Giovannetti Filippo, Priore Paolo, Raponi Ingrid, Valentini Valentino
From the Maxillofacial Surgery Department, Faculty of Medicine and Surgery, Sapienza University, Rome, Italy.
J Craniofac Surg. 2014 May;25(3):991-4. doi: 10.1097/SCS.0000000000000608.
Oral surgery is compounded by safe and well-known techniques and presents a low rate of complications. When the superior alveolar ridge is approached, surgery may result in oroantral fistula or tooth or implant dislocation in maxillary sinus. Those conditions lead to development of the maxillary sinusitis that, if underestimated, may evolve in orbital cellulitis and cerebritis or cerebral abscess. Our work aimed to compare the surgical techniques suitable for treatment of those complications and define the better surgical strategy.
Between 2005 and 2010, 55 patients, presenting with displaced or migrated oral implants in the paranasal sinuses, with oroantral communication or with paranasal sinusitis of odontoiatrogenic origin, were visited and referred for treatment in the Maxillofacial Surgery Department of the University of Rome "La Sapienza." Surgical treatment consists of one of the following procedures: functional endoscopic sinus surgery (FESS); intraoral approach to the sinus with Caldwell-Luc technique; and oroantral fistula closure with a local flap, alone or combined with FESS.
The study group consisted of 55 patients: 28 female and 27 male patients aged 43 to 78 years (mean, 60 years). All had undergone oral surgery before our first visit: 17 patients had a prosthetic implant surgery (3 lateral-approach sinus augmentation and 15 implant placement). Seventeen patients had tooth extractions, 7 did root canal treatments, and 14 had sinus maxillary augmentation.
Functional endoscopic sinus surgery has slowly taken the place of the Caldwell-Luc technique in treating odontogenic maxillary sinusitis. Advantages of FESS are the less invasivity, the preservation of sinus anatomy and physiology, the reduction of recovery time, and oral rehabilitation without loosening efficacy compared with the previous transoral approach.
口腔外科手术采用的是安全且广为人知的技术，并发症发生率较低。当接近上牙槽嵴时，手术可能导致上颌窦出现口鼻瘘、牙齿或种植体移位。这些情况会引发上颌窦炎，如果对此估计不足，可能会发展为眶蜂窝织炎、脑脊髓炎或脑脓肿。我们的研究旨在比较适用于治疗这些并发症的手术技术，并确定最佳手术策略。
2005年至2010年间，55例患者因鼻窦内口腔种植体移位或迁移、口鼻相通或牙源性上颌窦炎前来罗马第一大学颌面外科就诊并接受治疗。手术治疗包括以下程序之一：功能性鼻内镜鼻窦手术（FESS）；经口采用柯-陆氏技术进入鼻窦；单独或联合FESS使用局部皮瓣封闭口鼻瘘。
研究组包括55例患者，其中28例女性，27例男性，年龄在43至78岁之间（平均60岁）。所有患者在我们首次接诊前均接受过口腔手术：17例患者接受过种植修复手术（3例外侧入路鼻窦增大术和15例种植体植入）。17例患者接受过拔牙，7例进行过根管治疗，14例进行过上颌窦增大术。
在治疗牙源性上颌窦炎方面，功能性鼻内镜鼻窦手术已逐渐取代柯-陆氏技术。与以往经口入路相比，FESS的优点是侵入性较小、能保留鼻窦解剖结构和生理功能、恢复时间缩短且口腔修复效果不降低。
