CEFALEA Y RINITIS REFRACTARIAS SECUNDARIAS A IMPLANTE DENTAL

Abstract

INTRODUCTION: Dental implants are prosthetic devices that are inserted into the thickness of the bone of the maxilla for osseointegration using a screw system. They are increasingly used for both functional and aesthetic reasons. As in any medical or surgical procedure, there are some typical risks and possible sequelae that must be explained and prevented. However, sometimes not-associated-with-implantation rare complications that can cause great morbidity and decrease in the quality of life of the implant recipient can occur. A case of an unusual complication is reported,MATERIAL AND METHODS: A 65-year-old woman presented with a permanent mainly right-sided bilateral nasal obstruction with frequent watery rhinorrhea and headache with retro-orbital and infraorbital irradiation refractory to broad-spectrum antibiotic treatment, corticosteroids and analgesics that she associated with a dental implant two weeks before. . Sinusitis or implant-related complication were ruled out by the dentist and her Primary Care Physician, and therefore she was referred to otorhinolaryngological assessment after radiological study with maxillary sinuses free of disease. The physical examination demostrated inferior obstructive hypertrophic turbinates from the anterior third and thick clear rhinorrhea. After topic tetracaine with adrenaline ,retraction of the turbinates revealed a screw that after breaking the floor of the right nostril entered the thickness of the inferior turbinate. In the left nostril, soil procidence is identified with turbinal contact. An orthopantomography demonstrated the findings described above, highlighting also how the implant was inserted into the skeleton of the inferior turbinate. The sympthoms resolved after removal of the implant. Topical oxymetazoline and corticosteroids provided little relief meanwhile. DISCUSSION AND CONCLUSIONS: The functional objectives sought with dental implants can be compromised by complications such as the one described. Penetration of the implant into the maxillary sinus is not frequent although it is a typical risk, which may be favored by bone loss of the maxilla. Less frequent is the imprint or penetration in the nostril. These problems are generally due, according to the literature, to lack of experience or poor planning or measurement. However, in the reported case, this error is rude, as the penetration into the nose is bilateral and, in addition, in the right nasal fossa it is massive, with the consequences described both by the turbinal lesion and by foreign body effect. In these cases, the implant must be removed as the first and mandatory measure. Any nasal or sinus-related symptoms that appear after the placement of a dental implant, a possible complication should be investigated by means of nasal endoscopy folowing topical adrenaline application to improve the visualization of the sinus meatus, and a directed radiological study (CAT scan, orthopantomography).