Perforated Sinus Membrane: How do you repair and when you shouldnt

Sat, 09/26/2009 - 05:45 — Arroyodds

I recently did my first open sinus lift. I perforated it and repaired it with a membrane. I was uneasy to try and graft it so I put a membrane over the window and closed shop. My question is, what is ones protocol for doing a repair and grafting it versus, closing the case and coming back and relifting after it heals? I know many would have grafted but I felt its safer to come back based on my inexperience.

Sinus Lifts

Sun, 10/24/2010 - 10:36 — Tim Grant

Sinus Membrane tear repair protocol and issues

I would never suture a sinus menbrane perf. Don't even know how it's possible. I would tent the perf up with a collagen membrane and graft. Work very well with little complications.

Wed, 11/17/2010 - 07:05 — Mike Hollister DMD

Sinus Membrane Repair: Collagen tent

Out in California we started using collagen tents or pouches. The can be purchase at osseous technologies. Easy to use for repairing a tear.

Once again, never suture a membrane.

Tue, 06/29/2010 - 10:12 — Mike Hollister DMD

Suturing a sinus membrane tear: Suturing a NO NO

Dont Suture a torn sinus. Use a collagen membran and a platelet gel. Suturing will tear it more.

Mike

Mon, 06/07/2010 - 09:01 — Tom House DDS MD

Suturing a sinus membrane tear: 7.0 sutures a must

I learned this from an ENT during residency. Use a 7.0 chromic gut suture. Use a round skin needle that doesnt cut through the entire pass.

I do simple interupted sutures.

I usually cover with a membrane and prp.

Tom

Sun, 06/13/2010 - 08:14 — shazlovely

Suturing a sinus membrane tear: 7.0 sutures a must

I agree 7.0 suture is critical with a round needle.

I too cover with a membrane or collatape.

Sun, 06/06/2010 - 06:42 — Steve Wilson

Suturing a Sinus Membrane Tear: I dont see how this is possible

I dont see how this is plausible. Wouldnt you tear the membrane more?

Sat, 06/05/2010 - 06:43 — Tom House DDS MD

Why Cant you Suture a Sinus Membrane Perforation?

I have been an OMFS for years. When we do Lefort Surgery you frequently perf an membrane and you are able to suture.

During a sinus lift if you perf the membrane you can use 7.0 resorb suture, I then cover with a membrane and PRP.

Sometimes in the perf is to large or if I encounter pathology I will remove the sinue membrane all togethor.

Tom

Sat, 06/05/2010 - 13:39 — Perioplasticsurgeon

How do you suture a sinus membrane perforation?

Please explain how you do this without tearing the membrane more?

Wed, 06/02/2010 - 08:55 — Tim Grant

Sinus perf repair: Collagen barrier is a must

I repair the sinus perf using either biomend or bioguide. I place it over the perf and the graft. Please dont suture this is a far better technique with less risks.

When in doubt close the case and come back at a later date.

Mon, 05/31/2010 - 07:06 — OMFS GUY

Sinus membrane repair: Pikos Parachute technique

I agree with the below comments dont suture the membrane. I tried once and it was a disaster. I use the pikos technique which uses a collagen membrane with 4 slits in it to act as a parachute. I soak it in PRP.

Guy

Sun, 05/30/2010 - 09:41 — Tim Grant

DO NOT SUTURE A SINUS MEMBRANE PERFORATION

I would avoid that at all costs. You will make the perf bigger.

Sat, 05/29/2010 - 13:16 — shazlovely

You can suture the Sinus tear with a 7.0 suture

This can be done with 7.0 suture. I still would use a membrane and prp over the sutured sinus.

Sat, 05/29/2010 - 08:39 — Dr. Barbie

Sinus Complications: Handling a tear in the membrane

I think the best way is a membrane and PRP or PRGF.

Suturing is out of the question. I also agree if the tear is to larger the case should be closed and allow to heal.

My 2 cents

Barbs

Thu, 05/27/2010 - 15:47 — Dr90210

Sinus Membrane perf repair: Dont Suture

There is plenty of articles out there on how to repair a perf in the sinus membrane. The best way is use of a membrane to cover the area. If the perf is to large it is best to close the case and come back and relift after the membrane heals.

Wed, 05/26/2010 - 06:25 — Tom House DDS MD

Sinus perforation repair: You can suture

I have sutured the membrane before without issue. Not sure what all the hub bub is about. Use 7.0 suture with simple interupted. I usually cover the sutures with PRP and a membrane.

Why do people feel its a problem to suture?

Tue, 05/25/2010 - 09:48 — Dr. X

Never Suture a Sinus Perf

Dont suture a sinus perf. Not only is it time intensive, but it doesnt work and leads to bigger perforation.

