Ano letivo 2021/2022

DENTES ECTÓPICOS NO
SEIO MAXILAR – CASO
CLÍNICO
UC CLÍNICA INTEGRADA

Guilherme de Jesus Costa – up201704290

Helena Brêa da Silva – up201808786
CASO CLÍNICO
ANAMNESE
• Nome: SX
• Idade: 22 anos
• Sexo: Masculino
• Motivo da consulta: “Alinhar os dentes”
• Sem doenças sistémicas
• Hábitos de higiene: escovagem 2x/dia; não usa meios auxiliares de
HO.
Fotografias intraorais
Ortopantomografia

NOV 2021
CBCT
CBCT
CBCT
Erupção dentária ectópica
• Alterações no desenvolvimento dentário, patologias
ou iatrogenias;
• Dentes decíduos, permanentes, ou supranumerários;
• Palato, seios maxilares, cavidade nasal, côndilo
mandibular, apófise coronóide, órbita, e seio
etmoidal;
• Mais frequente no sexo masculino (60%), sem
preferência anatómica.

Mohan S, Kankariya H, Harjani B, Sharma H. Ectopic third molar in the maxillary sinus. Natl J
Maxillofac Surg. 2011;2(2):222-4.
Erupção dentária ectópica

• Movimentação dentária por trauma ou cistos;

• Infeções dentárias ou nasais;
• Densidade óssea excessiva;
• Retenção prolongada da dentição decídua;
• Fendas palatinas;
• Fatores genéticos.

Chagas Júnior OL, Moura LB, Sonego CL, de Farias EO, Giongo CC, Fonseca AA. Unusual Case of Sinusitis
Related to Ectopic Teeth in the Maxillary Sinus Roof/Orbital Floor: A Report. Craniomaxillofac Trauma
Reconstr. 2016;9(3):260-3.
Sintomatologia
• Clinicamente, podem ou não estar associados a sintomas;
• Habitualmente permanecem assintomáticos e são detetados em
exames radiológicos de rotina.

Chagas Júnior OL, Moura LB, Sonego CL, de Farias EO, Giongo CC, Fonseca AA. Unusual Case of Sinusitis
Related to Ectopic Teeth in the Maxillary Sinus Roof/Orbital Floor: A Report. Craniomaxillofac Trauma
Reconstr. 2016;9(3):260-3.
Sintomatologia
• Sinusite crónica,
• Rinorreia purulenta;
• Dor;
• Cefaleias severas;
• Obstrução do complexo osteomeatal e ducto nasolacrimal;
• Edema da face;
• Epistaxis e hemoptises

Cistos dentígeros são as patologias mais frequentes.

Chagas Júnior OL, Moura LB, Sonego CL, de Farias EO, Giongo CC, Fonseca AA. Unusual Case of Sinusitis Related to Ectopic Teeth in the
Maxillary Sinus Roof/Orbital Floor: A Report. Craniomaxillofac Trauma Reconstr. 2016;9(3):260-3.
ORTOPANTOMOGRAFIA VS
CBCT

• Permite detetar os dentes • Visualizar com detalhe e

ectópicos nas estruturas exatidão, uma maior área;
maxilofaciais; • Planeamento cirúrgico
• Baixo nível de radiação. otimizado;
• Analisar a morfologia dentária,
inclinação e posição das raízes
relativamente às estruturas
subjacentes;
• Prever dificuldades intra e pós-
operatórias e prognóstico.
Chagas Júnior OL, Moura LB, Sonego CL, de Farias EO, Giongo CC, Fonseca AA. Unusual Case of Sinusitis Related to Ectopic
Teeth in the Maxillary Sinus Roof/Orbital Floor: A Report. Craniomaxillofac Trauma Reconstr. 2016;9(3):260-3.
Tratamento
Assintomático e sem
Tratamento de escolha patologias associadas

Remoção do dente incluso Controlo clínico e radiográfico

Chagas Júnior OL, Moura LB, Sonego CL, de Farias EO, Giongo CC, Fonseca AA. Unusual Case of Sinusitis Related to Ectopic
Teeth in the Maxillary Sinus Roof/Orbital Floor: A Report. Craniomaxillofac Trauma Reconstr. 2016;9(3):260-3.
Topal Ö, Dayısoylu EH. Ectopic Tooth in the Maxillary Sinus. Turk Arch Otorhinolaryngol. 2017;55(3):151-2 .
Técnica cirúrgica de Caldwell-Luc

Kaufman E. Maxillary sinus elevation surgery: an overview. J Esthet Restor Dent. 2003;15(5):272-82; discussion
83.
Técnica cirúrgica de Caldwell-Luc
Cirurgia sinusal endoscópica
• Antrostomia do meato médio
• Antrostomia do meato inferior

Masalha M, Schneider S, Kassem F, Koren I, Eliashar R, Margulis A, et al. Endoscopic treatment of ectopic
teeth in the maxillary sinus. J Clin Exp Dent. 2021;13(3):e227-e33.
Técnica de
Caldwell-Luc
ou Cirurgia
endoscópica?
“Although the traditional Caldwell-Luc procedure provides a direct view into
the maxillary sinus, it is associated with more morbidities than is endonasal
endoscopy”

“It requires a large opening in the anterior maxillary sinus wall to extract the
tooth.”

