Compromised Schneiderian membrane: Correct Treatment Protocol?

Loma Linda pouch.

A tear in a healthy Schneiderian membrane can be repaired easily and should not be removed. Pikos only removed part of the membrane if there is associated pathology such as mucous retention cyst. If there is no fistula, treat it symptomatically as for sinus infection. Given enough time, the boy will heal itself. Check out his article in w ww. eugenol .c om.

Do not remove the membrane on initial entry to do lift, simply elevate it upward and insure the now exposed lateral walls and floor are exposed where you want your graft to be. Graft material must have blood supply. Place and secure your collagen loma linda pouch insuring that you are securing your graft material to the sinus floor and lateral walls. Use of PRF sinus repair technique as described by Dr. Ziv Mazor is highly recommended. On a revision re-entry, if membrane does not look healthy (dark color or leathery like), it most likely is not, then remove it. It is now dead tissue and will smell same when patient breaths in and out. Otherwise if it is still flexible, shiny, clear and looks vital leave it.

Use the Tijuana patch...works everytime. I learned that from a sinus elevation expert in Mexico.

Ok, I'll bite. What is the Tijuana patch?

The Tijuana Patch technique is use a resorbable leaf from the lady bug tree. Cut it into a small piece to cover your tear, then place the leaf inside the tear (not outside the tear as it is recommended in other technqiues). WHen the leaf resorbs over time (6-12 months...sometimes it doesn't resorb), it will create a foreign body reaction which will promote macrophages and granulation tissue, which will form a polyp. This polyp will cover the tear...no more tear...it is quite ingenious.

I live in the south so I would use magnolia. Perhaps we can name it the Birmingham Patch technique.

You were performing a sinus lift and had a large tear, and now you are blogging to ask what the the preferred mode of treatment should be? Seems like you have it a little backwards. If you are going to take on the responsibilty of performing a sinus graft, you should be prepared for all of the consequences (membrane tear, transection of the internal maxillary artery, mucocoele, polyp, sinus infection, retained root, root fragment lost in the sinus, or migrated implant). I am distressed at the concept of a watch one, do one, and teach one mentality that we are seeing all too often. And then, offering advice on a case with no records, no medical history, and no radiographs really begs the question; isn't it time we had a speciality of Oral Implantology so that clinicans would be well trained to evaluate and perform all of these procedures? RJM

Wow, that was really helpful Robert!