lateral sinus left

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Posted on By Robin Tran In Sinus Augmentation

57yo asian healthy woman has an upper left bridge from #12 to #16.1/ #12 will be saved with RCT and Crown.2/ #16 is used for temporary bridge from #12 to #16 and will be extracted later. 3/ #13 implant was placed on 2/14/17. 4/ lateral sinus lift(without implant for later stability) was done on #14 on 2/14/17. uneven bone height at crest was around 3 mm to 4 mm. Implant 4.0 x 8.5 will be placed later. I have around 2 mm at crest (after even it out), implant will be sinked 0.5 mm under bone crest, so i have 7 mm of implant. every 1 mm , i need .2cc of bone so i 7 mm of implant around 1.5cc of bone was graft in the sinus. I verified with PA, it did not think bone was high enough so i placed 0.5cc of bone more. Please see the preop pano and the post op pano.QUESTIONS:1/Did i blook the sinus?2/ if i did, what is the symptoms of blooking sinus. (Pt is breathing fine so far). 3/ even she does not have any symptoms now, can she develop any later. 4/ How can i fix this problem, if i did blook it

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2 Comments

Hi Robin you have not blocked the "sinus" from what I can see from your pano. Ideally this should be evaluated by cbct. I highly recommend pre-op cbct evaluation of a sinus prior to a maxillary sinus elevation procedure. When you say blocked the sinus you likely mean mean ostium. From your pano it seems you are far away from the ostium. If you had blocked ostium she would likely end up with an infection and sinusitis resulting in pain and pressure in the sinus as well as drainage of purulence from your surgical site. On average maxillary sinus is 15cc in volume so I'm sure you are fine with your graft volume. I recommend you educate yourself more about maxillary sinus anatomy, the surgery as well as risks and complications prior to completing more of these procedures. For this case you should be fine provided there was no membrane perforation and she doesn't end up with an infection. Hope this helps you.


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Robin, I would suggest that a pre-operative evaluation of the patency of the ostium (osteomeatal complex) is essential. Further, the lining of the maxillary sinus is a consideration. General rule: 5 mm. or less of schneiderian membrane thickening is considered mucosisits and you are probably OK for sinus grafting, Over 5 mm. of thickening has to be considered sinusitis and warrants an ENT consult. Both are easily evaluated with CBCT. Should the ostium be occluded, either prior to or after surgery, you are risking pain, infection and loss of the graft into the vestibular space. Routinely, I cover any sinus procedure with broad spectrum antibiotics; Augmentin, Cipro, or Z-pak. From the panorex, it appears that the graft is contained and dense. A post-op CBCT is regularly done to confirm your surgical results and I would do so at earliest convenience and explain it is normal protocol. The fact that the pt. seems to be asymptomatic is a good sign, however, CBCT will confirm. Good Luck.


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