上顎竇黏膜增厚及其對上顎竇增高術之影響：文獻回顧

Maxillary Sinus Membrane Thickening and Its Influences on Sinus Augmentation: A Literature Review

易婕安(Chieh-An Yi) ； 林怡君(Yi-Chun Lin) ； 賴玉玲(Yu-Lin Lai) ； 陳雅琪(Ya-Chi Chen) ； 王建興(Chien-Hsing Wang) ； 顏瑞瑩(Jui-Ying Yen) ； 陳柏堅(Bor-Jian Chen) ； 陳軒弘(Hsuan-Hung Chen)

《臺灣牙周病醫學會雜誌》 26卷1期 (2021/05) Pp. 11-20

https://doi.org/10.6121/TAP.202105_26(1).0002

摘要

上顎後牙區常因剩餘骨高度不足，在重建時需合併上顎竇增高術。當上顎竇有解剖構造變異或是病理性變化時，可能導致術中黏膜穿孔機率上升，進而增加術後鼻竇炎等併發症的發生率。而上顎竇黏膜增厚為上顎竇最常見之病理變化，盛行率約為37－64.5%。本文藉由文獻回顧，探討上顎竇黏膜增厚的定義與盛行率、黏膜增厚的相關因子、以及上顎竇黏膜增厚對於上顎竇增高術的影響。大部分文獻以2毫米或是3毫米作為上顎竇黏膜增厚的閾值，其形成原因可能與男性、年齡較長、抽煙、牙周病、牙髓病、上顎竇中隔、鼻過敏或鼻竇炎、以及上顎竇增高術術後反應相關。當上顎竇黏膜越厚，組織結構可能會改變，導致黏膜穿孔風險增加，在上顎竇增高術後，黏膜厚度再增加，也可能造成竇孔堵塞，引發術後鼻竇炎。而上顎竇黏膜增厚並非上顎竇增高術的禁忌症，經由術前詳細檢查，搭配錐狀束電腦斷層影像分析，必要時會診耳鼻喉科，無合併感染的黏膜增厚仍可獲得成功的結果。

關鍵字

上顎竇增高術 ； 上顎竇 ； 鼻黏膜 ； 牙科植體 ； 錐狀束斷層

並列摘要

Reconstruction of maxillary posterior teeth usually combines with maxillary sinus augmentation owing to inadequate residual bone height. The presence of anatomical variation or pathological change in the maxillary sinus may lead to increasing risk of sinus membrane perforation and subsequently more complications. Sinus membrane thickening, with the prevalence rate of 37-64.5%, is the most common pathological change in the maxillary sinus. The purpose of present article was to evaluate the definition, prevalence and related factors of sinus membrane thickening, as well as the influence on maxillary sinus augmentation by recent literature reviews. Sinus membrane thickness greater than 2 or 3mm is usually considered as pathologic change. Men, elder age, smoker, the presence of periodontal disease, endodontic disease, sinus septa, allergic rhinitis or sinusitis, and post-operative change after sinus augmentation are related to membrane thickening. Histological structure change could be noted in thicker membrane, which increases the risk of membrane perforation. Besides, the transiently post-operative change after sinus augmentation induces an even thicker sinus membrane, leading to obstruction of ostium and further post-operative sinusitis. However, with comprehensive diagnostic examination, cone-beam computed tomography (CBCT) image assessment, and otolaryngologist consultation, maxillay sinus membrane thickening without any infectious sign is not absolutely contraindicated in sinus augmentation.

並列關鍵字

Sinus Floor Augmentation ； Maxillary Sinus ； Nasal Mucosa ； Dental Implants ； Cone-Beam Computed Tomography