Incisive dental implant migration into the nasal septum

Abstract

We report the clinical case of a female patient who presented to our emergency department due to a septal abscess caused by the displacement of a dental implant into the nasal septum. The patient underwent surgical treatment for endoscopic foreign body excision and septal abscess drainage. Despite the presence of septal cartilage destruction, the L-shaped structure was preserved and no reconstruction was required. Postoperative healing was uneventful.

Background

Oral rehabilitation with osseointegrated dental implants has become a routine procedure in dentistry practice.

Despite this procedure being usually safe, cases of migration of dental implants into the paranasal sinus and orbit have been described.¹

We report the clinical case of a patient submitted to incisive dental implant complicated by the migration of the implant to the nasal septum with concurrent septal abscess.

There have been several reports of migration of dental implants into the maxillary sinus and less commonly to other adjacent craniofacial structures. As far as we know, there are no reports of migration of a dental implant to the nasal septum in the literature.

Case presentation

A woman aged 37 years, with no relevant personal history, presented to our emergency department due to nasal obstruction and nasal pain. She reported onset of symptoms after dental implant placement in the upper incisive region 1 week ago with progressive worsening of complaints. She mentioned that the surgery for dental implant positioning was uneventful and denied any complications in the immediate postoperative period. She reported having performed a preoperative dental panoramic X-ray which did not reveal any alterations, according to her dentist. Despite not reporting any local pain or swelling in the gingival mucosa, she reported progressive nasal complaints during the following week. She denied having fever, history of nasal trauma or illicit drug use. She was a non-smoker and non-drinker and was not actively taking any medications.

On examination, a suture was visible on the median upper gingival mucosa with no signs of complication. Anterior rhinoscopy demonstrated bilateral bulging of the anterior septum with exuberant oedema and erythema of mucosa conditioning complete bilateral obliteration of nasal cavity (figure 1). The remainder of the head and neck examination was unremarkable.

Figure 1.

Anterior rhinoscopy demonstrating bulging of the anterior septum with exuberant oedema and erythema of mucosa conditioning complete obliteration of nasal cavity.

Investigations

The patient underwent CT of nose and paranasal sinuses, which revealed the presence of a foreign body inside the nasal septum, superior to the maxillary crest and covered by septal mucosa with a component of abscess and associated septal cartilage destruction (figures 2-5).

Figure 2.

CT scan (coronal view) demonstrating the presence of a foreign body in the septal region with associated soft tissue thickening.

Figure 3.

CT scan (axial view) demonstrating the presence of a foreign body in the septal region with associated soft tissue thickening.

Figure 4.

CT scan (sagittal view) demonstrating the presence of a foreign body in the septal region with associated soft tissue thickening.

Figure 5.

CT scan (sagittal and axial view) demonstrating the bone defect left by the implant placement procedure (red circle).

Treatment

The patient underwent surgical treatment for foreign body excision and septal abscess drainage (figures 6-8). Despite the presence of destruction of the septal cartilage, the L-shaped structure was preserved and no reconstruction was required. Septal splints and nasal packing using absorbable material (NasoPore) were placed.

Figure 6.

Intraoperative visualisation of septal abscess.

Figure 7.

Intraoperative drainage of septal abscess.

Figure 8.

Intraoperative finding of foreign body in the nasal septum.

The patient was discharged from the hospital the following morning, medicated with a 7-day antibiotic treatment with amoxicillin-clavulanate, analgesia and nasal irrigation.

Outcome and follow-up

Nasal stents were removed in the first postoperative consultation, 8 days after surgery. Postoperative healing was uneventful with complete resolution of local inflammatory signs, without septal perforation or nasal deformity and the patient denied nasal obstruction (figure 9).

Figure 9.

Postoperative control on consultation after 2 weeks of foreign body removal. Complete healing of septal mucosa without perforation.

Discussion

To the best of our knowledge, there are no reports of migration of a dental implant to the nasal septum in the literature.

There has been several reports of migration of dental implants into the adjacent craniofacial structures. Most commonly, this affects the maxillary sinus and reports of migration into the sphenoid (one case) and ethmoidal (one case) sinuses, orbital floor (two cases) and also to the mandible body (one case) have been described.^1–5

Factors predisposing to this complication may be related to the quality and quantity of maxillary bone, which may be altered due to inflammatory/infectious processes, ageing, previous radiotherapy, treatment with bisphosphonates, osteoporosis or other systemic pathologies.^{1 2}

Hereby, we report this clinical case with a successful excision of a migrated dental implant into the nasal septum in a patient with no relevant medical history and with no precise mechanism for dental implant migration. We may suppose, in this case, that a combination of factors could be responsible for this occurrence, including technical misplacement of the implant associated with an osseointegration disturbance.

The prevention of this complication in patients undergoing osseointegrated dental implants implies the performance of a careful clinical and radiographic examination, an accurate planning and management of surgical techniques and also an adequate surveillance of the healing process.⁶

In this situation, immediate treatment with drainage of the septal abscess and excision of the exogenous material is imperative in order to prevent septal necrosis and perforation, saddle-nose deformity as well as local and systemic dissemination of the infection.

Informed consent

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Learning points.

• Immediate treatment of a septal abscess is imperative in order to prevent septal necrosis and perforation, saddle-nose deformity as well as local and systemic dissemination of the infection.

• The nasal septum is a potential adjacent structure to which a dental implant might migrate.

• Patient selection, adequate technique and follow-up are crucial to avoid complications in rehabilitation with osseointegrated dental implants.