Cluster headache is a primary headache by definition not caused by any known underlying structural pathology. However, symptomatic cases have been described, for example tumours, particularly pituitary adenomas, malformations, and infections/inflammations. The evaluation of cluster headache is an issue unresolved. I present a case of a 24-year-old patient who presented with a 4-week history of side-locked attacks of pain located in the left orbit. He satisfied the revised International Classification of Headache Disorders criteria for cluster headache. His medical and family histories were unremarkable. There was no history of headache. A diagnosis of cluster headache was made. The patient responded to symptomatic treatment. Low-dose computer tomography scan after 2 weeks displayed a left-sided acute maxillary sinusitis. The headache attacks resolved completely after treatment with antibiotics and sinus puncture. Although I cannot exclude an unintentional comorbidity, in my opinion, the co-occurrence of an acute maxillary sinusitis with unilateral headache, in a hitherto headache-free man, points toward the fact that in this case the cluster headache was caused or triggered by the sinusitis. The headache attacks resolved completely after the treatment and the patient also remained headache free at the follow-up. The response of the headache to sumatriptan and other typical cluster headache medications does not exclude a secondary form. Symptomatic cluster headaches responsive to this therapy have been described. Associated cranial lesions such as infections have been reported in cluster headache patients and the attacks may be clinically indistinguishable from the primary form. Neuroimaging, preferably contrast-enhanced magnetic resonance imaging including sinuses should always be considered in patients with cluster headache despite normal neurological examination. Acute maxillary sinusitis can present as cluster headache.
Grigor'eva, N V
Halotherapy was applied for non-puncture treatment of 45 patients with acute purulent maxillary sinusitis. The response was evaluated by changes in clinico-immunological, cytological, x-ray and bacteriological parameters. Halotherapy was found effective in the treatment of acute purulent maxillary sinusitis without puncture.
Plaza, G; Ferrando, J; Martel, J; Toledano, A; de los Santos, G
Maxillary sinus hypoplasia is rare, with an estimated prevalence of 1-5%. Out of the CT scans performed in sinusal patients between March 1998 and June 1999, we report on 4 isolated maxillary sinus hypoplasia, 4 maxillary sinus hypoplasia associated to concha bullosa, and 10 isolated conchae bullosas. All cases were evaluated by nasosinusal endoscopy and CT scan. Size, location and uni/bilateral presentation of concha bullosa is correlated to maxillary sinus hypoplasia presence, specially with regards to uncinate process presence, medial or lateral retraction. The pathogenesis of maxillary sinus hypoplasia is reviewed, and its relation to concha bullosa, evaluating how this could explain some cases of the so called chronic maxillary sinus atelectasia, as an acquired and progressive variant of maxillary sinus hypoplasia in adults.
Khanduri, Sachin; Agrawal, Sumit; Goyal, Swati
Maxillary sinus hypoplasia (MSH) is an uncommon abnormality of paranasal sinuses noted in clinical practice. Computed tomography (CT) scan helps in diagnosing the anomaly along with any anatomical variation that may be associated with it. MSH is usually associated with other anomalies like uncinate process hypoplasia. Three types of MSH have been described. Type 1 MSH shows mild maxillary sinus hypoplasia, type 2 shows significant sinus hypoplasia with narrowed infundibular passage and hypoplastic or absent uncinate process, and type 3 is cleft like maxillary sinus hypoplasia with absent uncinate process. CT and endoscopic examination usually complement each other in diagnosing MSH. PMID:25548709
Ugincius, Paulius; Kubilius, Ricardas; Gervickas, Albinas; Vaitkus, Saulius
The aim of the present study was to estimate average age of the patients in both sexes treated for MS, distribution by sex, amount of dexter and sinister MS with and without the fistulas into the maxillary sinus, with and without the foreign-bodies, length of stay in the Department of Maxillofacial Surgery at Kaunas Hospital of University of Medicine during the period from 1999 till 2004. The retrospective data analysis of the patients' treated from chronic MS was made. 346 patients (213 females and 133 males) were treated for chronic MS. 55 cases of chronic dexter MS with a fistula into maxillary sinus, 98 cases of chronic dexter MS without a fistula, 45 cases of chronic sinister MS with a fistula, 112 cases chronic sinister MS without a fistula, 16 cases of foreign-bodies in dexter maxillary sinus, 20 cases of foreign-bodies in sinister maxillary sinus have been detected. The main age of the female was 46.6+/-15.0, the main age of the men was 42.1+/-14.4. Statictically significant difference in the age difference of the women and the men was found (p=0.0024). It was determined, that females diagnosed and treated with chronic MS were 1.6 times more than males during the period from 1999 till 2004 in Kaunas Hospital of University of Medicine. Females treated for chronic MS were 4.5 years older than males.
Kshar, Avinash; Patil, Abhijeet; Umarji, Hemant; Kadam, Sonali
Mucoceles are defined as chronic, cystic lesions in the paranasal sinuses. When the mucocele content becomes infected, the lesion is defined as mucopyocele. Most mucoceles are located in the frontal and anterior ethmoid sinuses and normally they involve the frontal-ethmoid complex, expanding to the superior-medial region of the orbit, leading to ocular disorders; maxillary sinus presentation is rare. In the present article, the authors described a rare case of mucopyocele in the maxillary sinus. PMID:24688571
... headache. Acute sinusitis is mostly caused by the common cold. Unless a bacterial infection develops, most cases resolve ... Acute sinusitis is most often caused by the common cold, which is a viral infection. In some cases, ...
Renon, P; Casanova, M; Verdier, M; Asperge, A; Le Mouel, C
Suppurated maxillary sinusitis are frequent diseases. Diameatic puncture allows bacteriological investigations. Our results are positive in two thirds of cases. The bacterial flora is very varied, whose identification and antibiograms involve efficient treatment with daily washing and in situ antibiotherapy.
Simuntis, Regimantas; Kubilius, Ričardas; Vaitkus, Saulius
Maxillary sinusitis of odontogenic origin is a well-known condition in both the dental and otolaryngology communities. It occurs when the Schneiderian membrane is violated by conditions arising from dentoalveolar unit. This type of sinusitis differs in its pathophysiology, microbiology, diagnostics and management from sinusitis of other causes, therefore, failure to accurately identify a dental cause in these patients usually lead to persistent symptomatology and failure of medical and surgical therapies directed toward sinusitis. Unilateral recalcitrant disease associated with foul smelling drainage is a most common feature of odontogenic sinusitis. Also, high-resolution CT scans and cone-beam volumetric computed tomography can assist in identifying dental disease. Sometimes dental treatment alone is adequate to resolve the odontogenic sinusitis and sometimes concomitant or subsequent functional endoscopic sinus surgery or Caldwell-Luc operation is required. The aim of this article is to give a review of the most common causes, symptoms, diagnostic and treatment methods of odontogenic maxillary sinusitis. Search on Cochrane Library, PubMed and Science Direct data bases by key words resulted in 35 articles which met our criteria. It can be concluded that the incidence of odontogenic sinusitis is likely underreported in the available literature.
Kneis, Kyra C; Gandjour, Afschin
Sinfrontal, a complex homeopathic medication, is popular in Germany for the treatment of ear, nose and throat and respiratory tract infections. Unlike many other homeopathic or herbal medications, the efficacy and safety of Sinfrontal has been demonstrated in a number of clinical studies of patients with sinusitis. To assess the cost effectiveness of Sinfrontal versus placebo in the treatment of adults with acute maxillary sinusitis (AMS) in Germany. A secondary objective was to assess the cost effectiveness of Sinfrontal versus standard treatment with antibacterials. Sinfrontal was compared with placebo in a cost-utility analysis based on data from a randomized controlled clinical trial over 3 weeks (Sinfrontal group: n = 57; placebo group: n = 56). Trial data were analysed from a societal perspective; resource use was valued with German unit costs for 2005. In a secondary analysis, the longer-term cost utility of Sinfrontal versus placebo was estimated over a total of 11 weeks based on an 8-week post-treatment observational phase. In addition, the cost effectiveness of Sinfrontal versus antibacterials was determined based on an indirect comparison of placebo-controlled trials. Sinfrontal led to incremental savings of euro 275 (95% CI 433, 103) per patient compared with placebo over 22 days, essentially due to the markedly reduced absenteeism from work (7.83 vs 12.9 workdays). Incremental utility amounted to 0.0087 QALYs (95% CI 0.0052, 0.0123), or 3.2 quality-adjusted life-days (QALDs). Bootstrapping showed that these findings were significant, with Sinfrontal being dominant in 99.9% of simulations. The results were robust to a number of sensitivity analyses. In the secondary analysis, Sinfrontal led to incremental cost savings of euro 511 and utility gains of 0.015 QALYs or 5.4 QALDs compared with placebo. Compared with antibacterials, Sinfrontal had a significantly higher cure rate (11% vs 59%; p < 0.001) at similar or lower costs. The results of this economic
Kanthem, Ranjith Kumar; Guttikonda, Venkateswara Rao; Yeluri, Sivaranjani; Kumari, Geetha
Background: Individual identification is a subtle concept and often one of the most important priorities in mass disasters, road accidents, air crashes, fires, and even in the investigation of criminal cases. Matching specific features detected on the cadaver with data recorded during the life of an individual is an important aspect in forensics, and can be performed by fingerprint analysis, deoxyribonucleic acid matching, anthropological methods, radiological methods and other techniques which can facilitate age and sex identification. Sinus radiography is one such method that has been used for determination of the sex of an individual. Hence, an attempt is being made to use the different dimensions of the maxillary sinus in the determination of sex using coronal and axial sections of plain computed tomography (CT) scan. Materials and Methods: A total of 30 patients including 17 male and 13 female, visiting the Outpatient Department of the Mamata General Hospital were included as the study subjects. The dimensions of right and left maxillary sinuses of 30 subjects from plain CT were measured using SYNGO software and statistical analysis was done. Results: Sex determination using height, length, width, and volume of the maxillary sinus on both sides showed statistically significant results with a higher percentage of sexual dimorphism in the case of volume. Conclusion: Volume of the right maxillary sinus can be used as accurate diagnostic parameter for sex determination. PMID:26005308
Introduction Acute sinusitis is defined pathologically, by transient inflammation of the mucosal lining of the paranasal sinuses lasting less than 4 weeks. Clinically, it is characterised by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever. It affects 1−5% of the adult population each year in Europe. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in people with clinically diagnosed acute sinusitis, and with radiologically or bacteriologically confirmed acute sinusitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to August 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics (amoxicillin, co-amoxiclav, doxycycline, cephalosporins, macrolides, different doses [amoxicillin, co-amoxiclav, doxycycline, cephalosporins, macrolides], long-course regimens), antihistamines, cephalosporins or macrolides, decongestants (xylometazoline, phenylephrine, pseudoephedrine), doxycycline, saline nasal washes, steam inhalation, and topical corticosteroids (intra-nasal). PMID:19450327
Kulkarni, M V; Bonner, F M; Abdo, G J
A maxillary sinus hemangioma was detected as an incidental finding during magnetic resonance imaging of the head. The CT findings are more characteristic for the diagnosis of this lesion. Preoperative diagnosis of maxillary sinus hemangioma is important since these lesions can frequently cause a large amount of hemorrhage during surgery.
Cholesterol granuloma (CG) of the maxillary sinus is very rare. In this study, the searching of the literature was performed with the keywords of cholesterol granuloma and maxillary sinus. All retrieved literature were reviewed throughout to identify and analyze all individual characteristics. Two additional cases in our hospital were also included. The result showed that, in the overall 37 cases, the ratio of male to female was about 3:1. Caucasian (14/37) and Turkish (10/37) were reported more frequently. CG of maxillary sinus had an opposite sex predilection compared with the fungus balls of the maxillary sinus. In addition, the comorbidity of these two diseases was found only in one patient in the literature. These results suggested that the different mechanisms other than poor aeration of the maxillary sinus played a role in the formation of CG of maxillary sinus. The diagnosis for CG of the maxillary sinus before operation is difficult, but the clear golden yellow rhinorrhea and hemorrhagic signs may provide a good diagnostic evidence. The symptoms were vague and about half of the patients presented with non-specific symptoms. Therefore, it seemed reasonable that CG of the maxillary sinus was under diagnosed in the clinical practice. Treatment consists of complete excision via Caldwell-Luc or endoscopic approach and provides a good prognosis. Bilateral involvements are rare but possible in this disease entity.
Tan, G; Sun, H; Chen, J
To determine the clinical significance and operative method of maxillary sinus ostium in the treatment of chronic sinusitis and nasal polyps. Fifty-six patients (112 sides) undergone endoscopic sinus surgery were studied. The patency rates of the maxillary ostia in patients with enlarged and unchanged maxillary ostia were 92.9% and 80.4% respectively. Fifty-one patients (64 sides) undergone Caldwell-Luc operations were retrospectively studied. The patency rate of inferior antrostomy was 40.6%. CT scans of the sinuses of 38 cases with unilateral sinisitis or nasal polyps were reviewed. The scaled values of the maxillary hiatus on CT images showed no difference between the normal group and the diseased group. Pneumatization and proliferation of middle turbinate and bent uncinate process were the most common anatomic variation in the diseased group. The results suggest that management of anatomic variations surrounding the ostia is very important in the treatment of maxillary ostium.
Faucett, Erynne A; Marsh, Katherine M; Farshad, Kayven; Erman, Audrey B; Chiu, Alexander G
Methamphetamines are the second most commonly used illicit drug worldwide and cost the United States health-care system ∼$23.4 billion annually. Use of this drug affects multiple organ systems and causes a variety of clinical manifestations. Although there are commonly known sequelae of methamphetamine abuse such as "meth mouth," there is limited evidence regarding maxillary sinus manifestations. The following cases highlight the initial evaluation and management of two methamphetamine abusers with loculated purulent collections within the maxillary sinus as a result of methamphetamine abuse. Our aim was to delineate the otolaryngologic symptoms associated with the patients' methamphetamine abuse. Computed tomography and magnetic resonance imaging studies revealed loculated purulent collections within the maxillary sinus of probable odontogenic origin in both patients. Methamphetamine abuse leading to rampant caries and poor oral hygiene may predispose individuals for craniofacial infections and fluid collections. These cases illustrate the development of maxillary sinusitis and maxilla mucoceles that have been associated with methamphetamine use.
Bahadir, Osman; Bahadir, Aysenur; Kosucu, Polat; Livaoglu, Murat
The study showed that surgery in the maxillary sinus can affect its development. To quantitatively evaluate the long-term impact of sinus surgery on its development in the rabbit. This was an experimental study performed at an academic tertiary medical center using 20 4-week-old New Zealand white rabbits. The rabbits underwent unilateral right maxillary sinus surgery. The contralateral maxillary sinus used as a control did not undergo the operation. The maxillary sinus ostium was enlarged on the operated side. Volumetric analysis of the maxillary sinus was performed 1 year post-surgery. The maxillary sinus volumes of both sides were calculated using Multidedector CT and the volumetric measurements of the operated side were compared with the non-operated side. Maxillary sinus development was significantly reduced on the surgical side. Maxillary sinus growth on the surgical side was determined as 87% compared with the non-surgical side.
Kaymakci, Mustafa; Erel, Fuat; Bulbul, Erdogan; Yazici, Hasmet; Acar, Mustafa; Yanik, Bahar
We aimed to investigate the relationship between allergic rhinitis, which is an important reason of nasal obstruction, and maxillary sinus aeration. Three hundred fifteen patients who have a complaint of nasal obstruction and scheduled to undergo skin prick test (SPT) with a suspicion of allergic rhinitis (AR) were enrolled for this study. Thirty-two patients with positive SPT result and 30 patients with a negative SPT result were determined as group 1 and 2 (control group), respectively. A 3-dimensional reconstruction of computed tomography images of the 62 patients was used to assess and calculate maxillary sinus volumes (MSVs). Total maxillary sinus volumes were measured as 21.87 cm(3) and 30.15 cm(3) in group 1 and group 2, respectively. A statistically significant difference was observed between the MSVs of the groups (P < 0.001). Total maxillary sinus volumes were found to be significantly smaller for patients with a positive SPT compared to patients with a negative SPT. Thus, we may conclude that AR has a negative impact on maxillary sinus aeration.
Simuntis, Regimantas; Kubilius, Ričardas; Ryškienė, Silvija; Vaitkus, Saulius
We present a case of odontogenic maxillary sinusitis whose sinonasal symptomatology was thought to be the consequence of a previous midfacial trauma. The patient was admitted to the Clinic of Oral and Maxillofacial Surgery after more than 10 years of exacerbations of sinonasal symptoms, which began to plague soon after a facial contusion. We decided to perform CT of paranasal sinuses, and despite the absence dental symptomatology, the dental origin of sinusitis was discovered. The majority of sinonasal symptoms resolved after appropriate dental treatment, and there was no need for nasal or sinus surgery.
Faucett, Erynne A.; Marsh, Katherine M.; Farshad, Kayven; Erman, Audrey B.
Methamphetamines are the second most commonly used illicit drug worldwide and cost the United States health-care system ∼$23.4 billion annually. Use of this drug affects multiple organ systems and causes a variety of clinical manifestations. Although there are commonly known sequelae of methamphetamine abuse such as “meth mouth,” there is limited evidence regarding maxillary sinus manifestations. The following cases highlight the initial evaluation and management of two methamphetamine abusers with loculated purulent collections within the maxillary sinus as a result of methamphetamine abuse. Our aim was to delineate the otolaryngologic symptoms associated with the patients' methamphetamine abuse. Computed tomography and magnetic resonance imaging studies revealed loculated purulent collections within the maxillary sinus of probable odontogenic origin in both patients. Methamphetamine abuse leading to rampant caries and poor oral hygiene may predispose individuals for craniofacial infections and fluid collections. These cases illustrate the development of maxillary sinusitis and maxilla mucoceles that have been associated with methamphetamine use. PMID:25675268
Hurley, D B; Smith, G S; Vogler, G A; Desponde, Y; Citardi, M J
Since the late 1980s, the rabbit model for sinusitis has been widely used for experimental studies on sinusitis; however, the clinical relevance of these experimental data has been questioned. To elucidate the role of leukotrienes in the pathogenesis of sinusitis, leukotriene B4 (LTB4) levels were determined in acute Streptococcus pneumoniae sinusitis in this model. The rabbit model for acute maxillary sinusitis was utilized. Briefly, the right maxillary ostium of each New Zealand white rabbit was occluded with cyanoacrylate under general anesthesia. Twenty-four hours after occlusion, the occluded sinus received an inoculation of 10(8) Streptococcus pneumoniae (ATCC 10813) or a sham inoculation of saline alone. Rabbits were then sacrificed one week later, and the maxillary sinus mucosae were harvested. Leukotriene B4 levels were determined by ELISA assay. LTB4 levels in the sinuses inoculated with bacteria tended to be higher; however, statistical analysis did not reveal significant differences between the experimental and control groups. It is possible to reliably assess leukotriene B4 levels in this model of sinusitis. Although the data suggest a trend for elevated LTB4 levels, statistical analysis did not support this conclusion. The study also demonstrated significant limitations in the current rabbit model for sinusitis; that is, the standard human sinus bacterial pathogens are minimally pathogenic in rabbit sinuses and the small size of the sinus limits the material available for assay. Further modifications of the model are necessary. After such adjustments, the role of leukotrienes in sinusitis may be further explored.
Vaz, Paula; Faria-Almeida, Ricardo; Braga, Ana-Cristina; Felino, António
Background Proximity of the dental roots to the sinus floor makes dental disease a probable cause of maxillary sinusitis. The aim of this study was to find out if maxillary sinus pathologic changes were more prevalent in patients with dental disease and to evaluate the performance of computed tomography (CT) in analyzing and detecting apical periodontitis and other odontogenic causes on the maxillary sinusitis etiology in a Portuguese Caucasian population. Material and Methods Retrospective cohort study. The total sample of 504 patients and their CT was included in this study. The patients were from a private dental clinic, specializing in oral surgery, where the first complaint was not directly related to sinus disease, but with dental pathology. For each patient, the etiological factors of maxillary sinusitis and the imaging CT findings were analyzed. All the axial, coronal and sagittal CT slices were evaluated and general data were registered. The latter was selected based on the maxillary sinus CT published literature. Results 32.40% of patients presented normal sinus (without any etiological factor associated), 29.00% showed presence of etiological and imaging findings in the maxillary sinus, 20.60% had only imaging changes in the maxillary sinus and 18.00% of patients presented only etiological factors and no change in the maxillary sinus. Conclusions Radiological imaging is an important tool for establishing the diagnosis of maxillary sinus pathology. These results indicate that the CT scan should be an excellent tool for complement the odontogenic sinusitis diagnosis. Key words: Maxillary sinusitis/etiology, odontogenic, computed tomography, maxillary sinus. PMID:25858084
Dutta, Mainak; Kundu, Sohag; Barik, Sabyasachi; Banerjee, Shoham; Mukhopadhyay, Subrata
Mucosal cavernous hemangiomas of maxillary sinus and the lateral nasal wall are seldom encountered and difficult to diagnose with misleading radiologic features like bone erosion and heterogeneity due to patchy contrast uptake. The overall picture mimicking sinonasal malignancy, it is unclear whether there is true breach in the bone or remodeling due to the lesion's chronicity. Interestingly, it often does not bleed as expected during surgery, questioning the use of therapeutic embolization and pre-intervention vascular shrinkage. The clinical presentation and management protocol of sinonasal cavernous hemangiomas seem greatly individualized. We here present a patient with cavernous hemangioma of maxillary sinus and discuss the distinguishing clinical, histologic and imaging characteristics and subsequent management options, and attempt to establish the findings as the basis of considering it as an important differential diagnosis of radiologically heterogeneous sinonasal mass with suspected bone erosions presenting with nasal obstruction and epistaxis, mostly in young women.
Krishnan, Nagarajan; Ramamoorthy, Nathan; Panchanathan, Suresh; Balasundaram, Jothiramalingam S
Periorbital soft tissue swelling may result due to primary orbital pathology or from adjacent facio-maxillary or sino-nasal inflammatory causes. Osteomyelitis of maxilla in the pediatric age group is a rare entity in this era of antibiotics. We present an 11-month-old female infant who was brought with peri-orbital selling and purulent nasal discharge. Computed Tomography showed erosions of the walls of maxillary sinus suggestive of osteomyelitis. Culture of sinus scraping showed Staphylococcus aureus growth and the child improved with intravenous cloxacillin therapy. This case is presented due to the rarity of its presentation in this age group and for awareness to consider this entity in children having fever and peri-orbital swelling. PMID:25191055
Jammal, H; Barakat, F; Hadi, U
Vascular lesions of the sinonasal tract are rare. These lesions do not have typical signs or symptoms. They may present insidiously with minimal symptoms. A high index of suspicion and a good preoperative evaluation are needed for diagnosis. No standard surgical approach is indicated. We report a case of cavernous hemangioma of the maxillary sinus in an adult male. We present the diagnostic work-up and discuss the differential diagnosis and potential therapeutic approaches.
