ENT assessment in the integrated management of candidate for (maxillary) sinus lift
Identifieur interne : 002641 ( Pmc/Checkpoint ); précédent : 002640; suivant : 002642ENT assessment in the integrated management of candidate for (maxillary) sinus lift
Auteurs : L. Pignataro ; M. Mantovani ; S. Torretta ; G. Felisati ; G. SambataroSource :
- Acta Otorhinolaryngologica Italica [ 0392-100X ] ; 2008.
Abstract
As stated at the 1996 Consensus Conference at Babson College, a (maxillary) sinus lift is a “safe and predictable” procedure for increasing alveolar bone height in the postero-superior alveolar regions in order to allow oral rehabilitation and restore masticatory function by means of the insertion of a dental implant even in the case of an atrophic maxilla. However, the procedure has a well-known impact on the delicate homeostasis of the maxillary sinus: the concomitant presence of systemic, naso-sinusal or maxillary sinus disease may favour the development of post-operative complications (particularly maxillary rhino-sinusitis), which can compromise a good surgical outcome. On the basis of these considerations, the management of sinus lift candidates should include the careful identification of any situations contraindicating the procedure and, if naso-sinusal disease is suspected, a clinical assessment by an ear, nose and throat specialist, which should include nasal endoscopy and, if necessary, a computed tomography scan of the maxillo-facial district, particularly the ostio-meatal complex. This first preventive-diagnostic step should be dedicated to detect presumably irreversible and potentially reversible contraindications to a sinus lift, whereas the second (preventive-therapeutic) step is aimed at correcting (mainly with the aid of endoscopic surgery) such potentially reversible ear, nose and throat contraindications as middle-meatal anatomical structural impairments, phlogistic-infective diseases and benign naso-sinusal neoplasms the removal of which achieves naso-sinusal homeostasis recovery, in order to restore the physiological drainage and ventilation of the maxillary sinus. The third (diagnostic-therapeutic) step is only required if mainly infective and sinusal complications arise after sinus lift surgery, and is aimed at ensuring early diagnosis and prompt treatment of maxillary rhino-sinusitis in order to avoid, if possible, implant loss and, in particular, the related major complications. The purpose of this report is to describe these three steps in detail within the context of a multidisciplinary management of sinus lift in which otorhinolaryngological factors may be the key to a successful outcome.
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PubMed: 18646572
PubMed Central: 2644985
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<author><name sortKey="Torretta, S" sort="Torretta, S" uniqKey="Torretta S" first="S" last="Torretta">S. Torretta</name>
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<front><div type="abstract" xml:lang="en"><title>Summary</title>
<p>As stated at the 1996 Consensus Conference at Babson College, a (maxillary) sinus lift is a “safe and predictable” procedure for increasing alveolar bone height in the postero-superior alveolar regions in order to allow oral rehabilitation and restore masticatory function by means of the insertion of a dental implant even in the case of an atrophic maxilla. However, the procedure has a well-known impact on the delicate homeostasis of the maxillary sinus: the concomitant presence of systemic, naso-sinusal or maxillary sinus disease may favour the development of post-operative complications (particularly maxillary rhino-sinusitis), which can compromise a good surgical outcome. On the basis of these considerations, the management of sinus lift candidates should include the careful identification of any situations contraindicating the procedure and, if naso-sinusal disease is suspected, a clinical assessment by an ear, nose and throat specialist, which should include nasal endoscopy and, if necessary, a computed tomography scan of the maxillo-facial district, particularly the ostio-meatal complex. This first preventive-diagnostic step should be dedicated to detect presumably irreversible and potentially reversible contraindications to a sinus lift, whereas the second (preventive-therapeutic) step is aimed at correcting (mainly with the aid of endoscopic surgery) such potentially reversible ear, nose and throat contraindications as middle-meatal anatomical structural impairments, phlogistic-infective diseases and benign naso-sinusal neoplasms the removal of which achieves naso-sinusal homeostasis recovery, in order to restore the physiological drainage and ventilation of the maxillary sinus. The third (diagnostic-therapeutic) step is only required if mainly infective and sinusal complications arise after sinus lift surgery, and is aimed at ensuring early diagnosis and prompt treatment of maxillary rhino-sinusitis in order to avoid, if possible, implant loss and, in particular, the related major complications. The purpose of this report is to describe these three steps in detail within the context of a multidisciplinary management of sinus lift in which otorhinolaryngological factors may be the key to a successful outcome.</p>
