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Review

Transinusal Pathway Removal of an Impacted Third Molar with an Unusual Approach: A Case Report and a Systematic Review of the Literature

by
Luan Mavriqi
1,†,
Felice Lorusso
2,†,
Gianluca Tartaglia
3,
Francesco Inchingolo
4,‡ and
Antonio Scarano
2,5,*,‡
1
Faculty of Dental Medicine, Albanian University, 1023 Tirane, Albania
2
Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
3
Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20122 Milano, Italy
4
Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy
5
Department of Oral Implantology, Dental Research Division, College Ingà, UNINGÁ, Cachoeiro de Itapemirim 29312, Espirito Santo, Brazil
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
These authors contributed equally to this work.
Antibiotics 2022, 11(5), 658; https://doi.org/10.3390/antibiotics11050658
Submission received: 24 April 2022 / Revised: 5 May 2022 / Accepted: 11 May 2022 / Published: 13 May 2022

Abstract

:
Background: The purpose of the present case report was to investigate a very rare ectopic third molar removal by a trans-sinusal approach and report the study findings through a systematic review of the literature on this topic. Case presentation: A 38-year-old female patient was visited for pain at the level of the right maxillary region. No relevant medical history was reported. The CBCT tomography assessment revealed an impacted third tooth at the level of the postero-lateral maxilla. Review Methods: An electronic search was performed through Boolean indicators query on Pubmed/Medline, EMBASE, Cochrane Library databases. The clinical reports were identified and selected in order to perform a descriptive analysis. The surgical approach concerned a trans-sinusal access to the site for the ectopic tooth removal with a lateral antrostomy. No evident inflammatory alteration was associated to the ectopic tooth and a non-relevant post-operative sequelae was reported at the follow up. Results: A total of 34 scientific papers were retrieved from the database search. Only two cases reported a wait-and-see radiographical follow-up approach, while the most common treatment was surgical removal, also for asymptomatic cases. Conclusion: The third-molar ectopic tooth into the maxillary sinus is an uncommon occurrence that is beast treated by an in-chair intraoral tran-sinusal approach, with a consistent reduction of the invasivity, a mild morbidity and a successful functional outcome.

1. Introduction

Problems with mandibular and maxillary third molars together with maxillary canines are frequently observed in oral surgery and their extraction is one of the most widespread procedures in oral surgery. Clinical and radiologic evaluation of surgical difficulty can help the practitioner plan the surgical technique for avoing the possible complications. Different surgical techniques has been proposed for maxillary ectopic teeth that described trans-oral and Caldwell-Luc approaches, extra-oral accesses [1], nasal endoscopic assisted techniques [2], that take advantage to the teeth clinical presentation and localization in the paranasal cavities. The latter approach has the advantage of visualization of potential orbital floor defects. In the present paper, we report a case of headache, facial pain associated with a retained molar within the maxillary sinus.
Usually, the diagnosis of impacted third molars is performed during the first dentistry visit or during primary care. The extraction of a maxillary wisdom tooth involves the risk of complications. The most frequent complications reported are the displacement in the maxillary sinus [3], oroantral communication [4], displacement into the lateral buccal space [5], into infratemporal fossa [6]. The displaced tooth in the maxillary sinus or oral antral communication are the most frequent complications due to the intimate relationship between the wisdom tooth and the maxillary sinus tooth [7]. The purpose of this case report is to describe the trans-sinusal approach used to remove an impacted maxillary third molar and review the scientific literature regarding the recurrency of the ectopic molars in sinus cavity, the drugs administration and the techniques adopted.