Farneti, Paolo; Sciarretta, Vittorio; Macrì, Giovanni; Piccin, Ottavio; Pasquini, Ernesto
Silent sinus syndrome (SSS) and chronic maxillary atelectasis (CMA) are unusual conditions having subtle symptoms with a possible progressive evolution. They are particularly infrequent in the pediatric population. Our objective was to review our experience with pediatric patients having SSS or CMA, and to review all cases involving patients under 14 years of age reported in the literature. A retrospective review of 6 patients diagnosed with SSS or CMA surgically treated from 2001 to 2014 was carried out. All cases reported in literature were reviewed. All patients underwent functional endoscopic sinus surgery with an improvement in symptoms after surgery. Diplopia disappeared in two patients who presented with it and enophthalmos improved in all five patients presenting with it. Only one patient out of four presenting with headache had a persistence of the symptoms which were, however, milder than they had been preoperatively. Endoscopic examination demonstrated a reventilated maxillary sinus in all cases. A radiological examination at follow-up was performed in 5 cases and demonstrated a reexpansion of the maxillary sinus as compared to the contralateral side in all patients except one. None of the patients required an orbital floor reconstruction. Eleven similar cases reported in the literature were analyzed and compared. Endoscopic uncinectomy and middle meatal antrostomy should be the treatment of choice for these conditions in patients presenting with enophthalmos and/or hypoglobus and symptoms related to it. Orbital floor reconstruction should be performed as a delayed procedure only in selected cases. Chronic maxillary atelectasis or SSS should be considered as a possible cause of persistent headache of unknown origin in pediatric patients. Copyright © 2017 Elsevier B.V. All rights reserved.
Nouhaud, François-Xavier; Le Gal, Sophie
We report the rare case of a 72-year-old woman with maxillary sinus undifferentiated carcinoma with metachronous metastasis localized to the bladder. Bladder metastases and maxillary sinus carcinoma are rare tumors. The bladder is not 1 of the usual sites of distant extension for parasinus tumors. To our knowledge, no data have been reported regarding bladder metastasis originating from a maxillary sinus carcinoma. Copyright © 2012 Elsevier Inc. All rights reserved.
Rockhill, R C; Klein, M D
Paecilomyces lilacinus was isolated on two separate occasions from the left antrum of a patient with chronic maxillary sinusitis. The clinical presentation and characteristics of the fungus and the sinus debris histopathology are discussed. Images PMID:7430339
Crespo Del Hierro, Jorge; Ruiz González, Manuel; Delgado Portela, Margarita; García Del Castillo, Eduardo; Crespo Serrano, Juan
Sinusitis of dental origin is a relatively frequent entity, but the presence of an odontoma in the sinus as a source of this pathology is exceptional. Here we present a case of a young patient who presented chronic maxillary sinusitis over 2 years, originating in an odontoma located in the sinus drainage area.
Ramachamparambathu, Ashir Kolikkal; Vengal, Manoj; Siyo, Nizaro; Ahmed, Anis
Malignant tumours of maxillary sinus are rare. They are usually diagnosed in the late stages when they perforate the sinus walls. The presence of large air space in the maxillary sinus facilitates asymptomatic growth of the sinus malignancy. The clinical presentation of these tumours depends on the sinus wall involved by the disease. The medial wall is usually the first to become eroded, leading to nasal obstruction, epistaxis or discharge. Rarely, symptoms of maxillary sinus carcinoma can resemble dental infection and the affected patients may visit dental clinic seeking treatment. This report presents a case of carcinoma of maxillary sinus mimicking odontogenic infection. Computed tomographic findings explained the reason for the present lesion to masquerade as an inflammatory condition. The importance of advanced imaging modalities for prompt identification of such lesions is discussed. PMID:27790593
Fava, L R
A case is reported in which a perforation of the sinus floor of the maxillary sinus occurred with extrusion of a calcium hydroxide paste during routine root canal treatment of a maxillary premolar. All clinical manifestations are described as well as the results of a follow-up evaluation.
Kim, Young-Kyun; Hwang, Jin-Young; Yun, Pil-Young
The aims of this study were to evaluate the incidence of maxillary sinusitis associated with the sinus elevation procedure and to analyze the influence of maxillary sinusitis on the prognosis of dental implants. Data were collected from medical records and dental radiographic findings of patients who received dental implant therapy along with a sinus elevation procedure at Seoul National University Bundang Hospital from June 2003 to December 2008. A total of 338 sinus elevation cases (643 implants) were included in this study, out of which maxillary sinusitis was reported in 33 cases (9.8%). The type of surgical approach used and the occurrence of sinus membrane perforation could be considered factors affecting maxillary sinusitis associated with the sinus elevation procedure. The implants at the site of the maxillary sinusitis associated with the sinus elevation procedure showed lower survival rates in male patients. Better clinical outcomes were achieved in the group receiving combined medical and surgical therapy for sinusitis associated with the sinus elevation procedure. Postoperative maxillary sinusitis decreased the survival rates of implants, whereas early diagnosis and combined medical and surgical therapy had the opposite effect.
Uluyol, S; Arslan, İ B; Demir, A; Mercan, G C; Dogan, O; Çukurova, İ
This study aimed to evaluate the clinical significance of maxillary sinus hypoplasia and isolated agenesis of the uncinate process in sinusitis aetiology. Three patients with isolated agenesis of the uncinate process and 27 patients with 43 maxillary sinus hypoplasia variations were recruited. The frequencies of sinusitis episodes and radiological findings were compared between patient subgroups. In all, 23 type I maxillary sinus hypoplasia, 13 type II maxillary sinus hypoplasia and 7 type III maxillary sinus hypoplasia variations were detected. Patients with isolated agenesis of the uncinate process underwent antibiotic treatment an average of 7 times per year, whereas those with types I, II and III maxillary sinus hypoplasia were treated 1.57, 3.22, and 5.75 times per year, respectively, over a 5-year period. The antibiotic treatment frequency for patients with isolated agenesis of the uncinate process was significantly higher than for those with types I and II maxillary sinus hypoplasia. Isolated agenesis of the uncinate process seems to play a stronger role than types I and II maxillary sinus hypoplasia in the pathophysiology of chronic sinusitis.
Shibuya, H.; Horiuchi, J.; Suzuki, S.; Shioda, S.; Enomoto, S.
This hundred and sixteen patients with carcinoma of the maxillary sinus received primary therapy consisting of external beam irradiation alone or in combination with surgery and/or chemotherapy at the Department of Radiology, Tokyo Medical and Dental University Hospital, between 1953 and 1982. In our institution, methods of treating cancer of the maxillary sinus have been changed from time to time and showed different control rates and clinical courses. An actuarial 10-year survival rate of 21% has been obtained by the megavoltage irradiation alone as well as 34% actuarial 10-year survival rate by megavoltage irradiation with surgery. After the introduction of conservative surgery followed by conventional trimodal combination therapy, the local control rate has been improved. The amount of functional, cosmetic, and brain damages have been remarkably decreased by this mode of therapy. The actuarial five year survival rate was 67%. In addition, along with the improvement of the local control rate, the control of nodal and distant organ metastases have been emerging as one of the important contributions to the prognosis of this disease.
Arkhipov, A V
The paper describes the sinus-lifting technique useful in patients with alveolar bone deficiency. The technique allows significantly lowering the risk of maxillary sinus mucosa perforation and improves bone tissue regeneration.
Felisati, Giovanni; Saibene, Alberto Maria; Lenzi, Riccardo; Pipolo, Carlotta
A 55-year-old male patient was referred to our clinic with signs and symptoms of recurring sinusitis after a right maxillary sinus floor augmentation for implantological purposes. Investigations showed an antibiotic-resistant ethmoidomaxillary sinusitis resulting from bone graft infection and displacement of previously inserted xenograft material into the maxillary sinus. The patient thus underwent a surgical procedure combining nasal endoscopy and oral surgery in order to remove the infected graft and restore sinusal drainage. The procedure was apparently successful but sinusitis relapsed after surgery and persisted despite 2 weeks of antibiotic therapy and local medications. A CT scan showed persistence of grafting fragments in the maxillary sinus. A new surgical procedure was scheduled while a more accurate endoscopic local medication was performed. Six hours after the treatment, the patient spontaneously expelled the fragments and promptly recovered. The patient successfully underwent another maxillary sinus floor augmentation procedure 6 months later. PMID:23234824
Koppe, Thomas; Röhrer-Ertl, Olav; Breier, Silvana; Wallner, Claus-Peter
In a mixed sex sample of ten adult gibbon (Hylobates moloch) skulls, one cranium of a male with maxillary sinus atelectasis of the left side was identified. While external inspection revealed a slight drop of the left orbital floor, serial coronal computer tomography (CT) scans show characteristic changes of the left maxillary sinus and its surrounding structures. In addition to the sunken orbital floor, radiological features of the specimen include an inward bowing of the medial sinus wall, sinus opacification, and a reduction in maxillary sinus size to a slit-like cavity, which suggest a diagnosis of silent sinus syndrome. This report is the first, to our knowledge, of maxillary sinus atelectasis in a non-human primate. This finding is valuable for the understanding of the pathogenesis and etiology of maxillary sinus atelectasis. At the same time, however, paleoanthropologists and primatologists may refer to this information when dealing with the interpretation of maxillary sinus pneumatization of partially broken archaeological and fossil skulls.
Drumond, João Paulo Nunes; Allegro, Bruna Bianca; Novo, Neil Ferreira; de Miranda, Sérgio Luís; Sendyk, Wilson Roberto
Introduction Maxillary sinus disease is common and numerous disorders can affect this anatomical area. Abnormalities can be classified as: non-neoplastic, neoplastic benign, and neoplastic malignant. Objective Evaluate through CT the prevalence of diseases in maxillary sinuses, using the Radiology Department's database of a hospital in São Paulo city. Methods The sample consisted of 762 facial CT scans that we divided into three groups: Group A (12–19 years old); Group B (20–49 years old); Group C (above 50 years old); and male or female. We considered the following pathological processes: I - Mucoperiosteal Thickening; II - Chronic Sinusitis; III - Chronic Odontogenic Sinusitis; IV - Rhinosinusitis; V - Polypoid Lesions; VI - Bone Lesions; VII - Neoplasms; VIII - Antrolith; IX - Foreign Bodies; X - Oroantral Fistula. Results Our study found that 305 exams (40.02%) were normal and 457 exams (59.97%) were abnormal. We found the following disease frequencies: focal mucoperiosteal thickening (21.25%); polypoid lesions (10.76%); chronic sinusitis (7.48%); chronic odontogenic sinusitis (2.29%); neoplasms (2.03%); rhinosinusitis (1.77%); bone lesions, foreign bodies and oroantral fistula in 0.65%; 0.13% and 0.06% respectively. There was no significant difference between male and female, and Groups A, B, or C when relating the frequencies of abnormalities found. There was no significant difference between male and female and the age group for the side of the altered maxillary sinus. Conclusion We observed a high prevalence of sinus maxillary diseases. Mucoperiosteal thickening; acute, chronic, and odontogenic sinusitis; polypoid lesions and neoplasms have high prevalence in maxillary sinuses. Thus, facial CT exam was effective for the evaluation of diseases in maxillary sinuses. PMID:28382118
Bhushan, Bharat; Rychlik, Karen; Schroeder, James W
To examine the age related volume change of the maxillary sinus in children by measuring the change of the height, weight, and depth using computed tomography (CT). Children <18 years of age who underwent a CT Scan of the sinuses for reasons other than sinus related issues were included in the study. 139 patients were included (68 females and 71 Males) and the mean age of the patients was 9.6 ± 5.4 years. The cohort was divided into three groups based on their ages - Age <6 years (n = 45), age between 6 and 12 years (n = 44) and age > 12 years (n = 50). Patients in each age group demonstrated an increase in their Maxillary sinus height (p<0.001). Patients < 6years of age and between 6 and 12 years of age had a significant increase in their maxillary sinus width and depth (p < 0.001). The maxillary sinus width, depth and volume did not increase significantly after the age of 12 years in these patients. We demonstrated periods of significant size increase of the maxillary sinuses as determined by different dimensions in children at various ages. The height of the maxillary sinus has steady growth from birth to at least the age of 18 years. The width and depth increase up to 12 years of age. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Carvalho Visioli, Adriano Rossini; de Oliveira e Silva, Cléverson; Marson, Fabiano Carlos; Takeshita, Wilton Mitsunari
In this manuscript, we present a rare case report of giant complex odontoma in the maxillary sinus, where the applied therapy included complete excision of the lesion with a conservative approach. Odontomas are also called benign growth abnormalities or hamartomas. They represent a more common type of odontogenic tumor and are related to various disorders such as bad dental placements, expansion, increased volumetric bone, and no eruption of permanent teeth. Usually they have an asymptomatic evolutionary course. The etiologic factors, although obscure, are related to local trauma, infection, and genetic factor. The structural composition of an odontoma consists of mature dental tissues. Odontomas can be differentiated according to their anatomical presentations: Compound odontoma-clusters of several denticles and complex odontoma-well defined tumefaction mass. The diagnosis can be performed by radiographic examination. PMID:26389051
Akhlaghi, Fahimeh; Esmaeelinejad, Mohammad; Safai, Pooria
Context: Maxillary sinusitis is an important issue in dentistry and maxillofacial surgery. This study aims to present a systematic review of etiologies and treatments of odontogenic maxillary sinusitis. Evidence Acquisition: An electronic database search was performed based on related MeSH keywords. Articles published between January 2001 and December 2014 was selected according to the inclusion criteria. The information extracted from various studies was categorized in various tables. Results: The study selected 19 studies. In most studies, oroantral fistula (OAF) was the most common etiology of odontogenic sinusitis. Alpha-hemolytic streptococcus was the most common flora in sinusitis with dental origin. The literature shows that the Caldwell-Luc approach may be the best method for treating sinusitis in cases of displaced teeth. Conclusions: OAF is a common cause of odontogenic maxillary sinusitis and may easily be treated by endoscopy and fistula closure. Maxillofacial surgeons and dentists should consider this problem to avoid misdiagnosis and prevent complications. PMID:26756016
Li, Yanfeng; Hu, Pin; Han, Yishi; Fan, Jiadong; Dong, Xinming; Ren, Huan; Yang, Chunhao; Shi, Tingting; Xia, Dong
The objective of this study was to comparatively evaluate 3 different sinus lift tools, namely umbrella-shaped sinus lift curette YSL-04, our recently designed probe-improved sinus lift curettes, and our newly invented elevator 014, using our previous developed goat ex vivo models for direct visualizing the effectiveness of detaching sinus mucosa in real time. Goat ex vivo models for direct visualizing the effectiveness of detaching sinus mucosa in real time were generated according to our previously developed protocol. The effectiveness for each tool was evaluated through the length of sinus mucosa detached in mesial and distal directions or buccal and palatal directions, and the space volume created by detaching maxillary sinus mucosa in mesial, distal, buccal and palatal directions. The results showed that all 3 sinus lift tools could transcrestally detach the maxillary sinus mucosa and create extra space under the elevated sinus floor on the goat ex vivo sinus models. Moreover, our newly invented elevator 014 had advantages over the other 2 in term of the capability to detach the sinus mucosa. Our newly invented elevator 014 might be a promising tool for detaching maxillary sinus mucosa in transcrestal maxillary sinus floor elevation.
Sysoliatin, S P; Sysoliatin, P G; Palkina, M O; Solop, M V
The long-term results of dental implant placement in patients with the history of odontogenic maxillary sinusitis are assessed in retrospective study. Maxillary sinusotomy and endoscopic surgery procedures are compared in regard to complications risks after subsequent sinus lift and dental implantation, the latter proving to be method of choice in such cases.
Crovetto-Martínez, Rafael; Martin-Arregui, Francisco J.; Zabala-López-de-Maturana, Aitor; Tudela-Cabello, Kiara
Objectives: Odontogenic sinusitis usually affects the maxillary sinus but may extend to the anterior ethmoid sinuses. The purpose of this study is to determine the percentage of odontogenic maxillary sinusitis extended to the anterior ethmoid sinuses and determine also the surgical resolution differences between odontogenic maxillary sinusitis and odontogenic maxillary associated to anterior ethmoidal sinusitis. Study Design: This is a retrospective cohort study performed on 55 patients diagnosed of odontogenic sinusitis and treated surgically by functional endoscopic sinus surgery. Results: This study showed that 52.7% of odontogenic maxillary sinusitis spreads to anterior ethmoid, causing added anterior ethmoid sinusitis. We found that 92.3% of the odontogenic maxillary sinusitis (who underwent middle meatal antrostomy) and 96.5% of the odontogenic maxillary sinusitis extended to the anterior ethmoid (treated with middle meatal antrostomy and anterior ethmoidectomy) were cured. Conclusions: Ethmoid involvement is frequent in maxillary odontogenic sinusitis. The ethmoid involvement does not worsen the results of “functional endoscopic sinus surgery” applied to the odontogenic sinusitis. Key words:Odontogenic maxillary sinusitis, ethmoiditis, functional endoscopic sinus surgery. PMID:24608208
Leao de Queiroz, Cristhiane; Terada, Andrea Sayuri Silveira Dias; Dezem, Thais Uenoyama; Gomes de Araújo, Lais; Galo, Rodrigo; Oliveira-Santos, Christiano
Absract The purpose of this study was to evaluate dimensions of adult human maxillary sinuses on panoramic radiographs and their possible application on the sex determination for forensic purposes. The sample comprised 64 database panoramic radiographs from individuals aged 20 years or older (32 male and 32 female subjects), with complete permanent dentition (or absence of third molars). One examiner measured the width and height of the right and left maxillary sinuses using the software Image J 1.47v (National Institutes of Health, Bethesda, USA). Measurements were repeated to calculate intra-observer agreement. Chi-Square test, Kappa, ANOVA and T-Student were used for results analysis for p≤ 0.05. Intra-observer agreement with correlation Kappa ranged between 0.38 and 0.96. For female subjects, the mean height and width of the left maxillary sinus were 28.7856mm and 44.6178mm, respectively. And right maxillary sinus was 27.7163mm for height and 45.1850mm for width. Male subjects were found to have the mean height and width of the left maxillary sinus 30.9981mm and 48.7753mm, respectively. And right maxillary sinus was 30.7403mm for height and 48.5753mm for width. There was a statistically significant difference in the height and width of maxillary sinuses between males and females. It can be concluded that maxillary sinuses height and width on panoramic radiographs can be used to determine the gender of adult human subjects. PMID:27847394
Leao de Queiroz, Cristhiane; Terada, Andrea Sayuri Silveira Dias; Dezem, Thais Uenoyama; Gomes de Araújo, Lais; Galo, Rodrigo; Oliveira-Santos, Christiano; Alves da Silva, Ricardo Henrique
The purpose of this study was to evaluate dimensions of adult human maxillary sinuses on panoramic radiographs and their possible application on the sex determination for forensic purposes. The sample comprised 64 database panoramic radiographs from individuals aged 20 years or older (32 male and 32 female subjects), with complete permanent dentition (or absence of third molars). One examiner measured the width and height of the right and left maxillary sinuses using the software Image J 1.47v (National Institutes of Health, Bethesda, USA). Measurements were repeated to calculate intra-observer agreement. Chi-Square test, Kappa, ANOVA and T-Student were used for results analysis for p≤ 0.05. Intra-observer agreement with correlation Kappa ranged between 0.38 and 0.96. For female subjects, the mean height and width of the left maxillary sinus were 28.7856mm and 44.6178mm, respectively. And right maxillary sinus was 27.7163mm for height and 45.1850mm for width. Male subjects were found to have the mean height and width of the left maxillary sinus 30.9981mm and 48.7753mm, respectively. And right maxillary sinus was 30.7403mm for height and 48.5753mm for width. There was a statistically significant difference in the height and width of maxillary sinuses between males and females. It can be concluded that maxillary sinuses height and width on panoramic radiographs can be used to determine the gender of adult human subjects.
Lee, Jang Won; Yoo, Ji Yong; Paek, Seung Jae; Park, Won-Jong; Choi, Eun Joo; Choi, Moon-Gi; Kwon, Kyung-Hwan
The maxillary sinus mucosa is reported to recover to preoperative sterility after sinus floor elevation. However, when drainage of maxillary sinus is impaired, recovery can be delayed and maxillary sinusitis can occur. Therefore, in this study, we investigated the correlations between anatomic variants that can interrupt the ostium of the maxillary sinus and incidence of complication after sinus lifting. The subjects are 81 patients who underwent sinus lifting in Wonkwang University Dental Hospital (Iksan, Korea). Computed tomography (CT) images of the subjects were reviewed for presence of nasal septum deviation, anatomic variants of the middle turbinate, and Haller cells. Correlations between anatomic variations and occurrence of maxillary sinusitis were statistically analyzed. Patients with anatomic variants of ostio-meatal units, such as deviated nasal septum, concha bullosa or paradoxical curvature of the middle turbinate, or Haller cells, showed a higher rate of complication. However, only presence of Haller cell showed statistically significant. Before sinus lifting, CT images are recommended to detect anatomic variants of the ostio-meatal complex. If disadvantageous anatomic variants are detected, the use of nasal decongestants should be considered to reduce the risk of postoperative sinusitis.
