Maxillary Sinus Revision: Procedure, Indications & Care

What is a Maxillary Sinus Revision?

A maxillary sinus revision (also referred to as maxillary sinus surgery) is a surgical procedure in which the maxillary sinus (sinus maxillaris) – one of the largest paranasal sinuses in the facial skull – is opened, cleaned, and treated. The procedure is performed when conservative treatments are insufficient to resolve a disease of the maxillary sinus. Depending on the cause and surgical approach, the procedure may be carried out by an ear, nose, and throat (ENT) specialist, an oral and maxillofacial surgeon, or a dental surgeon.

Indications – When is Maxillary Sinus Revision Performed?

Maxillary sinus revision is indicated when pathological changes in the maxillary sinus cannot be resolved through medication alone. Common indications include:

• Chronic maxillary sinusitis: Long-lasting inflammation of the maxillary sinus that does not respond to antibiotics or decongestants.
• Odontogenic sinusitis: Sinus inflammation caused by dental roots or dental infections.
• Maxillary sinus cysts: Benign fluid-filled sacs that fill the sinus cavity and cause discomfort.
• Foreign bodies: For example, displaced dental roots, implants, or dental materials such as root canal filling material (e.g., zinc oxide eugenol paste) that have entered the sinus.
• Fungal infections (aspergilloma): Mold colonisation of the maxillary sinus, often triggered by overfilled root canal material.
• Nasal polyps: Benign mucosal growths that block drainage from the sinus.
• Tumors: Benign or, rarely, malignant neoplasms requiring surgical treatment.
• Implant revision: Correction of dental implants that have perforated into the sinus cavity.

Diagnostics Before Surgery

Prior to maxillary sinus revision, imaging studies are used to evaluate the sinus in detail:

• Digital Volume Tomography (DVT) or Computed Tomography (CT): Three-dimensional imaging of the sinus, dental roots, and foreign bodies.
• Panoramic Radiograph (OPG): Overview image of the teeth and sinuses.
• Nasal Endoscopy: Performed when polyps or mucosal changes are suspected.
• Microbiological Swabs: In cases of suspected bacterial or fungal infections.

Surgical Techniques

Depending on the cause and severity of the condition, different surgical techniques may be used:

Endoscopic Endonasal Sinus Surgery (FESS)

Functional Endoscopic Sinus Surgery (FESS) is the most modern and least invasive technique. A thin endoscope is inserted through the nose, allowing direct visualisation of the sinus. The natural drainage opening of the maxillary sinus (ostium) is widened, and diseased tissue, polyps, cysts, or foreign bodies are removed. This technique leaves no visible facial scars.

Caldwell-Luc Procedure

The Caldwell-Luc procedure involves opening the maxillary sinus through an incision in the oral vestibule (between the upper lip and gum). An access point is created through the anterior sinus wall to remove diseased tissue or foreign bodies. This approach is used less frequently today but remains relevant for specific indications such as large cysts or extensive findings.

Transoral / Dentoalveolar Access

For odontogenic causes or displaced dental roots and implants, access is often made through the alveolar socket of the affected tooth. This approach is preferred by oral and maxillofacial surgeons.

Procedure Overview

Maxillary sinus revision is typically performed under general anaesthesia or local anaesthesia with sedation, depending on the extent of the procedure. The surgeon removes pathological tissue, irrigates the sinus, and restores free drainage where necessary. Foreign bodies are completely removed. Tissue samples are often sent for histological (microscopic) examination.

Aftercare and Recovery

After surgery, the following measures are typically recommended:

• Regular nasal rinses with saline solution to support healing and mucosal regeneration.
• Antibiotic therapy in cases of bacterial infection.
• Short-term use of decongestant nasal drops to facilitate nasal breathing.
• Follow-up appointments with the treating physician to monitor recovery.
• Avoiding physical exertion and nose blowing in the first days after surgery.
• For endonasal procedures: nasal care with moisturising ointments or sprays.

Full healing of the mucous membranes may take several weeks. Swelling, mild pain, and a temporary sensation of pressure in the face are normal in the first days after surgery.

Possible Risks and Complications

As with any surgical procedure, maxillary sinus revision carries certain risks:

• Post-operative bleeding
• Infection or impaired wound healing
• Mucosal swelling and temporary nasal breathing difficulties
• Injury to adjacent structures (e.g., orbit, lacrimal duct, nerve pathways)
• Recurrence of the condition, particularly with polyps or fungal infections
• Rarely: cerebrospinal fluid leak or injury to the skull base

Modern endoscopic techniques and image-guided navigation (neuronavigation) have significantly reduced these risks in recent years.

References

1. Fokkens, W.J. et al. - European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020). Rhinology, 58(Suppl S29):1-464. DOI: 10.4193/Rhin20.600.
2. Stammberger, H. - Functional Endoscopic Sinus Surgery. The Messerklinger Technique. B.C. Decker, Philadelphia (1991).
3. Lechien, J.R. et al. - Odontogenic sinusitis: a systematic review. European Archives of Oto-Rhino-Laryngology, 277(2):335-354 (2020). DOI: 10.1007/s00405-019-05703-4.