Hard swelling after lateral wall sinus lift: thoughts?

Last Updated: Jul 30, 2015

I did a sinus lift using a lateral wall approach to install an implant in #14 area [maxillary left first molar; 36]. I used a xenograft for augmentation. I gave amoxicillin 500mg and Metronidazole 200mg on the day of surgery followed by a short course. The patient developed an extra-oral swelling adjacent to the surgical site on the first day and 5 days later it is still there. No sign of purulence or infection. The sinus is clear. The patient does not need an analgesic. Should I be concerned? Any recommendations?

10 Comments on Hard swelling after lateral wall sinus lift: thoughts?

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CRS

07/30/2015

Did you cover it with a membrane? It is either an organizing blood clot or the graft leached out. Treat it like an exostosis

Neeraj

07/30/2015

Yes it was covered by a membrane. In fact after i posted this question the patient developed quite a bit of hematoma also. She admitting to blowing her nose ( which she was warned not to ) after which she developed the hematoma . Hematoma involved The upper lip upto the midline and also spread down to the mandibular region via the buccal space. Could sneezing have caused it ?

CRS

07/31/2015

Most likely a post op bleed I would have to see a photo or a sinus film with a fluid level. Watch for post op infection significant complication.

07/31/2015

The swelling is less today , sinus is clear as before and no evidence of sinus infection. I have continued the antibiotics . Thank you for your comments . I think the patient is slowly getting better and will possibly take a week more for symptoms to subside.

doctor J

08/04/2015

Hard swelling after procedure=blood cells (ie the patient is bleeding). Not sinus infection, not "graft leaching out" and not because of or lack of a "membrane". Also this is not bone, so "treating like an exostosis" is simply foolish. An exostosis it is not. The bleeding that occurs after wounding can often "tamponade" initially but nothing else makes something "hard" so fast. Then, if the tamponade again leaks (as it likely will and did here) further bleeding will occur, and your "bruise" and hematoma will become grotesque--and extensive. The bottom line....any wound that is closed must first be hemostatic. THen, if it bleeds and forms a hematoma, it has to be reopened and repaired prior to closure. Surgery 101. Finally, "blame gaming" (ie nose blowing) is hard to pin on anybody, so bringing it up is just useless.

08/04/2015

Doctor J is spot on with comments. It really is Surgery 101.

valentini

08/05/2015

the cause is the sneezing. You should check the fragmentation of the graft with a CBCT and if needed you should raise flap and remove the mobile part of the graft. The bleeding could also be the cause of the swelling but only if the Alveolo antral artery was present with an intra bony passage and an intra operative bleeding occurred at the moment of the lateral osteoptomy

elkabir

08/05/2015

clotting screening if continue, nose blow can cause emphysema

08/05/2015

Thank you for all the comments. The artery was confirmed on ct high up and not involved in the bony window site. She is a bleeder but also clots very fast. Dr J and FS - hemostasis was achieved properly and the only little bleeding during closure was from the suture sites which is unavoidable. there was no bleeding after a few min after the site was fully closed for a submerged healing. But I agree with your comments that it could be just pure bleeding post op for some reason which presented with a hard swelling and then the tamponade effect. I saw the pt today ( 2 WEEKS POST SURG) and swelling is 95% gone and hematoma is 80% gone and getting better . no pain/ discomfort . I/O healing all good and sutures were removed today. Thank you all so much for your comments.

Dennis Flanagan DDS MSc

08/05/2015

I'm sure you have a pre-op CBCT. That could explain what happened. By hard do you mean indurated and fluctuant? Dennis Flanagan DDS

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