Removal of Inflammatory Tissue/Product by Sinus Membrane Puncturing during Lateral Sinus Augmentation in Asymptomatic Patients with Severely Opacified Sinuses: A Case Series

Abstract

It is generally recommended that severe sinus membrane (SM) thickening should be treated prior to maxillary sinus augmentation (MSA), but during lateral MSA, inflammatory tissue/product may be removed by puncturing the SM. The present case report demonstrates surgical experience of lateral MSA with simultaneous inflammatory tissue/product removal for sinuses with severe opacification. In three patients requiring dental implant placement in the posterior maxilla, severe SM thickening was observed, but they were asymptomatic. The SM was gently elevated, followed by puncturing the SM, removing inflammatory tissue via the punctured site, draining, and thorough saline irrigation. Then, bone grafting and implant placement were performed with extra care not to spread bone substitute material into the punctured area. The postoperative pain following this procedure was more severe as compared to conventional MSA. Nasal bleeding was reported for 2–3 days. All implants were successfully integrated and demonstrated adequate function. Tissue samples retrieved during the surgery showed advanced inflammatory cell infiltration. The follow-up cone-beam computed tomographic scans revealed a significant reduction in SM thickening. In conclusion, inflammatory tissue/product removal by puncturing the SM can be applied during lateral MSA. However, more data should be needed due to the empirical nature of the present outcomes.