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Background
A relevant number of patients undergoing implantological procedures require a preimplantological intervention to secure a successful outcome. With some 1.5 million implants sold every year in Italy alone, treating related complications is becoming increasingly important.
Sinonasal infections resulting from sinus floor augmentation represent, from the surgeon perspective, the most challenging complication of dental procedures. When treating such complications it is mandatory to remove the whole infected graft from the sinusal floor. In addition, a wide antrostomy is required to grant a good sinusal drainage. If the surgeon is sure of having performed a sufficiently wide antrostomy and if the patient's condition allows for it, it is possible to delay a second procedure: the maxillary sinus drainage will spontaneously tend to extrude foreign bodies through a patent ostiomeatal complex.
Case presentation
A 55-year-old male patient was referred to our clinic with signs and symptoms of right ethmoidomaxillary sinusitis recurring in the last 3 months. The patient's history revealed a right maxillary sinus floor augmentation with porcine bone grafts for implantological purposes 4 months before. The patient reported purulent discharge from the nose and purulent post-nasal drip. His right cheek was notably swollen and aching. Prior to our evaluation the patient had been treated with oral amoxicillin and clavulanate 1 g three times a day for 10 days followed by oral ciprofloxacin 500 mg twice a day for 14 days unsuccessfully.
Investigations
We performed an ENT physical examination, which confirmed the purulent discharge from the nose and revealed mucosal swelling around the right maxillary alveolar process. We also performed a nasal endoscopy with a flexible endoscope showing a medialisation of the right uncinate process and purulent discharge in the middle meatus (see figure 1 ). A maxillofacial CT scan revealed an ethmoido-maxillary sinusitis with infection and displacement of the maxillary bone xenograft, a right oro-antral fistula and a right septal spur (see figures 2 and 3 ).
The patient subsequently underwent the aforementioned combined procedure in order to treat the sinusitis, restore sinusal drainage and remove the bone grafts.
At 7- and 30 day postoperative endoscopic follow-up, the patient showed no signs of sinusal infection. Nevertheless, 40 days after the surgical procedure, the sinusitis relapsed, persisting in spite of oral antibiotic therapy.
We performed a second...