A patient has unilateral foul nasal discharge after upper-molar implant surgery. CT shows unilateral maxillary opacification centred on a dental implant protruding into the sinus. What is the best management?
Odontogenic sinusitis persists if the dental focus is ignored. Treatment requires dental/maxillofacial management of the implant or infection plus rhinological medical treatment and endoscopic drainage when disease does not resolve or the ostiomeatal pathway is obstructed.
A. Coordinate dental source control with restoration of sinus drainage: Odontogenic sinusitis persists if the dental focus is ignored. Treatment requires dental/maxillofacial management of the implant or infection plus rhinological medical treatment and endoscopic drainage when disease does not resolve or the ostiomeatal pathway is obstructed.
B. Endoscopic sinus surgery while leaving the infected dental source untreated: Sinus surgery alone has a high risk of persistence when the cause remains.
C. Long-term intranasal steroid as sole therapy: Topical anti-inflammatory treatment does not remove an infected implant or dental communication.
D. Bilateral radical maxillectomy: Disease is unilateral and inflammatory; radical oncological surgery is inappropriate.
E. Reassure that dental implants cannot cause sinusitis: Dental pathology is an important cause of unilateral maxillary disease.
If imaging showed an oroantral fistula, closure strategy and timing would need coordination with infection control and sinus ventilation.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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