Maxillary Sinusotomy

Sinusitis is an inflammation of the mucous membrane of the maxillary paranasal sinuses (maxillary sinus). The maxillary cavity (sinus) is lined with a mucous membrane, and its infection causes sinusitis. Thus, the nature of the disease is the same — an inflammatory process. However, there can be two sources of infection.

If the infection of the maxillary sinus comes through the nose, then the sinusitis is rhinogenic, and the patient should consult an otolaryngologist (ENT) for treatment.

Not many people know that the source of maxillary sinus infection can also be the teeth. In this case, it is odontogenic (dental) sinusitis, and a maxillofacial surgeon should be consulted for treatment.

Odontogenic sinusitis can be caused by problems with upper lateral teeth — premolars and molars (5th, 6th, 7th, 8th, sometimes 4th tooth).

Dental sinusitis can result from:

• poor-quality endodontic treatment: if the canal was not fully accessed, not completely treated, or infection remained — a cystogranuloma may develop at the root apex
• poor-quality canal filling: filling material extends beyond the root apex and enters the maxillary sinus
• poor-quality tooth extraction: a piece of root may fall into the maxillary sinus
• atypical positioning of wisdom teeth: if wisdom teeth with their follicles are located in the maxillary sinuses, or if the roots of wisdom teeth are highly intertwined
• complications after bone grafting procedures, such as sinus lift
• foreign body entry: most commonly this refers to implants that fall into the maxillary sinus (sometimes in such cases dentists refer to ENT, but it is impossible to retrieve an implant from the maxillary sinus with an endoscope)

Surgical treatment of sinusitis can be performed through the external nasal passage or through the oral cavity. In cases of dental sinusitis treatment at our clinic, maxillary sinusotomy is performed by a maxillofacial surgeon specifically through the oral cavity.

When it comes to dental causes of infection, surgical treatment of sinusitis is implied by default. Unfortunately, surgical intervention for sinusitis caused by mucous membrane infection through the teeth is inevitable. But the good news is the high effectiveness of such treatment — chronic sinusitis can be forgotten. And the cost of the surgery will be noticeably lower than the money spent on constant periodic and ineffective treatment.

In a number of state clinics in Ukraine, including in Kyiv, maxillary sinusotomy is performed using outdated methods: access is made through a large window in the outer wall of the maxillary sinus through the mouth, and an anastomosis is created through the inferior nasal passage. Such surgical treatment of sinusitis requires general anesthesia, hospital stay, and subsequent removal of the tampon through the nose the next day after the surgery. Moreover, this process is very painful and poorly tolerated by patients.

At Osadchyi Dental Clinic, we believe that surgical treatment of sinusitis should be effective and less traumatic for the patient, which is why we use a proprietary technique based on evidence-based medicine and the experience of our maxillofacial surgeon (over 1,000 similar operations).

Treatment of sinusitis involves a set of procedures, the most important part of which is the sinusotomy operation itself. Above the tooth root, inside the mouth, an incision is made (1-1.5 cm), then a perforation into the maxillary sinus is performed, through which the infecting component, destroyed tissues, or neoplasms are removed, and the maxillary sinus is sanitized and treated with medication. Then the incision is sutured.

This sinusotomy is performed under local anesthesia and takes 30 to 60 minutes. If necessary, we perform histological examination of removed pathological tissues.

It is important to understand that sinusotomy involves removing all foreign matter from the maxillary sinuses. In some cases, sinusotomy with preservation of the causative tooth is possible. At the same time, sinusotomy with tooth extraction is sometimes necessary. After such surgery, we provide further dental rehabilitation, including implant placement.

In most cases, dental sinusitis is unilateral, but inflammation on both sides is possible — in such cases, bilateral sinusotomy is performed.

The following stages of treatment:

• Identification of the flora that caused the infection

(the flora can be fungal or anaerobic and provoke the development of mycetomas, polyps, cysts).

• Prescription of medications

(all medications are prescribed individually, depending on the clinical picture; these may be antibiotics and/or antibacterial drugs).

The cost of maxillary sinusotomy in Kyiv may vary depending on the clinic and the technologies used by the doctor. Minimally invasive sinusotomy using a proprietary technique at Osadchyi Dental Clinic does not exceed average market prices, while offering a number of important advantages not only in terms of the operation itself but also in terms of recovery.

Sinusotomy using our method leaves no traces: the entrance to the maxillary sinus is so small that it is impossible to notice. Externally, the patient looks completely normal after the surgery; slight swelling is possible only in patients with prominent subcutaneous fat tissue. The full recovery period is up to 5 days, with relief coming as early as the next day after the surgery.

At Osadchyi Dental Clinic, we take on the follow-up care and observation of the patient until recovery, which does not increase the cost of the sinusotomy.

The operation is safe and effective, which is why we recommend it to our patients. Unlike constant visits to the ENT, minimally invasive sinusotomy performed by an experienced maxillofacial surgeon can completely eliminate sinusitis.

The main symptoms of sinusitis are: difficulty breathing, discharge from one (less often both) side(s) of the nose, headache, heaviness, pain when bending over, sleep disturbance, periodic runny nose.

If you have chronic sinusitis and otolaryngologist treatment is not helping, it is most likely dental sinusitis. However, not every dentist can make the correct diagnosis. Therefore, you should consult a maxillofacial surgeon.

Recurrences with minimally invasive sinusotomy for dental sinusitis are very rare. If symptoms return, it can be considered reinfection, which is possible when treating very advanced sinusitis. However, reinfection is also observed rarely.