Patient Has Polyps on Left Maxillary Sinus: Any Insight?

Sounds like the physician is treating the symptoms and not the disease. Anytime you have inflamatory sinus disease, you have an increased risk of complications after your sinus elevation and grafting. The likelihood of membrane tears or perforations decrease due to the thickening associated with a chronic condition, but postoperative inflamation, congestion and mucus retention leading to infection are more likely. I would obtain clearance from the ENT before proceeding. Good luck!

I had an identical case last week. Her ENT is treating her with steroids and wants to "wait". You have to find a surgical ENT and refer your patient to him/her. The physician I referred my patient to, told me that he was not familiar with the sinus lift procedures as we performe it. However once I explained him the LW procedure he concluded that he would remove the mass through the nose, and everytime time he does that he tries if at all possible, to leave the membrane intact. Healing time 2-3 weeks before you can go in and do your lateral window sinus lift. So look for a surgical ENT. Good luck.

If the problem is a mucous retention cyst, then this should be addressed before sinus lift. If there is a polyp present then this is usually of no concern. In fact there is usually less chance of tearing the membrane during the lift procedure due to the thickening of the membrane.

Your concern with this case should be the size of the mucus retention cyst especially in the right sinus . lifting this has a good chance of obstructing the osteum which will increase the risk of infection post surgery. this pt. should have sinus surgery to resolve this before the augmentation.

Boy ,you guys make it too easy sometimes. The one ent had never heard of a sinus lift, the second one is suggesting he can remove a polyp the size of a pro v 1 thru the nasal osmium . Please give the maxillofacial surgeons a shake at this stuff. I routinely refer endo involved teeth to endodonist and edentulous patients to prosthodontist and malocclusions to orthodontist and chronic perio patients to periodontist, what do y'all have against us. This is what maxillofacial means. Can someone else help me out here. This is why we go to school for 14-16 years. Bv

Dear colleagues, Before you all stand on the ENT platform I would suggest you get in touch with DR. Michael Pikos. Read his articles about taking out the polyps prior to sinus grafts. Any ENT who is simply waiting with drugs don't understand the way we do this kind of treatment. Please take Mike's courses or better yet, refer your patients to him.

Refer to dr. Pikos? Well your no help . How about refer to an omfs in your town. Pikos is an implant stud, but I'll put my fess , sino/nasal skills up against his any day. But you at least make a valid point. Bv

Dr boudet and dr Berne , not so sure I would go as far as to suggest thickened sinus membranes or sinuses with polyps are less likely to tear . If inflamed the membrane is indeed friable, and a rent maybe inevitable . Nasal steroids and preop po steroids do carry with it some credibility, first by making the osteum more patent and secondly by stabilizing an inflamed cell wall membrane. Bvinci

Regards to Baker vinci and be sure that Mr.Pikos is a great specialist who works with sinus complications during implant placement. I'm OMFS as you get it and works with implants enough long, about 5 years and face with such problems many times. 1. Never use topical steroids, when you plan LWSinusLift, beacuse theim maken the schneider membrane very thin and it will be very hard surgery. 2. Usualy I use nasal decongestants with non-steroid anti-inflammatory drugs (and antibiotics if it is necessary), waiting for month and making new CT-scan, to check it. Or if you used steroid you need to wait more then 2m - about 6m to recover musoca layer. 3. Never use steroind during osteogenesis, because they stops connective tissue formation (i.e. bone) 4. When the "polype" or muocous swelling is alredy reduced, but not at all, they can help you durig LWSL, because they makes mucous layer thick ;)... 5. Finaly if it is cyst or very big polype is impossibel to avoid sugery the ENT of OMFS need during the surgery maximally save the membrane, even if they need to leave a little part of changed mucosa, polyp or cyst. In this case you can make LWSL in after 2m ov post-op recovery, otherway - if the mucosae really damaged I'll not make any surgery during 1 st or maybe 2 nd year.... p.s. I have a big experience with sinus sugeries and knowt them from inside ;) Good luck!

About 60% of my scans have these lining thickenings and mucous congestion the key here is are there symptoms if not just go ahead as the ENT whilst curious about what a SL is , will not do anthing unless the Ostium is blocked ( thus with possible symptoms).Maybe to do with being in an inner city area or more smokers but this situation is not a big issue but maybe a nasal decongestant can be given . As to a second scan , would you scan yourself with regularity , no . As Bv says always a Lateral window so you can see what you are doing and in these cases the lining does feel more resiliant and harder to deflect so care is needed. As to tears it depends on the graft material being used as to how you deal with it but we have done numerous cases when removing objects from the sinus where the lining is destroyed and we place an implant and graft directly onto the implant and the body does the rest , load in 4 to 5 months. As to steriods I only use when the bone is thicker and hence access (Dask) more traumatic ( one 2mg Dexamethazone post op). Regards Peter

My regards, especially to peter fabian! My proposal for nasal decongestants is not only for this case, I prescribing them in cases of exudate presence in sinus (but I prefer the hyphertonic solution of NaCl rinses, because of decongestants side effect). What about steroids, so I usually makes as you one 2mg Dexamethazone post op, but not regularly as ENT prescribes the Mometazone, regularly during 2 month.

