Elective dental extractions and osseointegrated implant replacement to facilitate trans-oral endoscopic ENT surgical procedures

The latest publication from our unit concerns the use of elective dental extractions of maxillary anterior teeth to facilitate access for trans-oral ENT procedures.. We have developed this procedure increasing in Liverpool within our head & neck unit to facilitate a number of different procedures such as stapling of pharyngeal pouches or trans-oral laser resection of oro-pharyngeal malignancies.

The indications are usually a failed attempt at a trans-oral procedure where the alternative strategy would involve an open surgical procedure. In the case presented in the paper, the patient had previously undergone and open surgery to attempt management of his pharyngeal pouch which not only failed but left him in ITU for one month with mediastinitis..

Once the extractions have been carried out (usually 3 or 4 incisors are removed) access is much better and allows a more straight line access to the ENT problem. As soon as the procedure is completed immediate implant placement is undertaken – our preference is the use of co-axis dental implants from Southern Implants

Co-axis implants have a prosthetic axis which is angled at 12, 24 or even 36 degrees to the axis of the implant. They are excellent for immediate placement into extraction sockets and can demonstrate really excellent primary stability. The allow for the use of screw retained prosthetics which in situations like this is very important as often further surgeries may be required and the bridge may need to be removed easily in future.

The images from the recent paper are found below demonstrating the technique which has really improved access for our ENT surgeons whilst reducing morbidity for patients..

The full paper can be accessed via the links below
PUBMED reference.   Full download via the Journal of Laryngology & Otology.

Figures from the paper

We have now completed 4 cases using this technique with excellent results so far. With maxillary incisor dental extractions we have not failed to effectively treat pharyngeal pouches – even those who have had numerous attempts at stapling in other units and even those using specifically modified scopes to undertake these surgeries.. The use of screw retained bridges has been of paramount importance though as some patients have required additional stapling procedures at a later date and require the removal of the prosthesis to facilitate this.