Management of Ruptured Sinus Membrane in Maxillary Sinus Lift Surgery: a Systematic Literature Review
DOI:
https://doi.org/10.17921/2447-8938.2024v26n4p189-196Resumo
Abstract
Schneiderian membrane rupture is a common intraoperative complication during maxillary sinus surgery. The objective of this study was to verify the methods of conduct during rupture of the sinus membrane in maxillary sinus surgeries that offer the best clinical results. Google Scholar and PubMed (MEDLINE) databases were searched from April 2020 to May 2023 for articles published between 2016 and May 2023 with descriptors selected from DeCs/MeSH “cone-beam computed tomography”, “maxillary sinus”, “sinus floor augmentation” and “intraoperative complications”. This systematic review was carried out based on PRISMA methodology and registered in PROSPERO. The quality of the included studies was assessed using the MINORS index. The search term combinations resulted in a total of 724 titles. Altogether four studies met the inclusion criteria with 330 patients requiring graft in the posterior maxillary region with residual bone height <5 mm. The studies included 394 sinus lifting surgeries with access through the side window. A total of 114 cases of sinus membrane perforation (28.93%) were included with 88 cases (77.19%) successfully identified, 7 (6.14%) reporting failures in graft integration, and 19 cases (16.67%) of drilling were not rated for success/failure. Among the methods most cited for sinus membrane rupture, the membrane suture technique, collagen membranes, platelet rich fibrin, or not repairing the perforation were successful. Despite the success rates associated with various therapeutic modalities for rupture of the sinus membrane, no consensus in the literature exists regarding the technique offering the best result.
Keywords: Cone-beam Computed Tomography. Intraoperative Complications. Maxillary Sinus. Sinus Floor Augmentation.
Resumo
A ruptura da membrana sinusal é uma ocorrência transoperatória comum durante a cirurgia de levantamento do assoalho do seio maxilar. O objetivo do presente estudo foi verificar os métodos de conduta durante a ruptura da membrana sinusal que oferecem os melhores resultados clínicos. As bases de dados Google Scholar e PubMed (MEDLINE) foram pesquisadas de abril a junho de 2023 para artigos publicados entre 2016 e abril de 2023 com os termos “cone-beam computed tomography”, “maxillary sinus”, “sinus floor augmentation” e “intraoperative complications”. Esta revisão sistemática foi realizada de acordo com a metodologia PRISMA e sob registro da PROSPERO. A qualidade dos estudos foi avaliada pelo índice MINORS. As combinações dos termos de pesquisa resultaram em 724 títulos. Quatro estudos preencheram os critérios de inclusão com 330 pacientes que necessitaram de enxerto na região posterior de maxila com altura óssea residual <5 mm. Os estudos contemplaram 394 cirurgias de levantamento de seio via janela lateral. Um total de 114 casos de perfuração da membrana sinusal (28,93%) foram incluídos, com 88 casos (77,19%) identificados como sucesso, 7 casos (6,14%) relatando falhas na integração do enxerto e 19 casos (16,67%) de perfuração não foram avaliados quanto ao sucesso/fracasso. Dentre os métodos mais citados para manejo da ruptura de membrana sinusal, a sutura da membrana, membranas de colágeno, fibrina rica em plaquetas ou não reparo da perfuração foram bem-sucedidas. Apesar do sucesso associado às modalidades terapêuticas para ruptura da membrana sinusal, não existe consenso na literatura sobre a técnica com melhor resultado.
Palavras-chave: Tomografia Computadorizada de Feixe Cônico. Seio Maxilar. Levantamento do Assoalho do Seio Maxilar. Complicações Intraoperatórias.
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