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Research Foreign Body Displacement for the Maxillary Sinus and Surgical Removal by the Caldwell-Luc Technique: Clinical Case

Until some time ago it was relatively rare, the presence of foreign bodies in the sinuses of the face and the most commonly found ones were of residual roots or even of dental elements that by intimal conditions were introduced in the maxillary sinus, practically being remnants of perforating traumas. With the advent of the Age of Implantology, it has become more common to find cylinders introduced into the maxillary sinuses, mainly due to failure in surgical planning, lack of preparation of the specialty, or even failures at the time of cylinder placement, culminating in an important iatrogeny. The frontal and maxillary sinuses are the most frequently involved although there are reports involving the ethmoid and sphenoidal sinuses. This article reports the case of a patient with a foreign body in the maxillary sinus, the removal of which was performed using the Caldwell-Luc technique, with successful surgery, presenting good patient recovery.


Introduction
The maxillary sinus is represented by a pneumatized space, located bilaterally, inside the maxillary bone. The displacement of foreign bodies into its interior is a commonly encountered occurrence resulting from penetrating insults, as in high-energy kinetic traumas, in which objects (firearm projectiles, pieces of glass, stones, wood, and many others) Can be thrown into the breast and also during dental procedures when teeth, tooth roots, dental cement, printing paste, gutta percha cones, dental amalgam, implant cylinders, can also be thrown into the interior, characterizing Important iatrogenic 1, 3,7,9,10. In dental medicine it is common to find errors before, during and after treatments, and these iatrogenies can occur in all phases of the dental act, from the relationship with the patient, in the diagnosis, and in the treatment. The main and most common reasons refer to lack of planning, diagnostic error, human failures during treatment and accidents 2, 8,10.
To minimize the occurrence of these errors, the traditional sequence in clinical care must be strictly adhered to, ie a detailed anamnestic harvest, followed by meticulous physical examination, the request for complementary tests, the construction of diagnostic hypotheses and only from this point to decide Which conduct to be adopted, aiming at effectiveness and success in the planned conduct. 8.11 The Dentist when identifying the presence of a foreign body in the maxillary sinus has a challenge in both the diagnosis and the surgical procedure, since factors such as size of the object, difficulty of access, anatomical proximity of the foreign body to the adjacent vital structures must be taken In consideration for the choice of the best surgical technique 6,7,9.
The Caldwell-Luc technique has been suggested as a means of access to the maxillary sinus, allowing its inspection and treatment of the diseases that affect it. This technique is used for the treatment of irreversible chronic maxillary sinusitis, removal of dental roots and foreign bodies, excision of antrochoanal polyps, mucoceles, pioceles, tumors, odontogenic cysts and repair of fistulas 3,4,5,6,11 Currently, the patient is being followed up, with no complaints or episodes of inflammatory process recurrence, as well as any alteration of normality in the maxillary sinus.
The present report aims to present a clinical case of displacement of a dental implant into the maxillary sinus and its surgical removal through a bone window in the lateral wall of the maxilla by the technique of Caldwell Luc.

Case Report
Patient RSN, female, 52 years old, white skin, attended the Clinic referred by another professional for assessment, diagnosis and therapeutic conduct, and the reason for the consultation was for evaluation of foreign body in the maxillary sinus. In the anamnesis the patient reported that at the time of placing the dental implant there was the displacement into the maxillary sinus. Imaging, Panoramic Rx and Cone-Beam Tomography ( Figure 3) were performed, which are important for the diagnosis and treatment planning to be recommended.

FINAL CONSIDERATIONS
With the possibility of accidents occurring during surgical procedures and the presence of foreign body penetration in the maxillary sinus in routine dental care, it is of great relevance for dentists the complete anatomical domain of the region and the specific training for Interventions when necessary.
Panoramic radiography is the most commonly used complementary exam, although it can cause a widening measured around 25%. In this perspective, the location of a foreign body in a two-dimensional radiographic plane is difficult, requiring three-dimensional images that are provided by computed tomography.
Treatment of changes in the maxillary sinus, especially the removal of foreign bodies, is frequently reported in the literature using the Caldwell-Luc technique, although there are reports of alterations in the maxillary sinus after this type of surgery, such as fibro-osseous proliferations, and Antral contraction. The Caldwell-Luc technique allowed easy access and visualization of the foreign body and altered mucosa allowing easy removal.
To minimize the occurrence of iatrogenies, the traditional sequence in clinical care must be strictly adhered to, ie a detailed anamnestic harvest, followed by meticulous physical examination, the request for complementary tests, the construction of diagnostic hypotheses and only from this point decide Which conduct to be adopted, aiming at effectiveness and success in the planned conduct promoting health and improvements in patients' quality of life.