Maxillary sinus surgery is a complex area of oral surgery that encompasses the pathology of the maxillary sinus.
INTERVENTIONS INCLUDED IN MAXILLARY SINUS SURGERY
The most common procedures performed in our clinic are:
All interventions are primarily performed under local anesthesia.
SURGICAL MANAGEMENT OF CHRONIC CHANGES IN THE MAXILLARY SINUS
After a viral infection of the upper respiratory tract, maxillary sinus inflammation or sinusitis often occurs. In children under the age of three, ethmoidal-antral infections are more common.
Sinusitis in older children and adults affects the sinus mucosa and is accompanied by thickening, increased secretion, and nasal obstruction. Patients report swelling, discomfort, pain, and an inability to expel secretions.
The causes of acute sinus inflammation can be viruses, bacteria, fungi, polyps, allergies, or even trauma due to sudden atmospheric pressure changes.
In most cases, sinusitis is a secondary condition arising from an inflammatory process in the nose or at the root of a tooth.
It typically lasts up to a month, and conservative therapy involves the use of antibiotics and management of any existing dentogenic infection. If polyps are the causative agents of sinusitis, corticosteroid therapy and surgical removal are necessary.
In cases where inflammation lasts longer than four weeks, it is classified as chronic sinusitis. Signs indicating chronic inflammation of the sinuses also include nasal obstruction and purulent secretion. There may also be disturbances in the sense of smell, ear congestion, and severe irritative cough. In this type of disease, there is a high probability of affecting surrounding structures and developing complications, making surgical treatment essential.
Using functional endoscopic sinus surgery (FESS), drainage of the sinuses and removal of purulent accumulations or pathological changes are performed. Maxillary sinus surgery allows for proper ventilation and better patency of the sinus cavities.
Initially, FESS was applied only for treating nasal inflammation and polyposis, but this surgical method is now also used in the treatment of benign and malignant tumors.
MAXILLARY SINUS SURGERY – SURGICAL REMOVAL OF CYSTS AND PATHOLOGICAL FORMATIONS
Maxillary sinus surgery also deals with the removal of cysts and pathological formations within the maxillary sinus.
The most common cyst occurring in the frontal and maxillary sinuses is a mucocoele.
A sinus mucocoele represents a benign change in the sinuses, filled with mucous contents. This infiltrate exhibits a progressive tendency, exerting pressure on surrounding anatomical structures. This can lead to infection and partial or complete obstruction of the nasal cavity.
Signs indicating the presence of a cyst include nasal obstruction, frequent headaches, cheek swelling, and the discharge of thick mucus. Ptosis of the upper eyelid and diplopia may also suggest a mucocoele.
Mucocoeles are surgically removed and subsequently sent for histopathological analysis. Although naturally benign, papillomas present in the paranasal sinuses can undergo malignant degeneration and transform into a malignant tumor. The most frequent manifestation in patients is squamous cell carcinoma of the maxillary sinuses, followed by tumors of the nasal cavity and ethmoidal sinus (adenocarcinoma), while tumors of the frontal and sphenoid sinuses are rare.
Osteoma is the most common type of tumor, primarily located in the frontal sinus. Metastasis first spreads to lymph nodes and vital centers in the skull. Its progression may further involve distant organs, such as the lungs and kidneys.
Upon establishing a diagnosis, the maxillofacial surgeon determines the appropriate surgical therapy. Depending on the type, location, and extent of the tumor, radiological or chemotherapy may be necessary after removal.
LIFTING THE FLOOR OF THE MAXILLARY SINUS (SINUS LIFT) FOR PRE-PROSTHETIC PREPARATION
When the height of the alveolar bone in the area of the maxillary sinus is less than 10 mm, one of the methods for “raising” the floor of the maxillary sinus is generally indicated to avoid undesirable perforation of the mucosa and the intrusion of the implant into the sinus cavity. For most surgical techniques of this type, the term “sinus lift” is used in the literature. Depending on the height of the alveolar bone, lifting of the sinus floor can be performed in several ways.
PERFORMING THE SINUS LIFT
Preoperative preparation includes orthopantomographic imaging and CBCT imaging of the upper jaw and sinus to exclude potential sinus diseases, most commonly cysts.”Besides access through the implant site (transcrestal method), the most commonly applied technique for sinus lift is the lateral access through a trephine opening. The medial wall of the sinus is lifted by at least about 10 mm in order to obtain the necessary height for implant placement.
The opening on the lateral wall of the sinus is a method applied when the height of the remaining alveolar bone is less than 6 mm, and it allows for the elevation of the sinus floor by up to 10 mm. In this way, conditions for the placement of a dental implant are ensured.
This sinus lift technique includes the following procedures:
The augmentation of the sinus floor is most often performed using artificial bone granules, a mixture of these granules with host bone, or a combination of these with PRF. PRF is platelet-rich fibrin obtained from the patient’s blood.”