</div>
</front>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Acta Otorhinolaryngol Ital</journal-id>
<journal-id journal-id-type="publisher-id">Acta</journal-id>
<journal-title-group><journal-title>Acta Otorhinolaryngologica Italica</journal-title>
</journal-title-group>
<issn pub-type="ppub">0392-100X</issn>
<issn pub-type="epub">1827-675X</issn>
<publisher><publisher-name>Pacini Editore SpA</publisher-name>
<publisher-loc>Ospedaletto (Pisa), Italy</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">18646572</article-id>
<article-id pub-id-type="pmc">2644985</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Position paper</subject>
</subj-group>
</article-categories>
<title-group><article-title>ENT assessment in the integrated management of candidate for (maxillary) sinus lift</article-title>
<trans-title-group xml:lang="it"><trans-title>Il ruolo dello specialista ORL nella gestione integrata del paziente candidato al rialzo del seno (mascellare)</trans-title>
</trans-title-group>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Pignataro</surname>
<given-names>L</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mantovani</surname>
<given-names>M</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Torretta</surname>
<given-names>S</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Felisati</surname>
<given-names>G</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sambataro</surname>
<given-names>G</given-names>
</name>
</contrib>
<aff>Department of Otorhinolaryngological and Ophthalmological Sciences, University of Milan, Fondazione IRCCS Maggiore Policlinico Mangiagalli and Regina Elena Hospital, Milan</aff>
<aff id="A2"><label>2</label>
ENT Clinic “San Paolo” Hospital, University of Milan, Milan, Italy</aff>
<aff id="A1"><label>1</label>
LP and MM contributed equally to this study</aff>
</contrib-group>
<author-notes><corresp>Address for correspondence: Prof. L. Pignataro
<institution>Dipartimento di Otorinolaringoiatria e Scienze Oftalmologiche, Università di Milano, Fondazione I.R.C.C.S., Ospedale Maggiore Policlinico “Mangiagalli e Regina Elena”</institution>
<addr-line>via F. Sforza 35, 20122 Milano</addr-line>
<country>Italy</country>
<fax>+39 02 50320248</fax>
<email>lorenzo.pignataro@unimi.it</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>6</month>
<year>2008</year>
</pub-date>
<volume>28</volume>
<issue>3</issue>
<fpage>110</fpage>
<lpage>119</lpage>
<history><date date-type="received"><day>27</day>
<month>1</month>
<year>2008</year>
</date>
<date date-type="accepted"><day>7</day>
<month>3</month>
<year>2008</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2008 by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Roma Italy</copyright-statement>
<copyright-year>2008</copyright-year>
</permissions>
<abstract><title>Summary</title>
<p>As stated at the 1996 Consensus Conference at Babson College, a (maxillary) sinus lift is a “safe and predictable” procedure for increasing alveolar bone height in the postero-superior alveolar regions in order to allow oral rehabilitation and restore masticatory function by means of the insertion of a dental implant even in the case of an atrophic maxilla. However, the procedure has a well-known impact on the delicate homeostasis of the maxillary sinus: the concomitant presence of systemic, naso-sinusal or maxillary sinus disease may favour the development of post-operative complications (particularly maxillary rhino-sinusitis), which can compromise a good surgical outcome. On the basis of these considerations, the management of sinus lift candidates should include the careful identification of any situations contraindicating the procedure and, if naso-sinusal disease is suspected, a clinical assessment by an ear, nose and throat specialist, which should include nasal endoscopy and, if necessary, a computed tomography scan of the maxillo-facial district, particularly the ostio-meatal complex. This first preventive-diagnostic step should be dedicated to detect presumably irreversible and potentially reversible contraindications to a sinus lift, whereas the second (preventive-therapeutic) step is aimed at correcting (mainly with the aid of endoscopic surgery) such potentially reversible ear, nose and throat contraindications as middle-meatal anatomical structural impairments, phlogistic-infective diseases and benign naso-sinusal neoplasms the removal of which achieves naso-sinusal homeostasis recovery, in order to restore the physiological drainage and ventilation of the maxillary sinus. The third (diagnostic-therapeutic) step is only required if mainly infective and sinusal complications arise after sinus lift surgery, and is aimed at ensuring early diagnosis and prompt treatment of maxillary rhino-sinusitis in order to avoid, if possible, implant loss and, in particular, the related major complications. The purpose of this report is to describe these three steps in detail within the context of a multidisciplinary management of sinus lift in which otorhinolaryngological factors may be the key to a successful outcome.</p>
</abstract>
<trans-abstract xml:lang="it"><title>Riassunto</title>
<p>Il rialzo del seno (mascellare), attualmente, rappresenta una tecnica diffusa e di successo per ottenere un incremento dell’altezza dell’osso alveolare nei settori postero-superiori, così da permettere la riabilitazione orale con il ripristino della funzionalità masticatoria, tramite l’apposizione di impianti dentari, anche in presenza di atrofia mascellare. Tuttavia questa procedura esercita un ben noto impatto sulla delicata omeostasi del seno mascellare e la concomitante presenza di patologie sistemiche, naso-sinusali o di processi disventilatori a carico del seno mascellare può favorire la comparsa di complicanze post-operatorie, tra cui, prima fra tutte, la rinosinusite mascellare, con possibile compromissione del buon esito della procedura. Sulla base di questa considerazione la gestione del paziente candidato al rialzo del seno dovrebbe includere l’accurata identificazione di quelle situazioni che sono state indicate come potenziali controindicazioni alla procedura e, nel sospetto di una patologia rinosinusale, una valutazione otorinolaringoiatrica comprensiva di endoscopia nasale, oltre, se indicata, l’esecuzione di una tomografia computerizzata del distretto maxillo-facciale con acquisizione del complesso ostio-meatale. Ciò si verifica durante un momento preventivo-diagnostico (primo momento), grazie al quale vengono identificate, in campo otorinolaringoiatrico, le controindicazioni presumibilmente irreversibili e potenzialmente reversibili all’esecuzione del rialzo del seno. Successivamente, il momento preventivo-terapeutico (secondo momento) prevede, per lo più attraverso il trattamento chirurgico endoscopico, la risoluzione delle controindicazioni otorinolaringoiatriche potenzialmente reversibili, quali alterazioni anatomico-strutturali della regione medio-metale, processi infettivo-flogistici e neoplasie benigne del distretto rino-sinusale la cui rimozione permetta il ritorno all’omeostasi naso-sinusale, così da ripristinare il fisiologico drenaggio e la ventilazione del seno mascellare. L’ultima situazione nella quale è richiesto il coinvolgimento dello specialista otorinolaringoiatra riguarda la gestione delle complicanze iatrogene fra cui, prima fra tutte, la rinosinusite mascellare e si esplica nel momento diagnostico-terapeutico (terzo momento). Esso è finalizzato ad ottenere una precoce diagnosi e ad instaurare un sollecito trattamento della rinosinusite mascellare, così da scongiurare, quando possibile, la perdita degli impianti e soprattutto lo sviluppo delle complicanze sinusitiche più gravi. Il presente lavoro si sofferma sui tre momenti, all’interno della gestione multidisciplinare del rialzo del seno, in cui il ruolo dello specialista in otorinolaringoiatria si rivela veramente determinante per il successo chirurgico della procedura.</p>
</trans-abstract>
<kwd-group><kwd>Paranasal sinus</kwd>
<kwd>Sinus surgery</kwd>
<kwd>Sinus lift</kwd>
<kwd>Functional endoscopic sinus surgery</kwd>
<kwd>Rhino-sinusitis</kwd>
<kwd>ENT contraindications</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
<affiliations><list></list>
<tree><noCountry><name sortKey="Felisati, G" sort="Felisati, G" uniqKey="Felisati G" first="G" last="Felisati">G. Felisati</name>
<name sortKey="Mantovani, M" sort="Mantovani, M" uniqKey="Mantovani M" first="M" last="Mantovani">M. Mantovani</name>
<name sortKey="Pignataro, L" sort="Pignataro, L" uniqKey="Pignataro L" first="L" last="Pignataro">L. Pignataro</name>
<name sortKey="Sambataro, G" sort="Sambataro, G" uniqKey="Sambataro G" first="G" last="Sambataro">G. Sambataro</name>
<name sortKey="Torretta, S" sort="Torretta, S" uniqKey="Torretta S" first="S" last="Torretta">S. Torretta</name>
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