MaxillarySinusMembraneRepair:UpdateonTechniqueforLargeandCompletePerforationsMichaelA.Pikos,DDSGraftingofthemaxillarysinuswasfirstdescribedbyTatum,1BoyneandJames,2andlatermodifiedbyothers.Ithasbecomeahighlypredictablesurgicaltechniqueforposteriormaxillarysitedevelop-mentandimplantreconstructionifpropertreatmentplanning,carefulsur-gicaltechnique,adequateclinicianexperience,andpatientcompliancecriteriaaremet.1,3–8Thereare,how-ever,complicationsassociatedwiththistechniquethatwouldbeexpectedwithanysurgicalprocedure.Althoughtheoverallcomplicationrateislow,themostcommoncomplicationismembraneperforation.8–10Thepurposeofthisarticleistore-portonamodificationofapreviouslypublishedtechniquethatcanbeusedforpredictablerepairoflargeandcompletesinusmembraneperforations.AnatomyThemaxillarysinusbeginsatap-proximatelythethirdmonthoffetallifeasaninvaginationfromthemiddleme-atusofthenasalcavityintothemaxilla.Itisthefirstandlargestoftheparanasalsinusestodevelop,andcontinuestoin-creaseinsizeuntilthepermanentteethhaveerupted.Cervin11examined107peoplewithCTandshowedthatthemeantransversedimension(mediolat-eral)andwidth(anteroposterior)ofthenormaladultsinusare27and35.6mm,respectively.Thisstudyalsoshowedadirectcorrelationofadultsinuswidthwithbodyweightandinterzygomaticbuttressdistance.AnotherstudyusingaxialCTin115patientsagedmorethan20yearsshowedtheaveragevolumeofthenormaladultmaxillarysinustorangefrom4.56to35.21cm3(mean,14.71cm3).12Inawelldonecadaverstudy,Stammberger13showedthattheheightandthewidthofthemaxillarysinusinedentulousspecimensaresignificantlygreaterthanthoseofdentatecadavers.However,nosignificantdifferenceintheanteroposteriorlengthorvolumewasreported.Thissamestudyin-cludedasimulatedsinusliftthatre-vealedaninferiorsinusgraftvolumeof3.5cm3neededfora15mmaug-mentationand5.66cm3requiredfora20mmaugmentation.Themaxillarysinushasahorizon-talpyramidalshapeconsistingofabase,anapex,and4sides.Thebase(medialwall)formstheverticallateralwallofthenasalcavity,andtheapexisatthejunctionofthemax...
