Intracerebral Penetration of a Zygomatic Dental Implant and Consequent Therapeutic Dilemmas: Case Report

This case report describes a unique intracerebral penetration of a zygomatic implant inserted in the pterygoid region. A 47-year-old female patient developed severe persistent headaches immediately after two zygomatic and two standard implants were inserted under general anesthesia. However, no additional treatment or radiologic assessment was performed at that time by the treating surgeon. The maxilla was rehabilitated with an implant-supported fixed denture 3 months after the implants were placed. An episode of acute left maxillary sinusitis occurred shortly after insertion of the fixed denture. Treatment with antibiotics was insufficient, and the patient developed chronic left maxillary sinusitis. The patient presented herself to a neurologist with symptoms of chronic fatigue and severe headaches. Cerebral magnetic resonance imaging demonstrated the intracerebral penetration of a foreign body that resembled a dental implant. The authors sought to resolve the intracerebral penetration of the foreign body, along with the persistent maxillary chronic sinusitis with its concomitant risk of ascending cerebral infection. Computer-assisted preoperative planning associated with computer-assisted threedimensional transfer should be used to avoid such a dangerous complication. Postoperative computed tomography assessment should be performed after zygomatic implant surgery. Finally, any neurologic impairment of the patient after pterygoid implantation should also be treated immediately. Keywords: complication, dental implant, headache, neurology, pterygoid, zygoma