Maxillary sinus osteoplasty with vascularized pedicled bone flap Nicolas Lazaridis, DDS, MD, a Ioannis Tilaveridis, DDS, MD, b Gregory Venetis, DDS, MD, b and Maria Lazaridou, DDS, MD, c Thessaloniki, Greece DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY, ARISTOTLE UNIVERSITY Objective. This article describes the use of a vascularized pedicled bone flap, superiorly based on schneiderian membrane, for osteoplasty of maxillary sinus. Study design. A rectangular bony window was created on the anterior maxillary wall and pedicled from its inner surface with the schneiderian membrane attached to it and left intact superiorly. After the sinus pathology was addressed, the pedicled bony window was repositioned and stabilized with sutures. This technique was performed in 9 maxillary sinuses in 9 patients. A nasoantral window was opened in all of the cases. Results. The follow-up ranged between 12 and 38 months. Healing in all patients was uneventful. In 1 case, a temporary hypoesthesia of the infraorbital nerve was recorded. Conclusions. The procedure provides excellent visibility and access in the maxillary sinus, permitting the use of an advancement buccal pedicled flap for closure of an existing oroantral communication. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:828-832) Access to the maxillary sinus is usually performed by removal of the anterior maxillary wall, a procedure known as Caldwell–Luc operation. Some indications for Caldwell–Luc technique include removal of teeth or root fragments from the sinus, chronic maxillary sinus- itis, and cysts of the maxillary sinus. 1 The operation provides excellent visibility of the sinus and permits the subsequent creation of large nasoantral window in the inferior meatus for sinus drainage. 2 However, the pro- cedure is accompanied by serious complications in between 10% and 40% and can result in invagination of buccal soft tissue into the antrum, accompanied by postoperative pain and sinusitis. 3,4 Infraorbital nerve damage is also a possibility after this operation, and special care must be taken to protect the nerve superiorly and to avoid injury of tooth roots inferiorly. 2 Most of these complications are thought to be related to the surgical intervention used to remove pathologic lesions from the maxillary sinus and the destruction of the normal maxillary lining. 5 Osteoplasty of the anterior wall of the maxillary sinus was proposed to eliminate the complications encountered with Cald- well-Luc operation. 6 Endoscopic surgery of maxillary and other paranasal sinuses has changed the access to these cavities and reduced the complications related to the classic Cald- well-Luc operation. 7,8 Now, even though endonasal endoscopic surgery, with the advent of new endoscopic sinus procedures, is a reliable treatment option with excellent long-term results, there is difficulty using this method in selected cases. Some of these cases include cysts located in the lateral or anteroinferior portion of the maxillary sinus, small cysts in any location, or cysts with a bony wall. 9 Large foreign bodies, such as displaced teeth or antro- liths, odontogenic cysts extending into the sinus, are best treated by osteoplastic methods. In some instances, the osteoplastic aproach can be combined with endo- nasal endoscopic microsurgery. 7 When the osteoplastic method is used, it offers better results than the simple Caldwell-Luc operation. Vascu- larized bone flap has also been proposed for access to the maxillary sinus to avoid the complications related to the classic Caldwell-Luc procedure. 5 This paper proposes the use of a superiorly based vascularized bone flap based on schneiderian mem- brane for treatment of maxillary sinus diseases and describes the details related to this technique along with the clinical results. PATIENTS AND METHODS The procedure described in this paper was used in 9 sinuses of 9 patients with maxillary sinus diseases. The age of the patients ranged from 22 to 61 years, with an average age of 42 years, and the follow-up period was up to 36 months. Four patients were initially diagnosed as having chronic maxillary sinusitis with oroantral communication, 3 had mucoceles at the frontolateral aspect of the maxillary sinus, 1 had an impacted tooth a Professor, Head of Department. b Lecturer. c Resident. Received for publication Jan 28, 2008; returned for revision Apr 20, 2008; accepted for publication May 13, 2008. 1079-2104/$ - see front matter © 2008 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2008.05.030 828