(76) Repair of a Nasal Cavity Perforation with a Mixed Cortiocancellous Bone Allograft and Bone Tack-Fixated Pericardium Membrane: A Case Report

Introduction: Although rare, perforation of the nasal cavity can occur upon removal of a partially-integrated dental implant from the anterior maxilla. In contrast to the numerous papers that have been published describing techniques for repairing perforations of the maxillary sinus, very few reports exist regarding nasal cavity perforations (1-4). In this case report we describe a technique that was used to repair a nasal cavity perforation resulting from removal of a failing dental implant. This limited case report documents the use of a collagen membrane fixated with tacks in conjunction with a mixed corticocancellous bone allograft to repair a perforation of the nasal cavity.

Methods: A 67-year-old male patient with a medical history of high cholesterol and arthritis presented to the Penn Dental Medicine Periodontics Clinic for treatment of periimplantitis at site #4. Following administration of local anesthesia, a crestal incision with mesial and distal vertical releasing incisions were made, and a full-thickness mucoperiosteal flap was elevated. Following degranulation, extensive bone loss was detected on the implant and explantation was advised. The implant was removed via a torque wrench resulting in a 4 mm in diameter perforation of the nasal cavity. A pericardium membrane (CopiOs®︎) was trimmed to cover the base of the osteotomy and the perforation. Narrow facial/palatal extensions of the membrane that protruded out of the osteotomy were anchored in place with fixation tacks (Pro-fix™ Precision Fixation System). The extensions were kept as narrow as possible to minimize the volume of bone covered by the membrane to enhance regenerative potential. The osteotomy was filled with a mixed corticocancellous bone allograft (Purous®) and covered with pericardium membrane. Tension free primary closure was achieved. Post-surgical instructions and prescriptions were reviewed.

Results: The patient was evaluated two-weeks postoperatively and then monthly. Healing progressed without complications. A cone-beam CT scan was taken at the 5-month follow-up exam revealing closure of the perforation and complete bone fill of the osteotomy. The patient will return for placement of a 3.5 x 11.5 mm Nobel Active implant.

Conclusions: The use of a fixated pericardium membrane used in conjunction with a mixed corticocancellous bone allograft can be used to repair a perforation of the floor of the nasal cavity.

Lead Author's Contributions to the Research Project. : The lead author was performed the surgery and the composition of the abstract.