RESUMEN
AIM OF THE STUDY: To present the results of a prospective study on the management of infectious complications following maxillary sinus floor elevation procedures with a combined endoscopic (FESS) and intra-oral approach. MATERIALS AND METHODS: From 2005 to 2009, twenty consecutive patients were diagnosed for sinusal chronic infectious complications refractory to medical treatment following maxillary sinus floor elevation and grafting procedures. All patients were treated with a combination of functional endoscopic sinus surgery (FESS) through a transnasal approach and an intra-oral approach, performed by an ear, nose, and throat team and an oral and maxillofacial team, respectively, in the same surgical session under general anesthesia. RESULTS: In 16 of 20 patients, the 4-week endoscopic control demonstrated a complete clinical healing and recovery of the normal sinus ventilation and drainage. In two patients, the persisting sinusitis at the 4-week control was successfully treated (8th week) with an antibiotic therapy based on the antibiogram carried out on the bacterial culture obtained by the aspiration of the sinusal content. In one patient, the persisting sinusitis (3 months after surgery) was successfully treated with the aspiration of the infectious material from the maxillary sinus. In one patient, finally, it was necessary to perform a second combined surgical treatment to treat the persisting sinusitis. DISCUSSION AND CONCLUSIONS: In this study, a relevant number of cases of chronic infectious complications following sinus floor elevation procedures are presented. To the authors' knowledge, it is the first time that well-defined treatment protocols based on a combined endoscopic (FESS) and intra-oral surgical approach are proposed. The positive, albeit preliminary, results obtained in this study seem to validate this treatment modality.
Asunto(s)
Endoscopía/métodos , Sinusitis Maxilar/cirugía , Complicaciones Posoperatorias/cirugía , Elevación del Piso del Seno Maxilar , Adulto , Anciano , Regeneración Ósea , Sustitutos de Huesos , Enfermedad Crónica , Femenino , Regeneración Tisular Guiada Periodontal , Humanos , Masculino , Sinusitis Maxilar/diagnóstico por imagen , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Prospectivos , Radiografía Panorámica , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
A one-step surgical procedure is presented, including maxillary sinus floor elevation in association with functional endoscopic sinus surgery to remove rhino-sinusal malformations or pathoses that might contraindicate sinus floor elevation. Over a 2-year period, 10 patients requiring a sinus floor augmentation procedure to restore the missing dentition with endosseous implants, but presenting with local and reversible rhinologic contraindications to the augmentation procedure were consecutively treated with a surgical approach that included simultaneously functional endoscopic sinus surgery and a sinus floor elevation procedure through an intra-oral approach. Then 4-6 months after this procedure, oral implants were inserted and after a further waiting period, ranging from 3 to 6 months, patients were restored with prostheses and followed for 1 to 3 years after the completion of prosthetic restoration. In all 10 patients, complete recovery of para-nasal sinuses function was demonstrated and occurred in all cases within one month. All cases showed good integration and consolidation of the graft material used for maxillary sinus floor augmentation. None of the implants placed were lost during the follow-up period after completion of prosthetic loading. In conclusion, despite the limits of this study (which included only 10 patients), the combination of maxillary sinus augmentation procedures and functional endoscopic sinus surgery, to treat local contraindications to sinus augmentation has proven to be both effective and safe and has allowed the patient to avoid a second surgical procedure and a longer waiting period before final prosthetic rehabilitation. No sinusal complications related to sinus floor augmentation were encountered and the survival rate of implants placed in the augmented areas was consistent with those reported in cases of sinus floor augmentation performed in patients presenting with a healthy rhino-sinusal system.
