上颌窦黏膜病变对上颌窦底提升术的影响及治疗对策

Clinical guidelines for maxillary sinus floor elevation with sinus membrane lesions

上颌窦黏膜病变在种植治疗中常被广泛检出,也给上颌窦底提升术的治疗效果带来了不确定性。在此背景下,结合当前口腔医学研究及本科室的临床经验,笔者对上颌窦黏膜病变作一专题述评。临床上常见的由CBCT显示的上颌窦黏膜病变类型有病理性增厚、息肉/囊性病变、气-液平面等;其中2~5 mm的黏膜增厚、小于一半窦腔高度的息肉囊肿等对上颌窦底提升术影响较小,可以同期行上颌窦底提升术;而大于5 mm且伴有窦口阻塞的黏膜增厚、上颌窦-后鼻孔息肉、黏液囊肿、大于一半窦腔高度的息肉囊肿、气-液平面等需积极处理。对息肉囊肿的处理需综合考虑其类型、大小、窦腔炎症、窦口开放性等因素而采取保留囊肿,术前摘除延期提升或术中摘除同期提升等不同的治疗。对术后上颌窦炎的治疗以抗生素抗炎、引流为主,必要时行外科清创手术,同时需清除口腔病灶。术前影像学评估是上颌窦黏膜病变诊治的关键,对此笔者倡导口腔-耳鼻喉科的协作诊疗模式。

Maxillary sinus membrane lesions have been broadly detected before implant surgery in the posterior maxilla region,resulting in uncertainty regarding maxillary sinus floor elevation surgery.In this context,we composed this commentary article based on the current literature and the clinical experience of our department.We discuss the common lesion types shown by CBCT including membrane pathological thickening,polyps/cystic lesions and air-liquid level in the sinus.Maxillary sinus floor elevation surgery can be conducted in patients with membrane thickening of 2-5 mm or with polyps/cysts of less than half of the sinus height(because the above symptoms have little influence on the outcome of surgery).Membrane thickening of more than 5 mm with ostium obstruction,antrochoanalpolyps,mucoceles and cysts of more than half of the sinus height should be carefully treated.Different treatments can be performed such as conducting elevation surgery while retaining the cyst,removing the cyst before surgery or removing the cyst during surgery based on the cyst type and size,inflammation,patency of the ostium,etc.Antibiotics-anti-inflammatory-aspiration,surgical debridement and oral lesions eliminations are generally used for treating post-operative sinusitis.Presurgical radiographic evaluation is the key to diagnosing and treating these membrane lesions.We highly advocate collaboration between our dentists and otolaryngologists on this issue.