Abstract
In recent years, there has been an increase in the number of dental implants, and many complications may arise during implantation. In cases where an artificial tooth is implanted in the maxilla, complications such as acute maxillary sinusitis, oroantral fistula, and displacement of the dental implant to the maxillary sinus may occur due to the anatomical characteristics of the maxilla and the inexperience of providers. The authors report a case of massive maxillary sinus bleeding during dental implant that was controlled successfully by emergency surgery.
In recent years, there has been an increase in the number of dental implants, and many complications may arise during implantation . Since the maxilla is composed of low density cortical bone and short alveolar ridges, there is always the possibility of dental implant failure with other complications such as maxillary sinusitis, oroantral fistula, and displacement of the dental implant to the maxillary sinus . There have been reports of massive haemorrhage resulting from dental implant, usually occurring from the mandible , but bleeding from the maxilla is rare. The authors present a case of maxillary sinus bleeding during dental implant that was controlled without any complications after maxillary sinus osteoplasty with a vascularized pedicled bone flap through a maxillary sinus approach.
Case report
A 54-year-old female patient visited the emergency department following massive nasal bleeding during dental implantation at a local dental clinic. The patient had suffered facial trauma after falling down the stairs 1 year ago, but had not received treatment due to minor injuries. Other than that, there was no record of her taking medications that might have caused bleeding, and no operations or pertinent family history. Her vital signs, checked on admission, were blood pressure 150/90, pulse 126 bpm, respiratory rate 24, and body temperature 36.4°. Physical examination showed a pale face, anaemic conjunctiva, and general weakness. There was active bleeding from the packing gauze in the left nasal cavity, which was applied at the dental clinic, and signs of posterior nasal bleeding. There were no specific findings in the area of the dental implant except swelling of the gingiva. The authors failed to find the origin of the nasal bleeding using an endoscope, and anterior nasal packing was applied. Owing to continuous posterior bleeding, posterior nasal packing was carried out and the patient was admitted for close observation. Posterior nasal bleeding resumed after 6 h, and since the haemoglobin level was 8.6 g/dl, the patient was transfused with one unit of blood. One day after admission, the bleeding was not controlled, and the haemoglobin level measured 7.1 g/dl. It was decided that the patient needed to undergo emergency surgery. Computed tomography showed a dental implant measuring 0.8 cm × 1.2 cm at the base of the left maxillary sinus with a slightly enhanced fluid collection in the surrounding area ( Fig. 1 ).
Maxillary sinus osteoplasty with a vascularized pedicled bone flap through a maxillary sinus approach ( Fig. 2 ) was performed under general anaesthesia. During surgery, the dental implant was found to protrude towards the maxillary sinus covered with a thin layer of mucosa. It was assumed that the bleeding focus was due to injury of the posterior superior alveolar artery.