Asunto(s)
Trasplante Óseo , Implantación Dental Endoósea , Endoscopía , Seno Maxilar/cirugía , Enfermedades de los Senos Paranasales/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de los Senos Paranasales/complicacionesRESUMEN
This study retrospectively analyses paranasal sinus complications following displacement of oral implants in the maxillary sinus treated according to clinical situation by functional endoscopic sinus surgery (FESS), an intraoral approach, or a combination of both procedures. Over 5 years, 27 patients (13 male; 14 female), aged 27-73 years (mean 53.9 years), underwent treatment for postoperative complications involving the paranasal sinuses following displacement of oral implants in the maxillary sinuses. According to the complication (implant displacement, implant displacement with or without reactive sinusitis and/or with or without associated oro-antral communication), patients were treated with FESS, intraoral approach to the sinus, or FESS associated with an intraoral approach. Follow up lasted for at least 1 year with clinical and radiographic controls. 26 patients recovered completely; one patient underwent re-intervention with FESS and an intraoral approach 2 years after implant removal, due to persistent signs and symptoms of maxillary sinusitis and oro-antral communication. Postoperative recovery after the second procedure was followed by complete recovery. The results demonstrate that a rational choice of surgical protocol for the treatment of complications involving the paranasal sinuses following displacement of implants in the maxillary sinuses may lead to reliable results.
Asunto(s)
Implantes Dentales/efectos adversos , Cuerpos Extraños/cirugía , Seno Maxilar , Complicaciones Posoperatorias/cirugía , Adulto , Anciano , Protocolos Clínicos , Endoscopía/métodos , Femenino , Estudios de Seguimiento , Cuerpos Extraños/etiología , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Humanos , Masculino , Seno Maxilar/cirugía , Sinusitis Maxilar/etiología , Sinusitis Maxilar/cirugía , Persona de Mediana Edad , Fístula Oroantral/etiología , Fístula Oroantral/cirugía , Osteotomía/métodos , Recurrencia , Reoperación , Estudios Retrospectivos , Seno Esfenoidal/cirugía , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
Chronic maxillary sinusitis as an expression of infectious dental disease seemed destined to vanish. On the contrary, during the last years, the frequency of chronic maxillary sinusitis is rising again in relation to several factors, among these bacterial resistance as well as the poor dental hygiene and the limited access to odontologic care by not well-off patients play a key role. Anyway oral rehabilitative surgery (pre-implantologic and implantologic) is nowadays becoming the major cause of chronic maxillary sinusitis. The authors describe a recently observed case that, for its peculiarity, clearly exemplifies the variety of manifestations and the close relation between dental disease and anatomic nasal defects in the genesis of sinusal disease.
Asunto(s)
Cuerpos Extraños/complicaciones , Seno Maxilar , Sinusitis Maxilar/diagnóstico , Sinusitis Maxilar/etiología , Extracción Dental/efectos adversos , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Sinusitis Maxilar/microbiologíaRESUMEN
The purpose of this paper is to discuss the treatment required for a patient affected by chronic maxillary sinusitis following a sinus grafting procedure with an alloplastic material. Sinusitis was not the consequence of migration of alloplastic material into the maxillary sinus, but rather the consequence of overfilling the subantral space followed by obstruction of the ostium. The treatment involved removal of the alloplastic material and correction of the ostium obstruction via a nasal endoscopic approach.
Asunto(s)
Aumento de la Cresta Alveolar/efectos adversos , Sustitutos de Huesos/efectos adversos , Endoscopía , Sinusitis Maxilar/cirugía , Aumento de la Cresta Alveolar/métodos , Femenino , Humanos , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/etiología , Persona de Mediana Edad , Radiografía , Resultado del Tratamiento , Cornetes Nasales/cirugíaRESUMEN
The paper reports the results of an open study on the efficacy and tolerability of the association of sulbactam-ampicillin in antibiotic prophylaxis in ENT surgery. The study include 55 cases and confirmed both the total absence of major side-effects and a notable therapeutic efficacy of the drug in question. It is interesting to note the results obtained in ENT cancer surgery: out of 12 cases of partial or total laryngectomies there were 2 cases of infection in extra-operative sites (polmoniti ab ingestis from Pseudomonas aeruginosa) and none within the site of operation. Data regarding the efficacy of the drug were in line or better than previously published results and its low toxicity indicates the elective use of sulbactam/ampicillin in ENT surgical prophylaxis.