Scientific Online Resource System

Scripta Scientifica Medicinae Dentalis

A clinical case of perforation of the maxillary sinus membrane during sinus lift surgery and a proposed methodology for the management of subsequent complications

Elitsa Djongova, Tihomir Georgiev, Karen Dzhabalyan, Radosveta Andreeva, Mariana Dimova-Gabrovska


INTRODUCTION: Bony projections on the inner surface of the maxillary sinus are divided into two main groups: exostoses, which are rounded bone structures, and septa, defined as having a pointed end. Bony septa are common anatomical structures and can lead to complications during sinus augmentation procedures.

MATERIALS AND METHODS: The study reports a clinical case of a vertical partial basal bony septum, where upon elevation of the sinus membrane, its perforation was observed (size >5 mm).

RESULTS: The present study proposes a method of treatment of perforated sinus membranes.The post-surgical period was uneventful. The bone grafting material remained compact in the sinus augmentation site.

CONCLUSIONS: The proposed method for the management of perforated sinus membranes can be applied in surgical procedures for perforations > 5 mm in size.


cone-beam computed tomography, bony septum, maxillary sinus, sinus lift, bone augmentation, complications

Full Text


Ahmad M, Jenny J, Downie M. Application of cone beam computed tomography in oral and maxillofacial surgery. Aust Dent J. 2012 Mar;57 Suppl 1:82-94.

Parks ET. Cone beam computed tomography for the nasal cavity and paranasal sinuses. Dent Clin North Am. 2014 Jul;58(3):627-51. doi: 10.1016/j.cden.2014.04.003.

Bornstein MM, Seiffert C, Maestre-Ferrín L, Fodich I, Jacobs R, Buser D, von Arx T. An Analysis of Frequency, Morphology, and Locations of Maxillary Sinus Septa Using Cone Beam Computed Tomography. Int J Oral Maxillofac Implants. 2015 Oct 16. doi: 10.11607/jomi.4188. [Epubaheadofprint]

Gurler G, Delilbasi C. Relationship Between Preoperative Cone Beam Computed Tomography and Intraoperative Findings in Sinus Augmentation. Int J Oral Maxillofac Implants. 2015 Nov-Dec;30(6):1244-8. doi: 10.11607/jomi.3797.

Orhan K, Kusakci Seker B, Aksoy S, Bayindir H, BerberoÄŸlu A, Seker E. Cone beam CT evaluation of maxillary sinus septa prevalence, height, location and morphology in children and an adult population. Med Princ Pract. 2013;22(1):47-53. doi: 10.1159/000339849. Epub 2012 Jul 24.

Rosano G, Gaudy JF, Chaumanet G, Del Fabbro M, Taschieri S. [Maxillary sinus septa. Prevalence and anatomy]. [Article in French] Rev Stomatol Chir Maxillofac. 2012 Feb;113(1):32-5. doi: 10.1016/j.stomax.2011.10.005. Epub 2011 Nov 10.

R. Shindjalova, K. Prodanova,V. Svechtarov, Modeling Data for Tilted Implants in Grafted with Bio-Oss Maxillary Sinuses Using Logistic Regression, AIP Conference Proceedings, vol. 1631, pp. 58-62, 2014.

Georgiev T, Peev S, Arnautska H, Prodanova K, Dimova M. Variations and prevalence of maxillary sinus septa in patients of Varna region. Dental Review vol.7, p. 1-5

Li J, Zhou ZX, Yuan ZY, Yuan H, Sun C, Chen N. [Ananatomical study of maxillary sinus septum of Han population in Jiangsu region using cone-beam CT].[Article in Chinese] Shanghai Kou Qiang Yi Xue. 2013 Feb;22(1):52-7.

Jang SY, Chung K, Jung S, Park HJ, Oh HK, Kook MS. Comparative study of the sinus septa between dentulous and edentulous patients by cone beam computed tomography. Implant Dent. 2014 Aug;23(4):477-81. doi: 10.1097/ID.0000000000000107.

Dobele I, Kise L, Apse P, Kragis G, Bigestans A. Radiographic assessment of findings in the maxillary sinus using cone-beam computed tomography. Stomatologija. 2013;15(4):119-22.

Chan HL, Monje A, Suarez F, Benavides E, Wang HL. Palatonasal recess on medial wall of the maxillary sinus and clinical implications for sinus augmentation via lateral window approach. J Periodontol. 2013 Aug;84(8):1087-93. doi: 10.1902/jop.2012.120371. Epub 2012 Oct 29.

Pikos MA. Maxillary sinus membrane repair: update on technique for large and complete perforations. Implant Dent. 2008 Mar;17(1):24-31. doi: 10.1097/ID.0b013e318166d934.

Holtzclaw D. Maxillary Sinus Membrane Repair With Amnion-Chorion Barriers: A Retrospective Case Series. J Periodontol. 2015 Aug;86(8):936-40. doi: 10.1902/jop.2015.140087c. Epub 2015 May 12.

Baykul T, Fındık Y. Maxillary sinus perforation with presence of an antral pseudocyst, repaired with platelet rich fibrin. Ann Maxillofac Surg. 2014 Jul-Dec;4(2):205-7. doi: 10.4103/2231-0746.147144.

Massei G, Romano F, Aimetti M. An innovative technique to manage sinus membrane perforations: report of two cases. Int J Periodontics Restorative Dent. 2015 May-Jun;35(3):373-9. doi: 10.11607/prd.2195.

Peev S, Georgiev T, Krasnaliev I, Papanchev G, Aleksieva E. Sinus lift procedure using lateral access and a paste-like biphasic calcium phosphate bone grafting material. Dental Review, 4, 2012 (pp. 38-42)



About The Authors

Elitsa Djongova
Medical University of Varna

Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine

Tihomir Georgiev
Medical University of Varna

Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine

Karen Dzhabalyan
Medical University of Varna

Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine

Radosveta Andreeva
Medical University of Varna

Department of Pediatric Dentistry, Faculty of Dental Medicine

Mariana Dimova-Gabrovska
Medical University of Sofia

Department of Prosthetic Dental Medicine, Faculty of Dental Medicine

Font Size