Objectives The maxillary sinus mucosa is reported to recover to preoperative sterility after sinus floor elevation. However, when drainage of maxillary sinus is impaired, recovery can be delayed and maxillary sinusitis can occur. Therefore, in this study, we investigated the correlations between anatomic variants that can interrupt the ostium of the maxillary sinus and incidence of complication after sinus lifting. Materials and Methods The subjects are 81 patients who underwent sinus lifting in Wonkwang University Dental Hospital (Iksan, Korea). Computed tomography (CT) images of the subjects were reviewed for presence of nasal septum deviation, anatomic variants of the middle turbinate, and Haller cells. Correlations between anatomic variations and occurrence of maxillary sinusitis were statistically analyzed. Results Patients with anatomic variants of ostio-meatal units, such as deviated nasal septum, concha bullosa or paradoxical curvature of the middle turbinate, or Haller cells, showed a higher rate of complication. However, only presence of Haller cell showed statistically significant. Conclusion Before sinus lifting, CT images are recommended to detect anatomic variants of the ostio-meatal complex. If disadvantageous anatomic variants are detected, the use of nasal decongestants should be considered to reduce the risk of postoperative sinusitis. PMID:27847736
Sotobori, Megumi; Marukawa, Kohei; Higuchi, Masatoshi; Nakazawa, Ryuichi; Moroi, Akinori; Ishihara, Yuri; Iguchi, Ran; Kosaka, Akihiko; Ikawa, Hiroumi; Ueki, Koichiro
Sinusitis of dental origin is a relatively frequent entity, and odontomas are considered to be the most common odontogenic tumors of the oral cavity. Eruption and infection of odontomas are extremely rare. Here, we report an interesting case where odontoma was found in the wake of the maxillary sinusitis onset. PMID:24383013
Seong, Wook-Jin; Barczak, Michael; Jung, Jae; Basu, Saonli; Olin, Paul S; Conrad, Heather J
Pneumatization of the maxillary sinus limits the quantity of alveolar bone available for implant placement and may result in a lack of primary stability and difficulty in achieving osseointegration. The purpose of this study was to retrospectively analyze a group of patients who had implants placed in the posterior maxilla, calculate the prevalence of sinus augmentation, and identify factors related to sinus augmentation. With institutional review board approval, dental records from a population of patients who had implants placed in the maxillary posterior region between January 2000 and December 2004 were used to create a database. Independent variables were classified as continuous (age of the patient at stage 1 implant surgery [S1], time between extraction and S1, time between extraction and sinus augmentation, and time between sinus augmentation and S1) and categorical (gender, implant failure, American Society of Anesthesiologists system classification, smoking, osteoporosis, residual crestal bone height, implant position, implant proximity, prostheses type, and implant diameter and length). The dependent variable was the incidence of a sinus augmentation procedure. Simple logistic regression was used to assess the influence of each factor on the presence of sinus augmentation (P < .05). The final database included 502 maxillary posterior implants with an overall survival rate of 93.2% over a mean follow-up period of 35.7 months. Of 502 implants, 272 (54.2%) were associated with a sinus augmentation procedure. Among variables, residual crestal bone height (P < .001), implant position (P < .001), implant proximity (P < .001), prosthesis type (P < .001), implant failure (P < .01), and implant diameter (P < .01), were statistically associated with sinus augmentation. Within the limitations of this retrospective study, the results suggest that more than half (54.2%) of the maxillary posterior implants were involved with a sinus augmentation procedure. The
García, B; Peñarrocha, M; Peñarrocha, M A; Von Arx, T
To describe a method of carrying out apical surgery of a maxillary molar using ultrasonics to create a lateral sinus window into the maxillary sinus and an endoscope to enhance visibility during surgery. A 37-year-old female patient presented with tenderness to percussion of the maxillary second right molar. Root canal treatment had been undertaken, and the tooth restored with a metal-ceramic crown. Radiological examination revealed an apical radiolucency in close proximity to the maxillary sinus. Apical surgery of the molar was performed through the maxillary sinus, using ultrasonics for the osteotomy, creating a window in the lateral wall of the maxillary sinus. During surgery, the lining of the sinus was exposed and elevated without perforation. The root-end was resected using a round tungsten carbide drill, and the root-end cavity was prepared with ultrasonic retrotips. Root-end filling was accomplished with MTA(®) . An endoscope was used to examine the cut root face, the prepared cavity and the root-end filling. No intraoperative or postoperative complications were observed. At the 12-month follow-up, the tooth had no clinical signs or symptoms, and the radiograph demonstrated progressing resolution of the radiolucency. When conventional root canal retreatment cannot be performed or has failed, apical surgery may be considered, even in maxillary molars with roots in close proximity to the maxillary sinus. Ultrasonic sinus window preparation allows more control and can minimize perforation of the sinus membrane when compared with conventional rotary drilling techniques. The endoscope enhances visibility during endodontic surgery, thus improving the quality of the case. © 2010 International Endodontic Journal.
Colletti, Giacomo; Felisati, Giovanni; Biglioli, Federico; Tintinelli, Roberto; Valassina, Davide
A fungus ball is one of the fungal diseases that can affect the paranasal sinuses. It requires surgical treatment. Because there is only one previously reported case of dental implant placement after treatment of a maxillary sinus fungus ball, the authors here report on a case of a maxillary sinus fungus ball with bone erosion that was treated surgically with a combined endoscopic endonasal and endoral (Caldwell-Luc) approach. One year later, a graft from the ilium was obtained and a sinus elevation was performed to allow the placement of dental implants. Three months later, the dental implants were placed, and they were all osseointegrated at the 9-month follow-up.
Lentner, Mark; Li, Hui; Nagorsky, Matthew
Actinomycosis is a bacterial infection due to Actinomyces israelii, a gram-positive, anaerobic organism that normally affects the cervicofacial region. However, facial injury or trauma (i.e., dental procedures) can allow this bacteria to inhabit other regions. There have been rare reports of actinomycosis of the paranasal sinuses. We present a case of a 50-year-old female who originally presented with a suspected oroantral fistula who subsequently was found to have actinomycosis involving her right maxillary sinus. Additionally, the dental extraction site revealed no connection with the maxillary sinus. We discuss the diagnostic approach and management of this patient as it relates to the limited existing literature. PMID:28352486
Müsebeck, K; Rosenberg, H
Anemometry with the hot wire and hot film technique previously described, enables the rhinologist to record slow and rapidly changing air flow in the maxillary sinus. The advantages and disadvantages of this method are considered. Anemometry together with manometry may be designated sinumetry and used as a diagnostic procedure following sinuscopy in chronic maxillary sinus disease. The value of the function from velocity of time allows the estimation of flow-volume in the sinus. Furthermore, the method is useful to evaluate the optimal therapy to restore ventilation in the case of an obstructed ostium demonstrated before and after surgical opening in the inferior meatus.
Kainulainen, Leena; Suonpää, Jouko; Nikoskelainen, Jukka; Svedström, Erkki; Vuorinen, Tytti; Meurman, Olli; Ruuskanen, Olli
To study bacteria and viruses in maxillary sinuses of patients with primary hypogammaglobulinemia receiving immunoglobulin therapy. Prospective cross-sectional study during 6 months. Tertiary care university hospital. Seventeen patients with primary hypogammaglobulinemia (10 males and 7 females; mean age, 39 years [age range, 11-71 years]). Sixteen patients had common variable immunodeficiency, and 1 patient had X-linked agammaglobulinemia. Magnetic resonance imaging and x-ray imaging of paranasal sinuses when patients did not have signs of acute infection and reevaluation 6 months later. Maxillary sinus aspiration and lavage were performed at a follow-up visit. Sinus fluid analysis for bacteria and viruses was performed by culture and by polymerase chain reaction. A questionnaire on symptoms related to sinusitis was administered during the follow-up period. Among 17 patients, 9 (53%) had radiologically defined sinusitis without subjective symptoms at study enrollment. At reevaluation 6 months later, radiological findings remained unchanged in two thirds of the patients. Among 15 patients, bacteria were found in sinus lavage samples from 13 patients, and viruses were found in samples from 7 patients. Eight patients had 2 pathogens or more on bacterial culture. Rhinovirus was identified from sinus lavage samples in 5 patients (33%), enterovirus in 3 patients (20%), and respiratory syncytial virus in 1 patient (7%). Pathogenic bacteria were found in maxillary sinuses of all patients who tested positive for rhinovirus and enterovirus. No fungi were found. During the follow-up period, 6 patients reported mucopurulent drainage. Bacteria and viruses were commonly found in maxillary sinuses of patients with primary hypogammaglobulinemia. Yearly evaluation by an ear, nose, and throat surgeon is recommended.
Hirshoren, Nir; Turner, Yehonatan N; Sosna, Jacob; Hirschenbein, Aviv
Maxillary sinus air-fluid levels and sinus opacification may appear similar in cases of acute and chronic rhinosinusitis. Our aim was to evaluate whether air density analysis in addition to air-fluid level can be used as a metric to differentiate between cases of acute and chronic rhinosinusitis. A prospective study of three patient groups (n = 73) who underwent sinus CT was performed. A study group composed of 23 patients with clinical acute rhinosinusitis was compared with two different control groups (one with chronic rhinosinusitis and the other with healthy sinuses) with 25 patients in each. In each case air density within the maxillary sinus was measured using a region of interest of 1 cm(2), 0.5 cm away from the sinus wall. The mean and SD of air density of each maxillary sinus were calculated from five sequential CT slices. We compared the results of each group using a paired Student t test and analysis of variance. Mean air density was significantly higher in the acutely inflamed sinuses compared with chronic sinusitis and healthy aerated sinuses (-846.6 vs -980 and -975.8 HU, respectively; p < 0.05). Sinus air density SD was greater in the acutely inflamed sinus than in chronic sinusitis and healthy sinuses (78.3 vs 17.9 and 6.8 HU, respectively; p < 0.05). Increased sinus air density and heterogeneity may help differentiate acute from chronic rhinosinusitis.
Sugiura, Tsutomu; Yamamoto, Kazuhiko; Nakashima, Chie; Murakami, Kazuhiro; Matsusue, Yumiko; Horita, Satoshi; Sakagami, Go; Kirita, Tadaaki
We report a case of chronic maxillary sinusitis caused by denture lining material entering through an oroantral fistula after tooth extraction. The patient was an 80-year-old female who visited us with a complaint of pus discharge from the right posterior maxilla. She had extraction of the upper right second molar and had her upper denture relined with silicone lining material. The patient noticed swelling of the right cheek and purulent rhinorrhea 20 days before her first visit to our clinic. Oral examination showed an oroantral fistula with a diameter of 3 mm in the posterior alveolar ridge of the right maxilla. Computed tomography revealed a hyperdense foreign body in the right maxillary sinus and thickening of the mucosal lining. Under diagnosis of maxillary sinusitis caused by a foreign body, endoscopic maxillary surgery was performed simultaneously with the removal of the foreign body. The foreign body removed was 12 × 6 mm in size, oval in shape, light pink in color, and compatible with silicone denture lining material. During the follow-up it was observed that the oroantral fistula closed spontaneously after the removal of the foreign body. The maxillary sinus was in a good shape without recurrence of sinusitis seven months after surgery. PMID:27386012
Sugiura, Tsutomu; Yamamoto, Kazuhiko; Nakashima, Chie; Murakami, Kazuhiro; Matsusue, Yumiko; Horita, Satoshi; Sakagami, Go; Kirita, Tadaaki
We report a case of chronic maxillary sinusitis caused by denture lining material entering through an oroantral fistula after tooth extraction. The patient was an 80-year-old female who visited us with a complaint of pus discharge from the right posterior maxilla. She had extraction of the upper right second molar and had her upper denture relined with silicone lining material. The patient noticed swelling of the right cheek and purulent rhinorrhea 20 days before her first visit to our clinic. Oral examination showed an oroantral fistula with a diameter of 3 mm in the posterior alveolar ridge of the right maxilla. Computed tomography revealed a hyperdense foreign body in the right maxillary sinus and thickening of the mucosal lining. Under diagnosis of maxillary sinusitis caused by a foreign body, endoscopic maxillary surgery was performed simultaneously with the removal of the foreign body. The foreign body removed was 12 × 6 mm in size, oval in shape, light pink in color, and compatible with silicone denture lining material. During the follow-up it was observed that the oroantral fistula closed spontaneously after the removal of the foreign body. The maxillary sinus was in a good shape without recurrence of sinusitis seven months after surgery.
Waizel-Haiat, Salomón; Solano-Mendoza, María del Carmen; Vargas-Aguayo, Alejandro Martin
Maxillary sinus surgery has been evolving and, due to advances in technology, endoscopic surgery is widely used in the maxillary sinus for multiple pathologies that 15 years ago were treated through open approaches. For this reason, we conducted an observational descriptive study. We reviewed the clinical records of patients with pathology involving the maxillary sinus and who were surgically treated from January 2008 to December 2009, type of disease, surgical approach used, presence of complications, pre- and postoperative score according to the Lund-Mackay scale, and resolution (or not) of symptoms. We compared these results with a previous study carried out in 1994 in our hospital. We found a total of 177 patients with maxillary sinus-related pathology, of whom 46 patients were excluded. In 131 patients we found a clear predominance of chronic rhinosinusitis without polyps as a pre-surgical diagnosis. We used four different approaches: endoscopic (88.5%), combined approach (5.5%), sublabial expanded (4.5%) and Caldwell Luc (1.5%); 41% of the patients received 0 points on the postoperative Lund-Mackay scale. Surgery of the maxillary sinus in our hospital has evolved considerably; the endoscopic approach was used as a surgical treatment in >90% of patients with a low percentage of complications.
Dargaud, J; Cotton, F; Buttin, R; Morin, A
The maxillary sinus, or Highmore's antrum, is located in the maxillary bone. The maxillary, above the buccal cavity, below the orbital cavity and outside the nasal fossa, is going to take a part in the formation of the three cavities which surround it. Although voluminous, it is consists of a light bone. This distinctive feature is essentially due to the fact that the maxillary has a cavity. The maxillary sinus occupies the upper 2/3s of this maxillary bone. It is the largest of the facial structure's cavities. Its volume is very variable, depending on the individual, the condition of their edentulousness and their age. We find small, average or large sinuses. This sinus communicates with the corresponding nasal fossa by a canal. It opens at the level of the nasofrontalis duct by a meatic ostium, an ostium located at the top of the meatus nasi medius, i.e. under the floor of the sinus. This highly positioned drainage location easily explains the problems that sinus pathologies can come up against. The sinus is lined with a mucous membrane and we can point out that in the normal condition this mucous membrane adheres weakly to the bone. It is more or less thick as a function of the pathologies to which the sinus has been subjected, or even as a function of the geographical location where the individual lives. The imaging of this sinus as a function of age is not obvious due to the fact that it is invisible throughout embryonic and foetal development, and that it only becomes visible to X-rays relatively late, at about 6 years old. Its role is important at the level of the growth of the facial structure because it is always easier to have growth around cavities. It also has a mechanical role concerning the transmission of shockwaves during traumas. In old individuals, due to the condition of the edentulousness, the volume of the sinus is larger; in fact one can note the resorption of the alveolar bone. The maxillary sinus is a cavity which plays a very important role
Dental infections and maxillary sinusitis are the main causes of osteomyelitis. Osteomyelitis can occur in all age groups, and is more frequently found in the lower jaw than in the upper jaw. Systemic conditions that can alter the patient's resistance to infection including diabetes mellitus, anemia, and autoimmune disorders are predisposing factors for osteomyelitis. We report a case of uncommon broad maxillary osteonecrosis precipitated by uncontrolled type 2 diabetes mellitus and chronic maxillary sinusitis in a female patient in her seventies with no history of bisphosphonate or radiation treatment. PMID:26734561
Mahdavi, Omid; Boostani, Najmehalsadat; Karimi, Sharareh; Tabesh, Adel
Sinonasal undifferentiated carcinoma is an extremely rare malignancy of the paranasal sinuses and nasal cavity. It is of unknown etiology, and occurs more commonly in the elderly men, with a routinely shown aggressive behavior and poor prognosis for survival. Radiographically, it looks like severe osteomyelitis. Histopathologic study is essential to confirm diagnosis, and the undifferentiated histologic appearance often necessitates immunohistochemical studies for differentiation from other high-grade neoplasms. We present an 83-year-old man complaining of pain and unilateral swelling on the left side of the face due to a rare malignant tumor of maxillary sinus origin, a sinonasal undifferentiated carcinoma. He underwent hemimaxillectomy and radiotherapy, but refused chemotherapy. Maxillary sinus malignancy may be presented with unspecific symptoms mimicking sinusitis or dental pain. Coming across such symptoms, the physician or dentist must consider malignancies as well, and carry out medical and dental workups. PMID:24910668
Parra, Marcelo; Olate, Sergio; Cantín, Mario
Maxillary sinus lift for dental implant installation is a well-known and versatile technique; new techniques are presented based on the physiology of intrasinus bone repair. The aim of this review was to determine the status of graftless maxillary sinus lift and analyze its foundations and results. A search was conducted of the literature between 1995 and 2015 in the Medline, ScienceDirect, and SciELO databases using the keywords "maxillary sinus lift," "blood clot," "graftless maxillary sinus augmentation," and "dental implant placement." Ten articles were selected for our analysis of this technique and its results. Despite the limited information, cases that were followed for at least six months and up to four years had a 90% success rate. Published techniques included a lateral window, elevation of the sinus membrane, drilling and dental implant installation, descent of the membrane with variations in the installation of the lateral wall access and suturing. The physiology behind this new bone formation response and the results of the present research were also discussed. We concluded that this is a promising and viable technique under certain inclusion criteria.
Maxillary sinus lift for dental implant installation is a well-known and versatile technique; new techniques are presented based on the physiology of intrasinus bone repair. The aim of this review was to determine the status of graftless maxillary sinus lift and analyze its foundations and results. A search was conducted of the literature between 1995 and 2015 in the Medline, ScienceDirect, and SciELO databases using the keywords “maxillary sinus lift,” “blood clot,” “graftless maxillary sinus augmentation,” and “dental implant placement.” Ten articles were selected for our analysis of this technique and its results. Despite the limited information, cases that were followed for at least six months and up to four years had a 90% success rate. Published techniques included a lateral window, elevation of the sinus membrane, drilling and dental implant installation, descent of the membrane with variations in the installation of the lateral wall access and suturing. The physiology behind this new bone formation response and the results of the present research were also discussed. We concluded that this is a promising and viable technique under certain inclusion criteria. PMID:28875135
Mardinger, Ofer; Moses, Ofer; Chaushu, Gavriel; Manor, Yifat; Tulchinsky, Ze'ev; Nissan, Joseph
This study was a retrospective assessment of reentry sinus augmentation compared with sinus augmentation performed for the first time. There were 38 subjects who required sinus augmentation. The study group (17 patients, 21 sinuses) included subjects following failure of a previous sinus augmentation procedure that required reentry augmentation. The control group (21 patients, 21 sinuses) included subjects in which sinus augmentation was performed for the first time. Patients' medical files were reviewed. A preformed questionnaire was used to collect data regarding demographic parameters, medical and dental health history, habits, and intra- and postoperative data. Operative challenges in the study group included adhesions of the buccal flap to the Schneiderian membrane (62%, 13/21, P<.001), bony fenestration of the lateral wall with adhesions (71%, 15/21, P<.001), limited mobility of a clinical fibrotic Schneiderian membrane (71%, 15/21, P<.001), and increased incidence of membrane perforations (47%, 10/21, versus 9.5%, 2/21, P=.03). In the control group the Schneiderian membrane was thin and flexible. Sinus augmentation succeeded in all cases of both groups. Implant failure was significantly higher in the study group (11% versus 0%, P<.001). Clinical success of reentry sinus augmentation is predictable despite its complexity. Clinicians should be aware of anatomical changes caused by previous failure of this procedure. Patients should be informed about the lower success rate of implants when reentry sinus augmentation is required. Copyright (c) 2010 Mosby, Inc. All rights reserved.
Nuñez-Castruita, Alfredo; López-Serna, Norberto; Guzmán-López, Santos
To review the prenatal development of the maxillary sinus under the perspective of the sinus surgery. Cross-sectional study. Basic embryology laboratory. Morphometry and morphology of the maxillary sinus and its ostium were studied under stereomicroscopy in 100 human fetuses from the 9th to the 37th week. Fetuses were obtained from the Fetal Collection of the School of Medicine of the Universidad Autónoma de Nuevo León. Approval was granted by the Ethics Committee. Statistics were applied. The maxillary sinus begins its development at the 10th week. On the 37th week, the anterior-posterior diameter has a mean of 4.36 mm; ossification of the medial wall was absent, and the floor was located below the attachment of the inferior turbinate. Septa and recesses were temporarily observed. Some variations in shape were observed; however, only the oval shape persisted. Maxillary sinus hypoplasia was not found, although asymmetry was present in 30% of cases. The ostium was located at the anterior third of the ethmoid infundibulum; its final dimensions were 1.96 mm in length and 0.44 mm in width. The mean length between the ostium to the lamina papyracea and nasolacrimal duct was 1 mm. One case of double maxillary sinus was observed. Significant difference between the variables, in accordance with the age, was found (P = .02). Knowledge of prenatal development of the maxillary sinus improves the perspective of the sinus surgeon and helps the understanding of postnatal anatomy, especially in children.
Sánchez-Recio, Cristina; Peñarrocha-Diago, Maria; Peñarrocha-Diago, Miguel; Peñarrocha-Oltra, David
The aim of the present study was to evaluate the sinus membrane perforations that occurred during a sinus lift procedure using the ultrasound technique, and to evaluate the bone gain obtained. In 21 patients, 26 sinus lifts were performed using ultrasound and filled with bone graft material. The bone height and the bone gain obtained were observed in postoperative orthopantomographs, correcting for previous distortion. Of the 26 maxillary sinus lifts, 4 Schneiderian membrane perforations were observed. The average bone height prior to the intervention was 3.5 mm (scale 0.6- 8.7 mm ) and the average postsurgical bone height was 10.8 mm (scale 7.5- 15.6 mm). An average bone gain of 7.2 mm was observed (range 2.5- 11.7 mm). Based on the results of this study, during ultrasound sinus lift, few Schneiderian membrane perforations occurred and all were small .
Zhou, Lei; Xu, Shu-Lan; Xu, Shi-Tong; Huang, Jian-Sheng; Song, Guang-Bao; Zhang, Xue-Yang
To introduce and evaluate the procedure and the effect of maxillary sinus lift with closed technique by Summers osteotome, bone grafting and simultaneous implant placement. 66 cases with severely resorbed alveolar bone in maxillary posterior region received sinus lift with Summers osteotome, simultaneously bone grafting and implants placement. The final restoration was finished at 6 months postoperatively. The operation procedure were eventless in the 66 cases, the sinus floor were elevated by 2-5 mm, three-dimensional reconstruction of the CT scan pictures showed the smooth dome profile of the lifting sites and no signs of laceration on the membrane, and there were no maxillary antritis after operation. After 6 months, no significantly bone graft resorption and good osseointegration were noticed in X-ray imaging. The final restoration was finished at this time. 12-24 months after the restoration, all implants inserted were remain, the hard and soft tissue were healthy, prosthesis were stable and functioned. X-ray showed good osseointegration in the lifting sites, the vertical resorption around the implants were less than 1 mm. With properly use of Summers osteotome, scraps of the bone in the implant sockets can be pushed into the sinus, these autogenous bone scraps were in favor of the osseogenesis and the sinus floor can be easily elevated by the method with very infrequent complications. It enlarged indication of dental implants and avoided operation of harvesting autogenous bone in other site. The method is simple and valuable to clinical application.
