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

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. 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. 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. 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.