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Dental roots in the maxillary sinus
DENTAL
ROOTS
EDWARD
c?.
STAFNE,
IN THE
MAXILLARY
D.D.S.,”
ROCHESTER,
SINUS I\hNN.
of retained roots of teeth superimposed T HEsinusshadow is often seen in the roentgenogram. Nearly
on that of the maxillary all of these roots are situated in t,heir original position in the dental alveolar socket. Roots lying free in the maxillary sinus are rarely encountered ; when roots do occur in this location, they are most often recognized by a deviation from their normal vertical position in the arch and by an absence of the lamina dura which normally surrounds them. Some dental roots, particularly those of small size, which are forced into the maxillary sinus and are not recovered, may become incorporated in mucous secretions and may soon be eliminated through the normal sinus opening into the nostril. In the event that a root becomes lodged between the antral mucosa and the wall of the maxillary sinus, it may become a source of local inflammation or maxillary sinusitis. A root was found in t,his location in the following case. CASE
REPORT
A man, 41 years of age, was referred for the removal of a root in the upper left second premolar region. An attempt to extract the second premolar had been made some time previously but there had been a failure to remove the root in its entirety. A roentgenogram revealed a root in which root canal therapy had been performed and which, because of its deviation from a normal position, appeared to have been forced from its original position in the socket (Fig. 1, inset). There was also a history of a chronic maxillary sinusitis. The root was removed on Jan. 15, 1945, with the patient under local anesthesia. An incision was made along the crest of the alveolar ridge from the third molar region to a point near the first premolar, from which it was extended upward and forward to the buccal fold. The flap was made sufficiently large so that when it was replaced it covered completely the opening which had to be made in the wall of the maxillary sinus. The mucoperiosteum was retracted upward, exposing the lateral wall of the maxillary sinus. A slight discoloration of the bone directly overlying the root could be seen and an opening was made through the antral wall sufficiently large to deliver the root. The root was found encapsulated by a mass of soft tissue situated between the antral mucosa and the bony wall of the maxillary After removal of the root and the tissue which surrounded it, the mucoperiosteum sinus. was replaced and carefully sutured. The specimen which sections were made which of inflammatory tissue (Fig.
had been removed revealed that the 1).
was decalcified and root was completely
longitudinal surrounded
by
microscopic a capsule
A root or root fragment which is forced into the maxillary sinus may become a nucleus for the formation of a rhinolith. Roentgenograms of a patient *Section
on Dental
Surgery,
Mayo
Clinic. 586
Dental
Roots in J4axillary
Si?lus
583
who for several years had been suffering from chronic maxillary sinusitis revealed a foreign body in the left sinus. Dental roent,genograms revealed an absence of bone of the floor of the maxillary sinus in the first molar region which suggested that the object was probably a dental strurture that had been forced into the sinus. The degree of radiopaeit!- of the periphcr!. of’ the object
Fig.
Fig.
L-Longitudinal section rounded by a capsule of
I.-Dental
root
from
of a roob inflammatory
the
maxillkw)
removed tissue.
sinus in maxillary
ft,om the (X10.)
encapsulated sinus.
maxillary sinus: the root is SWInset, root in maxillary sinus.
by
calculus.
(X8.)
Inset,
root
suggested that the object might be the crown of a tooth (E’ig. 2, inset). After removal, a longitudinal ground section was prepared which revealed that the inner portion of the object contained a dental root. The entire root was covered by a heavy deposit of calculus. A portion of the calculus became separated from the root during sectioning (Fig. 2). The degree of radiopacity of a rhinolith does not vary greatly from that of a tooth structure, and the one may be confused with the other when the image appears on the roentgenogram. A radiopaque object which appeared in
Edward
C. Stafne
the lateral view roentgenogram of a maxillary sinus proved to be a rhinolith (Fig. 3). The specimen in this instance was div.ided in halves to determine if gross pieces of tooth structure were present in the center of the specimen, ‘and none were seen (Fig. 3, inset). Further, to rule out the possible presence of dental root substance, the specimen was pla.ced in a decalcifying solution but no root substance was found. However, as a result of decalcification, a thread about 1 cm. in length was found in the mass, a foreign body which probably had provided the niclus on which a deposition of calculus had been initiat,ed.
Fig.
3.-Rhinolith
in
the
maxillary
sinus.
Inset,
rhinolitlr.
(x7.)
There have been some instances in which patients have been referred for the removal of dental roots that recent,ly had been forced into the maxillary sinus but in whom the roots were no longer present when the patients presented themselves. Therefore, it is important, to make roentgenograms shortly prior to the time removal of the root is contemplated.
