Fractured root tip displaced into the maxillary sinus - what to do ?

Management of a Displaced Palatal Root into the Maxillary Sinus

It is not uncommon, during maxillary molar extractions—especially when dealing with fractured palatal roots beneath the furcation—for even experienced practitioners to encounter unexpected complications. A particular risk is the displacement of the palatal root into the maxillary sinus, especially when elevation is attempted in roots that are tightly embedded or pneumatized close to the sinus floor.

While referring such cases to a senior oral surgeon is often wise when the risk of complications is high, even the best-planned extractions can go awry. When a root is inadvertently displaced into the sinus, immediate recognition and appropriate management are critical.

Case Example:A 30-year-old Indian male was referred to me following such an incident. During the extraction of the upper left first molar, the palatal root fractured and was displaced into the left maxillary sinus. CT imaging clearly revealed the location of the displaced root fragment, which was lodged high within the sinus cavity—well beyond retrieval through conventional socket access.

Management:In this case, I opted for an alveolar crest approach. Under adequate anaesthesia and full aseptic technique:

• The socket was carefully re-entered and granulation tissue thoroughly debrided.

• Copious saline irrigation was performed to assist mobilisation of the root tip.

• With careful manipulation and suctioning, the fragment was successfully flushed and retrieved.

• The sinus was irrigated again to ensure clearance of debris.

• A watertight primary closure was achieved using 3-0 sutures.

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Post-operative Care:The patient was instructed on strict sinus precautions:

• No nose blowing or sneezing through the nose for a minimum of six weeks.

• Antibiotic coverage and nasal decongestants were prescribed to reduce the risk of sinusitis.

• Follow-up was scheduled to monitor healing and assess for any signs of oro-antral communication or sinus infection.

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Prevention Tips:

• Assess root proximity to the sinus via pre-op OPG or CBCT, particularly for upper molars with curved or divergent roots.

• Avoid aggressive elevation of palatal roots when radiographic suspicion of sinus proximity exists.

• Sectioning the tooth and retrieving roots individually may help reduce the risk.

• When in doubt, defer elevation and refer appropriately.