2. Case Report

The present study was conducted in accordance to the ethical laws and the World Medical Association Declaration of Helsinki [8] and the Surgical Case Report (SCARE) guidelines [9].
A 38-year-old female had chronic pain in the maxillary right region and was diagnosed with having an impacted third tooth by orthopantomogram (OPG) (Figure 1).
Clinical examination revealed absence of the right maxillary third molar, radiologic examination excluded the presence of carious or periodontal disease borne by neighboring teeth (Figure 2). The subject did not report a history of restorative or prosthetic treatment procedures performed in the recent years. After clinical examination a Cone Beam Computed Tomography (CBCT) (Vatech Ipax 3D PCH-6500, Fort Lee, NJ, USA) was executed to assess presence of carious, periodontal disease or impacted tooth. The radiograph showed an impacted wisdom without an enlarged follicle much higher with part of the crown and all part of the roots in the distal wall of the sinus maxillary and above the second molar (Figure 2).
After explaining the different surgical possibilities to the patient, we decided to perform a transinusal access. The wisdom extraction was scheduled in an ambulatory setting and under local anesthesia. Prior to surgical treatment, the patient’s mouth was rinsed with a chlorhexidine 0.2% digluconate solution (Curaden Healthcare S.p.A., Saronno, Italy) for 2 min. The local anesthesia was performend by the administration of Articaine® (Ubistesin 4%-Espe Dental AG, Seefeld, Germany) with epinephrine of 1:100,000.. Written informed consent was acquired from the patient for publication of the case report. A modified triangular flap without anterior release was performed as previously described for access to the sinus maxillary [10,11,12]. A window was opened by rosette round bur in the posterior part of the maxillary sinus (Figure 3).
The tooth was observed in the posterolateral aspect of the maxillary sinus, no bone was present around the dental crown and no pericoronal lesion was detected. The maxillary sinus was entered through the Schneiderian membrane and the tooth was dislocated with a lever and then grasped with a klemmer and removed.
The maxillary sinus window was covered by pericardium membrane (Shelter slow, Ubgen, Padova, Italy) [11]. The flap was carefully sutured with Polimid 4.0 (Assut, Magliano de’ Marsi, Italy), which was removed after seven days. An analgesic medication (ibuprofen 600 mg) 2 h following surgery and every 6 h afterward was prescribed, to be continued for 3 days. Also, a single dose of betamethasone 4 mg was given to limit postoperative edema of the face and cheek, and the patient was told not to blow her nose for two weeks to avoid mouth-antral communication. No complication was reported during post operative time. After 1 month the patient describes the disappearance of chronic pain in the right maxillary region.

3. Systematic Review Methodology

3.1. Search Strategies

Screening of the articles was performed in accordance to the Standards for Reporting Qualitative Research principles (SRQR) and the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. The search strategy was conducted on a keywords search strategy as described in Table 1. The initial screening was performed by PubMed/MEDLINE, EMBASE and Cochrane electronic databases (28 January 2022) following the Boolean indicators described in Table 1. The title and abstracts of the scientific studies was evaluated and an initial screening was performed. The articles were limited to randomized and non-randomized human clinical trials, prospective and retrospective studies, clinical case reports and case series with ectopic maxillary third molar into the sinus antrum and the full text was evaluated to conduct the eligibility to the descriptive analysis Table 2.

3.2. Inclusion and Exclusion Criteria

The criteria necessary for inclusion in the qualitative synthesis were limited to human clinical trials, prospective and retrospective studies with a minimum follow up of 1 month with no restriction of surgical technique, alternative medical approach, post-operative sequelae, and number of protocol stages. The exclusion criteria were systematic and literature reviews, letters to the editor, and in vitro and laboratory simulation. The articles written in non-English language were eliminated from the assessment.

3.3. Article Identification Procedure

The eligibility assessment was conducted independently by two expert reviewers (AS, FL). Also, a manual search was conducted to increase the article pool for the full-text assessment. The articles written in English that satisfied the inclusion criteria were considered while the duplicates and the articles excluded were categorized reporting the exclusion reasons.

3.4. Study Assessment

The data of the articles was evaluated independently by the reviewers using a special designed electronic form according to the following categories: study model design, patient’s age, major symptoms, neoplasms or associated neoformations, treatment protocol, surgical technique, post-operative sequelae, position of the teeth, number of subjects and study findings (Table 2). The peri-operative drugs administration has been recorded and discussed.

