2022 Volume 160 Pages 129-146
The pathogenesis of maxillary sinusitis caused by maxillary sinus floor elevation (maxillary sinus augmentation surgery: MSAS) is that the surgical procedure causes odontogenic infections and triggers an inflammatory cycle between odontogenic infections and the factors that interfere with the treatment of sinusitis. Impaired mucociliary function, bacterial and virus infections, occlusion of the ostiomeatal complex, or a combination of these three factors can perpetuate an inflammatory vicious cycle in the closed maxillary sinus and result in intractable maxillary sinusitis caused by MSAS.
There is no consensus on the management of bone prosthetic materials displaced into the maxillary sinus following MSAS. When the displacement of bone prosthetic material into the maxillary sinus occurs, first of all, closure of the perforation between the oral cavity and maxillary sinus should be performed to prevent infection. Next, antibacterial therapy should be initiated in conjunction with ventilation and drainage of the maxillary sinus. After this procedure, bone prosthetic materials displaced into the maxillary sinus will in most cases be drained out of the maxillary sinus via the natural ostium.
From the histopathological point of view, the pseudostratified ciliated columnar epithelium in cases of refractory maxillary sinusitis caused by MSAS is neither severely damaged nor irreversibly injured. As a result, the mucociliary function of the epithelium is almost certain to recover once the ventilation and drainage of the maxillary sinus are successfully restored. Consequently, the pathophysiology of refractory maxillary sinusitis caused by MSAS is one of the reasons why endoscopic sinus surgery (ESS) is indicated in cases of refractory sinusitis requiring surgery.
The treatment results are good once the ventilation and drainage of the maxillary sinus are successfully restored after ESS, and support the concept that ESS can be considered as the first-line therapy for refractory maxillary sinusitis caused by MSAS, followed by removal of the bone substitute, where necessary.
