This is in response to the latest reply regarding SA4 Lateral Sinus Augmenation.

Due to the combination of issues I am trying to overcome here I think I will refer this case.

If my GBR skills were at a higher level I think I would do GBR first and try to improve vertical and horizontal dimensions of the bone.

Doing both at the same time would increase my chances of having complications that could effect eachother. I.E infection of GBR and issues with sinus and vise versa.

Another concern here is the maxillary artery gives rise to the PSA artery, There is in intra and extraosseous branch sometimes detectable on CT.

In this case I believe on the PA we are seeing quite a large vessel which may represent the Intraosseous branch which  is running right through the window location that I would propose for lateral augmentation. If this vessel is damaged during the time the window is being made is it best to crush bone towards the posterior border of the window to stop bleeding.........or electrocautery? How often is this vessel an issue? Im sure many times it is not visible on even a CT but can you comment on complications in dealing with the intraosseous branch. Is it usually running on the surface of the Schneiderian membrane. Based on radiographs does it change the lateral approach planning?

One other comment on the steriods, obviously they help with swelling. I see that swelling is quite pronounced with these patients even the cases I refer. Do steroids make enough of a difference to give them to every patient so long as there medical history allows or is it like trying to take down an elephant with a BB gun.

Thanks

Chad