[Foreign body in the maxillary sinus. Considerations on maxillary sinus approaches wound closure]. / Corps étranger du sinus maxillaire. Considérations sur la fermeture des abords maxillaires.

INTRODUCTION: Paranasal intra-sinus foreign bodies are often related to wounding agents or to penetrating trauma, as caused by car crashes. The maxillary sinus is the most often affected region. We present an atypical clinical case of a foreign body in the maxillary sinus. CASE REPORT: A 27-year-old male patient, consulted for right facial pain associated to a yellow and fetid nasal discharge. Tooth no. 16 had been extracted five months before. Twenty days after extraction, there was an oro-antral fistula which was closed with surgical dental cement. At consultation, the fistula was patent in the tooth alveolus. A "cone beam" CT scan showed a 2-cm long hyper dense image with well-defined margins within the right maxillary sinus, associated with sinusal mucosa thickening. The diagnosis was an oro-antral fistula complicated by maxillary sinusitis due to a foreign body. The foreign body was removed under general anesthesia and antibiotic therapy, through an antero-lateral antrotomy, and sinus curettage was performed. The anterior cortical wall was fixed with a titanium miniplate. The fistula was closed with a buccal fat pad. There was no complication during the 24-month follow-up. DISCUSSION: Foreign bodies may be found in the sinuses, especially in the maxillary sinus. They are often of iatrogenic origin. CT scan may confirm the diagnosis. The treatment is surgical removal.

Do third molars weaken the mandibular angle?

OBJECTIVE: The purpose of this study is to estimate how is the magnitude of the impact of a mandibular third molar on the mandibular angle stiffness. STUDY DESIGN: It was performed a literature search on whole MEDLINE and LILACS data base to find articles that match the following inclusion criteria: cohort studies presenting data on patients with mandibular fractures and third molars; that had a similar angle fracture definition; and that present data available to be cross-classified in a statistic analysis. RESULTS: The sample was composed by 4 studies, involving 2533 patients from USA, Nigeria, Germany and Jordan, evaluated between 1976 and 2001. The analysis of the sample shows a relative risk for a mandibula to fracture, comparing patients with and without third molars, ranging from 1,18 to 2,25. The data of the sample was grouped because of the homogeneity of the articles methods. The estimated relative risk across the 4 studies was 1,94 (95% CI 1,6 - 2,35). CONCLUSIONS: The presence of a third molar may double the risk of an angle fracture of the mandible to occur. Even with this data, the present study cannot support conditions related to the third molar that may affect this impact. Further studies are necessary to discuss the true indication of removal of these teeth as a prophylactic measure in population groups more predisposed to fracture.