“(…) risk of complications, including damage to the sinus mucosa, retraction of

the soft tissues of the cheek, oroantral fistula, infra-orbital nerve injury, and
damage to the nasolacrimal duct and adjacent teeth.”

“(…) the Caldwell-Luc procedure (…) complications such as epistaxis, periorbital

injuries, damage
Alhashim FY, Almarhoon to extrinsic
FS, Alhashim eye
HY, Moumen A. muscles,
Endonasal endoscopic and orbital
management haemorrhage
of different (…)”
cases of dentigerous cysts and
ectopic teeth. J Surg Case Rep. 2021;2021(4):rjab099.
Chagas Júnior OL, Moura LB, Sonego CL, de Farias EO, Giongo CC, Fonseca AA. Unusual Case of Sinusitis Related to Ectopic Teeth in the
Maxillary Sinus Roof/Orbital Floor: A Report. Craniomaxillofac Trauma Reconstr. 2016;9(3):260-3.
“The endonasal endoscopic approach by using the use of
different angled endoscopes and instruments is a minimally
invasive surgery preserving physiological function while
minimizing morbidity and preventing complications.”
Alhashim FY, Almarhoon FS, Alhashim HY, Moumen A. Endonasal endoscopic management of different cases of
dentigerous cysts and ectopic teeth. J Surg Case Rep. 2021;2021(4):rjab099.

“All patients who presented symptomatically had complete

resolution of their symptoms following endoscopic removal of
the ectopic tooth.”
Levin M, Sommer DD. Endoscopic removal of ectopic sinonasal teeth: a systematic review. J Otolaryngol Head Neck Surg.
2019;48(1):30.
“In endoscopic approaches, it can be difficult to reach the lateral,
anterior, and inferior walls of the maxillary sinus.”
Topal Ö, Dayısoylu EH. Ectopic Tooth in the Maxillary Sinus. Turk Arch Otorhinolaryngol. 2017;55(3):151-2.
“(…) two main factors influence the choice of surgical technique in
this setting: the surgeon’s ability; and the anatomical position of
the ectopic tooth.”

“An exclusively transnasal endoscopic approach, preferably

through a middle meatal antrostomy, can be used when the tooth
and cyst are proximal to the osteomeatal complex. ”

”(…) combined endoscopic and Caldwell-Luc approach should be

considered if the tooth is too far from the lateral nasal wall, or
too close to the orbital floor or nasolacrimal duct, or if the cyst
and tooth are too large to be removed through an appropriately-
sized E,middle
Emanuelli meatotomy.”
Borsetto D, Brunello G, Sivolella S. Endoscopy-assisted removal through combined lower and middle meatotomies of
an ectopic upper third molar in the sinus associated with a dentigerous cyst. Oral and Maxillofacial Surgery Cases. 2018;4(1):23-31.
 “(…) the TEA approach was found to be feasible and safe, and should
be considered when the trans-labial approach is contra-indicated or
when the dentist desire to avoids violation of the oral anatomy for
future maxillary dental implantation with no previous intervention, or
when associated sinonasal disease coexists and require endoscopic
treatment anyway”

“Ectopic teeth in the maxillary sinus are usually resected using a

SLCFA, with or without using a sinuscope. However, in cases such as
Pathological bone quality, dentofacial deformities, and Severe
bone atrophy, oral surgeons may be less enthusiastic to use the trans-
oral sublabial approach.”
Masalha M, Schneider S, Kassem F, Koren I, Eliashar R, Margulis A, et al. Endoscopic treatment of ectopic
teeth in the maxillary sinus. J Clin Exp Dent. 2021;13(3):e227-e33.
?
 “(…) in the endoscopic era, (…) the CL procedure is
often used to provide easy access to the
maxillary sinus when ESS alone will be
insufficient. The formal CL operation, (…) is still an
operative and working method in oral and
maxillofacial surgery practice despite losing its
effectiveness in otorhinolaryngology.”
Şahin MM, Yılmaz M, Karamert R, Cebeci S, Uzunoğlu E, Düzlü M, et al. Evaluation of Caldwell-Luc
Operation in the Endoscopic Era: Experience From Past 7 Years. J Oral Maxillofac Surg.
2020;78(9):1478-83.
https://www.sciencedirect.com/science/article/pii/
S0196070916301521?via%3Dihub