Dataset Information

Surgical treatment of chronic rhinosinusitis after sinus lift.

ABSTRACT:

Background

The sinus lift (or sinus augmentation) is a common procedure to improve maxillary bone stock before dental implantation. Chronic rhinosinusitis (CRS) is a potential complication of this procedure and may be refractory to medical treatment. Functional endoscopic sinus surgery has previously been used to address CRS, however, results of previous studies indicated that implant removal is required. There are limited follow-up data available.

Objective

The purpose of this study was to characterize the long-term outcomes and efficacy of endoscopic sinus surgery for refractory CRS after sinus lift, including the ability to salvage dental implants.

Methods

This was a retrospective case series that described nine patients who, between June 2011 and September 2016, underwent endoscopic sinus surgery for CRS after a sinus lift procedure. The presenting symptoms of the patients, medical management, imaging results, operative procedures, and outcomes were reviewed.

Results

The majority of patients developed symptoms (mucopurulent nasal drainage, facial pain and/or pressure, nasal congestion, and foul smell) within 3 months of implant placement and were treated with at least three courses of antibiotics before referral to an otolaryngologist. All the patients underwent wide endoscopic maxillary antrostomy, with no surgical complications or postoperative reports of infection. There was a statistically significant improvement in 22-item Sino-Nasal Outcome Test scores (t(8) = -2.908; p = 0.02) and discharge, inflammation, and polyps/edema endoscopic scores ([z = -2.539; p = 0.011) between pre- and postsurgical treatment. Four patients had their dental implants removed before presentation. Among the five patients who presented with intact dental implants, none required removal before or after functional endoscopic sinus surgery.

Conclusion

Functional endoscopic sinus surgery was a reasonable and efficacious treatment option for patients who presented with paranasal sinus disease after a sinus lift. Dental implant removal may not be a requirement for successful treatment of CRS associated with sinus lift procedures.

SUBMITTER: Jiam NT

PROVIDER: S-EPMC5498319 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Publications

Surgical treatment of chronic rhinosinusitis after sinus lift.

Jiam Nicole Tin-Lok NT Goldberg Andrew N AN Murr Andrew H AH Pletcher Steven D SD

American journal of rhinology & allergy 20170701 4

<h4>Background</h4>The sinus lift (or sinus augmentation) is a common procedure to improve maxillary bone stock before dental implantation. Chronic rhinosinusitis (CRS) is a potential complication of this procedure and may be refractory to medical treatment. Functional endoscopic sinus surgery has previously been used to address CRS, however, results of previous studies indicated that implant removal is required. There are limited follow-up data available.<h4>Objective</h4>The purpose of this st ...[more]

PMID: 28716179

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Project description:BackgroundChronic rhinosinusitis (CRS) is associated with substantial productivity losses. Prior cross-sectional study has identified risk factors and symptom subdomains contributing to baseline productivity loss. This study evaluates correlations between posttreatment changes in symptom subdomain and productivity loss.MethodsA total of 202 adult patients with refractory CRS were prospectively enrolled into an observational, multi-institutional cohort study between August 2012 and June 2015. Respondents provided pretreatment and posttreatment 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Productivity losses were monetized using measures of absenteeism, presenteeism, lost leisure time, and U.S. government-estimated wage and labor rates.ResultsA total of 39 (19%) participants elected continued appropriate medical therapy (CAMT) and 163 (81%) elected endoscopic sinus surgery (ESS). CAMT patients experienced improvement in SNOT-22 total and rhinologic subdomain scores (both p ≤ 0.039). ESS patients reported improvement in SNOT-22 total scores and all subdomains (all p < 0.001). Mean monetized productivity losses were nearly unchanged following CAMT (-$200, p = 0.887) but significantly reduced following ESS (-$5,015, p < 0.001). Mean productivity losses were reported in CAMT patients reporting worse mean posttreatment extra-rhinologic, psychological, and sleep symptom severity scores; however, no statistically significant linear correlations (r ≤ 0.249; p ≥ 0.126) were reported.ConclusionTreatment modalities associate with different posttreatment productivity changes. Patients electing ESS experienced postoperative improvement in productivity distributed across all SNOT-22 symptom domains, suggesting productivity improvement correlates with multiple symptom domains. Patients electing CAMT had better baseline productivity compared to patients electing ESS, and this productivity level was maintained through treatment. Greater productivity loss occurred in patients with worse SNOT-22 scores in the extra-rhinologic, psychological, and sleep subdomains.

