New York state ear, nose, and throat specialists' views on pre-sinus lift referral

Dental implant surgery in the posterior maxilla often involves the maxillary sinuses. Sinus surgery for dental implants is highly successful, but the preoperative risk is difficult to assess because a routine preoperative evaluation does not include an intranasal examination by an otolaryngologist. The purpose of the present study is to obtain the opinions of ear, nose, and throat (ENT) specialists located within New York state in an effort to establish a referral protocol before performing a maxillary sinus elevation. This study assesses the need to consult an ENT specialist for evaluation and treatment recommendations in the pretreatment workup.

A questionnaire and a stamped, return envelope with an identification number was mailed to 302 physicians who maintained a current ENT-specialty practice or practiced that specialty in a hospital or clinic setting in New York state. The requirement criteria included a valid address and specialty designation. Up to two follow-up phone calls were made, and another questionnaire was mailed 30 days after the initial mailing. The questionnaire included eight computerized tomography (CT)?scan images that represented different sinus configurations. Answers to the five questions were statistically evaluated and analyzed. A total of 63 recipients returned the questionnaire and were included in the study.

A majority of 58.7% (95% confidence interval: 46.9% to 71.1%) of respondents recommended that a maxillary sinus CT scan should be routinely prescribed before a sinus-lift surgery. Patient symptoms that ENT specialists suggested indicated referral included nose complications/problems (40.1%) and sinus issues (23.6%). Of the eight CT-scan images, referral suggestions were >50% for the following: an occluded sinus with septum, inflammation at the base of the sinus only, a sinus with a generalized thickened membrane, an oroantral fistula, a thickened sinus membrane in association with teeth that had endodontic and/or periodontic involvement, and a nearly completely occluded sinus that was missing palatal bone. For patients with seasonal allergies, ENT specialists suggested delaying surgery (20.6%) or controlling symptoms before surgery (41.3%). Concerns included a past history of a sinus surgery (87.3%), chronic sinusitis (85.7%), presence of ostium stenosis (68.3%), nasal or sinus obstruction (82.5%), and oroantral fistulation (74.6%).

Within the limits of the study, an attempt is made to develop a preoperative protocol, and 63 responses from ENT specialists suggested that the majority (58.7%) would recommend a maxillary CT scan before a sinus-lift surgery. Their greatest concerns were a prior sinus surgery, severe sinus inflammation, nasal/sinus obstruction, and oroantral fistulation.