4. Literature Review Results

4.1. Paper Selection: General Characteristics

The manuscript screening and eligibility, as presented in Figure 1, followed the PRISMA guidelines. The electronic database and manual search output retrieved a total of 154 manuscripts, although a total of 9 duplicates were removed. After the initial screening, a total of 145 manuscript were considered but the full text of 10 papers was not available. The eligibility assessment was conducted on 135 articles and 2 reviews, 71 off-topic papers, 28 non-English papers. A total of 34 articles were selected for the qualitative synthesis (Figure 4).

4.2. Included Study Characteristics

The review selection included a total of 6 case series and 28 case reports for a total of 78 patients, 81 cases and 3 bilateral. The patients’ ages were between 8 years old and 61 years old. No clinical trial/randomized clinical trial related to the review search topic were identified. A total of 12 papers reported asymptomatic cases [13,14,15,16,17,18,19], while the most common main symptoms were chronic nasal obstruction [20,21], bilateral rhinorrhea [20,36,37,47], pus discharge [21,30,31,32,33,34,42], sinusitis [22,29,40,42,44,45], pain and swelling [23,33,35,36,37]. A total of 26 cases reported an associated dentigerous cyst [13,16,17,21,22,24,29,30,32,33,35,38,39,40,42,43,44,45], 2 cases of associated inflammatory cyst [25,26] and 1 case of associated osteoma [41]. In 2 subjects a “wait and see” approach was followed with a radiographical follow up very year [17,31]. In 11 cases an endoscopic approach was performed [13,14,19,21,26,27,28,29,40,41,42], while a total of 21 cases received a Caldwell-Luc antral approach [14,16,22,24,25,26,27,28,30,32,33,34,35,36,37,38,39,41,43,44,46]. The post-operative sequelae were often associated to a mild healing symptoms, while in some cases peri-orbital emphysema, transient cheek numbness and bleeding was present [13]. Referring to the wisdom molar position, the most frequent presentation was associated to the inferior and inferomedial wall [13,14,29,44]. Less frequent were the orbital wall presentation [13,16,19,38], the sinus floor [13,44], medial and postmedial wall [20,22,26,28,29,32,33,35,36,39,40,42].

4.3. Drug Administration Protocols

Very few information has been detected concerning the peri-operative antibiotics and analgesic protocols in the included studies. An heterogeneous antibiotics prophylaxis administration was reported while the most common were amoxicillin [23,46], amoxicillin combined with clavulanate potassium [26]. The most frequently administered analgesic therapy or non-steroidal anti-inflammatory substance were [16,19] diclofenac sodium [23], acetaminophen [46], nimesulide, and paracetamol [26]. Prolonged nasal decongestion therapy was adopted to reduce post-operative sinusitis occurrence [20].

