Modified endoscopic medial maxillectomy for recalcitrant zygomatic implant-related chronic rhinosinusitis: A case study

Objective: Zygomatic implants (ZI) are used for oral rehabilitation in the edentulous maxillae with deficient alveolar bone. When maxillary sinus mucosa is violated, a foreign body reaction can lead to chronic rhinosinusitis (CRS). We sought to demonstrate that modified endoscopic medial maxillectomy (MEMM) can be used safely manage ZI-related odontogenic CRS that fails conservative management. Methods: The clinical courses of a patient with ZI-related refractory CRS managed successfully with MEMM is described. Pre-operative clinical presentation, imaging, office endoscopies, surgical findings and techniques, and post-operative clinical and endoscopic outcomes were retrospectively reviewed. Results: The patient presented with congestion, purulent discharge, facial pain/pressure, and hyposmia after failing antibiotic therapy and a Caldwell-Luc procedure. Pre-operative computed tomography (CT) showed implant penetration into the sinus with complete opacification and osteitis. An MEMM and anterior ethmoidectomy was performed. Post-operative management included debridements, oral antibiotics, and oral steroids. Post-operative course was characterized by mild CRS exacerbations that resolved fully with culture-directed topical and oral antibiotics as well as topical steroids. Pre-operative Sinonasal Outcome Test-22 (SNOT-22) scores was 24 compared to 0 after 13 months of post-operative follow-up. Post-treatment endoscopy revealed healthy-appearing mucosa, an intact ZI, and minimal edema or drainage. Conclusion: This case demonstrates that MEMM is an efficacious procedure to address refractory odontogenic CRS caused by zygomatic implantation. MEMM with meticulous post-operative care may allow for zygomatic implant salvage.