How should you identify and manage a maxillary sinus floor perforation during extraction or implant placement?

• A. Ignore nasal symptoms
• B. Suspect with nasal/sinus symptoms; manage with antibiotics if infection risk, surgical repair if needed; consult ENT; plan for sinus augmentation if required
• C. Immediate implant placement
• D. Refer to orthodontist only

Answer: (B)

Recognizing a breach of the maxillary sinus floor during extraction or implant placement is crucial because it can create a conduit for infection and compromise healing. You identify it when nasal or sinus symptoms appear—congestion, nasal discharge, a foul taste, facial pressure—during the procedure or afterward; imaging with CBCT helps confirm a communication with the sinus and assesses the defect size and the sinus membrane status. If there is infection risk or signs of sinusitis, treat with antibiotics and manage the sinus environment to minimize contamination. For significant perforations or a torn sinus membrane, surgical repair is indicated to seal the opening and restore mucosal integrity, which may involve flap techniques, grafting materials, or a sinus-lift approach depending on the defect and the planned future implant. Consulting an ENT specialist is advised to ensure proper management and address any concurrent sinus pathology. If implant placement is still planned, plan for sinus augmentation to rebuild bone height and establish a safe sinus floor before proceeding. The aim is to prevent sinus complications, control infection, and secure a stable foundation for any future implant.