Avoid and use a membrane.

Tue, 05/25/2010 - 17:49 — N Shumaker DDS MS

I agree do not try to suture.

I agree do not try to suture. Use Pikos parachute technique (published by Pikos...look it up on Pubmed). For large perfs use suture stabilization technique advocated by Wallace to hold a membrane in place. Works great. Studies by Ardekian show no difference in implant success between sinus with intraoperative perf repairs vs unperforated.

Tue, 05/25/2010 - 09:59 — zivmazor

Suturing a sinus perf

I totally agree with Dr XI would never try and suture a perf.In most cases it will lead to a bigger perf not to mention the difficulty.In small or medium perfs the best would be using a PRF membrane.It is so easy and quick.Always stay with the KISS principle.
In large perfs use the Loma Linda pouch technique.

Tue, 05/25/2010 - 05:02 — shazlovely

Suturing a torn sinus membrane: 7.0 suture a must

I been suturing membrane perfs for years. It works fine, you need 7.0 suture. I then can usually relift the area after I suture the perf.

Shaz

Mon, 05/24/2010 - 07:07 — enlittedo

Sinus Tear Repair: Suture or membrane

You can suture the tear or cover with a membrane. I use PRGF over the membrane and the healing is great.

Ted

Mon, 05/24/2010 - 13:04 — mosalama

Sinus Tear Repair: Suture or membrane

Must agree here. Why suture the tear with a risk of putting tension and making tear larger let alone the technical skill required.
PRGF or PRF fibrin works very well to repair and protect these tears.
Biggest issue is to never attempt to lift near the tear, it only makes the tear larger, always work back from the furthest distance away from the tear. This relaxes the membrane and allows for the membrane to fold onto itself minimizing or sealing the tear completely.
Dr. S

Fri, 05/21/2010 - 16:46 — shazlovely

Sinus perf repair: Suture with 7.0 suture

I found you can repair the sinus membrane with fine 7.0 suture.

Mon, 05/10/2010 - 21:36 — leopold

THANK YOU ...SO...much

THANK YOU for short explanation.

Mon, 05/10/2010 - 12:15 — hawkeye

Sinus perf repair technique: I use several

I find the loma linda pouch is not easy to do. I usually try an suture the tear or use a collagen membrane soaked in PRP.

I have also completely removed the membrane when I encountered pathology and tore the membrane.

Fri, 05/07/2010 - 05:13 — Dr. X

Loma Linda Pouch technique

Here is the article. I encourage you to read it. It is very well written and goes through the technique step by step.

Int J Periodontics Restorative Dent. 2003 Dec;23(6):593-7.

The "Loma Linda pouch": a technique for repairing the perforated sinus membrane.
Proussaefs P, Lozada J.

Graduate Program in Implant Dentistry, Loma Linda University, School of Dentistry, California 92350, USA. pproussaef@hotmail.com

Abstract
A technique, the "Loma Linda pouch," is introduced for repairing the perforated maxillary sinus membrane during sinus grafting procedures. A collagen membrane is placed against the perforated site and subsequently covers the internal surface of the maxillary sinus. The collagen membrane is then folded along the lateral access window to form a pouch that surrounds and isolates the graft material.

Mon, 05/03/2010 - 17:07 — leopold

Loma Linda pouch technique

Please describe Loma Linda pouch technique for sinus repair,in which cases we should use it???
THANK YOU

Mon, 05/03/2010 - 08:19 — SL Kang

Sinus Perf repair: Use a collagen membrane and PRP

Since I started using piezo I get less tears so that is the first recommendation. If you do get a tear that is smaller then the size of a quarter I would use a collagen membrane and PRP. IF it is greater then a quarter I woul put a membrane over the window, close the case and come back two months later and relift after the membrane heals.

Sat, 10/24/2009 - 13:06 — Dr. Pratt

Sinus lift repair technique

I tend to use a collagen membrane. If the tear is bigger then a quarter I close, wait 2 months and come back and relift.

Tue, 09/29/2009 - 09:47 — Dr Chace Heatly

Sinus Perforation Repair Tech

I to use a variation of the Loma Linda Pouch. I think a collagen membrane can repair most perforations.

Look into Piezo, by doing sinus lifts via the piezo less likely to perf.

Tue, 09/29/2009 - 08:31 — Dr90210

Perforated sinus Repair technique and rules

First off, if the tear is bigger then a quarter where I feel I cant contain my bone graft, I put a membrane over the window and close up and come back 3-4 months later.

When I repair a sinus tear I tend to favor the Loma Linda pouch technique with a resorbable membrane and tacks.