u27s elevator. The patients were hospitalised and after the necessary analyses extirpation of the teeth was performed under general anaesthesia by an approach through the facial wall. After removal of the teeth tamponade of the floor of the sinus was done with Jodoform gauze, which was carried out in the mouth in the frontal part of the cut and removed on the third day after the operation. After removal of the sutures the patients were monitored until objective and subjective problems ceased. The examples are presented in order to warn that complications which are commonly thought of as only occurring in books, can happen to each of us. With this in mind we recommend the careful use of forceps only in cases when it is possible to grasp the tooth through the equator of its crown, and with some reservation instead of Bein\u27s lever we recommend any of the elevators which are normally used in the mandible for extracting the roots of multi-rooted teeth