Endoscopic Surgery of Maxillary Sinuses in Oral Surgery and Implantology

Due to the close anatomical relationship of the maxillary sinuses to the dentoalveolar complex, surgical procedures involving these anatomical structures represent a part of a everyday practice in oral surgery and implantology. Those interventions are directed mainly towards the treatment of odontogenic infections of the sinuses as well as surgical treatment of oroantral fistulae and odontogenic cysts and tumors of the upper jaw invading the antrum. Traditional approach under such circumstances is a Caldwell-Luc type of surgery, comprising osteotomy of the anterior sinus wall and creation of artificial opening of the sinus into the inferior nasal meatus. Although high success rates are reported, this kind of surgery may result in significant long-term complications, such as sclerosis of the antral walls, collapse of the sinus and creation of the postoperative cysts of maxilla (Nemec at al., 2009). Also, widespread use of dental implants resulted in development of numerous techniques of alveolar bone augmentation in order to provide adequate amount of bone for implant placement. Many of those techniques involve the maxillary sinuses. However, complications of dental implant placement and augmentation procedures may include injuries to the maxillary sinuses, infections of the sinuses and displacement of augmentation material or implants themselves into the sinus. Again, the primary treatment of those complications includes surgery of the sinus, most commonly a Caldwell-Luc procedure. Recent technological advances in field of endoscopy resulted in substantial improvement in techniques of endoscope–controlled surgery of nose and paranasal sinuses. Those techniques proved to be very useful in this area of complex anatomy and limited access to the surgical field. In particular, endoscopic surgery of the maxillary sinuses is widespread and has a long track of good results in ENT surgery. This is especially true for functional endoscopic sinus surgery (FESS). This technique, proved to be safe and effective for treatment of both chronic rhino-sinusitis and nasal polyposis (Chiu & Kennedy, 2004), nowadays is widely accepted as a standard of care for patients who require surgical treatment of chronic rhino-sinusitis. In contrast to this, surgical treatment of odontogenic diseases of the maxillary sinus still predominantly comprises traditional surgical techniques. Recently, several studies reported results of FESS for treatment of odontogenic sinusitis. Also, new techniques of endoscope– assisted surgery of odontogenic cysts and tumors were described. Finally, endoscope–