Maxillary sinusitis, in a patient with osteonecrosis of the maxilla on the background of bisphosphonate therapy, provoked by dental implantation. A clinical case.

Introduction. The incidence of maxillary sinusitis is widespread and tends to increase steadily. Etiological factors are diverse: from acute respiratory infections and allergic reactions to odontogenic processes and iatrogenic interventions. However, in recent years, patients with sinusitis, which is caused by osteonecrosis of the upper jaw (VHF), which develops against the background of long-term bisphosphonate therapy, have increasingly sought an appointment with an otorhinolaryngologist. This form of sinusitis is of particular clinical importance due to its resistance to standard therapy and the high risk of severe purulent-destructive complications.

The aim of the study. Demonstration of a clinical example of a patient with purulent maxillary sinusitis on the background of bisphosphonate osteonecrosis of the maxilla caused by removal of a dental implant, as well as analysis of diagnostic and tactical errors in the management of this category of patients.

Materials and methods. A clinical example of a 72-year-old patient with purulent left-sided maxillary sinusitis and an oroantral fistula after removal of a dental implant is presented. A CT scan revealed total darkening of the left maxillary sinus and a bone defect in the lower wall. Surgical treatment is contraindicated due to the risk of osteonecrosis progression. Conservative therapy (antibiotics, mucolytics, decongestants, irrigation) was prescribed, and a temporary improvement was achieved.

Results and discussion. Insufficient awareness among doctors about the patient's intake of bisphosphonates leads to erroneous treatment tactics. An interdisciplinary approach, educational activities and the development of protocols for the management of such patients are needed. Early detection and adequate therapy improve the quality of life and reduce the risk of complications.