Neuropathic Pain Due to an Extremely Rare Anatomical Variation of the Canalis Sinuosus After Dental Implant Placement: A Case Report

Accurate knowledge of anatomical structures is essential for safe and effective dental implant placement. Although conventional imaging modalities provide valuable diagnostic information, their inherent limitations may hinder comprehensive anatomical assessment. Cone beam computerized tomography (CBCT) has emerged as a reliable 3D imaging technique, offering high-resolution, cross-sectional views for precise evaluation. The canalis sinuosus (CS), a bony canal carrying neurovascular bundles from the infraorbital canal, is frequently overlooked due to its subtle radiographic presentation. This report emphasizes the importance of CBCT in identifying anatomical variations by presenting a rare case involving complications related to the CS following implant placement in the posterior maxilla. In the present case, a 50-year-old male patient underwent dental implant surgery after radiographic assessment via orthopantomography. Postoperatively, the patient experienced persistent, pressure-like pain in the upper left first molar region. Despite treatment with analgesics and pregabalin, the symptoms continued, and CBCT revealed the implant compressing the anterior superior alveolar nerve due to CS invasion. Following implant removal, the patient's symptoms resolved completely within 1 week. At the 3-month follow-up, the site showed bone regeneration without pathological findings, and the patient remained asymptomatic. This case underscores the necessity of considering anatomical variations of the CS in all maxillary procedures to prevent iatrogenic complications. CBCT imaging is strongly recommended for accurately identifying the CS and determining its anatomical course, thereby minimizing the risk of surgical complications.