JIACD
The Journal of Implant & Advanced Clinical Dentistry
Sinus Lift Complication: Please help granules and pus coming out her nose.
Wed, 01/05/2011 - 15:49 — Sam2493
I did a sinus lift 4 weeks ago. There was a tear of the sinus membrane in the distal part of the sinus measuring 5 mm. I proceeded with the lift and placed a collagen membrane covering the defect and fill the sinus with Biooss. The repair was done using a loma linda pouch technique The patient had antibiotics prior and then 10 days after surgery.
4 weeks later the patient presents with swelling, puss and granules coming out her nose.
How would you approach this? Can I recover? Do I get an ENT involved?
Sam
JIACD
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Comments
Sinus Lift Complication: You need to clean it out
Sam I think you have no choice but to go in and clean out the graft material.
I would refer to an ENT. I would wait a good 6 months before I would try and regraft the area.
I am concerned about the puss and granules coming out the nose. I have not seen that before.
Sinus lift complication
Hi Sam
According to what you have presented there is no doubt that you need to take everything out.Open up the sinus,suction out all the pus and graft material.Rinse with saline and metronidazole and perscribe the patient with antibiotics.
I would wait at least 4-5 months before rentering.
Sinus lift Complication: Can the Piezo or Ballon Avoided this?
I agree with Ziv. You need to clean everything out. You may need to remove some of the membrane as well. You should also manage this with an ENT.
Ziv would the balloon avoided this?
Sinus Complication- answer to Dr Wentkel
The Balloon technique reduces the perforation rate dramatically- this is a big advantage compared to the classical open window technique.
Question
Have you checked out her medical history, if she suffered from chronic sinusitis . This might have complicated your implant healing as well, especially when you mentioned pus and granules.
Sinus Complications
Hi,I agree w/d all the advices given above such as removing all the grafting materials, irrigating the sinus cavity and antibiotic coverage. But the comment of docra2ooo is i believe far more important. No matter how good is your surgical technique(pouch technique of loma linda) if the patient has existing sinus desease
such as chronic sinusitis w/c is one of the contraindication for subantral augmentation then complication like what your patient is experiencing now is inevitable.Patients who have history of sinus disease should be referred to an EENT doctor for possible treatment and clearance prior to the said treatment.
Sinus Complications Agree with Dr. Cynthia and Docra2000
I could agree more. Many clinicians overlook sinus disease and move right to clearance. I typically do CBCT scans prior on all my implant cases and if there is evidence of sinus pathology I refer to an ENT for clearance and consultation.
sinus lift and infecction rates
It looks that this patient had a:
1- preexisting sinus disease or
2- the osteomeatal complex was obstructed when placing the synthetic material into the sinus. Its a must always to check this complex by performing a Cone Beam scan a evaluating the sinus in not only a coronal but sagital space relationship.
Open the sinus debride and drain and let it heal, and perform a Cone beam scan
WOW
this is an unbelievable discussion. First of all, if you don't know how to manage sinus complications, what business do you have experimenting on patients? Secondly, I do not know many ENT surgeons who truly know what we are doing when we do sinus lift bone grafts. Sure, they can clear a sinus as far as osteomeatal complex patency, sinus health, etc., but they are not likely to understand a sinus lift bone graft.
i just don't understand why, when there are qualified and experienced oral & maxillofacial surgeons all around, general dentists are venturing into surgeries like this.
ASK an OMS or periodontist for help. They know the sinus... they know the bone graft. Maybe you should have had a specialist do this to begin with???
WOW
hawkoms, I agree with your first comment as per the ENT's. Oral Surgeons and periodontist do not have dominion over implant procedures. How many implant do most residents place----------very few. THE REALITY IS THAT ANY TRAINED AND MOTIVATED DENTIST CAN PERFORM THESE PROCEDURES. Truth be told there are GP's and specialist that should not perform these procedures.
sinus grafts
Dr. Hughes - we agree!
Dear friend dentist this is
Dear friend dentist this is an unusual situation on the grafting of the maxillary sinus that may have been induced by a pre existing diseases condition not detected or reported by you as membrane perforation sinusal.The best to be done in this situation, this is just a logical consideration initial, and curettage is the removal of grafting material and wait 6-8 months for new grafting, and remember that you will not have been the same baseline membrane became a scar tissue with new features histologics.Good luck and god bless you.Dr Cristiano Brazil
Sinus Graft complications: GP's Should refer
Hawk.OMS I agree with you on this one. This is a classic case where an inexperienced provider is over their head. Complications can occur no matter what. Put if you cant handle the heat get out of the kitche
Refer Refer Refer
WOW
Hawk, I completely agree with you. Dr. Hughes I completely disagree with you that residents only place a few implants. As a Perio resident I personally placed over 200 implants during my residency. The experienced gained is far superior and comprehensive than a weekend or a year course would provide. I know the specialists don't have dominion over the surgical or implant procedures but we do get to manage our failures and complications with supervision from trained specialists. I know there are a few truly great GP's who can handle these types of surgeries, but the majority can't even suture properly.
WOW
I stand corrected...thank you.
Place the patient on antibiotics and wait :Sinus issues
I would just put the patient on Antibiotics and wait
Amazing
I find it very distressing that all of the GPs want to refer to an ENT rather than involve an OMFS. As Hawk pointed out, they will go in and explore/enlarge the osteomeatal complex because that is what they do. The reason none of you suggest a referral to the recognized experts- OMFS and perio- is that you don't want to lose the patient to someone that has more experience with these procedures and someone that the patient is likely to complete care with. The only answer is to go back in and open up the site and remove the graft entirely. Dithering about preexisting sinus disease is pointless- the point is that the membrane was torn and grafting material entered the sinus cavity. Period. As for the contributor that would just place the patient on abx and wait- how long would you wait? In the presence of a failed and infected graft, you have no literature to back you up. The sinus has a poor blood supply, antibiotics without removal of the graft will not work.