Experiences with an Evacuable Anatomic Maxillary Sinus Implant for the Management of Orbital and Maxillary Injuries

Abstract

Fractures involving the walls of the maxillary sinus, particularly major fractures of the orbital floor, require optimal primary reduction and fixation. Conventional packing of the maxillary sinus or balloon-tipped catheters to support the orbital floor have several disadvantages: reduction may be inadequate, bleeding may occur when the packing is removed, and pressure necrosis may cause infections of the mucosal lining. To prevent these events, a special implant was developed at the Department of Maxillofacial Surgery in Salzburg (manufactured by G. Lixl, Department of Maxillofacial Surgery, Salzburg). In a pilot study, impression casts were obtained from 24 cadaveric maxillary sinuses. On the basis of the typical average shape (Schaeffer 1910), three thin-walled hollow implants of medical silicon were made for each side. To account for the variations in size, these were designed to accommodate volumes of 10, 15, and 20 cm3 (Holzner et al. 1986). The implant fit in the maxillary sinus is critically dependent on the correct attachment of the nasal drain, which is introduced through a window cut into the medial sinus wall (Fig. 1).