5. Discussion

In the present case report we describe the clinical characteristics of a patient with a wisdom tooth in the maxillary above the second molar that which caused chronic pain. Maxillary third molar extraction is a frequent surgical intervention in oral and maxillofacial surgery. As also evinced by the review of the literature, in this particular case the clinical presentation of the ectopic tooth was very rare and associated to the postero-lateral wall of the maxilla. In fact, the rationale of the present investigation was to contextualize the literature recurrency of this particular clinical condition and support a transinusal approach for impacted upper third molar. Many factors can influence ectopic tooth, including trauma presence of benign or malignant lesions including rhinogenic and odontogenic infections or iatrogenic activity [48,49]. The present case report represents a very rare case of a wisdom tooth producing pain without local sinus symptoms and inflammation. We decided to extract the tooth by transinusal pathway removal because this approach was found to be simpler and avoided all lesion of the second molar and for the high risk of displacement of the tooth into the maxillary sinus. In this case we would still have had to access the maxillary sinus to remove the tooth. Moreover, the transinusal approach is more invasive but the visibility is considerably better. However, this type of approach could be complicated by sinusitis or an oroantral fistula. In literature, a total of 34 cases were retrieved from the systematic analysis that reported having ectopic wisdom teeth in the maxillary sinus that can cause symptoms such as headache, facial pain, sinusitis or swelling, nasal obstruction, rhinorrhea compressing the nasolacrimal canal [50,51] or can be completely asymptomatic [48,52]. According to the present systematic search, the age of diagnosis is very heterogeneous and symptoms-correlated, while the most common presentation of ectopic upper third molar was associated to a posterior wall (24.13%), the lateral wall (22.41%), the medial wall (18.96%), inferior wall (17.24%), orbit floor (15.51%). The ectopic third molar is relatively rare at the level of the antrum anterior wall (1.72%). According to the drug prophylaxis, the antibiotics therapy is often administered through amoxicillin or amoxicillin/clavulanate combination associated to non-steroidal anti-inflammatory protocol [23,46]. The adopting of a prolonged nasal decongestion therapy is useful to reduce post-operative sinusitis sequelae. The using of corticosteroid is not always prescribed in literature [20]. The patient presented with headache, facial pain without inflammatory pericoronal lesion sign or sinusitis, that were confirmed by CBCT. In the case presented, a single dose of betamethasone was administered to avoid local edema, while no complications were reported during healing period with a complete recovery time of 1 month from the surgery. In the literature different approaches were proposed for managing ectopic teeth in the maxillary, such as extra and trans-oral approaches [1] or endoscopic assisted procedures [2], or the endoscopically assisted Caldwell-Luc approach [53,54]. The latter approach has the advantage of visualization of potential orbital floor defects. In the present paper, we report a case of headache, facial pain associated with a retained molar within the maxillary sinus.

6. Conclusions

In conclusions, the ectopic teeth localization could deeply influence the clinical manifestation, symptoms and the surgical approach to reduce the post-operative morbidity and complications sequelae. In order provide a useful guidance for surgeons and dentists for the management of ectopic wisdom in clinical practice, the transinusal pathway approach combined with the antibiotic prophylaxis and corticosteroid administration could reduce the post-operative symptoms reducing the face edema and accelerate the recovery period.

Author Contributions

L.M., F.L., G.T., F.I. and A.S. were involved with the literature review and performance of the surgery. All authors have read and agreed to the published version of the manuscript.

Funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Institutional Review Board Statement

The present clinical study was based in accordance to the ethical laws and the World Medical Association Declaration of Helsinki and the additional requirements of Italian legislation. Moreover, the University of Chieti-Pescara, Italy, classified the present study to be exempt from ethical review as it carries only negligible risk and involves the use of existing data that contains only non-identifiable data about human beings.

Informed Consent Statement

Written informed consent was acquired from the patient for publication of the case report. The requirements of the Helsinki Declaration were observed, and the patient gave informed consent for all surgical procedures. Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Data Availability Statement

All data generated or analyzed during this study are included in this published article.

Acknowledgments

The authors acknowledge the support of Carlo Barbone for tomography execution and radiograph elaboration of the present investigation.

Conflicts of Interest

Antonio Scarano, Gianluca Tartaglia, Felice Lorusso, and Francesco Inchingolo declare that they have no competing interests.

