All 180 Surgery Mrcs Podcasts: The Ultimate Audio Guide for MRCS Exam Preparation

Pathologies noted in the maxillary sinus, and their effect on the outcome of the sinus augmentation procedure has been debated since the introduction of the surgical procedure in 1977 by Tatum at a series of lectures presented at the Alabama Implants Study Group, in Birmingham Alabama.5 In general, any pathology or condition that may adversely affect healing of the surgical site should be taken into consideration prior to the surgical appointment. Soft tissue densities within the maxillary sinuses are a common manifestation of sinus pathology or abnormality.1 As a result, soft tissue density lesions at the floor of the maxillary sinus must be correctly diagnosed prior to surgical procedures. Sinus findings such as mucous retention pseudo-cysts (MRCs) seen superior to the implant surgical site in the maxillary sinus, has been a point of controversy since Ziccardi and Betts identified them as absolute contraindication for sinus augmentation procedures.6 Recently however, others have advocated them as posing no effect in the outcome of the surgery.2

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Interestingly, increases in the size of asymptomatic MRCs is not considered a strong reason to necessitate intervention.9 However when MRCs are accompanied with signs or symptoms such as headaches, intervention may become necessary.1,11 In cases of large size MRCs occupying great volume of the maxillary sinus, or in cases with indistinct diagnosis, further imaging and clinical evaluation prior to surgical intervention, to rule out radiographically similar appearing diseases is recommended. While asymptomatic MRCs are generally monitored without direct intervention, secondarily infected or large MRCs may become symptomatic necessitating intervention prior to sinus augmentation surgery.4

The presence of an intact Schneiderian membrane to tent the graft material between the maxillary sinus floor and the internal volume of the maxillary sinus is integral to the success of the procedure. Any disease or condition that reduces this integrity will have to be resolved prior to the sinus floor augmentation surgery. The question the authors set out to answer was whether MRCs affect this integrity and reduce the success and predictability of sinus augmentation technique in the same manner as other sinus pathologies do.

5. Mandelaris GA, Rosenfeld AL. Alternative applications of guided surgery: precise outlining of the lateral window in antral sinus bone grafting. Journal of Maxillofacial Surgery. 2009 2009;67(Suppl 3):23-30.

7. Harar RPS, Chadha NK, Rogers G. Are maxillary mucosal cysts and manifestation of inflammatory disease? The Journal Larngology & Otology. 2007 2007;121:751-754.8. Allard RHB, van der Kwast WAM, van der Waal I. Mucosal antral cysts review and report of a radiographic survey. Oral surgery, oral medicine, and oral pathology. January 1981 1981;52(1):2-9.

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