Abstract
Sinus membrane perforation is the most frequent intraoperative complication occurring during maxillary sinus floor elevation. Although numerous techniques for perforation management are present, grafting material dissemination may still occur, representing a potential trigger factor leading to acute or chronic sinusitis. This case report describes two cases of xenogeneic bone substitute in gel form accidentally dispersed into the sinus cavity during maxillary sinus floor elevation with a transcrestal approach. In both cases, immediately postoperative radiographic imaging showed an important amount of gel graft dislodged into the sinus cavity as a consequence of hidden perforations that remained undetected during surgery. Patients were monitored for 6 months after surgery and reported no signs or symptoms related to possible sinus disease. Control radiographs showed no sinus membrane hypertrophy and/or presence of residual disseminated gel, confirming complete clearance of the accidentally dispersed graft through the ostiomeatal complex. In order to minimize postoperative complications, bone substitutes in gel form could represent an interesting alternative to granular grafts for their easier clearance from the maxillary sinus cavity in case of accidental dissemination during sinus augmentation procedures.
Highlights
If the surgeon notices any biomaterial dislodgement, the grafting procedure should be immediately interrupted and disseminated particles should be carefully removed from the sinus cavity, by using sinus curettes and Volkmann spoons, irrigation with saline solution and
If the surgeon notices any biomaterial dislodgement, the grafting procedure should be immediately interrupted and disseminated particles should be carefully removed from the sinus cavity, by using sinus curettes and Volkmann spoons, irrigation with saline solution and surgical suction
Prompt individuation of graft displacement and effective cleaning procedures are relatively easy during sinus floor elevation with lateral technique: if the same adverse event occurs during the transcrestal approach, it is necessary to extend the mucoperiosteal flap in order to clean properly the sinus cavity through a lateral antrostomy
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Particulate grafting material displacement into the sinus cavity remains a possible adverse event in case of Schneiderian membrane perforation, even after attempting to seal it during surgery [9] Both autologous bone and various bone substitutes have been studied in the last decades as grafting materials for maxillary sinus floor elevation. Xenogeneic and alloplastic bone substitutes in gel form have been proposed in literature as grafting material for transcrestal sinus floor elevation [19,20,21,22]. These biomaterials are composed by micronized particles (generally up to 300 μm) suspended in an aqueous solution and embedded in a collagen matrix. The present report describes two cases of sinus membrane perforation during transcrestal sinus floor elevation by using grafts in gel form and the clinical outcomes following accidental membrane tearing and graft dispersion into the sinus cavity
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