Your going to see the ent community use steroids more than you could imagine . I have lots of respect for the specialty and owe a great deal of what I do to them,especially when it comes to retreating some of their trauma abortions. THEY HAVE NO CLUE AS TO WHAT WE ARE DOING IN THE SINUS,however.Let's keep it in "the family". Bvinci

Dr. M scan slightly higher , and you can see both osteal openings. Send the scan to an omfs or radiologist. On that particular scan ,the opening appears clear on the non polyp side . Scan is nondiagnostic, as far as reading the dz side. Just a suggestion. I am putting on a course on just reading these scans, in that they are so readily available and easy to read . Most practioners haven't had a lot of training in reading ct's.. I rarely send mine out, but have been reading them for a long time. Bv

Baker vinci Becareful on what you say. Dr. Pikos is an excellent OMFS with great skill with all facets that deal with implant surgery, which include sinus grafting. My best regards to Dr. Weinberg. AA

Dr. Aptekar, I am familiar with dr. Pikos . I said he was an implant stud. In English that is a complement. I know he is an omfs, and if he is lecturing as much as he is, he better be familiar with sinus lifting. My issue , was with the suggestion that was made by another doctor, to refer a patient to him from banglidesh for all I know. I believe your love for dr. Pikos left you blind, In that you missed my point all together. I will bet you a large sum of whatever your currency is, that in 20 years I have done ( well) a significantly larger number of rhinoplasties, septoplasties and fess procedures than he has, in that his practice is almost completely limited to implants. I one day would like to limit my practice to implants as well , but four young children and expensive hobbies, mandate that I remain proficient in full scope surgery. Are you his body qaurd? I promise I wan't speaking Ill of him. Bvinci

Are you a big fella? Hope not , I gave up fighting 30 years ago!!!Have a good day!!!!!

Dr. Vinci your arrogance and condescending comments are unbelievable. Dr. Pikos is just a colleague, and an excellent surgeon. This website is here to discuss cases and learn from one another. It is not here to compare on who does more of certain procedures and who is better then others. Come on...it is not a competition!

Dr. Aptekar, have someone translate your posting and mine. I did nothing but praise dr. Pikos in the only way I know how. Your response, in the English language, was threatening. Excuse me for making lite of that fact, but get over yourself. I would doubt dr. Pikos does anything but implant related surgery, and as I said before, that is my ultimate goal. As of now, however, I don't have the luxury of subspecializing , therefore I stay very current in all forms of our specialty. Arrogant , I am not . Current , up to date, open minded and always willing to learn ,is what lead to this website. Did you go to one of his courses? Great , I heard they are a wonderful adjunct to formal specialized surgical training. Sweet dreams!! Bvinci

Do you not think it is absurd for your friend to suggest that a patient from the other side of the world , go see him because he has sinus retention cyst or a thickened dz sinus . There are 6 boarded surgeons In my town that could handle this problem. I agree the site is for educational purposes and I have personally changed about five things , that I have been doing as per dogma since I started on this website. I am not being condescending when I call some one out for being " out of the park". I'll try to cut back on some of the idiomatic expressions , In that I'm learning they are not universal . Get used to it, because I'm here to stay! This is an excellent forum, with some truly inspiring minds. I'll throw a couple of my own cases on here , so you can have a go at me! End of conversation , from my side . Sincerely bvinci

Dr.Vinci It is all good. Looking forward to more interested comments in the future on other cases.

interesting

Dr. Levon, pretty certain there are no clinical trials to support some of these statements. Topical steroids thin the schn. Membrane? Systematic steroids slow ostegenisis. You are aware that steroids work at the rough endoplasmic reticulum where protein formation is orchestrated, correct? I certainly can understand your recalcistrence when it comes to using steroids, but it's tough to read statements like that without raising some question. Steroids have "shaken " their bad rap, for the most part , and simple studies have proven that minor surgeries such as impacted third molars do much better , post-op , with pre and post surgical iv dosing . I have personally witnessed in 20 plus years ,a significant difference in my patients that get parenteral steroids pre- op and post -op for two to three days after big recon. Cases. I believe more studies ate warranted to encourage the dental world to follow medical surgical specialities. If not trials, maybe just some reading! Bv

When I first came in this website,I found some implantologists can not sleep all night like me. I read some comments and feel that we are friends from all over the world.Thank you for your kindness comments. Please..........PEACE.

Dr pisotroj, relatively speaking we are just a " blink In time". So any criticisms should never be taken personally. We are in a business that requires precision and passion. I have also found this site to be refreshing and fun. Bv