Name of the Procedure:

Primary Closure of a Sinus Perforation (D7261) Common names: Sinus Perforation Repair, Sinus Membrane Closure

Summary

Primary closure of a sinus perforation involves surgically closing an opening that has occurred between the oral cavity and the sinus, often as a result of tooth extraction or trauma.

Purpose

This procedure addresses issues such as chronic sinus infections, nasal regurgitation during drinking, and discomfort from the open passage between the mouth and the sinus. The goal is to restore normal sinus function and prevent recurrent infections and discomfort.

Indications

• Persistent sinus infections
• Oral-to-nasal leakage of fluids
• Pain or discomfort in the sinus area
• Visible or diagnosed sinus perforation following dental procedures or trauma

Preparation

• Patients may need to fast for a specified period before the procedure.
• Adjustments to medications, especially blood thinners, might be necessary.
• Diagnostic imaging, such as CT scans of the sinus, might be required for detailed assessment.

Procedure Description

1. The patient is usually administered local or general anesthesia.
2. An incision is made to access the perforation site.
3. Tissue flaps are raised and meticulously positioned to close the sinus opening.
4. Sutures are placed to ensure the perforation is tightly sealed.
5. The surgical area is then cleaned and, if necessary, a dressing is applied.

Tools: Surgical scalpels, suturing materials, possibly bone grafting materials.

Duration

The procedure typically takes about 1 to 2 hours, depending on the case complexity.

Setting

• Outpatient clinic
• Hospital surgical center

Personnel

• Oral Surgeon or ENT Specialist
• Surgical Nurses
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Infection at the surgical site
• Bleeding
• Sinus complications, such as chronic sinusitis
• Failure of the closure, requiring additional procedures
• Temporary or permanent numbness in the affected area

Benefits

• Relief from symptoms like sinus infections and fluid leakage.
• Improved quality of life with normal sinus function restored.
• Prevents future complications related to the perforation.

Recovery

• Patients may need to follow a soft food diet for a few days.
• Prescribed medication to manage pain and prevent infection.
• Avoid strenuous activities for a week or more.
• Follow-up appointments to ensure proper healing.
• Complete recovery varies but typically ranges from a few weeks to two months.

Alternatives

• Use of a prosthetic device to temporarily seal the perforation.
• Non-surgical management with antibiotics and saline rinses.
• Risks with alternatives include persistent symptoms and potential for chronic issues.

Patient Experience

During the procedure, under anesthesia, the patient should feel minimal to no pain. Post-procedure, there might be discomfort, swelling, and a possible dull ache at the surgical site. Pain management includes prescribed medications and over-the-counter pain relievers. Most patients can return to daily activities within a week, following the surgeon's specific care guidelines.