Managing Antral Wall Discontinuities in Sinus Elevation Surgery.

INTRODUCTION

Schneiderian membrane perforation (SMP), which is usually readily manageable, is the most common intraoperative complication of sinus elevation surgery. Some evidence suggests that SMP is associated with increased risk for postoperative complications, including maxillary sinusitis. Antral wall discontinuity (AWD) is an acquired condition that may increase SMP likelihood and lead to larger, less-manageable perforations.

CASE PRESENTATION: A generally healthy patient receiving sinus elevation surgery exhibited an AWD in the palatine process of the maxilla. The osseous defect was isolated intraoperatively, and the Schneiderian membrane was sharply dissected from the palatal connective tissue. Favorable augmentation of the maxillary sinus was noted on cone-beam computed tomography (CBCT) assessment at postoperative month 34.

CONCLUSIONS

AWD (fusion of the Schneiderian membrane with the periosteum of the maxilla) is a condition identifiable on preoperative CBCT images, which may increase the incidence and severity of SMP during sinus elevation procedures. Careful assessment for integrity of antral osseous walls before surgery is essential. Presence of AWD may obligate modifications to the surgical plan, or in some cases, contraindicate sinus elevation surgery.