Maxillary sinus elevation in conjunction with transnasal endoscopic treatment of rhino-sinusal pathoses: preliminary results on 10 consecutively treated patients

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

Odontogenic rhinosinusitis and sinonasal complications of dental disease or treatment: prospective validation of a classification and treatment protocol

PURPOSE: Odontogenic sinusitis and sinonasal complications of dental disease or treatment (SCDDT) represent a heterogeneous group of conditions that often require multidisciplinary care. The present study aims to prospectively validate a classification and treatment protocol for SCDDT patients. METHODS: One hundred twenty-eight consecutive patients (73 females and 45 males, mean age 52.4 years) affected by SCDDT not responding to dental and medical therapy were classified and surgically treated according to the proposed protocol. The protocol classified patients into three aetiology-based groups (preimplantologic, implantologic, and related to traditional dental diseases and procedures, respectively). The groups were further divided into classes according to the presence of oro-antral communications and/or dislocated dental hardware. Each condition was treated according to the class-related, protocol-defined treatment, by either a transnasal or combined transnasal/transoral approach. All patients were successfully classified according to our protocol. None of the proposed classes were redundant, and no condition fell outside the definitions. RESULTS: The surgical treatment protocol proved to be adequate and effective, in that 125 of the 128 patients completely recovered after surgical treatment. CONCLUSIONS: The term SCDDT and the consequent classification proposed by the authors appear, therefore, to be nosologically correct. Furthermore, the protocol-related proposed treatment appears to be clinically sound, with a success rate nearing 98%

Un nuovo metodo di filtraggio digitale per l'analisi dei potenziali evocati del tronco encefalico

Analysis and interpretation of auditory evoked brainstem potentials, as well as of any other kind of evoked potential, rely on two different steps: a) identification of each individual response wave or "wave labeling"; b) latency measurements. This two steps are closely linked since the identification of a given wave is basically the result of some previous initial proximation measurement of its latency. The major source of uncertainty is mainly due to the residual presence of background noise (low- and high-frequency noise). The aim of the present paper is to propose a new data analysis method that has proven o greatly increase the reliability of the entire procedure. The method is based on the use of a linear, non casual, zero-phase digital filter that can easily be implemented, even onto small computers. Its use is fast an simple and has not required any prior knowledge of the temporal structure of the signal being analyzed. This means that it can be successfully applied in the analysis of traces with large waveform alterations. Method performance is shown on the responses measured from a population of subjects suffering from multiple sclerosis, a pathology that often produces responses with large alterations

Maxillary sinusitis today : a consequence of dental and nasal disease. A case presenting with a difficult differential diagnosis

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

Endoscopic removal of an unusual foreign body in the sphenoid sinus : an oral implant

Aim: Migration of oral implants displaced in the maxillary sinus toward the sphenoid sinus is an extremely rare event. This case report is focused on the possibility of treating such a rare complication by means of endoscopic treatment through the nasal cavity. Material and methods: A 45-year-old female patient received one oral implant for the substitution of the left first upper molar, but during the surgical procedure the implant was displaced in the maxillary sinus. Owing to a delay in treatment, a spontaneous migration of the implant in the sphenoid sinus occurred. Results: The implant was removed endoscopically through the nasal cavity: postoperative recovery was uneventful. Conclusion: To the authors\u2019 knowledge, this case represents the first report concerning migration of an oral implant into the sphenoid sinus and demonstrates the reliability and safety of an endoscopically driven surgical removal of the foreign body, thus preventing potential complications with extremely low postoperative morbidity

La collaborazione interdisciplinare nella chirurgia del seno mascellare

Negli ultimi anni le problematiche cliniche correlate alla patologia del seno mascellare si stanno trasformando radicalmente in relazione ai progressi ed alla diffusione delle applicazioni implantologiche. Gli otorinolaringoiatri, i chirurghi maxillo-facciali e gli odontoiatri si trovano oggi ad affrontare complesse problematiche secondarie a complicanze di chirurgia implantologica o pre-implantologica (rialzo del seno) o, specularmente, devono tentare di finalizzare il gesto chirurgico eseguito su una patologia primaria non solo a scopi funzionali respiratori, ma anche in previsione di una riabilitazione funzionale dell\u2019occlusione. Frequentemente il singolo specialista fatica a dominare le differenti tecniche chirurgiche (per via esterna, endoscopiche) e, soprattutto, non pu\uf2 conoscere compiutamente le problematiche legate ad una corretta riabilitazione implanto-protesica. Esempi clinici di quanto sopra accennato possono essere individuati, ad esempio, in sinusiti odontogene con fistola oro-antrale che non siano limitate al solo seno mascellare, oppure in neoplasie con estensione combinata al cavo orale ed al seno mascellare. In queste situazioni spesso i pazienti devono affrontare interventi plurimi, eseguiti da differenti specialisti senza un programma comune ben definito. L\u2019esperienza che gli Autori intendono riportare \ue8 invece quella della collaborazione interdisciplinare, volta a stabilire un unico programma terapeutico da affrontare in equipe, minimizzando il numero degli interventi chirurgici. Il video riporta alcuni esempi clinici relativi ad interventi combinati

Postoperative infections in otorhinolaryngologic surgery. Open study on efficacy and tolerability of antibiotic prophylactic treatment with sulbactam-ampicillin

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 prophylaxi