Objectives\u00a0 <\/b>Objectives is to describe a com\u00adplex multidisciplinary case.<\/p>\n
Materials and methods\u00a0 <\/b>Odontogenic sinusitis accounts for about 10% of all cases of si\u00adnusitis. The incidence of sinusitis rises dramatically in immunosup\u00adpressed patients, frequently re\u00adquiring a combination of medical and surgical therapy. To the best of our knowledge, this is the first case report to be published re\u00adgarding the management of od\u00adontogenic maxillary sinusitis in an immunosuppressed patient. A 72-year-old female came to our tertiary referral hospital with pro\u00adfound asthenia and slowly-resolv\u00ading hematomas of the lower limbs. Neutropenia was also present. She was diagnosed with acute my\u00adeloid leukemia (AML) on bone mar\u00adrow examination, showing matura\u00adtion arrest of the medullary series, and consequent neutropenia, mye\u00adloid blasts were 33% of total cellu\u00adlar amount. A paranasal sinus CT scan performed for nasal obstruc\u00adtion revealed complete obliteration of the left maxillary, frontal and ethmoidal sinus, with obstruction of the ostiomeatal complex, and the presence of a dental implant in the left alveolar bone. Nasal endos\u00adcopy confirmed ostiomeatal ob\u00adstruction with purulent secretions in the medial meatus. An OPT and odontoiatric assessment led to the diagnosis of peri-implantitis.<\/p>\n
The mandatory treatment for her AML was chemotherapy, which could only be performed in the absence of widespread inflammatory or in\u00adfectious conditions. The patient therefore underwent a combined simultaneous surgical treatment under general anesthe\u00adsia involving functional endoscop\u00adic sinus surgery (FESS) performed jointly by an ENT surgeon and an oral surgeon who implemented an intraoral approach. During the intraoral part of the surgical procedure, a maxillary nerve blockage was performed through the greater palatine ca\u00adnal, under paraperiosteal local an\u00adesthesia of teeth 2.4, 2.5 and 2.6. A full-thickness trapezoidal flap was incised and elevated, reveal\u00ading that two of the three implants were not osteointegrated, while the third was partially osteointe\u00adgrated. All three implants were re\u00admoved with a minimal osteotomy. Granulation tissue was also re\u00admoved and sent for histological examination. Bichat\u2019s bulla was isolated, left pedicled and rotated to form the deep first layer. After periosteal incision, a mucosal flap was advanced and used to form the second layer, using an absorb\u00adable suture. Complete left uncinectomy, medi\u00adal antrostomy, dranage of the pu\u00adrulent secretions from the sinus, frontal sinusotomy and ethmoid\u00adectomy were performed. Granula\u00adtion tissue was also removed from the maxillary sinus and sent for histological examination.<\/p>\n
Histology of the surgical specimens showed mucosal edema with lym\u00adphoplasmacytic cell inflammation of the subepithelial connective tis\u00adsue associated with the aggrega\u00adtion of myeloid blasts. PAS-D stain\u00ading showed no growth of fungal spores, and microbiological exami\u00adnation revealed growth of a mul\u00adtiresistant Klebsiella pneumoniae. Postoperative antibiotic therapy was administered and, 10 days after surgery, the patient started chemotherapy. A combined, multidisciplinary, en\u00addoscopic and intra-oral surgical treatment was adopted, aiming to avoid any severe complications and any need to delay the initiation of chemotherapy.<\/p>\n
Results and conclusions\u00a0 <\/b>The outcome of our surgical ap\u00adproach was excellent, proving an appropriate solution for managing odontogenic sinusitis in this im\u00admunosuppressed patient.<\/p>\n
Clinical significance\u00a0 <\/b>It is fundamental a team coopera\u00adtion treating complex patients.<\/p>\n
Per continuare la lettura gli abbonati possono scaricare l’allegato.<\/i><\/p>\n
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