Guymorotomy

Maxillary sinus surgery gives the surgeon direct access to the sinus to remove the cause of inflammation: filling material pushed in during dental treatment, a root fragment, a cyst, a polyp or diseased lining. At UKRMED, it is performed by maxillofacial surgeon Anna Kravchenko. The operation is planned only after a CT scan shows exactly what is inside the sinus and where.

How the teeth and the maxillary sinus are connected

The maxillary sinuses are paired cavities inside the upper jaw, connected to the nose through a natural opening. In many people, the roots of the upper premolars and molars sit right against the sinus floor, and sometimes project into it. A dental problem can therefore easily spread into the sinus.

This is odontogenic sinusitis — sinus inflammation of dental origin. Its causes include:

• infection from a tooth with pulpitis or apical periodontitis;
• root canal filling material pushed beyond the root tip into the sinus;
• a root fragment displaced upwards during an extraction;
• an opening between the mouth and the sinus after an extraction;
• an implant or bone graft material that has moved into the sinus.

A 2022 state-of-the-art review stresses that odontogenic sinusitis is more common than previously reported and is most often one-sided. Typical signs are congestion and pressure on one side, a foul smell and flare-ups that return after each course of medication. People can treat "ordinary sinusitis" for years while the real cause stays in the tooth or the sinus.

When a maxillary sinus operation is needed

Antibiotics settle a flare-up but cannot remove a foreign object or a cyst. The same review notes that oral antibiotics are generally ineffective while a treatable dental cause remains, and that when both the tooth and the sinus are treated, resolution is achieved in 90–100% of cases. Odontogenic sinusitis treatment is therefore teamwork between a dentist, a maxillofacial surgeon and, when needed, an ENT specialist. A 2021 international consensus explicitly recommends this multidisciplinary approach to diagnosis.

Surgical treatment of maxillary sinusitis is considered when CT shows:

• filling material, a root fragment or an implant in the sinus;
• a cyst or polyp filling the sinus or blocking its drainage;
• chronic inflammation that keeps returning despite treatment;
• an opening between the mouth and the sinus that has not closed on its own.

Endoscopic surgery or an approach through the mouth

The approach depends on where the problem lies.

Endoscopic maxillary sinus surgery. The surgeon works through the nose, viewing the sinus on a screen through a thin endoscope. There is no external incision. An endoscopic maxillary antrostomy — widening of the natural sinus opening — suits cases where diseased lining, a polyp or a cyst near the nasal wall must be removed and drainage restored. The European guideline EPOS 2020 regards endoscopic sinus surgery as the main surgical option for chronic rhinosinusitis when medical treatment has failed.

Approach through the mouth (Caldwell-Luc). The surgeon opens the sinus through a small window in the front wall of the upper jaw; the incision is made inside the mouth above the teeth and is not visible from outside. The classic radical operation is used selectively today: when a foreign object lies low on the sinus floor, a cyst is large or endoscopic access is not enough. Recent case reviews show that a modified oral approach remains effective in such situations.

Sometimes both approaches are combined, to remove an object from below and restore drainage through the nose at the same time.

Step by step

1. Anaesthesia — local, or sedation supervised by an anaesthesiologist, depending on the extent of surgery.
2. Access to the sinus — endoscopically through the nose or through the mouth.
3. Inspection and removal of the cause: removal of tissue from the maxillary sinus, a root fragment, an implant, a cyst or a polyp. Maxillary sinus cyst removal is one of the most common tasks.
4. Maxillary sinus debridement — clearing pus and diseased lining.
5. Checking the natural opening so the sinus can ventilate and drain normally.
6. Closing any opening between the mouth and the sinus.

The causative tooth is treated in parallel: its canals are treated, or it is extracted if it cannot be saved. A 2025 review shows that when there is an oroantral opening, an infected graft or an implant in the sinus, combining dental treatment with endoscopic sinus surgery in one stage gives the highest success rate — close to 97%.

Recovery

In the first days, congestion, slight blood-stained discharge and discomfort are common; after an approach through the mouth, the cheek swells more often. According to Cleveland Clinic, most people return to work about a week after endoscopic sinus surgery and to their normal routine within two weeks, while full recovery can take a few months.

To avoid pressure in the sinus:

• do not blow your nose for at least seven days;
• sneeze with your mouth open;
• avoid heavy exercise, saunas and flying until the surgeon allows them;
• rinse your nose and take prescribed medicines as instructed.

Follow-up visits confirm that the sinus is clearing and that any opening to the mouth has closed.

Costs and diagnostics

The surgeon sets the cost of the operation itself after the CT scan: it depends on the approach, the extent of surgery and the anaesthesia. Diagnostics and related procedures follow the price list:

At UKRMED, oral and maxillofacial surgery works alongside dentistry, so the tooth that caused the problem is treated in the same clinic.

Sources

1. Craig J. R., Poetker D. M., Aksoy U. et al. Diagnosing odontogenic sinusitis: An international multidisciplinary consensus statement. Int Forum Allergy Rhinol, 2021. https://doi.org/10.1002/alr.22777
2. Craig J. R. Odontogenic sinusitis: A state-of-the-art review. World J Otorhinolaryngol Head Neck Surg, 2022. https://doi.org/10.1002/wjo2.9
3. Fokkens W. J., Lund V. J., Hopkins C. et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020). Rhinology, 2020. https://doi.org/10.4193/Rhin20.600
4. Albu S., Roman A. Navigating the Treatment Landscape of Odontogenic Sinusitis: Current Trends and Future Directions. Medicina (Kaunas), 2025. https://doi.org/10.3390/medicina61122175
5. Nelke K. et al. Odontogenic Sinusitis: The Selective Role of a Modified Caldwell-Luc Approach in Two CT/CBCT-Documented Cases. Diagnostics (Basel), 2026. https://doi.org/10.3390/diagnostics16162567
6. Cleveland Clinic. Functional Endoscopic Sinus Surgery (FESS). https://my.clevelandclinic.org/health/treatments/17478-functional-endoscopic-sinus-surgery