Large lesion extending into sinus: advice?

Last Updated February 04, 2019
Reviewed By:  Dr. Vipul Shukla

I have begun the initial work-up started on this patient. There are several issues that I see we need to work through. Most of us are doing cone beam ct imaging and now we can see the full extent of the lesion. I was curious about:
1- If there has been any research on the success or limitations with endo based on the size and extent of the lesion? It would be good to know some odds going forward so this can be part of the evaluation and conversation in treatment planning.
2- I know several on this site have treated this type of extension into the sinus. Is this an OS and ENT sequenced procedure assuming the tooth is coming out? Any experience here or advice would be helpful. Do you extract, do minimal curettage or aggressive curettage? Do you wait and revaluate changes in the sinus, and if so, how long do you wait and what are you looking for? Or is this not going to resolve and needs to be cleaned out via some access and would that be the plan?
3- When you have a maxillary molar that in your curettage and digital views has apparent granulation tissue into the sinus, how aggressive do you get with your curettage when you know there is a possibility you will, or could, perforate the sinus membrane and make things worse? In other words, will the lesion resolve itself?

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