ROOTS
EDWARD
c?.
STAFNE,
IN THE
MAXILLARY
D.D.S.,”
ROCHESTER,
SINUS I\hNN.
of retained roots of teeth superimposed T HEsinusshadow is often seen in the roentgenogram. Nearly
on that of the maxillary all of these roots are situated in t,heir original position in the dental alveolar socket. Roots lying free in the maxillary sinus are rarely encountered ; when roots do occur in this location, they are most often recognized by a deviation from their normal vertical position in the arch and by an absence of the lamina dura which normally surrounds them. Some dental roots, particularly those of small size, which are forced into the maxillary sinus and are not recovered, may become incorporated in mucous secretions and may soon be eliminated through the normal sinus opening into the nostril. In the event that a root becomes lodged between the antral mucosa and the wall of the maxillary sinus, it may become a source of local inflammation or maxillary sinusitis. A root was found in t,his location in the following case. CASE
REPORT
A man, 41 years of age, was referred for the removal of a root in the upper left second premolar region. An attempt to extract the second premolar had been made some time previously but there had been a failure to remove the root in its entirety. A roentgenogram revealed a root in which root canal therapy had been performed and which, because of its deviation from a normal position, appeared to have been forced from its original position in the socket (Fig. 1, inset). There was also a history of a chronic maxillary sinusitis. The root was removed on Jan. 15, 1945, with the patient under local anesthesia. An incision was made along the crest of the alveolar ridge from the third molar region to a point near the first premolar, from which it was extended upward and forward to the buccal fold. The flap was made sufficiently large so that when it was replaced it covered completely the opening which had to be made in the wall of the maxillary sinus. The mucoperiosteum was retracted upward, exposing the lateral wall of the maxillary sinus. A slight discoloration of the bone directly overlying the root could be seen and an opening was made through the antral wall sufficiently large to deliver the root. The root was found encapsulated by a mass of soft tissue situated between the antral mucosa and the bony wall of the maxillary After removal of the root and the tissue which surrounded it, the mucoperiosteum sinus. was replaced and carefully sutured. The specimen which sections were made which of inflammatory tissue (Fig.
had been removed revealed that the 1).
was decalcified and root was completely
longitudinal surrounded
by
microscopic a capsule
A root or root fragment which is forced into the maxillary sinus may become a nucleus for the formation of a rhinolith. Roentgenograms of a patient *Section
on Dental
Surgery,
Mayo
Clinic. 586
Dental
Roots in J4axillary
Si?lus
583
who for several years had been suffering from chronic maxillary sinusitis revealed a foreign body in the left sinus. Dental roent,genograms revealed an absence of bone of the floor of the maxillary sinus in the first molar region which suggested that the object was probably a dental strurture that had been forced into the sinus. The degree of radiopaeit!- of the periphcr!. of’ the object
Fig.
Fig.
L-Longitudinal section rounded by a capsule of
I.-Dental
root
from
of a roob inflammatory
the
maxillkw)
removed tissue.
sinus in maxillary
ft,om the (X10.)
encapsulated sinus.
maxillary sinus: the root is SWInset, root in maxillary sinus.
by
calculus.
(X8.)
Inset,
root
suggested that the object might be the crown of a tooth (E’ig. 2, inset). After removal, a longitudinal ground section was prepared which revealed that the inner portion of the object contained a dental root. The entire root was covered by a heavy deposit of calculus. A portion of the calculus became separated from the root during sectioning (Fig. 2). The degree of radiopacity of a rhinolith does not vary greatly from that of a tooth structure, and the one may be confused with the other when the image appears on the roentgenogram. A radiopaque object which appeared in
Edward
C. Stafne
the lateral view roentgenogram of a maxillary sinus proved to be a rhinolith (Fig. 3). The specimen in this instance was div.ided in halves to determine if gross pieces of tooth structure were present in the center of the specimen, ‘and none were seen (Fig. 3, inset). Further, to rule out the possible presence of dental root substance, the specimen was pla.ced in a decalcifying solution but no root substance was found. However, as a result of decalcification, a thread about 1 cm. in length was found in the mass, a foreign body which probably had provided the niclus on which a deposition of calculus had been initiat,ed.
Fig.
3.-Rhinolith
in
the
maxillary
sinus.
Inset,
rhinolitlr.
(x7.)
There have been some instances in which patients have been referred for the removal of dental roots that recent,ly had been forced into the maxillary sinus but in whom the roots were no longer present when the patients presented themselves. Therefore, it is important, to make roentgenograms shortly prior to the time removal of the root is contemplated.