**8. Short-term postoperative complications**

#### **8.1. Incision line opening**

Incision line opening is uncommon for this procedure because the crestal incision is in attached gingiva and at least 5 mm away from the lateral access window. Incision line opening occurs more commonly when lateral augmentation is performed at the same time as sinus graft surgery, or when implants are placed over above the residual crest and covered with the soft tissue. It may also occur when a soft tissue-supported prosthesis compresses the surgical area during function before suture removal. The consequences of the incision line opening are delayed healing, leaking of the graft material into the oral cavity, and increased risk of infection. However, if the incision line failure is not related to the lateral onlay graft and is only on the crest of the ridge and away from the sinus access window, then the posterior crestal area is allowed to heal by secondary intention. If incision line opening includes a portion of nonresorbable membrane, then the membrane should be cleaned at least twice daily with oral rinses of chlorhexidine. If the incision line does not close after two months, then a surgical procedure should reenter the site, expand the tissues, remove the bone regeneration mem‐ brane, and reapproximate the tissue.

#### **8.2. Nerve impairment**

In severely atrophic maxillas, the infra orbital neurovascular structures exiting the foramen may be close to the intraoral residual ridge and should be avoided when performing sinus graft procedures to minimize possible nerve impairment.

#### **8.3. Acute maxillary sinus rhinosinusitis**

Acute postoperative sinusitis occurs as a complication in approximately 3% to 20% of sinus graft procedures, and it represents the most common short term complication. Most often the infection begins more than 1 week after surgery.

Radiographic evaluation of acute rhinosinustis is both expensive and often inaccurate. As such, a patient history for acute sinusitis is a benefit and is diagnostic when two or more of the following factors are present: (1)facial congestion or fullness, (2)nasal obstruction or blockage, (3)nasal discharge, (4)purulence or discolored postnasal discharge, (5)facial pain or pressure, (6)hyposomia or anosomia, (7)purulence in the nares on physical examination, (8)fever, (9)headache, (10)halitosis, (11)dental pain, (12)cough, (13)ear pain.

Previous studies and treatment modalities used amoxicillin as the first drug of choice. However, with the increasing prevalence of penicillinase and beta-lactamase producing strains of haemaphilus influenza and moraxells catarrhalis, along with penicillin-resistant strains of streptococcus pneumonia, other alternative antibiotic drugs should be selected. If symptoms are not alleviated with antibiotic and decongestant medications, then possible referral to the patient's physician or otolaryngologist is warranted.

#### **8.4. Overfilling the sinus**

When the septum is in the posterior compartment of the sinus, it is often distal to the last implant site. When this occurs, the posterior septum is treated through the posterior wall of

Incision line opening is uncommon for this procedure because the crestal incision is in attached gingiva and at least 5 mm away from the lateral access window. Incision line opening occurs more commonly when lateral augmentation is performed at the same time as sinus graft surgery, or when implants are placed over above the residual crest and covered with the soft tissue. It may also occur when a soft tissue-supported prosthesis compresses the surgical area during function before suture removal. The consequences of the incision line opening are delayed healing, leaking of the graft material into the oral cavity, and increased risk of infection. However, if the incision line failure is not related to the lateral onlay graft and is only on the crest of the ridge and away from the sinus access window, then the posterior crestal area is allowed to heal by secondary intention. If incision line opening includes a portion of nonresorbable membrane, then the membrane should be cleaned at least twice daily with oral rinses of chlorhexidine. If the incision line does not close after two months, then a surgical procedure should reenter the site, expand the tissues, remove the bone regeneration mem‐

In severely atrophic maxillas, the infra orbital neurovascular structures exiting the foramen may be close to the intraoral residual ridge and should be avoided when performing sinus

Acute postoperative sinusitis occurs as a complication in approximately 3% to 20% of sinus graft procedures, and it represents the most common short term complication. Most often the

Radiographic evaluation of acute rhinosinustis is both expensive and often inaccurate. As such, a patient history for acute sinusitis is a benefit and is diagnostic when two or more of the following factors are present: (1)facial congestion or fullness, (2)nasal obstruction or blockage, (3)nasal discharge, (4)purulence or discolored postnasal discharge, (5)facial pain or pressure, (6)hyposomia or anosomia, (7)purulence in the nares on physical examination, (8)fever,

Previous studies and treatment modalities used amoxicillin as the first drug of choice. However, with the increasing prevalence of penicillinase and beta-lactamase producing strains

**8. Short-term postoperative complications**

580 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

the sinus.

**8.1. Incision line opening**

brane, and reapproximate the tissue.

**8.3. Acute maxillary sinus rhinosinusitis**

infection begins more than 1 week after surgery.

graft procedures to minimize possible nerve impairment.

(9)headache, (10)halitosis, (11)dental pain, (12)cough, (13)ear pain.

**8.2. Nerve impairment**

The maximum length requirement of an implant with adequate surface of design is rarely more than 15 mm, and as a result, the goal of the initial sinus graft is to obtain at least 16mm of vertical bone from the crest of ridge. Overfilling the sinus can result in blockage of the ostium, especially if membrane inflammation or the presence of a thickened sinus mucosa exists. The majority of sinus graft overfills do not have postoperative complications. If, however, a postoperative sinus infection occurs without initial resolution, re-entry and removal of a portion of the graft and changing the antibiotic protocol may be appropriate. [17, 18]