Amorim, Klinger de Souza; da Silva, Vanessa Tavares; da Cunha, Rafael Soares; Souto, Maria Luisa Silveira; São Mateus, Carla Rocha; Souza, Liane Maciel de Almeida
The maxillary sinus or antrum is the largest of the paranasal sinuses. It is located in the maxillary bone and has a proximity to the apexes of upper molars and premolars, which allows it to form a direct link between the sinus and the oral cavity. Dislocation of a foreign body or tooth to the interior of a paranasal sinus is a situation that can occur as a result of car accidents, firearm attacks, or iatrogenic in surgical procedures. Therefore, it is necessary to know how to treat this kind of situation. This study's objective is to report the case of a 23-year-old female patient, leucoderma, who sought treatment from the Surgical Unit at the Dental Faculty of the Federal University of Sergipe. She had a history of pain and edema in the right side of the genian region and two failed attempts at removing dental unit (DU) 18. The extraoral clinical exam revealed intense edema of the left hemiface with signs of infection, excoriation of the labial commissure, hematoma, a body temperature of 39°C, and a limited ability to open her mouth. The patient was medicated and treated surgically. The tooth was removed from the maxillary sinus with caution, as should have been done initially. PMID:25705524
Yoon, Wook-Jae; Jeong, Kyung-In; You, Jae-Seek; Oh, Ji-Su; Kim, Su-Gwan
The aim of this study was to retrospectively evaluate the clinical survival rate of Astra Tech implants in the maxillary molar region performed with sinus lift and bone graft. Ninety-nine Astra Tech implants (Osseospeed) placed in the maxillary molar region using sinus lift from September 2009 to February 2012 were selected with a minimum follow-up period of 1 year. The height of alveolar bone, sinus approach technique, bone material and implant survival rate were evaluated. Of the 99 implants, the survival rate was 90.9%; 8 implants failed within 1 year after implant placement, and 1 implant failed 1 year after implant loading. All failed implants were placed with sinus lift simultaneously. The average height of alveolar bone before implant placement was 6.9 mm, while the height of alveolar bone of failed implants was 2.1 mm, on average. Astra Tech implants placed in the maxillary molar region had generally good survival rates, but the relationship between reduced pre-implant alveolar bone height and implant failure requires further attention.
Garcia Hejl, C; Sanmartin, N; Samson, T; Soler, C; Koeck, J-L
Aerobic, spore-forming gram-positive Bacillus spp infections are rare and reported mainly in immunocompromised hosts. We report a case of acute unilateral maxillary sinusitis, caused by Bacillus licheniformis, in a 35-year-old French soldier stationed in Djibouti. It was easily identifiable due to its typical culture and resistance profile. This case is interesting for two reasons: first, it is, to our knowledge, the first case of sinusitis attributed to this microbe, and second, it has rarely been described in immunocompetent patients without altered skin or mucous membranes.
Kirihene, Ravi K D R A; Rees, Guy; Wormald, Peter-John
Nitric oxide (NO) is produced in significant quantities in the nasal sinuses and is thought to have a beneficial effect on the mucociliary transport of the sinuses and nose and to have significant antibacterial properties that contribute to the health of the sinuses. Recently, the concept of "mini-functional endoscopic sinus surgery" has been introduced where the uncinate is removed without enlargement of the maxillary ostium. Although no scientific evidence has been published, enlargement of the ostium is thought to possibly disrupt the mucociliary pathway and decrease the concentration of NO in the nose and sinuses. The aim of this study was to establish the effect of enlargement of the maxillary ostium on sinus and nasal NO. Twenty-nine patients who were post-endoscopic sinus surgery were included with 52 who were maxillary sinus ostia cannulated. There were 22 large maxillary sinus ostia and 30 small ostia. Smoking, allergy status, and topical steroid use were recorded. NO levels were measured in the nose and maxillary sinus after decongestion with patients mouth breathing and breath holding. This study shows that enlargement of the maxillary sinus ostium above its normal size (20 mm2) produces a significant decrease in both the maxillary sinus and the nasal cavity NO levels. In addition, the size of the ostium showed a significant correlation to the sinus NO level. Use of topical nasal steroid sprays and topical decongestants were shown to effect NO levels in the sinuses and nasal cavity. The lowered levels of NO were found irrespective of the technique of measurement of the NO. The effect of this lowered NO level on the susceptibility of the maxillary sinuses to recurrent infection is yet to be determined.
Kim, Ha-Rang; Choi, Byung-Ho; Xuan, Feng; Jeong, Seung-Mi
There have been reports of successful bone formation with sinus floor elevation induced by simply elevating the maxillary sinus membrane and filling the sinus cavity with a blood clot. We investigated the feasibility of maxillary sinus floor augmentation using the patient's own venous blood in conjunction with a sinus membrane elevation procedure. An implant that protruded 8 mm into the maxillary sinus after sinus membrane elevation was placed in the maxillary sinus of six adult female mongrel dogs. The resulting space between the membrane and the sinus floor was filled with autologous venous blood retrieved from each dog. The implants were left in place for 6 months. During the experimental period, the created space collapsed and the sinus membrane fell down onto the implant. A small amount of new bone formation occurred in the space created by the collapsed membrane. The average height of newly formed bone around the implants in the sinus was 2.7+/-0.7 mm on the buccal side and 0.6+/-0.3 mm on the palatal side. The results of this pilot study indicate that blood clots do not have sufficient integrity to enable the sinus membrane to remain in an elevated position for therapeutically effective periods of time. Accordingly, it is recommended that this method be used only when a small amount of new bone formation is necessary around implants in the maxillary sinus cavity.
Kim, Kyung Yeon; Bae, Jung Ho; Park, Jee Soo; Lee, Seung-Sin
Extrapulmonary tuberculosis is not rare and occurs mainly in the head and neck region. Cervical tuberculous lymphadenopathy is the most common form of extrapulmonary tuberculosis. Sinonasal tuberculosis is known to occur very rarely due to the protective functions of sinonasal mucosa. Although some signs of sinonasal tuberculosis may be present, such as associated facial abscesses, the symptoms and signs are usually nonspecific. Clinical suspicion is important for timely diagnosis and proper management of sinonasal tuberculosis due to its rarity and nonspecific clinical presentation. We report a case of tuberculosis confined to the unilateral maxillary sinus that was first misdiagnosed as recurrent rhinosinusitis after endoscopic sinus surgery.
Dwyhalo, Kristina M; Donald, Carrlene; Mendez, Anthony; Hoxworth, Joseph
Acute invasive fungal sinusitis is the most aggressive form of fungal sinusitis and can be fatal, especially in patients who are immunosuppressed. Early diagnosis and intervention are crucial and potentially lifesaving, so primary care providers must maintain a high index of suspicion for this disease. Patients may need to be admitted to the hospital for IV antifungal therapy and surgical debridement.
Agacayak, Kamil Serkan; Gulsun, Belgin; Koparal, Mahmut; Atalay, Yusuf; Aksoy, Orhan; Adiguzel, Ozkan
Background Oral breathing causes many changes in the facial anatomical structures in adult patients. In this study we aimed to determine the effects of long-term oral breathing (>5 years) on the maxillary sinus volumes among adult male patients. Material/Methods We accessed medical records of 586 patients who had undergone cone beam computed tomography (CBCT) for any reason between September 2013 and April 2014. Patients who had undergone cone-beam dental volumetric tomography scans for any reason and who had answered a questionnaire about breathing were screened retrospectively. Cone beam dental volumetric tomography (I-Cat, Imaging Sciences International, Hatfield, PA, USA) was used to take the images of the maxillo-facial area at a setting of 120 kVp and 3.7 mA. This study involved male patients older than 21 years of age. Results The study included a total of 239 male patients, of which 68 were oral breathers and 171 were nasal breathers. The mean age of the oral breathers was 48.4 years and that of the nasal breathers was 46.7 years and the difference was not statistically significant (p>0.05). The mean maxillary sinus volumes of the oral and nasal breathers were 9043.49±1987.90 and 10851.77±2769.37, respectively, and the difference in maxillary sinus volume between the 2 groups was statistically significant (p<0.001). Conclusions The volume of maxillary sinus in oral breathers (>5 years) was significantly lower than in nasal breathers, but it remains unclear whether this is due to malfunctioning of the nasal cavity or due to the underlying pathological condition. PMID:25553770
Koo, Soo Kweon; Kwon, Soon Bok; Chon, Kyong Myong; Kim, Yang Jae; Kim, Young Joong
The objective of the study was to determine the effect of the maxillary sinus on the voice. The prospective study was conducted at an academic secondary referral center. A prospective chart review of 43 patients (17 males, 26 females) who conducted a voice recording and survey before and 3 months after middle meatal antrostomy whose lesion was confined to the maxillary sinus. Subjective voice changes were surveyed using a questionnaire. After phonation [∧m ma: the Korean pronunciation of 'mother'], [Nu Na: the Korean pronunciation of 'sister'], we analyzed the nasal consonant [m] of [∧m ma] and nasalized vowel [a] of [∧m ma] and [a] of [Nu Na]. In the poll conducted, the change rates for males and females were 41.1 % (7/17) and 15.4 % (4/26), respectively; of the male patients, 85.7 % (6/7) felt that the sound quality was better and 14.3 % (1/6) that it was worse. However, all the female patients felt it was better. Among of the patients with an improved voice, reduced nasal sound was the most frequent observation. In an objective analysis, a tendency to lowered frequencies was observed for nasalized vowels after surgery. Significant differences were observed at second formant frequencies of [a] of [∧m ma] and first formant frequencies of [a] of [Nu Na] in female subjects (P < 0.005). Our findings indicated that the maxillary sinus plays a role in the modification of voice quality. Preoperative counseling is important for patients concerning expected changes in the voice after maxillary sinus surgery.
Sigler, Lynne; Bartley, James R.; Parr, Dinah H.; Morris, Arthur J.
We present a case of maxillary sinusitis in a diabetic female caused by the basidiomycete fungus Schizophyllum commune. Identification of the isolate was hampered by its atypical features. Subcultures formed sterile medusoid structures from nonclamped mycelia until spontaneous dikaryotization resulted in the development of characteristic fan-shaped fruiting bodies. Identification was confirmed by the presence of spicules formed on the hyphae and by vegetative compatibility with known isolates. PMID:10488217
Kato, Hideharu; Nomura, Jouji; Matsumura, Yoshihiro; Tagawa, Toshiro
We report a rare case of desmoplastic ameloblastoma lesion that filled the entire maxillary sinus. The patient visited our hospital with a chief complaint of swelling around the upper left premolars. A panoramic X-ray captured an image of a mixture of ill-defined radiolucency and radiopacity from the swollen area to the maxillary sinus. Computed tomography (CT) and Magnetic resononce imaging (MRI) showed that the lesion occupied almost the entire left maxillary sinus and had entered the nasal cavity. A pathologic diagnosis of ameloblastoma was made after biopsy, and the tumor was removed and the marginal bone curetted under general anesthesia. A CT scan at 4 months postoperatively indicated the presence of residual and recurrent tumor in the area of the upper left lateral incisor, and removal and curettage were performed again. Recurrence may be detected relatively easily based on radiographic characteristics, and therefore follow-up with an X-ray examination such as a CT scan is important. PMID:22090771
Perella, Andréia; Rocha, Sara Dos Santos; Cavalcanti, Marcelo de Gusmão Paraiso
The aim of this study was to evaluate the precision and accuracy of linear measurements of maxillary sinus made in tomographic films, by comparing with 3D reconstructed images. Linear measurements of both maxillary sinus in computed tomography CT of 17 patients, with or without lesion by two calibrated examiners independently, on two occasions, with a single manual caliper. A third examiner has done the same measurements electronically in 3D-CT reconstruction. The statistical analysis was performed using ANOVA (analyses of variance). Intra-observer percentage error was little in both cases, with and without lesion; it ranged from 1.14% to 1.82%. The inter-observer error was a little higher reaching a 2.08% value. The accuracy presented a higher value. The perceptual accuracy error was higher in samples, which had lesion compared to that which had not. CT had provided adequate precision and accuracy for maxillary sinus analyses. The precision in cases with lesion was considered inferior when compared to that without lesion, but it can't affect the method efficacy.
Angiero, Francesca; Borloni, Roberto; Macchi, Maurizia; Stefani, Michele
Ameloblastic carcinoma is a very rare malignant odontogenic neoplasm of the mandible and maxilla, accounting for some 66 reported cases. The case of a 68-year-old man who presented a fistula with orosinus communication of 14-year duration that, after anti-aggregant therapy, began bleeding is reported. The initial microscopic evaluation of the biopsy and radiographic findings were consistent with benign peripheral ameloblastoma without cellular atypia and extensive fields of acantomatous pattern, but immunohistochemical investigation found strong positivity for Bcl-2, cytokeratins CAM 5 and 6, and for Ki-67/MIB-1, changing our diagnosis. The treatment consisted of left maxillary resection followed by reconstruction. Cellular features of malignancy in the surgical specimen confirmed the diagnosis of ameloblastic carcinoma. This case of an aggressive ameloblastic carcinoma of the maxillary gingiva that presented with an unusual histological pattern illustrates that these tumors can create a diagnostic challenge that may require extensive surgical sampling and/or removal to establish the diagnosis. Immunohistochemically analyzed expression of bcl-2 protein, cytokeratins CAM 5 and 6, and Ki-67/MIB-1 antigen serve to characterize the cyto-differentiation and cellular activity of ameloblastic carcinoma.
Lanzer, Martin; Pejicic, Rada; Kruse, Astrid L; Schneider, Thomas; Grätz, Klaus W; Lübbers, Heinz-Theo
The removal of wisdom teeth is one of the most common interventions in oral surgery. In order to avoid complications, a profound knowledge of the anatomy of teeth and adjacent tissues is crucial. In the case of maxillary wisdom teeth, their relationship to the maxillary sinus, to the pterygoid fossa, to the maxillary tuber and the adjacent venous plexus is particularly important. Three-dimensional (3D) imaging, for example by means of cone beam computed tomography (CBCT), is increasingly utilized in practice. However, the necessity of CBCT imaging is still a matter of intensive debate. The aim of this study was to describe the anatomic (positional) variation of maxillary wisdom teeth and, based on these findings, to elucidate the additional benefit of such imaging. A retrospective case study was performed using patients examined by means of CBCT imaging in the Department of Dento-Maxillofacial Radiology during the period from 2008 to 2013. Primary study variables comprised the spatial relationship of the teeth to the maxillary sinus, the degree of retention and root development, the covering of the root with bone and mucosa, the root configuration, and the developmental stage of the tooth. In addition, the association of the inclination of teeth in the transversal and sagittal plane with the above variables was evaluated. Descriptive statistical parameters were calculated for all results of the examination. In total, CBCT recordings of 713 maxillary wisdom teeth from 430 patients were evaluated. Their mean age was 29.8 years, and the proportion of male patients slightly prevailed (54.4%). Most teeth exhibited fully developed roots (64.1%). Overall 22.9% of third molars were impacted, 32.3% were retained, and 6.5% were erupting. In more than a third of the patients, wisdom teeth were in occlusion. The inclination of the third molars both in the transversal and sagittal plane was significantly associated with the distance of the root from the maxillary sinus as well
Möhlhenrich, Stephan Christian; Heussen, Nicole; Peters, Florian; Steiner, Timm; Hölzle, Frank; Modabber, Ali
The morphometric analysis of maxillary sinus was recently presented as a helpful instrument for sex determination. The aim of the present study was to examine the volume and surface of the fully dentate, partial, and complete edentulous maxillary sinus depending on the sex. Computed tomography data from 276 patients were imported in DICOM format via special virtual planning software, and surfaces (mm) and volumes (mm) of maxillary sinuses were measured. In sex-specific comparisons (women vs men), statistically significant differences for the mean maxillary sinus volume and surface were found between fully dentate (volume, 13,267.77 mm vs 16,623.17 mm, P < 0.0001; surface, 3480.05 mm vs 4100.83 mm, P < 0.0001) and partially edentulous (volume, 10,577.35 mm vs 14,608.10 mm, P = 0.0002; surface, 2980.11 mm vs 3797.42 mm, P < 0.0001) or complete edentulous sinuses (volume, 11,200.99 mm vs 15,382.29 mm, P < 0.0001; surface, 3118.32 mm vs 3877.25 mm, P < 0.0001). For males, the statistically different mean values were calculated between fully dentate and partially edentulous (volume, P = 0.0022; surface, P = 0.0048) maxillary sinuses. Between the sexes, no differences were only measured for female and male partially dentate fully edentulous sinuses (2 teeth missing) and between partially edentulous sinuses in women and men (1 teeth vs 2 teeth missing). With a corresponding software program, it is possible to analyze the maxillary sinus precisely. The dentition influences the volume and surface of the pneumatic maxillary sinus. Therefore, sex determination is possible by analysis of the maxillary sinus event through the increase in pneumatization.
Purpose. Radiography is important in forensic odontology for the identification of humans. The maxillary sinus is the largest of the paranasal sinuses and first to develop. Sinus radiography has been used for identification of skeletal remains and determination of gender. Hence, the aim and objectives of the present study were to establish a new method for gender determination using maxillary sinus index from lateral cephalometric radiographs and to establish the reliability of maxillary sinus for gender determination. Methods. A total of 50 adult digital lateral cephalometric radiographs (25 males and 25 females) were included in the study. The maxillary sinus analysis was performed on these radiographs using the height and width measurement tools of Sidexis XG software. Maxillary sinus index was calculated, discriminant function analysis performed, and discriminant equation derived for determination of gender. Results. The mean maxillary sinus height and width were found to be higher in males, whereas the maxillary sinus index was greater in females. The discriminant function analysis derived in the study was able to differentiate the sex groups with sensitivity of 68% and specificity of 76%. Conclusions. From the results of the present study, it may be concluded that morphometric analysis of maxillary sinus can be used as a reliable tool in gender determination. PMID:28373883
Khaitan, Tanya; Kabiraj, Arpita; Ginjupally, Uday; Jain, Ritika
Purpose. Radiography is important in forensic odontology for the identification of humans. The maxillary sinus is the largest of the paranasal sinuses and first to develop. Sinus radiography has been used for identification of skeletal remains and determination of gender. Hence, the aim and objectives of the present study were to establish a new method for gender determination using maxillary sinus index from lateral cephalometric radiographs and to establish the reliability of maxillary sinus for gender determination. Methods. A total of 50 adult digital lateral cephalometric radiographs (25 males and 25 females) were included in the study. The maxillary sinus analysis was performed on these radiographs using the height and width measurement tools of Sidexis XG software. Maxillary sinus index was calculated, discriminant function analysis performed, and discriminant equation derived for determination of gender. Results. The mean maxillary sinus height and width were found to be higher in males, whereas the maxillary sinus index was greater in females. The discriminant function analysis derived in the study was able to differentiate the sex groups with sensitivity of 68% and specificity of 76%. Conclusions. From the results of the present study, it may be concluded that morphometric analysis of maxillary sinus can be used as a reliable tool in gender determination.
Hegde, Rakshith; Prasad, Krishna; Shroff, Kaiwan Khurshed
Implants have a predictable outcome and are the foremost treatment modality for prosthetic rehabilitation of edentulous patients. Due to loss of bone after extraction and pneumatization of maxillary sinus, there is insufficient bone volume for implant placement. The direct maxillary sinus lift procedure has been performed with different grafting materials (autogenous bone grafts, alloplasts, allografts, and xenografts) and without grafting material, having new bone formation around the implant. There is no evidence to prove the need for grafting material in all direct sinus lift procedures, hence the need for this review. Previous meta-analysis showed that survival rates of implants placed in grafted maxillary sinuses had similar survival rates whether autogenous, allogenous, or alloplastic grafts were used. This paper aims to review scientific data on the direct sinus elevation technique without use of any grafting material, volume of new bone formed, and also mechanism behind this technique. Articles were searched from 1997 to October 2014 in PubMed, Google Scholar, and Cochrane CENTRAL. The study eligibility criteria were (1) direct sinus lift procedure without any graft material during implant placement and (2) human or animal studies with a minimum follow-up of 6 months or more. Two authors independently scrutinized the literature and if any controversy was raised, third author's opinion was sought to arrive at a mutual consensus for including the study in the review. Due to the heterogeneity across all studies in all study designs, the data were not pooled and a meta-analysis was not performed. Taking into consideration all factors reviewed in this regard along with the outcomes, the direct sinus lift technique without grafting can be suggested as a viable treatment option keeping in mind the limitations involved. The average bone gain was seen across all studies ranging from 2.37 to 10 mm and with an implant survival rate ranging from 79.9% to 100% across
Pigache, Pénélope; Anavekar, Namrata; Raoul, Gwénaël; Ferri, Joël
Although sinus lift procedures are reliable, some complications can lead to serious maxillary sequelae, including the development of oro-antral fistula (OAF). Maxillary reconstruction in such patients presents a challenge owing to sinus floor alterations, graft remnants, chronic infection, and morbidity from the original sinus lift approach. The current study describes our technique of maxillary reconstruction using a Le Fort 1 approach following major sinus lift complications with associated residual OAF. This technique provides excellent access for sinus curettage, OAF closure, and osseous reconstruction. It allowed a successful rehabilitation in our patients, with no implant loss and good functional and esthetic results.
Hazan, A; Le Roy, A; Chevalier, E; Benzaken, J; Waisberg, A; Cymbalista, M; Adotti, F; Peytral, C
We analyzed atelectasic processes occurring in the maxillary sinus. Several publications in the literature have tempted to analyze the pathogenesis. Clinically the processes are often silent and only revealed when the major opthalmological complication, enophthalmia, becomes patent. In other cases there is a long history of chronic sinusitis. There is a spectacular retraction of the maxillary sinus walls leading to collapse of the orbital floor and enophthalmia. We report four cases of maxillary sinusitis with atelectasia of the sinus walls at different stages of progression. These observations and data in the literature emphasize the importance, whatever the state of development, of endoscopic osteal decompression to avoid ophthalmological complications.
Zheng, JiSi; Zhang, ShanYong; Lu, ErYi; Yang, Chi; Zhang, WenJie; Zhao, JingYang
The aim of this study was to introduce a modified endoscopic lift of the floor of the maxillary sinus in Beagles. Twelve operations (bilateral and randomly chosen) were done in 6 Beagles each in the test group (modified endoscopic operation), and the control group, in which the operation was done with an osteotome. All operations were evaluated by two indices of safety (perforation of the sinus membrane and nasal bleeding) and 3 effective indices (the intraoperative height after lifting, volume of bone grafts, and dislocation of the sinus grafts). The sinus membrane was not perforated and there were no nasal bleeds in either group. The intraoperative height after lifting was 13.7 (0.8) mm in the test group and 9.1 (0.5) mm in the control group, so it was significantly higher in the test group than the control group (p=0.0001). Similarly, the volume of bone graft was 0.9 (0.04) ml in the test group and 0.5 (0.02) ml in the control group (p=0.0001). The volume of the anterior and posterior bone grafts in the implant cavity in the test group did not differ significantly (p=0.102), while there were significant differences in the control group (p=0.002). Endoscopic lifting of the floor of the maxillary sinus is a safe and effective approach based on direct observation in Beagles. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
... my acute sinusitis is caused by viruses or bacteria? Acute viral sinusitis is likely if you have ... to tell if my sinusitis is caused by bacteria? Because sinusitis is treated differently based on cause. ...
DeMuri, Gregory; Wald, Ellen R
On the basis of strong research evidence, the pathogenesis of sinusitis involves 3 key factors: sinusostia obstruction, ciliary dysfunction, and thickening of sinus secretions. On the basis of studies of the microbiology of otitis media, H influenzae is playing an increasingly important role in the etiology of sinusitis, exceeding that of S pneumoniae in some areas, and b-lactamase production by H influenzae is increasing in respiratory isolates in the United States. On the basis of some research evidence and consensus,the presentation of acute bacterial sinusitis conforms to 1 of 3 predicable patterns; persistent, severe, and worsening symptoms. On the basis of some research evidence and consensus,the diagnosis of sinusitis should be made by applying strict clinical criteria. This approach will select children with upper respiratory infection symptoms who are most likely to benefit from an antibiotic. On the basis of some research evidence and consensus,imaging is not indicated routinely in the diagnosis of sinusitis. Computed tomography or magnetic resonance imaging provides useful information when complications of sinusitis are suspected. On the basis of some research evidence and consensus,amoxicillin-clavulanate should be considered asa first-line agent for the treatment of sinusitis.
