Sinus disventilation and atrophy of the upper maxilla: a combined surgical approach is possible?

This study aims to assess the effectiveness and reliability of a new combined approach to treat the maxillary atrophy and chronic rhinosinusitis (CRS) and other rhino-sinusal pathologies. This 1-step procedure consisting functional endoscopic sinus surgery (FESS) and maxillary sinus-lift with simultaneous implant placement for patients with a severe reabsorbed maxillary bone and sinuses' disease. In case of disventilation and maxillary sinuses flogosis, the mucociliary clearance and physiological ventilation have to be aided, in order to make a safer and predictable sinus-lift surgery. This new surgical approach provides the restitution ad integrum of sinus health and at the same time, its grafting. If possible, implants were placed during the same surgical procedures. A 1 center retrospective study was performed in a private clinic of Rome, from January 2006 to November 2013. Seventy-eight adult patients with maxillary atrophy and sinus disventilation no responding to 3-week pharmacological therapy were admitted. All of them underwent to medical history, clinical examination, nasal endoscopies, and computed tomography (CT) scan of nose and paranasal sinuses. Patients were divided in 2 groups using Lund Mackay CT scoring. A 1-step surgery based on FESS and maxillary sinus-lift was performed. Simultaneous implant placement was performed when a crestal thickness of at least 4 mm was present on CT examination. Patient's symptoms scoring was evaluated through visual analogical scale both pre- and postoperatively. Computed tomography scores were usually not in accordance with presurgical clinical condition. Patients with clinical symptoms of disventilatory sinus and low evidence of CRS on CT showed relevant improvements in symptoms' scores after endoscopic surgery. All implants achieved good primary stability; Only 1 patient had lost implant due to peri-implantitis during 1-year follow-up period (1.3%)