Misplaced Pterygoid Implant removed following Surgical Exploration

Abstract

A 62-year-old male patient had reported to our department with a history of pterygoid implant placement in the right maxillary region. The referring dentist had updated us about the possibility of a misplaced implant. The patient was anxious but showed no clinical signs of discomfort or pain. A CT scan with contrast was done to check for the location of the implant and also visualize the proximity to any vital structures. The CT study revealed an implant seen in the right parapharyngeal space closely abutting the internal carotid artery. The screw of the implant was sharp and since it was closely abutting the internal carotid artery it warranted removal at the earliest. An endoscopic approach was discussed with the ENT surgeons but due to the size of the implant and limited access through the antrum we had to look for an alternative method. The technique of performing an access osteotomy of the maxilla would give better visualization and access to the implant but would require the maxilla to be plated and the patient who was 62 years old was not too keen on the thought of this procedure. Finally, an extraoral submandibular approach was finalized and used. Under general anaesthesia, a submandibular incision was marked and dissection was done, the carotid was first identified and taken control off in case we encountered any bleeding or injury to the internal maxillary artery while removing the implant. Dissection continued towards the mandible and the masseter was split to give access to the pterygoid region. An intraoperative C- arm showed that the implant was in close vicinity. The implant was removed intraorally via the buccal vestibule and the wound sites were closed without any complications.