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Figure 1. Impacted symptomatic 18 on OPG.
Figure 1. Impacted symptomatic 18 on OPG.
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Figure 2. Coronal section shows wisdom tooth much higher with part of the crown and all part of the roots in the distal wall of the sinus maxillary and above the second molar.
Figure 2. Coronal section shows wisdom tooth much higher with part of the crown and all part of the roots in the distal wall of the sinus maxillary and above the second molar.
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Figure 3. A modified triangular flap without anterior release was performed for access to the sinus maxillary (A). A window by rosette round bur was opened in the posterior part of the maxillary sinus (B). After dislocation the wisdom tooth was aspirated (C).
Figure 3. A modified triangular flap without anterior release was performed for access to the sinus maxillary (A). A window by rosette round bur was opened in the posterior part of the maxillary sinus (B). After dislocation the wisdom tooth was aspirated (C).
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Figure 4. Prisma flowchart of the database search and study retrieval process.
Figure 4. Prisma flowchart of the database search and study retrieval process.
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Table 1. Electronic database boolean search: keyword strategy.
Table 1. Electronic database boolean search: keyword strategy.
Search Strategies
Keywords:Advanced keywords search:
((ectopic OR wisdom OR Third molar) AND teeth AND maxilla* sinus))
DatabasesPubmed/Medline, EMBASE, Cochrane Library
Table 2. Articles selection descriptive synthesis.
Table 2. Articles selection descriptive synthesis.
AuthorsJournalStudy DesignAgePrincipal SymptomsLesionsTreatment ProtocolTechniquePost Operative SequelaeDrug TherapyPositionSubject(s)Study Findings
Masalha et al. [13]J Clin Exp DentCase seriesRange 16–61 yo(1) Sinonasal symptoms (7),
(2) asymptomatic (2),
(3) oro-antral fistula (1)
dentigerous cyst (8)Lesion enucleation/exodontiatransnasal endoscopic approach (TEA)(a) self-limited periorbital emphysema (1)
(b) transient cheek numbness (1)
(c) early post-operative bleeding (1)
-(a) Inferior wall (n = 1)
(b) Inferior/Medial wall (n = 2)
(c) Orbital floor (n = 3)
(d) Floor (n = 3)
(e) Anterior/medial
wall (n = 1)
(f) Lateral wall (n = 1)
10 subjects (11 cases)Trans-nasal Endoscopic surgery is feasible and safe
Allen et al. [14]J Surg Case RepCase report14 yoasymptomatic-ExodontiaCaldwell–Luc endoscopic approach with maxillary antrostomyPostoperative period unremarkable.-Posterior inferior maxillary sinus1 subjectThe transoral removal of the tooth in pediatric subject with no anterior nasal trauma.
Yagiz et al. [15]J Stomatol Oral Maxillofac Surg.Case report38 yoasymptomatic-ExodontiaIntraoral exodontiaPostoperative period unremarkable.-Lateral wall1 subjectThe tooth evidence on the OPT was ghost image of the impacted distomolar at the contralateral side
Balaji et al. [16]Indian
J Dent Res
Case report42 yoasymptomaticdentigerous cystExodontiaIntraoral Caldwell Luc procedurePostoperative period unremarkable.Antibiotic coverage and non-steroidal anti-inflammatory drugs were administered for 5 daysOrbit floor1 subjectAn ectopic distomolar along the floor of the orbit with dentigerous cystic features is rare.
Liu et al. [17]J Int Med ResCase report6 yoasymptomaticdentigerous cystNo intervention-Postoperative period unremarkable.-Posterior wall1 subjectA congenital bone defect was observed in the posterior wall of the maxillary sinus
Lai et al. [18]J Radiol Case RepCase report52 yoasymptomatic-ExodontiaIntraoral maxillary antrostomyPostoperative period unremarkable.-posterolateral wall1 subjectEctopic tooth in the maxillary sinus is a rare condition