Kucybała, Iwona; Janik, Konrad Adam; Ciuk, Szymon; Storman, Dawid; Urbanik, Andrzej
Summary Background The aim of the study was to assess if the presence of nasal septal deviation and concha bullosa is connected with the development of sinuses and the incidence of inflammation within them. Material/Methods We retrospectively analysed 214 patients who underwent paranasal sinus computed tomography. There were 125 females and 89 males, the mean age being 47.67±16.74 years (range 18–97). Exclusion criteria included: age under 18 years, prior sinonasal surgery and S-shaped septum. Results Mean volume of the right maxillary sinus was 17.794 cm3, while for the left one it was 17.713 cm3. Nasal septal deviation was found in 79.9% of computed tomography examinations and concha bullosa was observed in 42.1% of the patients’ examinations. There was an association between the presence of unilateral or dominant concha bullosa and contralateral direction of septal deviation [right-sided (p=0.039), left-sided (p=0.003)]. There was higher incidence of bilateral maxillary sinusitis in patients with septal deviation (p=0.007). Bilateral concha bullosa did not influence the incidence of bilateral maxillary sinusitis (p=0.495). Neither septal deviation (right sided: p=0.962; left-sided: p=0.731), nor unilateral/dominant concha bullosa (right: p=0.512; left: p=0,430) affected the asymmetry in volumes of maxillary sinuses. Bilateral concha bullosa was connected with larger volume of maxillary sinuses (right sinus: p=0.005; left sinus: p=0.048). Conclusions Nasal septal deviation, contrary to concha bullosa, has influence on the development of maxillary sinusitis. There is a connection between the presence of concha bullosa and direction of septal deviation. Only bilateral concha bullosa affects maxillary sinus volumes. PMID:28348652
Deniz, Y; Zengin, A Z; Karli, R
Foreign bodies in paranasal sinuses are very rare and most of them are encountered in the maxillary sinus. These foreign bodies may be organic or inorganic and can enter the maxillary sinus through an oro-antral fistula. The oro-antral fistula is formed by a break in the bony segment of the maxillary sinus floor and usually arises subsequent to maxillary premolar and molar extractions. A 63-year-old female patient evaluated for a nonhealing, left, toothless palate lesion and chronic headache occurring over 4 years. Radiography and computed tomography revealed bone discontinuity in the left floor of the maxillary sinus and calcifications within the antrum. A blue foreign body, later identified as dental impression material, was removed by intranasal endoscopy. A careful oral examination is recommended prior to prosthetic restorations. In addition, paranasal sinus foreign bodies should be surgically removed to prevent secondary soft tissue reactions.
Hansen, Chase C.; Eisenbach, Colby; Torres, Carlos; Graham, Suzanne
An inflammatory myofibroblastic tumor (IMT) is an immunohistochemically diverse entity demonstrating neoplastic and nonneoplastic qualities. Although IMTs can arise in any area of the body, lesions arising in certain sites, namely, the nasal cavity, paranasal sinuses, and pterygopalatine fossa, demonstrate a heightened neoplastic and invasive potential. Despite case specific complete tumor regression and disease remission in response to pharmacotherapeutics, a subset of IMTs remain resistant to all forms of therapy. We present such a case, a 34-year-old female patient, with a highly resistant, maxillary sinus IMT. Her refractory, ALK-1 negative IMT has not responded well to novel therapies reported in current literature. This case suggests the role of zonal expressivity within a single lesion as a probable mechanism for its highly resistant nature and should promote determination of each IMT's cytogenetic profile to provide more effective targeted therapy. Paper includes a literature review of all maxillary sinus IMTs from 1985 to 2014 along with their immunohistochemical staining, treatments, and outcomes. PMID:25763286
Borie, Eduardo; Watanabe, Plauto C.A.; Orsi, Iara A.; Fuentes, Ramón
INTRODUCTION Exostoses in paranasal sinuses have been reported in the otolaryngology literature, but they have not been described in the dental literature to our knowledge. The aim of this article is to describe an idiopathic and rare case of bilateral exostosis obtained by cone-beam computed tomography. PRESENTATION OF CASE The case shows a healthy and asymptomatic patient with a different size and form of exostoses in both maxillary sinuses. DISCUSSION It is difficult to clinically diagnose the antral exostosis due the asymptomatic nature of this condition, unless the approach would be through endoscope. Sometimes this condition is related with nasal irrigants, however in this case the patient asserted not having used nasal irrigation ever; thus, it is impossible to relate this kind of treatment as a principal cause. CONCLUSION The published data of exostoses in maxillary sinus seem to be limited in the dental literature, and this condition is important to consider in an implant treatment planning. Also, it is important to perform a follow-up of the cases in trying to find the possible causes of exostosis. PMID:25128728
Zhu, Jian Hua; Lee, Heow Pueh; Lim, Kian Meng; Gordon, Bruce R; Wang, De Yun
We evaluated, by CFD simulation, effects of accessory ostium (AO) on maxillary sinus ventilation. A three-dimensional nasal model was constructed from an adult CT scan with two left maxillary AOs (sinus I) and one right AO (sinus II), then compared to an identical control model with all AOs sealed (sinuses III and IV). Transient simulations of quiet inspiration and expiration at 15 L/min, and nasal blow at 48 L/min, were calculated for both models using low-Reynolds-number turbulent analysis. At low flows, ventilation rates in sinuses with AOs (I ≈ 0.46 L/min, II ≈ 0.54 L/min), were both more than a magnitude higher than sinuses without AOs (II I ≈ 0.019 L/min, IV ≈ 0.020 L/min). Absence of AO almost completely prevented sinus ventilation. Increased ventilation of sinuses with AOs is complex. Under high flow conditions mimicking nose blowing, in sinuses II, III, and IV, the sinus flow rate increased. In contrast, the airflow direction through sinus I reversed between inspiration and expiration, while it remained almost constant throughout the respiration cycle in sinus II. CFD simulation demonstrated that AOs markedly increase maxillary sinus airflow rates and alter sinus air circulation patterns. Whether these airflow changes impact maxillary sinus physiology or pathophysiology is unknown. Copyright © 2012 Elsevier B.V. All rights reserved.
Chehal, Asmaa; Lobo, Rosabel; Naim, Asmaa; Azinovic, Ignacio
Ameloblastoma is a benign aggressive odontogenic tumor which requires early diagnosis and appropriate treatment. It commonly affects the mandible and radical surgery is the gold standard treatment. We report the case of a patient with ameloblastoma in extremely advanced phase affecting the maxillary sinus who was treated with intensity modulated conformal radiation therapy. Patient's evolution was marked by complete remission maintained after 24 months follow-up. Maxillary ameloblastoma is not well documented in the literature. It is usually diagnosed at the later stage when optimal surgery cannot be performed. This case study aimed to demonstrate that radiation therapy is a real therapeutic alternative in the treatment of advanced and inoperable forms of ameloblastoma.
A 4-year-old girl presented to a medical clinic with a painless right facial swelling. The treating physician ordered a radiograph of the sinuses and received a report of "maxillary sinusitis." After appropriate antibiotic treatment, the facial swelling increased, and the mother took the child to her community pediatrician. After a period of observation and additional imaging, the diagnosis of dentigerous cyst was made. After appropriate surgical intervention, the cyst was removed, and over the ensuing 6 weeks the facial swelling gradually diminished. Dentigerous cysts, although uncommon, need to be considered in the differential diagnosis of children with painless facial swelling.
Sahlstrand-Johnson, Pernilla; Jannert, Magnus; Strömbeck, Anita; Abul-Kasim, Kasim
We have previously proposed the use of Doppler ultrasound to non-invasively stage sinus infection, as we showed that acoustic streaming could be generated in nonpurulent sinus secretions and helped to distinguish it from mucopurulent sinus secretions. In order to continue this development of a clinically applicable Doppler equipment, we need to determine different dimensions of the paranasal sinuses, especially the thickness of the anterior wall of the maxillary sinus (at the canine fossa). To the best of our knowledge, this is the first report on the thickness of the canine fossa. This study aimed to (a) estimate different dimensions of the maxillary and frontal sinuses measured on computed tomography (CT) of the head, (b) define cut-off values for the normal upper and lower limits of the different measured structures, (c) determine differences in age, side and gender, (d) compare manually and automatically estimated maxillary sinuses volumes, and (e) present incidental findings in the paranasal sinuses among the study patients. Dimensions of 120 maxillary and frontal sinuses from head CTs were measured independently by two radiologists. The mean value of the maxillary sinus volume was 15.7±5.3 cm3 and significantly larger in males than in females (P=0.004). There was no statistically significant correlation between the volume of maxillary sinuses with age or side. The mean value of the bone thickness at the canine fossa was 1.1±0.4 mm. The automatically estimated volume of the maxillary sinuses was 14-17% higher than the calculated volume. There was high interobserver agreement with regard to the different measurements performed in this study. Different types of incidental findings of the paranasal sinuses were found in 35% of the patients. We presented different dimensions of the maxillary and frontal sinuses on CTs. We believe that our data are necessary for further development of a clinically applicable Doppler equipment for staging rhinosinusitis.
Nouri, H; Raji, A; Ait M'barek, B
Ameloblastic fibro-odontoma, ameloblastic fibroma, and odontoma are rare malformations, which are classified as odontologic tumors. They usually progress in an asymptomatic way, and making the histological distinction between these variants is very difficult. We report the case of a 14-year-old girl presenting with an ameloblastic fibro-odontoma of the maxillary sinus. The clinical signs were nasal obstruction and jugular tumefaction. Surgical excision was performed through a paralateronasal approach. The diagnosis of fibro-odontoma was confirmed by the histopathological analysis of the surgical piece. Odontologic tumors form a complex entity, the histological nature and the correlations of which are discussed.
Banihashem Rad, Seyed Ali; Mortazavi, Hamed; Eshghpour, Majid; Salehinejad, Jahanshah; Shahakbari, Reza
Introduction: Ameloblastic fibro-odontoma is a rare, benign, asymptomatic tumor. The term ameloblastic fibro-odontoma was first used by Hooker in 1967 as a separate lesion from ameloblastic odontoma. Case Report: This case report describes an eleven years old female with large ameloblastic fibro-odontoma in the right maxillary sinus. Conclusion: There is a low potential for recurrence after complete Enucleation of ameloblastic fibro-odontoma, but due to the risk of ameloblastic sarcoma after recurrence, the surgery should be perfect along with a careful follow up. PMID:24745000
T, Parthasaradhi; B, Shivakumar; Kumar, T.S.S.; P, Suganya
Objectives: Maxillary sinus augmentation surgical techniques have evolved greatly allowing successful placement of dental implants in the atrophic posterior maxillary region. The purpose of the present study is to evaluate the clinical and radiological outcomes and postoperative morbidity of sinus floor elevation procedures performed using the minimally invasive surgical technique the Sinu lift system. Materials and Methods: Sinus lift procedure was done using the sinu lift system by a transcrestal approach and bone augmentation was done on ten systemically healthy patients using β- tricalcium phosphate and platelet rich plasma mix. The study was evaluated upto six months period with bone related parameters being assessed at base line using CT scan, OPG and after six months the results were analysed using SPSS Version 18.0 software (p < 0.01 (0.005). Wilcoxson signed rank sum test was used to correlate between preoperative and postoperative measurements. Implant placements were done at the desired area of sinus augmentation with a two year follow up. (Nobel Biocare, Nobel Biocare Holding AG, Zürich-Flughafen, Switzerland) Results: The augmented sites had a significant increase in the bone parameters at the desired grafted region. The mean gain in bone height as observed in CT Scan had revealed increased measurements from 5.80mm±0.98 to 10.20mm±1.68 at the sixth month evaluation. This was statistically significant (0.005). Clinically, no complications were observed during or after the surgical procedure. Conclusion: Within the limitations of this study, the Sinu lift system with a controlled working action resulted in high procedural success and this procedure may be an alternative to the currently used surgical methods. PMID:25954702
T, Parthasaradhi; B, Shivakumar; Kumar, T S S; Jain, Ashish R; P, Suganya
Maxillary sinus augmentation surgical techniques have evolved greatly allowing successful placement of dental implants in the atrophic posterior maxillary region. The purpose of the present study is to evaluate the clinical and radiological outcomes and postoperative morbidity of sinus floor elevation procedures performed using the minimally invasive surgical technique the Sinu lift system. Sinus lift procedure was done using the sinu lift system by a transcrestal approach and bone augmentation was done on ten systemically healthy patients using β- tricalcium phosphate and platelet rich plasma mix. The study was evaluated upto six months period with bone related parameters being assessed at base line using CT scan, OPG and after six months the results were analysed using SPSS Version 18.0 software (p < 0.01 (0.005). Wilcoxson signed rank sum test was used to correlate between preoperative and postoperative measurements. Implant placements were done at the desired area of sinus augmentation with a two year follow up. (Nobel Biocare, Nobel Biocare Holding AG, Zürich-Flughafen, Switzerland) Results: The augmented sites had a significant increase in the bone parameters at the desired grafted region. The mean gain in bone height as observed in CT Scan had revealed increased measurements from 5.80mm±0.98 to 10.20mm±1.68 at the sixth month evaluation. This was statistically significant (0.005). Clinically, no complications were observed during or after the surgical procedure. Within the limitations of this study, the Sinu lift system with a controlled working action resulted in high procedural success and this procedure may be an alternative to the currently used surgical methods.
Matern, Jean-François; Keller, Pierre; Carvalho, Jean; Dillenseger, Jean-Philippe; Veillon, Francis; Bridonneau, Thomas
Implant therapy has become an excellent treatment modality as its inception into the modern era of dentistry. However, when patients present with advanced atrophy of the maxillary alveolar ridge, the procedure of choice to restore the anatomic bone deficiency is surgical maxillary sinus floor elevation or sinus lift. The purpose of this study was to describe the CT guided sinus lift technique and to illustrate the minimally invasive aspect of this new radiological procedure called radiological sinus lift. For this prospective study, 17 cadaver heads which met our inclusion criteria (edentulous posterior maxillary sector and bone height less than 5 mm) were analyzed using cone beam computed tomography (CBCT) and orthopantomography (OPT). CT and sinus endoscopy was used to guide each step in the procedure. The radiological sinus lift technique consists of the following four stages: Approach. A 14.5 G OstyCut needle was inserted mesial to the canine eminence, and manual drilling was performed parallel to the sinus floor. Osteotomy. An inner obturator with a blunt tip was introduced to compress bone, to push it in close proximity to the sinus membrane and finally to create an osseous window opening into the submucosal space. Lifting. The sinus lift was performed using hydrodissection with dilute iodinated contrast medium. Filling. The submucosal space was then filled with an injection of dilute collagen. Success of the radiological sinus lift procedure was defined by the presence of a dome shape visible within the maxillary alveolar recess. All cases were imaged postoperatively using OPT and maxillary CBCT. Twelve maxillary sinuses underwent the radiological sinus floor elevation procedure. A dome shape of the Schneiderian membrane was achieved in eight maxillary sinuses (66.7%). All failures (n = 4) were caused by mucosal perforation at the time of maxillary sinus osteotomy. Mean height of membrane elevation was 12.0 mm, with a mean intervention time of 45 min. This
Wang, Xinyu; Di, Ping; Li, Jianhui; Hu, Xiulian; Lin, Ye
To evaluate the clinical outcome of maxillary sinus augmentation and implant placement following removal of a maxillary antral cyst. In this study 32 patients with 33 maxillary antral cysts were enrolled. The partial wall of cyst was removed through a small lateral sinus approach and cyst spontaneous shrink was expected when wall of cyst was destroyed for open drainage. Three to six months later the secondary sinus approach 1.5 mm circling the first approach for augmentation was undertaken. Dental implants were placed simultaneously or later. All patients finished prosthetic rehabilitation in the study and were followed up for (30.9 ± 11.5) months. The intraoperative and postoperative complications were recorded. The survival rate of the implants was calculated. In this study, 33 maxillary antral cysts of 32 patients were removed. Maxillary sinus augmentation was performed after a mean of (4.5 ± 1.5) months (range, 2-8 months). Sixty-two implants were inserted and all patients finished prosthetic rehabilitation after a mean of (10.8 ± 2.7) months (range, 5-17 months). The survival rate of implants was 95% (59/62). Three implants failed before their prosthesis delivered due to failure of osseointegration and were reinserted later. No recurrence of cyst was observed until the last recall. In this study, 24 specimens were mucosal cysts. Five specimens were mucoceles and 4 specimens were not certain in pathology. Maxillary sinus cysts have a negative effect on maxillary sinus augumentation if not removed. The present preliminary data of the study suggests that the clinical result of maxillary sinus augmentation and implant placement following removal of a maxillary antral cyst is predictable.
Al-Juboori, Mohammed Jasim
The displacement of a dental implant into the maxillary sinus may lead to implant failure due to exposure of the apical third or the tip of the implant beyond the bone, resulting in soft tissue growth. This case report discusses dental implant placement in the upper first molar area with maxillary sinus involvement of approximately 2 mm. A new technique for progressive implant loading was used, involving immediately loaded implants with maxillary sinus perforation and low primary stability. Follow-up was performed with resonance frequency analysis and compared with an implant placed adjacent in the upper second premolar area using a conventional delayed loading protocol. Implants with maxillary sinus involvement showed increasing stability during the healing period. We found that progressive implant loading may be a safe technique for the placement of immediately loaded implants with maxillary sinus involvement. PMID:25678816
Al-Juboori, Mohammed Jasim
The displacement of a dental implant into the maxillary sinus may lead to implant failure due to exposure of the apical third or the tip of the implant beyond the bone, resulting in soft tissue growth. This case report discusses dental implant placement in the upper first molar area with maxillary sinus involvement of approximately 2 mm. A new technique for progressive implant loading was used, involving immediately loaded implants with maxillary sinus perforation and low primary stability. Follow-up was performed with resonance frequency analysis and compared with an implant placed adjacent in the upper second premolar area using a conventional delayed loading protocol. Implants with maxillary sinus involvement showed increasing stability during the healing period. We found that progressive implant loading may be a safe technique for the placement of immediately loaded implants with maxillary sinus involvement.
Li, Juanjuan; Lee, Kyungmo; Chen, Haohua; Ou, Guomin
Because of the low bone quality in the posterior maxilla, edentulism in this area often results in a resorbed osseous structure and a pneumatized maxillary sinus, which makes dental implant surgery in the posterior maxilla a challenge. Two main surgical approaches are available for the sinus lift procedure: lateral and crestal. Improvement of the maxillary sinus floor elevation technique and increase in predictability are desirable. This article describes an innovative approach to maxillary sinus floor elevation with piezoelectric surgery and hydraulic pressure for xenograft and simultaneous implant placement in situations with insufficient residual alveolar bone.
sinusitis is evident. females (41.8%; P < .0001). 12.1% had right maxillary sinusitis , 15.6% had left-sided involvement , and 21.0% had bilateral sinus ...19.9%) 395 (80.1%) 206 (41.8%) 287 (58.2%) Figure 3: Coronal CT scan demonstrating bilateral maxillary sinusitis (arrows). The degree of sinus ...concha. There is similar degree of sinus inflammation in both maxillary sinuses . of 171 patients with deviated septum had no evidence of maxillary
Srouji, S; Ben-David, D; Lotan, R; Riminucci, M; Livne, E; Bianco, P
Maxillary sinus membrane lifting is a common procedure aimed at increasing the volume of the maxillary sinus osseous floor prior to inserting dental implants. Clinical observations of bone formation in sinus lifting procedures without grafting bone substitutes were observed, but the biological nature of bone regeneration in sinus lifting procedures is unclear. This study tested whether this osteogenic activity relies on inherent osteogenic capacity residing in the sinus membrane by simulating the in vivo clinical condition of sinus lifting in an animal model. Maxillary sinus membrane cells were cultured in alpha-MEM medium containing osteogenic supplements (ascorbic acid, dexamethasone). Cultured cells revealed alkaline phosphatase activity and mRNA expression of osteogenic markers (alkaline phosphatase, bone sialoprotein, osteocalcin and osteonectin) verifying the osteogenic potential of the cells. Fresh tissue samples demonstrated positive alkaline phosphatase enzyme activity situated along the membrane-bone interface periosteum-like layer. To simulate the in vivo clinical conditions, the membranes were folded to form a pocket-like structure and were transplanted subcutaneously in immunodeficient mice for 8 weeks. New bone formation was observed in the transplants indicating the innate osteogenic potential within the maxillary Schneiderian sinus membrane and its possible contribution to bone regeneration in sinus lifting procedures. Copyright 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Edgem, S R
The objective of the present study was to estimate the clinical efficacy of local antibacterial therapy in the children presenting with sinusitis. The study included a total of 104 patients allocated to 2 groups. In one of them, the patients underwent therapeutic and diagnostic punctures of the maxillary sinuses to obtain the material for subsequent microbiological analysis and to administer antibiotics into the sinuses. The results of the study give evidence that local application of antibacterial agents in combination with mucolytic drugs is at least as efficient for the treatment of acute maxillary sinusitis as the traditional methods for the management of the same conditions with the use of systemic antibiotics. The study confirmed the expediency of using the puncture technique for the treatment of patients with acute inflammatory process in maxillary sinuses.
Wald, Ellen R
Acute otitis media and acute bacterial sinusitis are 2 of the most common indications for antimicrobial agents in children. Together, they are responsible for billions of dollars of health care expenditures. The pathogenesis of the 2 conditions is identical. In the majority of children with each condition, a preceding viral upper respiratory tract infection predisposes to the development of the acute bacterial complication. It has been shown that viral upper respiratory tract infection predisposes to the development of acute otitis media in 37% of cases. Currently, precise microbiologic diagnosis of acute otitis media and acute bacterial sinusitis requires performance of tympanocentesis in the former and sinus aspiration in the latter. The identification of a virus from the nasopharynx in either case does not obviate the need for antimicrobial therapy. Furthermore, nasal and nasopharyngeal swabs are not useful in predicting the results of culture of the middle ear or paranasal sinus. However, it is possible that a combination of information regarding nasopharyngeal colonization with bacteria and infection with specific viruses may inform treatment decisions in the future.
