Guymorotomy

At UKRMED in Kyiv, maxillary sinus surgery is used when there is a specific problem inside the sinus that needs direct treatment. CT is usually the starting point: it shows whether there is dental material, a root fragment, a cyst or another change, and where exactly it is located.

The tooth was treated weeks ago. Maybe months ago. Still, something is not right. There is pressure under one cheek. The nose blocks on the same side. Medication helps, then the symptoms return. A CT scan may finally show the reason. Sometimes a tiny fragment of filling material is sitting near the floor of the sinus. Sometimes it is part of a tooth root. That changes the situation. Inflammation can be treated with medication. A foreign object cannot.

What does the surgeon actually need to do?

First, reach the problem. After that, the operation depends on what is there. A root fragment needs to come out. The same applies to dental material or an implant that has moved into the sinus. A cyst is a different job. Chronically altered tissue is another one. So two patients can both be scheduled for maxillary sinus surgery and still have noticeably different procedures.

CT first

The important information is often hidden from view. You cannot look through the mouth and see where a small fragment lies inside the sinus.

CT can. It may show an object sitting almost on the sinus floor. Or farther back. Or near the opening that connects the sinus with the nasal cavity. Location matters because it changes the easiest way in. The scan also shows the condition of the sinus lining and whether part of the cavity is filled with inflammatory content.

Working through the nose

Sometimes the nasal route makes sense. A small endoscope gives the surgeon a view inside while instruments are passed through the nasal cavity. Nothing is cut on the outside of the face.

This approach is particularly useful when the problem is closer to the nasal side or when the natural sinus opening needs to be checked or treated at the same time. But a fragment sitting low beside the dental roots may be awkward to reach this way. Then another route can be better.

Working through the mouth

The upper teeth sit directly below the maxillary sinus. Suppose a piece of material has passed through the area of an upper molar and now lies close to the sinus floor. In that situation, approaching from inside the mouth may offer a shorter path.

The incision remains inside the oral cavity. No visible facial scar. There are also cases where one route alone does not give enough access. Then approaches can be combined.

The choice is mostly anatomy: where the problem sits and how it can be reached without doing unnecessary work around it.

Why dental problems end up in the sinus

For some people, the roots of upper premolars and molars lie extremely close to the sinus floor. That creates a fairly obvious connection between dentistry and sinus problems. A root canal material can pass beyond a root tip. During a difficult extraction, a small root piece may move upward. Occasionally an implant can end up inside the sinus as well.

What does that feel like? Often, nothing dramatic. Pressure. Congestion on one side. A bad smell. Episodes that keep being treated as sinusitis. Then they return. If the dental source is still there, that pattern makes sense.

During the operation

Once the surgeon has reached the sinus, the next step is based on the finding. A foreign object is taken out. A cyst or polyp is treated if present. Inflamed or altered tissue may need attention too. If there is purulent content, it is cleared.

After that, the surgeon checks whether the sinus has a reasonable route for drainage. This part matters. Removing one tiny object may be enough in one case, while another sinus needs more work because inflammation has been present for a long time.

The first days afterwards

Recovery depends quite a lot on the route. With an oral approach, the cheek may feel swollen or tender. After nasal endoscopy, congestion inside the nose can be more noticeable. There are also a few temporary restrictions.

Activities that create pressure around the sinus — forceful nose blowing, heavy exercise or flying — may need to wait. The surgeon gives a timeline based on what was actually done, not just the name of the operation.

Maxillary sinus surgery at UKRMED

At UKRMED in Kyiv, the main question is not simply whether the sinus is inflamed. It is why. A dental fragment? Filling material? A cyst? Changes in the lining? CT usually gives the map. The surgeon then chooses the route and the amount of treatment needed for that particular case.