Viterbo et al. [19]J Craniofac SurgCase report29 yoasymptomatic-Exodontiaendoscopic sinus surgeryPostoperative period unremarkable.Antibiotics was administered from the day before the surgery and prolonged for 5 days postoperatively. Corticosteroid and analgesic administration was provided.Floor of the orbit1 subjectIf untreated, this occurrenc could determine infections or develop a cyst
Lombroni et al. [20]Indian J Dent ResCase report37 yochronic nasal obstruction and moderate bilateral rhinorrhea-radiology follow-up--Prophylaxis associated to prolonged nasal decongestion therapy was administeredMedial wall1 subjectThe follow up approach is mainly for asymptomatic patients, preferring periodic checks every 6–8 months
Liau et al. [21]J Craniofac SurgCase report63 yochronic nasal obstruction with associated intraoral discharge. Tuber chronic oroantral fistuladentigerous cystLesion enucleation/exodontiaendoscopic-assisted middle meatal antrostomies surgeryPostoperative period unremarkable.-Posterosuperior wall1 subjectThe combined technique with of endoscopic visualisation for a Caldwell-Luc approach
Datli et al. [22]J Craniofac SurgCase report41 yoChronic Sinusitisdentigerous cystLesion enucleation/exodontiaCaldwell-Luc maxillary antrostomy/Penrose drainPostoperative period unremarkable.-posteromedial-lateral walls1 subjectDentigerous cysts caused by an ectopic tooth should be resected
Rai et al. [23]Indian J Dent ResCase report46 yocomplaints of watering from the left eye, pain and swelling-ExodontiaIntraoral maxillary antrostomyPostoperative period unremarkable.Amoxicillin (500 mg × 3/day) for a week and diclofenac sodium (50 mg × 2/day) were administered for 5 daysLateral/superior wall1 subjectIntraoral approach is superior to the extraoral and endoscopic approach
Kara et al. [24]J Istanb Univ Fac DentCase report16 yoexpansile swellingdentigerous cystLesion enucleation/exodontiaMarsupialization, Caldwell-Luc maxillary antrostomy (2 stage surgery)Postoperative period unremarkable.-Posterosuperior wall1 subjectMarsupialization and enucleation was preferred for treatment, because of size of cyst and anatomical relationship of tooth.
Touiheme et al. [25]Pan Afr Med JCase report23 yoFacial pain, chronic synusitis and mucopurulent rhinorrhoeaInflammatory cystLesion enucleation/exodontiaCaldwell-Luc maxillary antrostomyPostoperative period unremarkable.-Lateral wall1 subjectThe extraction can be performed by conventional approach or by transnasal endoscopic approach with less morbidity.
Chagas Júnior et al. [26]Craniomaxillofac Trauma ReconstrCase report60 yoFacial trauma (age 6), claiming breathing and phonatory difficultiesInflammatory cystExodontiacombined approach of endoscopic sinus surgery and Caldwell-Luc procedurerecurrent oroantral fistula.Amoxicillin Clavulanate Potassium (875 mg + 125 mg) each 12 h for two weeks, Nimesulide (100 mg) every 12 h for 4 days, paracetamol (750 mg) every 6 h in case of pain or feverMedial/superior wall1 subjectThe Caldwell-Luc was chosen to remove the cyst adjacent
Saleem et al. [27]Head Face MedCase report45 yohaemoptysis.-Exodontiaendonasal endoscopic uncinectomy and Caldwell-Luc maxillary antrostomyPostoperative period unremarkable.-Lateral- superior wall1 subjectPresence of foreign bodies and ectopic teeth in paranasal sinuses can be reliably excluded
Topal et al. [28]Turk Arch OtorhinolaryngolCase report32 yoleft buccal mucosa was diffusely edematous.-Exodontiacombined approach of endoscopic sinus surgery and Caldwell-Luc procedurePostoperative period unremarkable.-Medial wall1 subjectSurgical removal is required for complicated patients.
