[Surgery of the odontogenic-diseased maxillary sinus. Technic and experiences with the bone cover method]

In the well known extranasal surgical methods described by Caldwell-Luc and Denker, the opening of the bone of the facial wall created during surgery remains open. Scar tissue contract around the infraorbital nerve, fistulae, invasion of soft cheek tissue through the bone defect, and closure of the drainage window may result. The "Bone Lid" method avoids these disadvantages. During osteoplastic surgery of the maxillary sinus routinely performed by the author in more than 700 cases since 1973 a piece of bone (the "Bone Lid") including the attached mucosa is cut out of the anterior wall of the maxillary sinus in such a fashion that it serves perfectly to close the opening again as a free graft at the end of the operation. This procedure simplifies treatment of circumscribed changes in the mucosa, and facilitates precise creation of a drainage window essential for the healing of inflamed mucosa of the maxillary sinus. Coverage of the basal bony lesion initially present at the site of this window by a flap of muco-periosteum is simplified and secured by packing using an inflatable balloon. This stops bleeding reliably in the area of the inferior turbinate and around the window and simultaneously assures ventilation and drainage of the maxillary sinus during the healing period. The techniques used and the experience gained with this method are reported in detail.