Mahmood, Usama; Cerussi, Albert; Dehdari, Reza; Nguyen, Quoc; Kelley, Timothy; Tromberg, Bruce; Wong, Brian
Diagnosing sinusitis remains a challenge for primary care physicians. There is a need for a simple, office-based technique to aid in the diagnosis of sinusitis without the cost and radiation risk of conventional radiologic imaging. We designed a low-cost near-infrared (NIR) device to transilluminate the maxillary sinuses. The use of NIR light allows for greater interrogation of deep-tissue structures as compared to visible light. NIR imaging of 21 patients was performed and compared with computed tomography (CT) scans. Individual maxillary sinuses were scored on a scale from 0 to 2 based on their degree of aeration present on CT and similarly based on the NIR signal penetration into the maxilla on NIR images. Our results showed that air-filled and fluid/tissue-filled spaces can be reasonably distinguished by their differing NIR signal penetration patterns, with average NIR imaging scores for fluid-filled maxillary sinuses (0.93+/-0.78, n=29) significantly lower than those for normal maxillary sinuses (1.62+/-0.57, n=13) (p=0.003). NIR imaging of the sinuses is a simple, safe, and cost-effective modality that can potentially aid in the diagnosis of sinusitis. Long-term, significant device refinement and large clinical trials will be needed to determine the diagnostic accuracy of this technique.
Abouali, Omid; Keshavarzian, Erfan; Farhadi Ghalati, Pejman; Faramarzi, Abolhasan; Ahmadi, Goodarz; Bagheri, Mohammad Hadi
Realistic 3-D models of the human nasal passages were developed pre and post virtual uncinectomy and Middle Meatal Antrostomy. A 3-D computational domain was constructed by a series of coronal CT scan images from a healthy subject. Then a virtual uncinectomy intervention and maxillary antrostomy were performed on the left nasal passage by removing the uncinate process and exposing the maxillary sinus antrum. For several breathing rates corresponding to low or moderate activities, the airflows in the nasal passages were simulated numerically pre and post virtual routine maxillary sinus endoscopic surgery. The airflow distribution in the nasal airway, maxillary and frontal sinuses were analyzed and compared between pre and post surgery cases. A Lagrangian trajectory analysis approach was used for evaluating the path and deposition of microparticles in the nasal passages and maxillary sinuses. A diffusion model was used for nanoparticle transport and deposition analysis. The deposition rate of the inhaled micro and nanoparticles in the sinuses were evaluated and compared for pre and post operation conditions. The results showed that after maxillary sinus endoscopic surgery, the inhaled nano and microparticles can easily enter this sinus due to penetration of the airflow into the sinus cavity. This was in contrast to the preoperative condition in which almost no particles entered the sinuses. These results could be of importance for a better understanding of the effect of sinus endoscopic surgery on patient exposure to particulate pollution and inhalation drug delivery. The significantly higher airflow rate and particle deposition in the sinus could be a reason for the discomfort reported by some patient after maxillary sinus endoscopic surgery. Copyright © 2012 Elsevier B.V. All rights reserved.
Trimarchi, M; Tomazic, P V; Bertazzoni, G; Rathburn, A; Bussi, M; Stammberger, H
The anterior wall of the maxillary sinus represents a blind spot in maxillary sinus endoscopic surgery because of the absence of proper visualisation and instrumentation to reach it. The aim of this study was to validate a new approach through the oral cavity into the nose with a flexible video endoscope (oro-nasal endoscopic approach; ONEA) to visualise the entire anterior maxillary wall including the anteromedial angle. We started from a dried bone cadaver model, and then dissected fresh-frozen cadavers. The maxillary sinus was explored with a rigid and a flexible endoscope entering from the nose. Next, a flexible endoscope was introduced through the mouth and back up through the choana, it accessed the maxillary middle antrostomy, entering inside the sinus and looking at the anterior wall. A small ruler inserted inside the sinus demonstrated all the angles visualised. The new ONEA technique allows complete visualisation of the anterior wall of the maxillary sinus with inspection of all blind spots. It is therefore possible to detect lesions that would normally not be visible with a normal rigid endoscope. We demonstrate the validity of a novel technique that allows visualisation of the infero-medial angle of the anterior wall of the maxillary sinus.
Das, Saumik; Sinha, Ramanuj; Aggarwal, Neeraj; Chakravorty, Sriparna
Sporotrichosis is commonly a chronic infection caused by Sporothrix schenckii, a saprophytic fungus and is usually limited to cutaneous and subcutaneous tissues. Disseminated systemic, osteoarticular or pulmonary sporotrichosis have been reported but nasal sinusitis by this fungus is extremely infrequent. Earlier report from southern India documented a case of maxillary sinusitis by Sporothrix schenckii. Here we report a similar case of bilateral maxillary sinusitis in a middle aged female from a village of Bihar, a state in eastern India. She underwent endoscopic maxillary sinus surgery for nasal symptoms and diagnosed to have sporotrichotic infection of maxillary sinuses. The diagnosis was done by mycological and histopathological examination and patient improved under antifungal chemotherapy. PMID:27134873
Zalmanovici Trestioreanu, Anca; Yaphe, John
Acute sinusitis is a common reason for primary care visits. It causes significant symptoms and often results in time off work and school. We examined whether intranasal corticosteroids (INCS) are effective in relieving symptoms of acute sinusitis in adults and children. We searched CENTRAL 2013, Issue 4, MEDLINE (January 1966 to May week 2, 2013), EMBASE (1990 to May 2013) and bibliographies of included studies. Randomised controlled trials (RCTs) comparing INCS treatment to placebo or no intervention in adults and children with acute sinusitis. Acute sinusitis was defined by clinical diagnosis and confirmed by radiological evidence or by nasal endoscopy. The primary outcome was the proportion of participants with either resolution or improvement of symptoms. Secondary outcomes were any adverse events that required discontinuation of treatment, drop-outs before the end of the study, rates of relapse, complications and return to school or work. Two review authors independently extracted data, assessed trial quality and resolved discrepancies by consensus. No new trials were found for inclusion in this update. Four studies involving 1943 participants with acute sinusitis met our inclusion criteria. The trials were well-designed and double-blind and studied INCS versus placebo or no intervention for 15 or 21 days. The rates of loss to follow-up were 7%, 11%, 41% and 10%. When we combined the results from the three trials included in the meta-analysis, participants receiving INCS were more likely to experience resolution or improvement in symptoms than those receiving placebo (73% versus 66.4%; risk ratio (RR) 1.11; 95% confidence interval (CI) 1.04 to 1.18). Higher doses of INCS had a stronger effect on improvement of symptoms or complete relief: for mometasone furoate 400 µg versus 200 µg (RR 1.10; 95% CI 1.02 to 1.18 versus RR 1.04; 95% CI 0.98 to 1.11). No significant adverse events were reported and there was no significant difference in the drop-out and
Acocella, Alessandro; Bertolai, Roberto; Nissan, Joseph; Ellis, Edward; Sacco, Roberto
The reconstruction of edentulous patients with adequate bone volume and density by the use of bone graft and, subsequently, the placement of dental implants has become a viable treatment option with high predictability. According to many authors, maxillary antral cysts are one of the most common benign pathologies of the maxillary sinus, and they also represent an important contraindication to sinus regenerative surgical technique. The authors report a case of maxillary atrophy which is augmented by fresh frozen bone chips in the presence of antral cysts.
Testori, Tiziano; Rosano, Gabriele; Taschieri, Silvio; Del Fabbro, Massimo
The purpose of the present case report was to document a maxillary sinus floor augmentation procedure involving ligation of a blood vessel with a nearly 3-mm diameter in the lateral wall of the maxillary sinus. A bilateral maxillary sinus floor augmentation procedure was performed in a 51-year-old healthy man. The preoperative computed tomography scan revealed a bony canal within the lateral maxillary sinus wall of the right as well as the left side close to the alveolar ridge. A vessel with a diameter of nearly 3 mm was identified during the sinus floor augmentation on the left side. The vessel was exposed and ligated. A vessel with a diameter of approximately 1 mm was identified on the right side and the sinus floor augmentation was performed without ligation. No complications were observed and the postoperative healing was uneventful. Although accidental laceration of vessels with an unusually large diameter during maxillary sinus floor augmentation is not life-threatening, impaired visualisation may compromise the augmentation procedure, including the elevation of the Schneiderian membrane. Moreover, postoperative bleeding and formation of a haematoma may occur. Therefore, ligation of vessels with an unusually large diameter is recommended during maxillary sinus floor augmentation to minimise intra- and postoperative complications.
Zhong, Weijian; Chen, Binke; Liang, Xin; Ma, Guowu
The exposing of dental implant into the maxillary sinus combined with membrane perforation might increase risks of implant failure and sinus complications. The purpose of this study was to investigate the effects of the dental implant penetration into the maxillary sinus cavity in different depths on osseointegration and sinus health in a dog model. Sixteen titanium implants were placed in the bilateral maxillary molar areas of eight adult mongrel dogs, which were randomly divided into four groups according to the different penetrating extents of implants into the sinus cavities (group A: 0 mm; group B: 1 mm; group C: 2 mm; group D: 3 mm). The block biopsies were harvested five months after surgery and evaluated by radiographic observation and histological analysis. No signs of inflammatory reactions were observed in any maxillary sinus of the eight dogs. The tips of the implants with penetrating depth of 1 mm and 2 mm were found to be fully covered with newly formed membrane and partially with new bone. The tips of the implants with penetrating depth over 3 mm were exposed in the sinus cavity and showed no membrane or bone coverage. No significant differences were found among groups regarding implant stability, bone-to-implant contact (BIC) and bone area in the implant threads (BA). Despite the protrusion extents, penetration of dental implant into the maxillary sinus with membrane perforation does not compromise the sinus health and the implant osseointegration in canine.
Frank, Dennis O; Zanation, Adam M; Dhandha, Vishal H; McKinney, Kibwei A; Fleischman, Gitanjali M; Ebert, Charles S; Senior, Brent A; Kimbell, Julia S
The effects of increases in maxillary sinus (MS) airflow following functional endoscopic sinus surgery (FESS) are unknown. The goal of this study was to quantify the effects of FESS on airflow into the MS in a cohort of patients with chronic rhinosinusitis, and compare MS flow rate with patient-reported outcome measures. A pilot study was conducted in which preoperative and postoperative computed tomography scans of 4 patients undergoing bilateral or unilateral FESS were used to create 3-dimensional (3D) reconstructions of the nasal airway and paranasal sinuses using Mimics™ (Materialise, Inc.). The size of the maxillary antrostomies post-FESS ranged from 107 to 160 mm(2). Computational meshes were generated from the 3D reconstructions, and steady-state, laminar, inspiratory airflow was simulated in each mesh using the computational fluid dynamics (CFD) software Fluent™ (ANSYS, Inc.) under physiologic, pressure-driven conditions. Airflow into the MS was estimated from the simulations and was compared preoperatively and postoperatively. In addition, patients completed preoperative and postoperative Rhinosinusitis Outcome Measure-31 (RSOM-31) questionnaires and scores were compared with MS airflow rates. CFD simulations predicted that average airflow rate into post-FESS MS increased by 18.5 mL/second, and that average flow velocity into the MS more than quadrupled. Simulation results also showed that MS flow rate trended with total RSOM-31 and all domain scores. CFD simulations showed that the healed maxillary antrostomy after FESS can greatly enhance airflow into the MS. Our pilot study suggests that to some extent, increasing airflow into the MS may potentially improve chronic rhinosinusitis patients' quality of life pre-FESS and post-FESS. © 2013 ARS-AAOA, LLC.
KOPPE, THOMAS; NAGAI, HIROSHI
To investigate the claim that the primate paranasal sinuses possess not a functional but a structural role associated with the skull architecture (Blaney, 1990), the relationship between the maxillary sinus and the skull architecture was studied ontogenetically in 30 skulls of male and female Japanese macaques (Macaca fuscata). Coronal CT scan series and computerised 3-dimensional images served to evaluate the maxillary sinus. The definitive hemispherical shape of the sinus was already achieved after the completion of the primary dentition. Sinus volume increased with a trend indicating positive allometry. When compared with an ontogenetic data set of orang-utan (Koppe et al. 1995), however, the growth rate of the maxillary sinus of M. fuscata was significantly less. The maxillary sinus both of male and female macaques enlarged according to a common growth pattern. However, no sexual dimorphism could be established for the maxillary sinus size. Although the volume of the right maxillary sinus was normally bigger than that of the left side, the results suggested that asymmetry in maxillary sinus volume is related neither to skull size nor sex. Whereas a correlation analysis showed close relationships between the maxillary sinus volume and external cranial dimensions, the partial correlation coefficients revealed that these relationships were highly influenced by skull size. Although it cannot be ruled out that the paranasal sinuses are to some extent linked to the skull architecture, this study does not support a solely structural role for these air cavities. PMID:9183677
Krasny, Kornel; Krasny, Marta; Kamiński, Artur
Bone tissue atrophy may constitute a relative contraindication for implantation. The methods used in reconstruction of the alveolar ridge within the lateral section of the maxilla have been well known but not perfect. Presentation of the two-stage, closed sinus lift technique as well as efficacy evaluation of reconstruction of the alveolar ridge in the maxilla within its vertical dimension with the use of this technique. The total procedure was performed in 26 out of 28 patients qualified for the study. The height of the alveolar ridge at the site of the planned implantation was no <3 mm, the width of the ridge was no <5 mm. During the treatment stage 1 the sinus lift was performed for the first time. The created hollow was filled with allogeneic granulate. After 3-6 months stage 2 was performed consisting in another sinus lift with simultaneous implantation. The treatment was completed with prosthetic restoration after 6 months of osteointegration. In 24 out of 26 cases stage 1 was completed with the average ridge height of 7.2 mm. In stage 2, simultaneously with the second sinus lift, 26 implants were placed and no cases of sinusitis were found. In the follow-up period none of the implants were lost. The presented method is efficient and combines the benefits of the open technique-allowing treatment in cases of larger reduction of the vertical dimension and the closed technique-as it does not require opening of the maxillary sinus.
Acute rhinosinusitis is a common illness in children. Viral upper respiratory tract infection is the most common presentation of rhinosinusitis. Most children resolve the infection spontaneously and only a small proportion develops a secondary bacterial infection. The proper choice of antibiotic therapy depends on the likely infecting pathogens, bacterial antibiotic resistance, and pharmacologic profiles of antibiotics. Amoxicillin-clavulanate is currently recommended as the empiric treatment in those requiring antimicrobial therapy. Isolation of the causative agents should be considered in those who failed the initial treatment. In addition to antibiotics, adjuvant therapies and surgery may be used in the management of acute bacterial rhinosinusitis.
Tange, R A
Sinus surgery probably originates from the time of the New Kingdom of ancient Egypt. Instruments were used to remove the brain through the nose as a part of the mummification process. The interest in the pathology of the maxillary sinus started to rise in the 17th century. Antral trephination for suppuration was the most common maxillary sinus operation in that period. An oro-antral fistula was often created by the extraction of a molar to drain the infected maxillary sinus daily. Later on the anterior wall of the maxillary sinus was opened through the canine fossa and was kept open for irrigation. Caldwell (1893), Scanes Spicer (1894) and later Luc in 1897 closed the canine fossa incision after an intranasal antrostomy and the removal of the infected mucosa. This so-called Caldwell-Luc procedure is still the most commonly used maxillary sinus operation today. After the introduction of the endoscopy in the beginning of this century endonasal surgery has been developed in the last decades into one of the important surgical procedures for maxillary sinus infections today.
Laureti, Mauro; Ferrigno, Nicola; Mencio, Francesca; Pompa, Giorgio; Di Carlo, Stefano
Displacement of dental implants into the maxillary sinus is not an uncommon event in implant dentistry and may lead to serious complications, such as sinusitis. To avoid systemic problems, performing the removal of the foreign body as soon as possible is suggested. Despite the fact that early implants dislocation has been reported several times, late migration into maxillary sinus has been described by just a few studies. The purpose of this study was to report a rare case of dental implant migration into maxillary sinus after 12 years of function. A 61-year-old woman came to our attention in June 2015 after being visited by an otolaryngologist and being diagnosed with sinusitis and presence of a foreign body into the right maxillary sinus. A panoramic radiograph and a CT scan showed the migration of dental implant sited in 1.6 positions into the maxillary sinus. The implant was removed following a Caldwell-Luc procedure under local anesthesia. Postoperative course was uncomplicated and the patient reported no symptoms of sinusitis after 12 months of follow-up. PMID:28392949
Venekamp, Roderick P; Thompson, Matthew J; Hayward, Gail; Heneghan, Carl J; Del Mar, Chris B; Perera, Rafael; Glasziou, Paul P; Rovers, Maroeska M
Acute sinusitis is the inflammation and swelling of the nasal and paranasal mucous membranes and is a common reason for patients to seek primary care consultations. The related impairment of daily functioning and quality of life is attributable to symptoms such as facial pain and nasal congestion. To assess the effects of systemic corticosteroids on clinical response rates and to determine adverse effects and relapse rates of systemic corticosteroids compared to placebo or standard clinical care in children and adults with acute sinusitis. We searched CENTRAL (2014, Issue 1), MEDLINE (1966 to February week 1, 2014) and EMBASE (January 2009 to February 2014). Randomised controlled trials (RCTs) comparing systemic corticosteroids to placebo or standard clinical care for patients with acute sinusitis. Two review authors independently assessed the methodological quality of the trials and extracted data. Five RCTs with a total of 1193 adult participants met our inclusion criteria. We judged methodological quality to be moderate in four trials and high in one trial. Acute sinusitis was defined clinically in all trials. However, the three trials performed in ear, nose and throat (ENT) outpatient clinics also used radiological assessment as part of their inclusion criteria. All participants were assigned to either oral corticosteroids (prednisone 24 mg to 80 mg daily or betamethasone 1 mg daily) or the control treatment (placebo in four trials and non-steroidal anti-inflammatory drugs (NSAIDs) in one trial). In four trials antibiotics were prescribed in addition to oral corticosteroids or control treatment, while one trial investigated the effects of oral corticosteroids as a monotherapy.When combining data from the five trials, participants treated with oral corticosteroids were more likely to have short-term resolution or improvement of symptoms than those receiving the control treatment: at days three to seven (risk ratio (RR) 1.3, 95% confidence interval (CI) 1.1 to 1
Taschieri, Silvio; Fabbro, Massimo Del; Corbella, Stefano; Weinstein, Tommaso; Rosano, Gabriele; Tsesis, Igor
A referred patient presented with a lesion of endodontic origin located at the apex of tooth #27. The tooth had been endodontically treated and re-treated. A periapical radiograph revealed a close relationship between the lesion and the maxillary sinus. A cone-beam computed tomography scan confirmed that the lesion had invaded the sinus cavity. The treatment plan consisted of periapical surgery using an endoscope as a magnification device. Due to a sinus membrane perforation, a new sinus membrane repair technique was performed. Twelve months after surgery, a cone-beam computed tomography scan revealed successful healing of the lesion. The continuous preservation of the sinus physiology was also observed. The use of an endoscope as a magnification device and a tailored technique for sinus membrane management allowed us to achieve a successful treatment outcome in the case of an endodontic lesion invading the maxillary sinus.
Schopper, C; Moser, D; Wanschitz, F; Watzinger, F; Lagogiannis, G; Spassova, E; Ewers, R
Sinus grafting, a popular and standard treatment for maxillary atrophy, uses a variety of grafting materials. In this study, specimens obtained 6 months after sinus grafting with Algipore were evaluated under light microscopy and showed osseoformation, xenograft degradation, and bone ingrowth into particles. Osteoblastic cells were embedded in the intracorpuscular bone matrix, which indicated that xenograft particles are an osseoconductive scaffold and stimulate matrix deposition. Acute inflammatory responses after insertion of Algipore did not occur. Particles were degraded during physiologic bone remodeling, and newly formed bone gradually replaced resorbed biomaterial.
Oh, Heesoo; Herchold, Kiri; Hannon, Stephanie; Heetland, Kelly; Ashraf, Golnaz; Nguyen, Vince; Cho, Heon Jae
This case report describes the successful orthodontic tooth movement through the maxillary sinus in an adult patient. A 41-year-old Asian woman had severe lip protrusion and multiple missing posterior teeth. Her orthodontic treatment included the extraction of 2 teeth, maximum retraction of the incisors using the extraction spaces and the existing spaces from the missing molars, and closure of all remaining spaces. Even though the treatment time was extended because of the anatomic and biologic challenges associated with moving posterior teeth over a long distance through the maxillary sinus, a successful outcome was obtained, with significant bone modeling of the maxillary sinus. The results demonstrate that a carefully selected force system can overcome the anatomic limitations of moving tooth against the cortical bone of the maxillary sinus wall in adult patients.
Oh, Heesoo; Herchold, Kiri; Hannon, Stephanie; Heetland, Kelly; Ashraf, Golnaz; Nguyen, Vince; Cho, Heon Jae
This case report describes the successful orthodontic tooth movement through the maxillary sinus in an adult patient. A 41-year-old Asian woman had severe lip protrusion and multiple missing posterior teeth. Her orthodontic treatment included the extraction of two teeth, maximum retraction of the incisors using the extraction spaces and the existing spaces from the missing molars, and closure of all remaining spaces. Even though the treatment time was extended because of the anatomic and biologic challenges associated with moving posterior teeth over a long distance through the maxillary sinus, a successful outcome was obtained, with significant bone modeling of the maxillary sinus. The results demonstrate that a carefully selected force system can overcome the anatomic limitations of moving tooth against the cortical bone of the maxillary sinus wall in adult patients.
Gumus, Nazim; Coban, Yusuf Kenan
We present an unusual dentoalveolar fracture case who had displacement of teeth into maxillary sinus cavity. This patient was 15 years old. He had oral bleeding and lost teeth after falling from the top of a building. Examination of maxillofacial region showed that there were left maxillary teeth lost, alveolar fracture, gingival bleeding and laserations. Maxillofacial bones were found intact. Canine, both premolars and the first molar teeth on left maxilla were lost. Pantomographic evaluation viewed two teeth in the left maxillary sinus. In addition, computerized tomography clearly showed oroantral fistula, alveolar fracture and teeth into maxillary sinus. Extraction of teeth from sinus cavity was performed as well as repair of oroantral fistula and alveolar fracture. This patient is thought that dentoalveolar injury may be more serious than expected according to the oral examination and it requires careful evaluation, even if dentoalveolar trauma does not pose a significant morbid risk.
Marques, José; Figueiredo, Rui; Aguirre-Urizar, José Manuel; Berini-Aytés, Leonardo; Gay-Escoda, Cosme
A maxillary sinus mucocele is an infrequent but benign lesion that develops from the obstruction of a seromucous glandular duct of the maxillary sinus mucosa. This clinical entity is generally asymptomatic and self-limited. Mucoceles are described as rounded dome-shaped soft tissue masses frequently located on the floor of the maxillary sinus. In this paper, we present a case of a slightly radiopaque well defined shadow arising from the left maxillary sinus floor that produced the root resorption of the upper second left molar. After the surgical removal of the lesion through a Caldwell-Luc approach, histologic study confirmed the initial diagnosis of mucocele. This case report emphasizes the need of clinical and radiologic follow-up to detect any complications associated with these benign lesions, because, in rare occasions, they can show an aggressive growth pattern.