Abd El-Fattah et al. [29]Clin OtolaryngolCase seriesRange 28–48 yoLoosening of tooth, Sinusitis, Ocular paindentigerous cystLesion enucleation/exodontia(1) Endoscopic-assisted transoral sublabial approach
(2) Endoscopic endonasal through middle meatal antrostomy
(3) Endoscopic endonasal pre-lacrimal approach
Postoperative period unremarkable.-(a) Inferior wall (n = 5)
(b) Superior wall (n = 2)
(c) Medial wall (n = 2)
(d) Lateral wall (n = 2)
11 subjectsEctopic teeth associated with cysts in the could be removed with the endoscopic/endoscopic-assisted approaches
Guruprasad et al. [30]J Clin Imaging SciCase report21 yonasal discharge of pus, Swellingdentigerous cystLesion enucleation/exodontiaCaldwell-Luc maxillary antrostomyPostoperative period unremarkable.-Lateral wall1 subjectManagement of dentigerous cyst arising from ectopic third molar in the maxillary sinus is usually enucleation.
Di Felice et al. [31]Aust Dent JCase report35 yonasal discharge of pus, Swelling-radiology follow-up-Solved through antibiotic theraphy-Postero-lateral wall1 subjectTreatment of ectopic teeth in the maxillary sinus is usually surgical extraction.
Kasat et al. [32]Contemp Clin Dent.Case report22 yonasal pus dischargedentigerous cystLesion enucleation/exodontiaIncisional biopsy, Caldwell-Luc procedurePostoperative period unremarkable.-posteromedial-lateral walls, Oro-antral fistula1 subjectOccurrence of an ectopic tooth in the maxillary sinus and association of a dentigerous cyst with it is a rare
phenomenon.
Sharma et al. [33]Int J Surg Case RepCase report27 yonasal discharge and facial paindentigerous cystLesion enucleation/exodontiaIntraoral Caldwell Luc procedurePostoperative period unremarkable.-medial wall (2)1 subject (bilateral)Dental ectopia may occur in antrumand present
Jendi et al. [34]Indian J Otolaryngol Head Neck SurgCase report24 yonasal discharge and heaviness-ExodontiaIntraoral Caldwell Luc procedurePostoperative period unremarkable.-Lateral nasal wall1 subjectLess invasive transnasal endoscopic shaver-assisted technique has been advocated for the retrieval of any foreign body
Ramanojam et al. [35]Ann Maxillofac SurgCase seriesRange 21–32 yoPain and swelling cheek, pain ATM joint (1), Asymptomatic (1)dentigerous cyst (1)ExodontiaCaldwell-Luc procedurePostoperative period unremarkable (5).
hypoaesthesia of infraorbital nerve (1)
-(a) Medial wall6 subjects (6 cases)The endoscopic techniques are being used for removal of an intranasal ectopic tooth
Mohan et al. [36]Natl J Maxillofac SurgCase report28 yoPain and swelling, purulent rhinorrhea-ExodontiaCaldwell-Luc procedurePostoperative period unremarkable.-Superomedial wall1 subjectIf untreated, it has the tendency to form a cyst or tumor and/or the lesion may cause perforation of the orbital floor and obliteration of the nasal cavity
Thakur et al. [37]BMJ Case RepCase report25 yoPain and swelling, purulent rhinorrhea ExodontiaCaldwell-Luc procedurePostoperative period unremarkable.-Lateral- Inferior wall1 subjectIt is important as certain antral diseases like dentigerous cyst, odontogenic keratocyst may co-exist with an ectopic molar
Demirtas et al. [38]J Craniofac SurgCase report19 yopain, discomfort, and fullness in the right cheekdentigerous cystLesion enucleation/exodontiaFirst marsupialization, second enucleation with
Caldwell-Luc approach (2 stage surgery)
Postoperative period unremarkable.-Floor of the orbit1 subjectEarly diagnosis and treatment of these lesions allow a reduced patient’s morbidity
Srinivasa Prasad et al. [39]Indian J Dent ResCase report45 yorecurrent purulent rhinorrheadentigerous cystLesion enucleation/exodontiaCaldwell-Luc procedurePostoperative period unremarkable.-Postero-medial wall1 subjectThe treatment of an ectopic tooth in the maxillary sinus is usually removal
