Every year, I perform numerous direct sinus lifts using a lateral window and grafts. Lately, I have been having several cases with the same type of post-op complication.
The surgery is uneventful, where I enter the sinus through a lateral window and place an allograft/xenograft mix, and cover the window with a membrane. Tension free primary closure is obtained using 3.0 PGA sutures, and I do use a periosteal releasing incision of the buccal flap to make sure the flap is not under any tension. Patient is put on antibiotics, analgesics, and dexamethasone. In addition Ancef [cefazolin] is used on a collagen membrane in the superior wall, and also mixed into the graft particulate.
About 2-3 weeks post-op, patient has a mild swelling. Intraorally on palpation, slight exudate is seen along the anterior releasing incision line. I have re-opened the flap in these situations, irrigated and debrided, as I would like to correct the problem to help salvage the graft. When I do open them, I find that the exudate/infection, is coming more apical, around the base of the flap, and NOT from the lateral window/graft, i.e. the graft is intact. In analyzing the few times this has happened, I am thinking that possibly some loose graft particulate has gotten trapped in the base of the flap, or in one of the periosteal releasing incisions, and has led to a localized infection. What is your analysis?
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