(TC52) Management of Unexpected Exposed Maxillary Sinus with a Broken peeso reamer Trapped InsideManagement of Unexpected Exposed Maxillary Sinus with a Broken peeso reamer Trapped Inside

The patient was a healthy 20-year-old woman who had been referred to the Department of Endodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, by a general dental practitioner for the retreatment of the maxillary right first molar and the removal of a separated instrument visible on the patient’s panoramic radiograph. The patient underwent several periapical radiographs from different angles during the first visit and examination. Based on the radiographs, a decision was made to retrieve the broken piece of the instrument. However, on the second visit, radiographs showed that the separated instrument had been displaced apically, extruded from the root canal space, and entered the sinus space. The treatment plan was immediately modified. A mucoperiosteal flap was elevated. An osteotomy procedure was carried out, a window was prepared, and the sinus membrane was reflected. After the broken instrument was located, it was removed with forceps along with the extruded gutta-percha. After irrigating the area with serum, the flap was repositioned and sutured with chromic catgut sutures. Then the apical perforation of the distobuccal canal was sealed with ProRoot MTA, and the remaining root canals were obturated.

Conclusion: Foreign bodies in the maxillary sinus are rare issues, which are usually secondary to dental procedures. Whatever the foreign body is, it must be removed to prevent chronic infections even if it is asymptomatic. Great care must be taken during dental procedures, and root canal retreatment in particular, not to accidentally introduce foreign bodies into the antrum.