AlKhudair et al. [40]Int J Surg Case RepCase report19 yorecurrent sinusitisdentigerous cystLesion enucleation/exodontiaendoscopic-assisted middle meatal antrostomies surgeryPostoperative period unremarkable.-(a) Lateral wall
(b) Medial wall
1 subject (bilateral)The endonasal endoscopic approach is a minimally invasive approach
Aydın et al. [41]Balkan Med JCase report21 yoSinus infection, oro-antral fistulaOsteomaLesion enucleation/exodontiaendonasal endoscopic uncinectomy and Caldwell-Luc maxillary antrostomyrecurrent oroantral fistula.-Posterior wall1 subjectA pediatric maxillofacial trauma might cause the eruption of the tooth
Almomen et al. [42]J Surg Case RepCase report-Sinusitis, nasal dischargedentigerous cystLesion enucleation/exodontiatransnasal endoscopic approach (TEA)Postoperative period unremarkable.-medial wall1 subjectThe endonasal endoscopic approach is a direct minimally
invasive procedure
Buyukkurt et al. [43]Oral Surg Oral Med Oral Pathol Oral Radiol EndodCase seriesRange 19–32 yoSwelling, paindentigerous cystLesion enucleation/exodontiaCaldwell-Luc procedurePostoperative period unremarkable.-(a) Latero-inferior wall (1)
(b) Postero-inferior wall (1)
(c) Lateral wall (1)
3 subjects (3 cases)Transnasal extraction may be attempted if the tooth is small and near the ostium
Bodner et al. [44]J Laryngol OtolCase series-Swelling, pain, acurte sinusitisdentigerous cystLesion enucleation/exodontiaCaldwell-Luc procedurePostoperative period unremarkable.-(a) Inferior-lateral wall (3)
(b) Lateral wall (7)
Supero-llateral wall
12 subjectsCT is useful for diagnosis and treatment planning of teeth in the maxillary antrum
Baykul et al. [45]Auris Nasus LarynxCase seriesRange 15–52 yoSwelling, pain, acurte sinusitisdentigerous cyst (1)(a) radiology follow-up (2)
(b) lesion enucleation/exodontia (7)
Endoscopyc assisted surgery removalPostoperative period unremarkable.-Postero-lateral wall9 subjects (4 cases of ectopic 3rd molar)Ectopic tooth in the maxillary sinus may lead to the misdiagnosis of sinusitis
Elmorsy et al. [46]F1000ResCase report13 yo dentigerous cystLesion enucleation/exodontiaIntraoral Caldwell Luc procedurePostoperative period unremarkable.
the bone requiring longer time to form and be detected radiographically
−500 mg amoxicillin/8 h/5 days
−325 mg acetaminophen/4 h/day
−4 mg betamethasone
posterosuperior wall1 subjectAsymptomatic cases should be managed with a similar protocol due to their tendency to form cysts or malignancies.
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Mavriqi, L.; Lorusso, F.; Tartaglia, G.; Inchingolo, F.; Scarano, A. Transinusal Pathway Removal of an Impacted Third Molar with an Unusual Approach: A Case Report and a Systematic Review of the Literature. Antibiotics 2022, 11, 658. https://doi.org/10.3390/antibiotics11050658

AMA Style

Mavriqi L, Lorusso F, Tartaglia G, Inchingolo F, Scarano A. Transinusal Pathway Removal of an Impacted Third Molar with an Unusual Approach: A Case Report and a Systematic Review of the Literature. Antibiotics. 2022; 11(5):658. https://doi.org/10.3390/antibiotics11050658

Chicago/Turabian Style

Mavriqi, Luan, Felice Lorusso, Gianluca Tartaglia, Francesco Inchingolo, and Antonio Scarano. 2022. "Transinusal Pathway Removal of an Impacted Third Molar with an Unusual Approach: A Case Report and a Systematic Review of the Literature" Antibiotics 11, no. 5: 658. https://doi.org/10.3390/antibiotics11050658

APA Style

Mavriqi, L., Lorusso, F., Tartaglia, G., Inchingolo, F., & Scarano, A. (2022). Transinusal Pathway Removal of an Impacted Third Molar with an Unusual Approach: A Case Report and a Systematic Review of the Literature. Antibiotics, 11(5), 658. https://doi.org/10.3390/antibiotics11050658

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