Pignataro L, Mantovani M, Torretta S, Felisati G, Sambataro G
Department of Otorhinolaryngological and Ophthalmological Sciences, University of Milan, Fondazione IRCCS Maggiore Policlinico Mangiagalli, Regina Elena Hospital, Milan, Italy.
Acta Otorhinolaryngol Ital. 2008 Jun;28(3):110-9.
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 maxillofacial 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.
正如1996年在巴布森学院召开的共识会议上所指出的，（上颌）窦底提升术是一种“安全且可预测”的手术，用于增加后上牙槽区域的牙槽骨高度，以便即使在上颌骨萎缩的情况下，也能通过植入牙种植体实现口腔修复并恢复咀嚼功能。然而，该手术对上颌窦微妙的内环境稳定有众所周知的影响：全身、鼻-鼻窦或上颌窦疾病的同时存在可能会促使术后并发症（尤其是上颌鼻窦炎）的发生，这可能会影响良好的手术效果。基于这些考虑，对窦底提升术候选者的管理应包括仔细识别任何禁忌该手术的情况，并且，如果怀疑有鼻-鼻窦疾病，应由耳鼻喉科专家进行临床评估，这应包括鼻内镜检查，必要时还应进行颌面区域的计算机断层扫描，特别是窦口鼻道复合体。第一步预防诊断措施应致力于检测可能不可逆和潜在可逆的窦底提升术禁忌证，而第二步（预防治疗）措施旨在纠正（主要借助内镜手术）诸如中鼻道解剖结构损伤、炎性感染性疾病和良性鼻-鼻窦肿瘤等潜在可逆的耳鼻喉科禁忌证，去除这些病变可恢复鼻-鼻窦内环境稳定，以恢复上颌窦的生理引流和通气。第三步（诊断治疗）措施仅在窦底提升术后主要出现感染性和鼻窦并发症时才需要，其目的是确保对上颌鼻窦炎进行早期诊断和及时治疗，以尽可能避免种植体丢失，特别是相关的严重并发症。本报告的目的是在窦底提升术的多学科管理背景下详细描述这三个步骤，其中耳鼻喉科因素可能是成功结果的关键。
