Schneiderian Membrane Perforation During Sinus Lift Surgery
This clinical case addresses a complex sinus lift that involved a Schneiderian membrane perforation and a buccal bone defect during implant surgery. A 60-year-old patient came to our clinic seeking fixed rehabilitation in the upper left quadrant.
Planning and Initial Complication: Buccal Bone Loss
The patient had internal resorption in tooth 25 and lacked sufficient bone in the left maxillary sinus. We planned to extract tooth 25, place a post-extraction implant, and perform a sinus lift via Cadwell-Luc access for site 26.
During surgery, we encountered the first complication: a missing buccal bone plate at site 25. To manage it, we placed an implant anchored apically and palatally. We then grafted autologous bone and secured it using titanium mesh and osteosynthesis screws.
Managing Schneiderian Membrane Perforation Intraoperatively
The second complication was a Schneiderian membrane perforation, which prevented us from proceeding as planned. In smaller tears, folding the membrane and placing a collagen membrane is often enough.
However, this was a large perforation. We drilled small holes in the sinus wall and sutured the membrane to the bone. This method restored integrity and allowed us to continue. After confirming Valsalva recovery, we placed the implant at site 26 and grafted bone from the tuberosity. We sealed the sinus window with mesh and screws.
