Removal of a maxillary third molar accidentally displaced into the maxillary sinus: presurgical and surgical management

Extraction of impacted maxillary third molar is a common procedure usually performed either by oral surgeons or general dentists. tuber maxillae fractures and oroantral communications are the most frequently listed intraoperative complications, while the displace- ment of the tooth in the maxillary sinus is rarely de- scribed.1 this event may lead to acute or chronic sinus- itis and, for this reason, a timely surgical removal of the tooth from the sinusal cavity is strongly suggested.2 in this exemplary case, a patient was referred to our department twenty days after the accidental displace- ment of the left third upper molar into the maxillary si- nus, during an attempt of extraction. the orthopanoram- ic exam showed the tooth vertically disposed close to the medial wall with an inverted axial position (Figure 1) and, within the limits of this radiological exam, a sinusal mucosa without signs of inflammation. A cone beam computed tomography (cBct) of the maxillofa- cial complex comprising the paranasal sinuses and the osteomeatal complex, was performed for the pre-sur- gical assessment (Figure 2). cBct volume rendering, obtained by using a postprocessing DicoM software (3Diagnosys, 3DM, cantù, como, italy), allowed the manipulation of a three-dimensional visualization of the tooth displaced in the sinus (Figure 3).