Survey of recommended referral patterns for incidental maxillary sinus and airway findings on CBCT analysis in an orthodontic population.

Abstract

Introduction: Cone beam computed tomography (CBCT) is an increasingly more common form of radiography, and dental professionals are obligated to manage all incidental findings identified on scans. Clarification of standards for management of CBCT findings would help the practitioner, especially for findings of the airway and sinuses. Aims: The primary aim was to evaluate recommendations of otolaryngologists to dentists for follow up of sinus and airway findings identified on CBCT analysis. The secondary aim was to report on prevalence of maxillary sinus and airway findings on CBCT analysis in an orthodontic population. Methods: A survey with CBCT images of 22 sinus and airway findings was submitted to otolaryngologists (n = 269) for review, and de-identified CBCT reports of orthodontic patients were reviewed to evaluate the prevalence of sinus and airway findings. Frequencies were calculated for responses and findings. Results: Thirty-six otolaryngologists participated in the survey. The most commonly recommended actions were to 1) immediately refer the patient to an otolaryngologist, and 2) ask additional questions regarding sinonasal symptoms before referring. In the orthodontic population studied, a total of 53.8% patients had maxillary sinus or airway findings listed on CBCT scan reports. The most commonly reported finding was mucosal thickening. Conclusions: Incidental maxillary sinus and airway findings are commonly found on CBCT scans. When such findings are identified on CBCT analysis, otolaryngologists generally recommend evaluating the patient for symptoms, and referring the patient to an otolaryngologist for follow up. For findings that are variants of normal, the recommendation is to not refer the patient for follow up unless they are positive for sinonasal symptoms. For findings that demonstrate inflammatory conditions, the recommendation is to refer the patient for follow up, especially if they have sinonasal symptoms. For findings with changes in the bony wall of the sinuses, the recommendation is to immediately refer the patient to the otolaryngologist for follow up. Consultation with an oral and maxillofacial radiologist or otolaryngologist is recommended to best manage incidental sinus and airway findings present on CBCT scans.