Dr. S. asks:
I have treatment planned a bilateral external sinus lift on a patient. While I was reviewing the CBVT scan I noticed on the lower part of the maxillary sinus an apparent thickening of the sinus membrane of about 5mm. The patient is in good health with no known allergies or acute or chronic sinusitis or other illnesses. Is it safe to perform a sinus lift in this situation? Should I refer the patient to an ENT for an opinion on the thickening of the sinus membrane? Have any of you seen this and what do you recommend?
Thickening of the Sinus Membrane: What Do You Recommend?
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Given the fact that the patient, other than a 5 mm thickening of the membrane, has a healthy sinus, I would move forward with the sinus lift. The membrane will actually be easier to elevate with less chance of tearing. The only caveat is to evaluate the degree of lift, i.e. the amount of obliteration of the sinus that will take place with the augmetation and/or implant placement, so that the ostium remains patent.
Was the CBCT volume read by a radiologist and is the ostium patent?
yes the ostium is patent…..
Possible Polyp ? go ahead use lateral window easier to see how things are , in fact prefer the lateral window especially with DASK
Mucous cysts or diffuse mucosal thickenings are found in roughly 15% of the population but may even be higher. These deviations are most notable on CBVT radiographs and are difficult or impossible to see with periapicals or panoramic views. 5 mm is a modest thickening and should pose no problem to performing a sinus elevation. When there is a mucous retention cyst that occludes 30% or more of the sinus (I have seen 90% occlusion) the prevailing recommendation is surgical removal. Dr. Pikos advocates a pouching membrane and simultaneous grafting. Others recommend stripping out the cyst with schneiderian membrane, waiting for recovery and then grafting several months later.
For forensic reasons I would consult the ENT. Thickening of the sinus membrane, especially unilateral, may be caused by an obstructed ventilation of that sinus. Especially these sinus tend to have an incresed acidity- by lack of ventilation. (Is there a septum deviation, or polyps) Thickening might be caused by prior infects too or age. But 5mm ?? unilateral ?? Thickened sinus mucosa never diasppears on its own- even if the cause seems to have- residual.
The most polite procedure- secure free nasal (ENT) ventilation, remove thickend “mucosa” without grafting-wait for histologic result.(If to many septae and the ENT refuses do it by the window procedure- you will be the one to graft lateron anyway)
The bony reorganization of any graft will develop better if no additional or chronik acidity is provided to the inevitable surgical one.
Three months later you can do it even microinvasive and sleep well.
what about a patient that came to my office with a unliateral irregular 10mm mucous thickening??Any chance the membrane will tear more easily if i try to lift it/???