• Yi-Wei Chen, Fu-Ying Lee, Po-Hung Chang, Chi-Che Huang, Chia-Hsiang Fu, Chien-Chia Huang, and Ta-Jen Lee.
• Department of Otolaryngology, Chang Gung Memorial Hospital, Taipei.
• Laryngoscope. 2018 Jun 1; 128 (6): 1261-1267.

ObjectivesTo determine a paradigm for evaluating and managing maxillary sinus conditions before dental implantation via preoperative sinonasal assessment.Study DesignProspective cohort study.MethodsEighty-four patients who underwent dental implantation with or without sinus augmentation were included. Maxillary sinus conditions were classified into groups 1 to 6 according to cone-beam computed tomography (CT) findings: 1) nonspecific findings, 2) solitary polyp or cyst, 3) mucosal thickening, 4) air-fluid level or fluid accumulation, 5) near-total opacification of the maxillary or other paranasal sinus, and 6) calcification spots in the maxillary sinus. Dental implantation with or without sinus augmentation was suggested with postoperative sinus observation (groups 1-3), after medication for acute sinusitis (group 4), and after comprehensive treatment of chronic or fungal sinusitis (groups 5-6). Intraoperative and postoperative sinus-related complications were recorded.ResultsTwo patients (groups 1 and 3) developed acute rhinosinusitis after sinus augmentation; both recovered completely with medical treatment. Schneiderian membrane perforation occurred during sinus lift surgery in six patients (group 1): five recovered after conservative medical therapy and close observation, whereas one required endoscopic sinus surgery and recovered well. No chronic rhinosinusitis developed after dental implantation.ConclusionCraniofacial CT is crucial for pre-dental implantation sinonasal evaluation. The risk of dental implant-related chronic rhinosinusitis is low for patients with cysts, polyps, or mucosal thickening in the maxillary sinus. However, preventive endoscopic sinus surgery is recommended for patients with incurable chronic rhinosinusitis, fungal sinusitis, and large polyps or cysts.Level Of Evidence4. Laryngoscope, 128:1261-1267, 2018.© 2017 The American Laryngological, Rhinological and Otological Society, Inc.

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