Tear of sinus membrane beyond repair: best course of action?

Yes you did the correct thing ,,, there are other ways to get things done but what you did was the best solution for you at that time . As to when to go back in ,there will be many different answers but an ENT friend suggested that best is 2 to 3 weeks as the lining would have healed and as you had a membrane covering the osteotomy there will have been soft tissue ingrowth so just easily go back in and lift the healed and hopefully tickened lining . Peter

Yes I agree with Peter. Now do the right thing and refer the case to an experienced surgeon who knows the way to handle a giant tear, there is a published technique which was not covered in your training. I think that this patient will not be so understanding the second time around. I feel that it is important to know how to treat an intra operative issue and have the right materials and technique available at the right time. There is a way to fix this at surgery and going in a second time with the same skill set is not advisable. Be glad it healed the first time from the iatrogenic complication, membranes don't tear on their own and tears are handled at surgery, now you have a compromised medial wall for the second surgeon ie scar tissue which will make the second surgery more difficult. Also how thick is the bone? There could be an issue with a post op iatrogenic oral antral communication if it is thin be advised thanks

You did the right thing best to abort at this point as nothing there to contain the graft. membrane will reestablish and repair give it 2 months then re-enter to graft it but becareful the periosteum will be connected to the sinus membrane at that point at the window so you will need to carefully with a scalpel and split the tissue leaving half in the sinus and half in the flap

You did the right thing. Waite about two to three weeks and revisit. I suggest you learn about the Loma Linda Pouch.

This advice is not going to help you or the patient, give them the money back and refer elsewhere before you get into more trouble, not knowing how to handle an intra operative complication is not wise. You won't magically learn what to do and should "learn on " a trusting patient. It's not as easy as it looks and it should have been handled at the original surgery but you did not know what to do. It's honest advice I hope you take it prudently, good luck.

Hi CRS's advice is the best option for you to follow, you said it your self, you were not sure how to treat the tear so if an understanding patient becomes a letigious patient (if it happens again) you would not really have way to defend yourself. The fact that you stopped and closed up the first time because you got out of your depth means you should be OK - you have to plan defensivley until the skill set is attained.

I agree with CRS you can't afford to have a second surgery and not have it be successful. Therefore I recommend referring it out but it's all in the wording. "Mrs Pt your membrane is unusally thin based on this I suggest we send you to Dr Good Lift who has experience with cases such as yours." I am a GP who performs alot of Sinus lift procedures but if I have a blow out case I refer it out for th esecond attempt.

Congrats on stopping and not plowing forward Bigger tear= let it heal for longer period of time. 1 side-effect of trauma to the schneiderian membrane is that it (eventually) grows back thicker. Id wait 4 months and re-open. If the membrane is too thin, I will open the window, try to elevate it a bit. If things aren't going my way, Ill close and re-open in 2 months. Membrane is much more pliable at that time. 2 surgeries, but at least its a successful 2-step surgery instead of unsucessful 1-step surgery.