Maxillary sinusitis after augmentation of the maxillary sinus floor: A report of 2 cases

Abstract

Augmentation of the floor of the maxillary sinus with an autogenous bone graft is a generally accepted pre-implantology procedure to enable successful placement of endosseous implants in an optimal prosthetic position. As reported in the literature, complications of the sinus augmentation procedure predominantly consist of disturbed wound healing, hematoma, sequestration of bone, and transient maxillary sinusitis. 1,2 The last complication can occur as a result of contamination of the maxillary sinus with oral or nasal pathogen or because of a lack of asepsis during the surgical procedure. 3 Other causes are ostial obstruction due to postoperative swelling of the maxillary mucosa 4-6 and nonvital bony fragments freely floating in the maxillary sinus. 7 The incidence of maxillary sinusitis after augmentation of the sinus floor with iliac crest bone grafts ranges from 0% to 27%. 8-16 However, one has to consider that these data are derived from clinical studies in which the presence of maxillary sinusitis was not scored according to standard criteria in the field of otolaryngology for the diagnosis of sinusitis, 17-24 and specific preoperative evaluation of sinus drainage was not performed. Timmenga et al 25 reported that clearance of the maxillary sinus is rarely compromised after sinus floor augmentation, and that the development of a chronic maxillary sinusitis, with all its therapeutic consequences, still has to be considered as a rare condition. Between 1988 and 1998, 156 patients were treated in our clinic; 7 patients (4%) developed a transient (subacute) sinusitis, and 2 patients (2%) developed a chronic purulent maxillary sinusitis. In this report, these 2 complicated cases of chronic purulent maxillary sinusitis following augmentation of the maxillary sinus with autogenous bone grafts are discussed and guidelines for specific treatment of both transient and chronic maxillary sinusitis are given.