Dizziness or benign paroxysmal positional vertigo is a rare complication that at times occurs in patients underwent sinus lift procedure for dental implant placement in the upper jaw.
Benign paroxysmal positional vertigo (BPPV) arises due to problem in inner ear. Symptoms reoccur such as whirling sensation, loss of balance, Vertigo, spinning sensation etc.
Patients with bone less than 10mm in the upper jaw are the ones need to go for sinus elevation procedure, since the missing teeth over a period of time leads to bone loss & causes sinuses to expand. The outcome of this procedure provides an adequate amount of bone height to replace upper molar.
With such a rare occurrence, it would be better to know what causes dizziness/BPPV after sinus lift procedure.
The procedure is continued via osteotome instrument & mallet. The mallet is used for percussion taps on osteotome & this lifts up the sinus floor. Via osteotomy site, the clinician adds on graft (bone) material & finally place implant.
The surgical trauma caused by percussion via surgical mallet, along with hyperextended neck position during surgery leads to displacement of otoliths into the semicircular canal, eventually lead to benign paroxysmal positional vertigo.
Otoliths in mammals are the deposits of calcium carbonate & protein matrix. Otoliths are essential component that sense gravity & linear acceleration; also they sense motion according to their orientation. Without otoliths one would have poor abilities to motion sense as well as orientation to gravity.
To sum it all up, when the percussions are made, it disturbs the balance in the ears & also leads to displacement of otoliths by the tapping action. Consequently, osteotome sinus floor elevation technique leads to benign paroxysmal positional vertigo (in rare cases).
How to diagnose & treat one with BPPV?
- Patient with BPPV can be diagnosed by moving rapidly into a supine position with the head turned; patients experience vertigo on this quick change in position.
- Fortunately BPPV is a short term & self limiting condition which resolves on its own within a month or so.
- Since the condition is incapacitating, to reduce the spinning sensation, clinicians prescribe antihistamines like diphenhydramine, meclizine & benzodiazepines like clonazepam, diazepam.
- Also, the displaced otoliths can be repositioned from semicircular canal to the vestibule, through a series of changes in head position.
Patients with vertigo should always mention the history before the surgery begins.
The clinicians should be cautious while performing the sinus lift via osteotome techniques. Also, they must be aware of such a condition might happen after such procedure & also should know the handling techniques. Gentle malleting with limited force or use of other surgical kits for a crestal approach & the lateral approach, can lessen the trauma to the craniofacial region as much as possible. This should decrease your unexpected chance of dizziness/vertigo after having sinus lift.
As mentioned before, BPPV is a rare condition & can be prevented via good control over mallet & incorporating the use of advanced techniques. You can visit Dental Implant India for the BPPV treatment.