Danesh-Sani, Seyed Amir
Maxillary sinus augmentation has been shown to be a predictable treatment option for placing dental implants in areas of posterior maxilla with lack of sufficient residual alveolar bone height.(1) The transalveolar (crestal) and the lateral window are the main techniques for the maxillary sinus augmentation with the goal of creating a space beneath the Schneiderian membrane in which to place various grafting materials in order to increase alveolar bone height.
The present report describes the case of a patient who underwent maxillary sinusitis right after dental implant installation with sinus lifting. Computed tomography scan revealed a dental implant (#16) was protruded inside the right maxillary sinus and confirmed the obstruction of ostium. A symptom remission was gained with the dual approaches combined by functional endoscopic sinus surgery and an intra-oral approach. Fully recovered function and healing of sinus were identified after 10 months follow-up. We report the case of sinusitis caused by protrusion of implants with sinus floor lift procedures and propose that practitioners should be aware of the possible its complications and management. PMID:24868506
Horvath, Lukas; Kraft, Marcel; Fostiropoulos, Karolos; Falkowski, Anna; Tarr, Philip E.
In this study, we report the first case of reptile-associated maxillary sinusitis due to Salmonella enterica subspecies diarizonae in a snake handler and the third case of salmonella-associated sinusitis worldwide. The case highlights the potential of respiratory transmission and atypical salmonellosis presentations. PMID:27186588
Lee, Seung Ju
The medial maxillary sinus roof is a ridge formed by the superior margin of the maxillary sinus antrostomy. The posterior wall of the maxillary sinus is always included in operative fields. To perform a radiologic study assessing the utility of the medial maxillary sinus roof and the posterior wall of the maxillary sinus as fixed landmarks for providing a safe route of entry into the sphenoid sinus. We reviewed 115 consecutive paranasal sinus Computed Tomographic scans (230 sides) of Korean adult patients performed from January 2014 to December 2014. Using the nasal floor as a reference point, the vertical distances to the highest point of the medial maxillary sinus roof, the sphenoid ostium and anterior sphenoid roof and floor were measured. Then the vertical distances from the highest point of the medial maxillary sinus roof to the sphenoid ostium and anterior sphenoid roof and floor were calculated. The coronal distance from the posterior wall of the maxillary sinus to the sphenoid ostium was determined. The average height of the highest point of the medial maxillary sinus roof relative to the nasal floor was measured to be 33.83±3.40mm. The average vertical distance from the highest point of the medial maxillary sinus roof to the sphenoid ostium and anterior sphenoid roof and floor was 1.79±3.09mm, 12.02±2.93mm, and 6.18±2.88mm respectively. The average coronal distance from the posterior wall of the maxillary sinus to the sphenoid ostium was 0.78mm. The sphenoid ostium was behind the coronal plane of the posterior wall of the maxillary sinus most frequently in 103sides (44.4%). It was in the same coronal plane in 68 sides (29.3%) and in front of the plane in 61 sides (26.3%). The medial maxillary sinus roof and the posterior wall of the maxillary sinus can be used as a reliable landmark to localize and to enable a safe entry into the sphenoid sinus. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by
Troeltzsch, Matthias; Pache, Christoph; Troeltzsch, Markus; Kaeppler, Gabriele; Ehrenfeld, Michael; Otto, Sven; Probst, Florian
The purpose of the study was to analyze the causative pathology associated with symptomatic unilateral maxillary sinusitis requiring surgical treatment. A retrospective review of all patients that have been treated surgically for unilateral symptomatic maxillary sinusitis between 2006 and 2013 at a single institution was performed. Demographic, anamnesis, clinical, radiological, microbiological and histological data were gathered and analyzed. The patients were allocated into groups depending on the underlying cause of the disease. Descriptive and inferential statistics were computed (level of significance: p ≤ 0.05). The study sample was composed of 174 patients (72 female; 102 male) with a mean age of 52.7 years (SD 16.9). Most cases (130; 75%) were triggered by odontogenic pathology following dentoalveolar surgical interventions (83/130 patients; 64%). Other etiological factors for odontogenic unilateral sinusitis were periapical (23/130 cases; 18%) and periodontal pathology (13/130 cases; 10%). Rhinogenic factors for sinusitis were detected in 13 patients (7.5%) and dental implant-associated unilateral maxillary sinusitis was diagnosed in nine patients (5.2%). Four patients (2.3%) had undergone previous sinus augmentation surgery. A leading cause for the sinus infection could not be identified in 18 patients (10%) who all had a history of midfacial surgery. Medication-related osteonecrosis of the jaw (8) and squamous cell carcinoma (2) were incidental findings. There were no differences in the clinical appearance of the disease with respect to its etiology. Odontogenic causes for maxillary sinusitis must be considered especially in unilateral cases. Maxillary dental implants may induce symptomatic unilateral maxillary sinusitis.
Pignataro, L; Mantovani, M; Torretta, S; Felisati, G; Sambataro, G
Summary As stated at the 1996 Consensus Conference at Babson College, a (maxillary) sinus lift is a “safe and predictable” procedure for increasing alveolar bone height in the postero-superior alveolar regions in order to allow oral rehabilitation and restore masticatory function by means of the insertion of a dental implant even in the case of an atrophic maxilla. However, the procedure has a well-known impact on the delicate homeostasis of the maxillary sinus: the concomitant presence of systemic, naso-sinusal or maxillary sinus disease may favour the development of post-operative complications (particularly maxillary rhino-sinusitis), which can compromise a good surgical outcome. On the basis of these considerations, the management of sinus lift candidates should include the careful identification of any situations contraindicating the procedure and, if naso-sinusal disease is suspected, a clinical assessment by an ear, nose and throat specialist, which should include nasal endoscopy and, if necessary, a computed tomography scan of the maxillo-facial district, particularly the ostio-meatal complex. This first preventive-diagnostic step should be dedicated to detect presumably irreversible and potentially reversible contraindications to a sinus lift, whereas the second (preventive-therapeutic) step is aimed at correcting (mainly with the aid of endoscopic surgery) such potentially reversible ear, nose and throat contraindications as middle-meatal anatomical structural impairments, phlogistic-infective diseases and benign naso-sinusal neoplasms the removal of which achieves naso-sinusal homeostasis recovery, in order to restore the physiological drainage and ventilation of the maxillary sinus. The third (diagnostic-therapeutic) step is only required if mainly infective and sinusal complications arise after sinus lift surgery, and is aimed at ensuring early diagnosis and prompt treatment of maxillary rhino-sinusitis in order to avoid, if possible, implant loss
Newaskar, Vilas; Rajmohan, Sushmita; Dashore, Dolly
Odontogenic Keratocyst (OKC) also termed as Keratocystic Odontogenic Tumour (KCOT) (WHO 2005) is a pathology with unique behavior because of which it is under much scrutiny and continued study. The pathology usually presents itself commonly in mandible and less commonly in maxilla. The occurrence of KCOT in maxillary sinus is reported as rare and multiple occurrences are mostly associated along with the presence of Nevoid Basal Cell Carcinoma (NBCC) syndrome. Here, we present a rare case of bilateral Maxillary OKC involving maxillary sinuses, without the presence of NBCC syndrome. An interesting feature of this case is the presence of left upper third molar in ectopic position in maxillary sinus and a vertically impacted right third molar suggesting an origin from the dental lamina. PMID:27656578
Lorkiewicz-Muszyńska, Dorota; Kociemba, Wojciech; Rewekant, Artur; Sroka, Alicja; Jończyk-Potoczna, Katarzyna; Patelska-Banaszewska, Magdalena; Przystańska, Agnieszka
Anatomical and developmental descriptions of the maxillary sinus may be of great clinical importance. An understanding of age-related changes in the dimensions and volume of the normal maxillary sinus may help in the evaluation of radiographs and identification of sinus abnormalities. The aim of the present study was to define growth patterns of maxillary sinuses in children up to the age of 18 years and evaluate the correlation between normal age-related changes in dimensions and volume. The research sample consisted of CT scans of 170 patients subdivided into 17 groups based on age. Normal developmental changes were investigated and linear dimensions measured. The maxillary sinus, present at birth, increases in size until the end of the 18th year. The growth pattern includes changes in vertical, horizontal and antero-posterior directions. No bilateral dimorphism was observed, but gender-related differences were found in children over the age of 8 years. The most extensive period of growth occurs during the first 8 years and by the end of the 16th year the maximal values of all diameters and volume are reached. A CT study of developing maxillary sinuses allowed a precise evaluation of age-related changes in all diameters and volume to be made. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Ekedahl, C; Holm, S E; Bergholm, A M
A micro-method was developed for determination of the concentrations of antibiotics in the mucous membranes of the maxillary sinus in man. At different times after the administration of antibiotics (potassium phenoxymethylpenicillin, lymecycline and bacampicillin) the concentration was determined in serum and in pieces of maxillary sinus mucosa obtained at operation. It was found that the concentrations in the mucosa varied within wide ranges during the first 60 minutes after the operation but in samples taken at 90 minutes the fluctuations between the individuals were within the standard error of the method. Concentrations well above the MIC values for the majority of bacterias found in sinusitis were registered in the peaks. Six hours after the administration considerable amounts of active antibiotics were still detected in the maxillary sinus mucosa.
El Merhie, Amira; Navarro, Laurent; Delavenne, Xavier; Leclerc, Lara; Pourchez, Jérémie
Enhancement of intranasal sinus deposition involves nebulization of a drug superimposed by an acoustic airflow. We investigated the impact of fixed frequency versus frequency sweep acoustic airflow on the improvement of aerosolized drug penetration into maxillary sinuses. Fixed frequency and frequency sweep acoustic airflow were generated using a nebulizing system of variable frequency. The effect of sweep cycle and intensity variation was studied on the intranasal sinus deposition. We used a nasal replica created from CT scans using 3D printing. Sodium fluoride and gentamicin were chosen as markers. Studies performed using fixed frequency acoustic airflow showed that each of maxillary sinuses of the nasal replica required specific frequency for the optimal aerosol deposition. Intranasal sinus drug deposition experiments under the effect of the frequency sweep acoustic airflow showed an optimal aerosol deposition into both maxillary sinus of the nasal replica. Studies on the effect of the duration of the sweep cycle showed that the shorter the cycle the better the deposition. We demonstrate the benefit of frequency sweep acoustic airflow on drug deposition into maxillary sinuses. However further in vivo studies have to be conducted since delivery rates cannot be obviously determined from a nasal replica.
Falco, Antonello; Amoroso, Cinzia; Berardini, Marco; D'Archivio, Lanfranco
The aim of this clinical investigation was to evaluate the clinical and radiologic outcomes of a single-step surgical procedure that includes functional endoscopic sinus surgery (FESS) and maxillary sinus elevation by the lateral window approach in patients with reversible contraindications to sinus elevation. Thirty-eight patients with insufficient bone height in the posterior maxilla caused by pneumatization of the sinus and with reversible ear-nose-throat (ENT) contraindications to sinus elevation were recruited for this investigation between January 2010 and January 2012. All patients were treated in a single session under general anesthesia for a total of 69 consecutive sinus augmentations. FESS was performed by an ENT specialist, and an oral surgeon carried out sinus elevation through the lateral window approach. Particulate xenograft was used beneath the sinus membrane. Intraoperative and postoperative complications (eg, membrane tears, rhinosinusitis, graft infection or loss) were reported. Nasal endoscopies were performed at 7, 14, and 30 days and 3 months after treatment. After a healing period of 6 months, 137 implants were inserted. Computed tomography scans were performed after 6 months and 1 year. Intraoperative membrane perforation occurred in only one case. No implant failures were recorded during the follow-up period. Radiologic and clinical findings showed the resolution of ENT disease and good bone graft integration after 1 year. A relapse of mucosal thickening observed in some patients did not influence the graft healing. Preliminary rhinosinusal evaluation by an ENT specialist and computed tomography of the ostiomeatal complex are necessary in patients needing maxillary sinus elevation. A single-step approach to FESS and sinus elevation is a predictable technique to manage patients with ENT reversible contraindications to sinus elevation.
Sekerci, Ahmet-Ercan; Köse, Emre; Sisman, Yildiray
Background This study assessed the relationship between mucosal thickness (MT) of the maxillary sinus and periodontal bone loss (PBL) and periapical condition of related teeth. We also aimed to identify the association between root apices and the inferior wall of the maxillary sinus using Cone beam computed tomography (CBCT). Material and Methods In this study, CBCT images of 205 patients with 410 maxillary sinuses were examined, retrospectively. A total of 582 maxillary molars and 587 premolars were observed. The relationship of each root with maxillary sinus and apical lesions of these roots were classified, PBL was examined and the situations of adjacent teeth were estimated. The effect of these conditions on sinus mucosal thickness (MT) was evaluated. Results There was a significant correlation between MT of maxillary sinus and both PBL and age (r = 0.52, p=0.000 and r = 0.111, p= 0.002, respectively). The frequency of MT increased as the severity of apical lesion enlarged. A positive correlation was found between MT and degree of PBL and periapical lesions. To reveal the association between MT and pulpoperiapical condition bivariate correlation was done and a significant relationship between the pulpoperiapical condition and MT was found (r = 0.17, p=0.000). Conclusions This retrospective study showed that MT of the maxillary sinus was common among patients with PBL and MT was significantly associated with PBL and apical lesions. The relationship of maxillary sinus to adjacent teeth had also positive correlation with MT. CBCT imaging enabled better evaluation of maxillary sinus, posterior teeth and surrounding structures compared to other imaging tools. Key words:Maxillary sinus mucosal thickness, apical periodontitis, periodontal bone loss, CBCT. PMID:26241459
Dragan, Eliza; Odri, Guillaume A.; Melian, Gabriel; Haba, Danisia; Olszewski, Raphael
Background The aim of our study was to investigate, in 3 dimensions, the maxillary sinus septa as an alternative site for dental implant placement to avoid sinus lift procedures. Material/Methods We selected 100 dentate and 100 edentate patients with the presence of a maxillary sinus septum by reviewing a larger cone beam computer tomography (CBCT) database from the Department of Oral and Maxillofacial Surgery at Cliniques Universitaires Saint Luc in Bruxelles, Belgium. Three-dimensional reconstructions of 200 maxillary sinus septa were performed using Maxilim software. Ten measurements (length, lateral height, and thickness of the middle and medial region of the septum) were performed by 1 observer, 2 times, with an interval of 1 week between measurements. The angle between the septum and the maxillary plane was also measured. Finally, localization and orientation were assessed for each septum. Results There was no statistically significant difference between the 2 intraobserver measurements (p>0.05). Student’s t-test was used to compare means. Middle height was the only measurement for which there was a difference between edentate and dentate patients (p=0.0095, edentate mean < dentate mean). The location of the septa observed in our study groups demonstrated greater prevalence in the posterior region than in the anterior and middle regions. For the spatial orientation of the septum, we found that most septa (81.2% in dentate patients, 53% in edentate patients) were oblique. Conclusions Three-dimensional evaluation of maxillary sinus septa using 3D CBCT imaging showed that the sinus septum could offer an alternative site for implant placement in the maxillary sinus. PMID:28323814
Ohashi, Yasufumi; Katsumata, Akitoshi; Fujita, Hiroshi; Nakayama, Miwa; Fukuda, Motoki; Nozawa, Michihito; Ariji, Eiichiro
Objectives: It is unclear whether computer-aided detection (CAD) systems for panoramic radiography can help inexperienced dentists to diagnose maxillary sinusitis. The aim of this study was to clarify whether a CAD system for panoramic radiography can contribute to improved diagnostic performance for maxillary sinusitis by inexperienced dentists. Methods: The panoramic radiographs of 49 patients with maxillary sinusitis and 49 patients with healthy sinuses were evaluated in this study. The diagnostic performance of the CAD system was determined. 12 inexperienced dentists and 4 expert oral and maxillofacial radiologists observed the total of 98 panoramic radiographs and judged the presence or absence of maxillary sinusitis, under conditions with and without the support of the CAD system. The receiver operating characteristic curves of the two groups were compared. Results: The CAD system provided sensitivity of 77.6%, specificity of 69.4% and accuracy of 73.5%. The diagnostic performance of the inexperienced dentists increased with the support of the CAD system. When the inexperienced dentists diagnosed maxillary sinusitis with CAD support, the area under the curve (AUC) was significantly higher than that without CAD support. When the focus was only on panoramic radiographs in which CAD support led to a correct diagnosis, the AUC of the inexperienced dentists increased to an equivalent level to that of the experienced radiologists. Conclusions: The CAD system supported the inexperienced dentists in diagnosing maxillary sinusitis on the panoramic radiographs. If the accuracy of the CAD system can be increased, the benefits of CAD support will be further enhanced. PMID:26837670
Erdur, Omer; Ucar, Faruk Izzet; Sekerci, Ahmet Ercan; Celikoglu, Mevlut; Buyuk, Suleyman Kutalmıs
Studies about maxillary sinuses of cleft lip-palate patients have increased since sinusitis is commonly observed in these patients. It is evident that maxillary sinus will be morphologically affected in these patients. And anatomic differences may be a cause or at least a contributor of sinusitis. The aim of this study was to compare maxillary sinus volumes of the non-syndromic patients with unilateral cleft lip-palate and control group by using Cone-Beam computed tomography. Tomography scans of 44 unilateral cleft lip-palate patients (18 right and 26 left) with age and gender matched 45 control patients were evaluated for the study. The images used in the study were part of the diagnostic records collected due to dental treatment needs. All tomographs were obtained in supine position by using Cone-Beam computed tomography (NewTom 5G, QR, Verona, Italy). The patient-specific Hounsfield values were set to include the largest amount of voxels in the sinuses volume calculation individually. All data were measured in mm(3). There was no statistically difference between the gender and age distributions of the groups. No statistically significant difference was found on the cleft and non-cleft side, the right and left side of the unilateral cleft lip-palate patients and the control group (P>0.05). For the inter group comparison, mean maxillary sinus volumes volume of unilateral cleft lip-palate patients (9894.55±4171.44mm(3)) was statistically smaller than the control group (11,977.90±4484.93mm(3)) (P<0.05). Maxillary sinus volumes were effected negatively in unilateral cleft lip-palate patients when compared with the healthy control group. No difference was found on the cleft, non-cleft side and the right-left side of the unilateral cleft lip-palate patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Kim, Young-Sung; Kim, Su-Hwan; Kim, Kyoung-Hwa; Jhin, Min-Ju; Kim, Won-Kyung; Lee, Young-Kyoo; Seol, Yang-Jo
Purpose This study was performed to establish an experimental rabbit model for single-stage maxillary sinus augmentation with simultaneous implant placement. Methods Twelve mature New Zealand white rabbits were used for the experiments. The rabbit maxillary sinuses were divided into 3 groups according to sinus augmentation materials: blood clot (BC), autogenous bone (AB), and bovine-derived hydroxyapatite (BHA). Small titanium implants were simultaneously placed in the animals during the sinus augmentation procedure. The rabbits were sacrificed 4 and 8 weeks after surgery and were observed histologically. Histomorphometric analyses using image analysis software were also performed to evaluate the parameters related to bone regeneration and implant-bone integration. Results The BC group showed an evident collapse of the sinus membrane and limited new bone formation around the original sinus floor at 4 and 8 weeks. In the AB group, the sinus membrane was well retained above the implant apex, and new bone formation was significant at both examination periods. The BHA group also showed retention of the elevated sinus membrane above the screw apex and evident new bone formation at both points in time. The total area of the mineral component (TMA) in the area of interest and the bone-to-implant contact did not show any significant differences among all the groups. In the AB group, the TMA had significantly decreased from 4 to 8 weeks. Conclusions Within the limits of this study, the rabbit sinus model showed satisfactory results in the comparison of different grafting conditions in single-stage sinus floor elevation with simultaneous implant placement. We found that the rabbit model was useful for maxillary sinus augmentation with simultaneous implant placement. PMID:23346463
Calcifying cystic odontogenic tumor (CCOT) is an uncommon benign cystic neoplasm of the jaw that develops from the odontogenic epithelium. Invasion into the maxillary sinus by a CCOT is not a typical, and the recurrence of the cystic variant of CCOT in the posterior maxilla is rare. This report describes a recurrent CCOT occupying most of the maxillary sinus of a 24-year-old male patient. As a treatment, marsupialization was carried out as a means of decompression, and the involved teeth were all endodontically treated. Afterward, surgical enucleation was performed. The size of the lesion continued to shrink after marsupialization, and the maxillary sinus restored its volume. This patient has been followed-up for 3 years after the surgery, and there have not been any signs of recurrence. PMID:27847742
Chahed, H; Bachraoui, R; Kedous, S; Ghorbel, H; Houcine, A; Mediouni, A; Marrakchi, J; Zainine, R; Ben Amor, M; Beltaief, N; Besbes, G
Describe the clinical presentations of orbital complications of acute sinusitis and discuss therapeutic approaches. Retrospective study of 29 cases of acute sinusitis with orbital extension hospitalized over a period of 12years (2000 to 2012). There were 23 men and 6 women. The mean age was 15.75years. The average time until consultation was 7.68 days. Sinusitis was ethmoido-maxillary in 20 cases, ethmoidal in 6 cases, and frontal in 3 cases. Orbital extension was grouped according to the Chandler classification: stage I (3 cases), stage II (3 cases), stage III (15 cases), stage IV (8 cases). Antibiotic therapy was prescribed in all cases. Surgery was performed in 22 cases. Bacterial cultures revealed streptococcus (2 cases), aspergillus fumigatus (1 case) and were negative in 8 cases. The outcome was favorable in 27 cases. In two cases, the outcome was unfavorable with associated intracranial complications. Oculoorbital extension of acute sinusitis is a diagnostic and therapeutic emergency. Paranasal sinus CT is essential to confirm orbital extension and identify the causative sinus. Intravenous antibiotic therapy is the main treatment. The roles of corticosteroid and heparin therapy remain controversial. Surgery is indicated in the case of abscess or high visual risk. Endoscopic endonasal surgery appears to have a double role, in diagnosis and treatment. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Kashima, Tomoyuki; Goldberg, Robert A; Kohn, Jocelyne C; Rootman, Daniel B
Purpose Chronic maxillary atelectasis is characterized by unilateral spontaneous enophthalmos and hypoglobus due to increased orbital volume secondary to maxillary sinus inward deformation. Reformation of the sinus architecture and reconstruction of the orbit are key to a successful outcome. Here, we introduce a one-staged surgery that addresses both these goals. Patients and methods We retrospectively reviewed 11 patients treated with one-stage orbital and sinus surgery. A transconjunctival subperiosteal approach was used to create slats in the thinned orbital floor. A nasal endoscopic approach was utilized to access the maxillary sinus and place a modified Foley catheter balloon through the enlarged maxillary ostium. A bridge graft of nasal septal, ear cartilage, or LactSorb was placed on the reconstructed and balloon-supported orbital floor. The balloon was deflated and removed at 10–14 days. All patients underwent complete ophthalmic and orbital evaluation, including standardized photography and radiologic imaging. Results Eleven patients, mean age 39.5 years, presented with diplopia in upgaze, superior sulcus deformity, and at least 2 mm of relative enophthalmos. After initial overcorrection, enophthalmos improved in all cases. Symmetry within 1 mm was accomplished in 10 of 11 cases. Follow-up time was 259±320 days. Full motility was recovered in all patients. Conclusion We describe a one-staged surgery consisting of cutting slats in the orbital floor, dilating the maxillary sinus with a balloon, and stabilizing the orbital floor with a cartilage graft placement. Our anecdotal experience suggests that this surgical approach can safely achieve normalization of the pathologic sinus outflow and restoration of the orbit anatomy. The balloon ensures orbital floor stability during the healing process, and it may act to stent open the sinus ostium during early mucosal healing. PMID:27932858
Cone-beam computed tomography (CBCT) has an important function in understanding implant operations. CBCT can be used to evaluate the basic condition of implant site before implant operation and decide whether it is suitable for implanting. CBCT also ensures whether the direction of implant and the operation method are satisfactory. CBCT can be used pre- or post-operation as long as the case involves the maxillary sinus. Clinical implant cases using CBCT were introduced to evaluate the maxillary sinus pre- or post-operation.
