Surgical Technique for Submaxillectomy

Preoperative Considerations

The American Academy of Periodontology recommends a comprehensive radiographic evaluation, preferably with three-dimensional images, to identify specific anatomy, presence of sinus septa, and anatomic variations in approximately 30% of patients 1, 2
Consultation with an otorhinolaryngologist is recommended if there is a history of sinusitis or related symptoms 2
Verification that the patient has received adequate antibiotic prophylaxis is necessary 3
Preparation of all surgical materials, sterile instruments, and necessary equipment is crucial 3

The American Academy of Periodontology suggests desinfecting the perioral region adequately 3
Placement of sterile fields is necessary 3
Administration of local anesthesia with a vasoconstrictor in the surgical area is recommended 3
A supracrestal incision with vertical release is used to access the area 4
Elevation of a complete mucoperiosteal flap is necessary to visualize the lateral wall of the maxillary sinus 4
Creation of an access window using a diamond round bur with a high-speed handpiece, piezoelectric equipment, and/or a manual bone rasp is recommended 4
The window should be located near the zygomatic process to optimize access 4
Careful detachment of the sinus membrane from the bony walls using sinus membrane elevators and/or blunt piezoelectric tips is necessary 4
Special care should be taken to avoid perforations and overextension beyond the planned region 4
If a perforation occurs (the most frequent complication, 19.5% of cases), it should be sealed with an absorbable barrier membrane or a fibrin construct 5, 2

The American Academy of Periodontology recommends prescribing broad-spectrum antibiotics (amoxicillin or levofloxacin) for 7-10 days 5
Appropriate analgesics should be indicated for pain control 3
Detailed postoperative instructions should be provided to the patient 3
A follow-up appointment should be scheduled between 10-14 days after surgery to remove sutures, perform careful cleaning of plaque and residues, and reinforce postoperative instructions 5

Perforation of the Schneiderian membrane (19.5% of cases) should be sealed with an absorbable barrier membrane 5, 2
Abnormal postoperative bleeding (14.5%) is usually associated with damage to the posterior superior alveolar artery 5
Postoperative infections and subacute sinusitis (1.0% and 0.2%, respectively) require surgical drainage, debridement, removal of graft material, broad-spectrum systemic antibiotics, and close monitoring 5