Project description:It is generally believed that the microbiome plays a role in the pathophysiology of chronic rhinosinusitis (CRS), though its exact contribution to disease development and severity remains unclear. Here, samples were collected from the anterior nares, nasopharynx, and maxillary and ethmoid sinuses of 190 CRS patients and from the anterior nares and nasopharynx of 100 controls. Microbial communities were analyzed by Illumina sequencing of the V4 region of 16S rRNA. The phenotype and patient characteristics were documented, and several serum inflammatory markers were measured. Our data indicate a rather strong continuity for the microbiome in the different upper respiratory tract (URT) niches in CRS patients, with the microbiome in the anterior nares being most similar to the sinus microbiome. Bacterial diversity was reduced in CRS patients without nasal polyps compared to that in the controls but not in CRS patients with nasal polyps. Statistically significant differences in the presence/absence or relative abundance of several taxa were found between the CRS patients and the healthy controls. Of these, Dolosigranulum pigrum was clearly more associated with URT samples from healthy subjects, while the Corynebacterium tuberculostearicum, Haemophilus influenzae/H. aegyptius, and Staphylococcus taxa were found to be potential pathobionts in CRS patients. However, CRS versus health as a predictor explained only 1 to 2% of the variance in the microbiome profiles in an adonis model. A history of functional endoscopic sinus surgery, age, and sex also showed a minor association. This study thus indicates that functional studies on the potential beneficial versus pathogenic activity of the different indicator taxa found here are needed to further understand the pathology of CRS and its different phenotypes. (This study has been registered at ClinicalTrials.gov under identifier NCT02933983.)IMPORTANCE There is a clear need to better understand the pathology and specific microbiome features in chronic rhinosinusitis patients, but little is known about the bacterial topography and continuity between the different niches of the upper respiratory tract. Our work showed that the anterior nares could be an important reservoir for potential sinus pathobionts. This has implications for the diagnosis, prevention, and treatment of CRS. In addition, we found a potential pathogenic role for the Corynebacterium tuberculostearicum, Haemophilus influenzae/H. aegyptius, and Staphylococcus taxa and a potential beneficial role for Dolosigranulum Finally, a decreased microbiome diversity was observed in patients with chronic rhinosinusitis without nasal polyps compared to that in healthy controls but not in chronic rhinosinusitis patients with nasal polyps. This suggests a potential role for the microbiome in disease development or progression of mainly this phenotype.

Project description:ObjectivesPrior studies have indicated that olfactory cleft (OC) opacification correlates with olfaction in patients with chronic rhinosinusitis (CRS). However, the results have been unclear in patients without polyps. The purpose of this study was to further explore the relationship between OC opacification, sinus opacification, and olfactory function in patients with CRS.MethodsOne hundred and forty-eight patients with CRS were prospectively enrolled across five institutions. Olfactory function was evaluated using the Sniffin' Sticks tests (Burghardt, Wedel, Germany) and the 17-item Questionnaire of Olfactory Disorders (QOD-NS). Computed tomography (CT) scans for each patient were acquired and Lund-Mackay scores recorded. Opacification of the OC was determined using OsiriX MD (Pixmeo, Bernex, Switzerland) and correlated with olfaction scores.ResultsA total of 148 CRS patients, 73 CRS without nasal polyps (CRSsNP) and 75 CRS with nasal polyps (CRSwNP), as well as 30 control subjects were enrolled. Overall OC opacification averaged 63.7% in CRS patients and 47.1% in control subjects (P < 0.001). In the overall cohort, OC opacification significantly correlated with threshold, discrimination, and identification (TDI) (r = -0.520; P < 0.001) and QOD-NS scores (r = 0.374; P < 0.001). CRSwNP patients demonstrated a significant correlation between OC opacification and TDI scores (r = -0.464; P < 0.001) but not the CRSsNP group (r = -0.143; P = 0.229). Lund-Mackay score correlated with TDI in both the CRSsNP (r = -0.300; P = 0.010) and CRSwNP (r = -0.271; P = 0.019) groups.ConclusionCT opacification is associated with olfactory dysfunction differentially based on nasal polyp status. Smell loss in CRSwNP correlated with both OC opacification and Lund-Mackay score, whereas CRSsNP correlated only with Lund-Mackay score, indicating different relationships between olfactory function and local inflammatory processes in these disorders.Level of evidence2 Laryngoscope, 130:2311-2318, 2020.

Dataset Information

Surgical treatment of chronic rhinosinusitis after sinus lift.

Background

Objective

Methods

Results

Conclusion

Publications

Surgical treatment of chronic rhinosinusitis after sinus lift.

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