Freitas, Rubens Moreno de; Spin-Neto, Rubens; Marcantonio Junior, Elcio; Pereira, Luís Antônio Violin Dias; Wikesjö, Ulf M E; Susin, Cristiano
The aim of this systematic review was to evaluate clinical and safety data for recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) carrier when used for alveolar ridge/maxillary sinus augmentation in humans. Clinical studies/case series published 1980 through June 2012 using rhBMP-2/ACS were searched. Studies meeting the following criteria were considered eligible for inclusion: >10 subjects at baseline and maxillary sinus or alveolar ridge augmentation not concomitant with implant placement. Seven of 69 publications were eligible for review. rhBMP-2/ACS yielded clinically meaningful bone formation for maxillary sinus augmentation that would allow placement of regular dental implants without consistent differences between rhBMP-2 concentrations. Nevertheless, the statistical analysis showed that sinus augmentation following autogenous bone graft was significantly greater (mean bone height: 1.6 mm, 95% CI: 0.5-2.7 mm) than for rhBMP-2/ACS (rhBMP-2 at 1.5 mg/mL). In extraction sockets, rhBMP-2/ACS maintained alveolar ridge height while enhancing alveolar ridge width. Safety reports did not represent concerns for the proposed indications. rhBMP-2/ACS appears a promising alternative to autogenous bone grafts for alveolar ridge/maxillary sinus augmentation; dose and carrier optimization may expand its efficacy, use, and clinical application. © 2013 Wiley Periodicals, Inc.
Zhang, Sijia; Song, Yingliang; Wei, Hongbo; Ren, Shuai
Introduction Whether mucosal cyst of maxillary sinus is contraindication for sinus floor augmentation surgery has been a controversial hot spot for years. Presentation of case This case aims to present the surgical procedure of sinus floor augmentation surgery with cyst (18.72 mm × 24.61 mm) in diabetic patient. And 6 months later, the cyst decreased in size. The authors elevated the sinus floor and cyst simultaneously. The surgery was carried out successfully without sinus membrane perforation and the alveolar ridge gained about 8 mm height. Six months later, the cyst decreased in size and osseointegration was observed. Discussion Interdisciplinary cooperation is encouraged to diagnose benign mucosal cyst. The isolation between sinus lumen and the grafted sub-sinus space is important. Graft contamination or dispersion into the sinus lumen should be avoided. The integrity of the sinus membrane and use of antibiotics are very important to prevent the occurrence of postoperative sinus infection Conclusion The authors conclude that sinus augmentation surgery could be done with mucosal cyst in diabetic patient. PMID:26479781
Scribano, E; Ascenti, G; Loria, G; Cascio, F; Gaeta, M
The purpose of the study was to determine the correlation between bony anatomic variations of the ostiomeatal unit (OMU) and chronic maxillary sinusitis. The study was based on the hypothesis that the mucosal contact caused by the variations represents the critical factor in increasing the risk of maxillary sinusitis. Thin section high resolution computerised tomography (CT) examinations of the paranasal sinuses in 73 consecutive patients with 113 anatomic variations of the OMU were retrospectively reviewed. The following CT features were assessed: (1) Type of anatomic variations, (2) presence of a mucosal contact in the OMU and (3) presence of maxillary disease. Statistical evaluation was carried out using chi 2-test. The following bony anatomic variations were found: Concha bullosa (67 cases), abnormalities of the uncinate process (18 cases), Haller's cells (24 cases) and large ethmoidal bulla (four cases). Only 52 of the 113 anatomic variations were associated with ipsilateral maxillary disease (mucosal thickening, mucous retention cysts, polyps, retained secretions). Of 113 variations, 44 caused a mucosal contact, 35 of these were associated with maxillary abnormalities, while in nine cases there were no pathologic changes. Of 69 variations, 17 did not cause mucosal contact (P < 0.05). Our data shows that, in the presence of anatomic bony variations, a contact between the mucosal surface of the OMU is valuable in predicting the likelihood of a maxillary inflammatory disease.
Morcom, Samuel; Phillips, Nicholas; Pastuszek, Andrew; Timperley, Daniel
Acute and chronic sinusitis are common primary care presentations. They are caused by mucosal inflammation, which inhibits mucociliary function of the nose and paranasal sinuses. This article provides an overview of acute and chronic sinusitis, and a guide to workup and management in a primary care setting. Complications and other indications for referral are discussed. Sinusitis involves a wide spectrum of presentations, both acute and chronic. It is primarily a medical condition, and surgical management is reserved for complicated or refractory cases.
Fusari, Pietro; Doto, Matteo; Chiapasco, Matteo
Background. Rehabilitation of edentulous jaws with implant-supported prosthesis has become a common practice among oral surgeons in the last three decades. This therapy presents a very low incidence of complications. One of them is the displacement of dental implants into the maxillary sinus. Dental implants, such as any other foreign body into the maxillary sinus, should be removed in order to prevent sinusitis. Methods. In this paper, we report a case of dental implant migrated in the maxillary sinus and removed by means of the bone lid technique. Results and Conclusion. The migration of dental implants into the maxillary sinus is rarely reported. Migrated implants should be considered for removal in order to prevent possible sinusal diseases. The implant has been removed without any complications, confirming the bone lid technique to be safe and reliable. PMID:23762641
Jalali, Elnaz; Al-Salman, Wesam; Jambhekar, Shantanu; Katechia, Bina; Almas, Khalid
Purpose Sinus elevation procedures have become a routine and reliable way to gain bone volume in the edentulous maxilla for dental implant placement. Presence of bony septations and pathology in the maxillary sinus often cause complications leading to graft or implant failure or both. The aim of this study was to retrospectively evaluate the prevalence of pathology, direction of the septa, and sinus width measured at 2 mm, 5 mm, and 10 mm from the sinus floor in maxillary sinuses using cone-beam computed tomography (CBCT). Materials and Methods Seventy-two sinuses from 36 random preoperative CBCT scans referred for implant therapy were retrospectively evaluated for the number, prevalence, and direction of bony septations and presence of pathology. Width of the sinus was also measured at 2 mm, 5 mm, and 10 mm from the sinus floor to account for the amount of bone available for implant placement. Results Maxillary sinus septa were found in 59.7%. Presence of a single septum was noted in 20 sinuses (27.7%), followed by two septa in 17 sinuses. The most common direction of the septum was the transverse direction. Retention pseudocyst and mucosal thickening were the most commonly seen abnormality/pathology. Conclusion Based on the high prevalence of septa and sinus pathology in this sample, a preoperative CBCT scan might be helpful in minimizing complications during sinus augmentation procedures for dental implant therapy. PMID:27358818
de Oliveira, Greison R; Olate, Sergio; Cavalieri-Pereira, Lucas; Pozzer, Leandro; Asprino, Luciana; de Moraes, Marcio; de Albergaría-Barbosa, Jose Ricardo
The maxillary sinus lift is recognized and stable, and there have been different innovations to optimize the technique. The aim of this study was to investigate the maxillary sinus lift technique with the use of a blood clot and without the use of a bone graft. Ten patients were recruited for a unilateral sinus lift; patients without sinus pathology or other contraindication were selected. The maxillary sinus was accessed conventionally under local anesthesia followed by an osteotomy and a 1-cm(2) bony window access. The sinus membrane was detached and the window was repositioned above and stabilized with a 12- or 14-mm osteosynthesis screw introduced through the alveolar ridge. Dental implants were installed in the second surgical stage. Standardized panoramic radiographic checks were performed at every stage. Seven completely edentulous patients and 3 partially dentate patients were treated surgically. From the first to the second surgery, a bone gain of 2.37 mm was obtained, although loss of bone height was observed in 1 completely edentulous patient. In 7 patients, it was not possible to install the implants owing to insufficient bone height or inadequate bone quality. The protocol used in this investigation failed in the bone increase required for implant installation. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Riben, Christopher; Thor, Andreas
There is a limited amount of studies evaluating long-term results of the sinus membrane elevation technique for bone formation around implants in the maxillary sinus floor without the use of bone graft material. To investigate the long-term results of this technique with regard to implant survival and bone gain in the maxillary sinus floor. A retrospective study was conducted on patients who had undergone the surgical procedure from November 2001 to August 2008. Thirty-six patients with a total of 87 implants (ASTRA TECH Implant System™) in 53 sinuses were examined. After a submerged healing period of 6 months and at least 12 months of loading, the patients were examined clinically and radiologically. Implant stability was measured using resonance frequency analysis (RFA). The mean follow-up time was 4.6 years (range 1.5-7 years). Five implants were lost giving a survival rate of 94.3%.Subantral preoperative vertical bone levels were in the range of 1 to 10 mm. The average bone gain at the sinus floor was 6 mm. The 55 fixtures eligible for RFA displayed a mean implant stability quotient of 77 (range 56-85.5). The present study illustrates the long-term reliability of the technique. © 2015 Wiley Periodicals, Inc.
Kilic, Cenk; Kamburoglu, Kivanc; Yuksel, Selcen Pehlivan; Ozen, Tuncer
Objectives: The aim of the present study was to assess the relationship between the maxillary sinus floor and the maxillary posterior teeth root tips using dental cone-beam CT. Methods: A total of 87 right and 89 left maxillary sinus regions from 92 patients were examined using dental cone-beam CT. Images were analyzed by a specialist in oral and maxillofacial radiology. Perpendicular lines were drawn on the cross-sectional images between the deepest point of the maxillary sinus floor and the root tips of the maxillary first and second premolars and first, second and third molars, and the distances were measured using built-in measurement tools. Means, standard deviations and minimum and maximum values were calculated for all right and left premolars and molars. T-tests were used to compare measurements between left and right sides and between female and male patients. Results: The distance between sinus floor and root tip was longest for the first premolar root tip and shortest for the second molar buccodistal root tip for both right and left sides. No statistically significant differences were found between the right and left side measurements or between female and male patients (P>.05). Conclusions: Knowledge of the anatomical relationship between the maxillary sinus floor and the maxillary posterior teeth root tips is important for the preoperative treatment planning of maxillary posterior teeth. PMID:20922167
Thomas, Colin; Aizin, Vitali
OBJECTIVE To evaluate the oropharyngeal red streak sign for diagnosing acute sinusitis. DESIGN Exploratory cohort study. SETTING A Veterans Affairs medical center urgent care center. PARTICIPANTS Sixty consecutive subjects presenting with nasal symptoms lasting 4 weeks or less. MEASUREMENTS AND MAIN RESULTS Each subject underwent a structured history and physical examination, followed by a sinus computed tomography (CT) scan. Acute sinusitis was defined by an air-fluid level or opacification of 1 or more sinuses on CT imaging. Twenty-seven subjects were diagnosed with sinusitis. A localized red streak in the lateral recess of the oropharynx was associated with sinusitis, with a positive likelihood ratio (LR+) and 95% confidence interval (CI) of 2.11 (1.23, 3.63) and a negative likelihood ratio (LR−) and 95% CI of 0.44 (0.24, 0.83). Opacity on maxillary or frontal sinus transillumination was also associated with sinusitis (LR+ of 1.89; CI 1.03, 3.32 and LR− of 0.56; CI 0.32, 0.96). Symptom duration >10 days was associated with acute sinusitis with an LR+ of 1.89 (1.06, 3.59). A history of facial pain (LR+ of 0.59; CI 0.39, 0.90 and LR− of 2.85; CI 1.27, 6.41) and the finding of sinus percussion tenderness (LR+ of 0.22; CI 0.05, 0.90 and LR− of 1.88; CI 1.17, 3.03) were inversely associated with sinusitis. CONCLUSIONS The oropharyngeal red streak may be an accurate physical sign for diagnosing acute sinusitis. This sign should be included in future studies of clinical diagnostic criteria for acute sinusitis. PMID:16918746
Wald, Ellen R
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the etiologic agents of acute bacterial sinusitis (ABS). Staphylococcus aureus has been an uncommon cause of ABS despite its frequent occupancy within the anterior nares. A quantitative culture of a maxillary sinus aspirate is the gold standard for determining etiology of ABS. Cultures of the middle meatus cannot be used as a surrogate for a maxillary sinus aspirate in children with ABS, although they may be used in adults if interpretation is confined to usual sinus pathogens. Recent studies highlighting S. aureus as a major pathogen in ABS should be interpreted cautiously. Most isolates in recent pediatric studies were derived from cultures of the middle meatus. The range of reported results for the incidence of S. aureus as a cause of ABS in adults is similar to the results reported for staphylococcal colonization of the middle meatus in healthy adults.
Hayek, Elie; Nasseh, Ibrahim; Hadchiti, Wahib; Bouchard, Philippe; Moarbes, Maria; Khawam, Georges; Bechara, Boulos; Noujeim, Marcel
The blood supply to both the lateral wall of the maxillary sinus and the overlying membrane originates from the posterosuperior alveolar artery (PSAA) and the infraorbital artery. The purpose of the present study was to evaluate the anatomic characteristics of the PSAA in a large number of subjects of the Lebanese population. Images of 696 sinuses were analyzed using cone beam computed tomography (CT). Coronal, axial, and sagittal CT images were evaluated for the presence of an osseous canal in the lateral wall of the sinus, and the prevalence, position, and location of the canal were studied and presented.
Chen, Min-zhen; Xie, Yong-fu; Xie, Hui; Wang, Guo-hai; He, Jia-cai
To observe the incidence, location, morphological characteristics of sinus septa among Changzhou population, and to investigate the relationship between maxillary posterior teeth loss and bony septum, and the guiding significance for sinus lift. One hundred and twenty-four subjects were selected, the preoperative cone-beam CT (CBCT) data was analyzed by NNT software, which provided a three-dimensional measurement of the maxillary sinus septa. SPSS 13.0 software package was used for statistical analysis. 33.87%（42/124）subjects had sinus septa, 27.42%（68/248）sinus had septa. 66.18% (45/68) of the septa were located in the middle region, 22.06% （15/68）in the posterior region, 11.76%（8/68） in the anterior region. The occurrence of sinus septa had no relation with gender, age and loss of teeth. The sinus septa can be observed by CBCT for the position, pattern, to predict the difficulty of the surgery, and enhance the success rate.
Kim, Jin-Woo; Cho, Kyung-Mo; Park, Se-Hee; Park, Soh-Ra; Lee, Sang-Shin
This is a case report of chronic maxillary sinusitis caused by root canal overfilling of Calcipex II (Techno-Dent). A 60 year-old male complained of dull pain in the right maxillary molar area after complicated endodontic treatment using Calcipex II paste and was finally diagnosed with a chronic maxillary sinusitis through a clinical and radiological observation. In the biopsy examination, the periapical granuloma contained a lot of dark and translucent Calcipex II granules which were not stained with hematoxylin and eosin. They were usually engulfed by macrophages but rarely resorbed, resulting in scattering and migrating into antral mucosa. Most of the Calcipex II granules were also accumulated in the cytoplasms of secretory columnar epithelial cells, and small amount of Calcipex II granules were gradually secreted into sinus lumen by exocytosis. However, chronic granulomatous inflammation occurred without the additional recruitment of polymorphonuclear leukocytes (PMNs) and lymphocytes, and many macrophages which engulfed the Calcipex II granules were finally destroyed in the processes of cellular apoptosis. It is presumed that Calcipex II granules are likely to have a causative role to induce the granulomatous foreign body inflammation in the periapical region, and subsequently to exacerbate the chronic maxillary sinusitis in this study. PMID:24516832
Kreppel, Matthias; Safi, Ali-Farid; Scheer, Martin; Nickenig, Hans-Joachim; Zöller, Joachim; Preuss, Simon; Meyer, Moritz; Rothamel, Daniel; Dreiseidler, Timo
There are two major challenges in the early diagnosis of maxillary sinus carcinoma: the maxillary sinus is not susceptible to direct inspection and palpation, and symptoms are uncharacteristic. The aim of this study was to assess the impact of the time interval between first symptoms noticed by the patient and the detection of the tumor on survival. 88 patients with maxillary sinus tumors were included in the retrospective study. Prognostic factors were identified through univariate analysis. Univariate analysis (p = 0.019) revealed a significant impact of the time interval from first symptom to diagnosis on overall survival. With increasing duration of the symptoms 5-year overall survival was reduced from 65 % for duration between 0 and 2 months to 24 % for duration of symptoms longer than 12 months. Furthermore, we found a significant association (p = 0.033) between local extension of the tumor and time interval from first symptom to diagnosis. Early diagnosis is often difficult because of uncharacteristic symptoms, which are identical with benign diseases of the maxillary sinus. The delay between the occurrence of the first symptom and diagnosis often makes a curative treatment impossible.
Kim, Jin-Woo; Cho, Kyung-Mo; Park, Se-Hee; Park, Soh-Ra; Lee, Sang-Shin; Lee, Suk-Keun
This is a case report of chronic maxillary sinusitis caused by root canal overfilling of Calcipex II (Techno-Dent). A 60 year-old male complained of dull pain in the right maxillary molar area after complicated endodontic treatment using Calcipex II paste and was finally diagnosed with a chronic maxillary sinusitis through a clinical and radiological observation. In the biopsy examination, the periapical granuloma contained a lot of dark and translucent Calcipex II granules which were not stained with hematoxylin and eosin. They were usually engulfed by macrophages but rarely resorbed, resulting in scattering and migrating into antral mucosa. Most of the Calcipex II granules were also accumulated in the cytoplasms of secretory columnar epithelial cells, and small amount of Calcipex II granules were gradually secreted into sinus lumen by exocytosis. However, chronic granulomatous inflammation occurred without the additional recruitment of polymorphonuclear leukocytes (PMNs) and lymphocytes, and many macrophages which engulfed the Calcipex II granules were finally destroyed in the processes of cellular apoptosis. It is presumed that Calcipex II granules are likely to have a causative role to induce the granulomatous foreign body inflammation in the periapical region, and subsequently to exacerbate the chronic maxillary sinusitis in this study.
Orsini, Giovanna; Scarano, Antonio; Piattelli, Maurizio; Piccirilli, Marcello; Caputi, Sergio; Piattelli, Adriano
The purpose of the present study was the histologic and ultrastructural evaluation of a biomaterial composed of cortical pig bone in the form of granules. After maxillary sinus augmentation using this biomaterial, 10 specimens were retrieved after 5 months in 10 patients using this biomaterial. The specimens were processed to be observed under light microscopy (LM) and transmission electron microscopy (TEM). Histomorphometric measurements were presented by means +/- standard deviations. LM showed that most of the particles were surrounded by newly formed bone. In some areas, the osteoid matrix was present; however, mainly compact bone was present at the interface. There was no evidence of an acute inflammatory infiltrate. The newly formed bone was 36% +/- 2.8% and marrow spaces were 38% +/- 1.6%, whereas residual grafted material was 31% +/- 1.6%. Under TEM, all phases of bone formation (osteoid matrix, woven, and lamellar bone) were observed in proximity with the biomaterial particles. The bone-biomaterial interface showed a close contact between the porcine bone particles and the surrounding bone that had mainly features of mature bone with numerous osteocytes. A lamina limitans was sometimes present at this interface. According to our knowledge, this is the first study presenting data on TEM of a porcine bone-derived biomaterial used in sinus augmentation procedures in humans. Our findings show that this is a biocompatible biomaterial that can be used for maxillary sinus augmentation procedures without interfering with the normal reparative bone processes.
Kusunoki, Takeshi; Ikeda, Katsuhisa
We report a case of a neuroendocrine carcinoma arising in a wound of the postoperative maxillary sinus that was difficult to distinguish from a postoperative maxillary cyst. The patient was a 65-year-old Japanese woman who complained of left exophthalmos with cheek swelling and eye movement disorders. In past history, she had, 40 years previously undergone operation on the bilateral maxillary sinus by Caldwell-Luc's method. In a preoperative computed tomography, a mass occupied the left maxillary sinus showing irregular densities with destruction of the posterior bone walls and invasion into the left orbital. Both TI and T2 weighted magnetic resonance imaging showed low intensities and unevenness in the mass. We performed a biopsy of the maxillary tumor according to Caldwell-Luc's method. Histological examination diagnosed neuroendocrine carcinoma. Radiation therapy (total 66Gy) resulted in partial response for this tumor. However, sinonasal neuroendocrine carcinoma has been identified as highly aggressive, with a high probability of recurrence and metastasis. PMID:24765415
Dhandapani, Radha Bharathi; Baskaran, Shivakumar; Arun, Kurumathur Vasudevan; Kumar, Thirunelveli Saravanan Subbu
The posterior maxillary segment frequently exhibits insufficient bone mass to support dental implants. Sinus floor augmentation enables implant placement in the posterior maxilla. This case series included ten sites, in which sinus floor elevation was done using sinus lift balloon system followed by augmentation utilizing irradiated cancellous bone allograft. Postoperative radiographic assessment of vertical bone gain was done at 3 and 6 months follow-up period. The mean initial and final bone height were 6.16 and 10.50 mm, respectively, with a mean increase of 4.34 mm at 6 months being observed with nil complication. The presented technique might represent a viable alternative for sinus elevation in posterior atrophied maxilla. Irradiated cancellous bone allograft can be advocated as an ideal bone graft material for sinus augmentation procedures. PMID:28298833
You, Joon S.; Cerussi, Albert E.; Kim, James; Ison, Sean; Wong, Brian; Cui, Haotian; Bhandarkar, Naveen
Efficient management of chronic sinusitis remains a great challenge for primary care physicians. Unlike ENT specialists using Computed Tomography scans, they lack an affordable and safe method to accurately screen and monitor sinus diseases in primary care settings. Lack of evidence-based sinusitis management leads to frequent under-treatments and unnecessary over-treatments (i.e. antibiotics). Previously, we reported low-cost optical imaging designs for oral illumination and facial optical imaging setup. It exploits the sensitivity of NIR transmission intensity and their unique patterns to the sinus structures and presence of fluid/mucous-buildup within the sinus cavities. Using the improved NIR system, we have obtained NIR sinus images of 45 subjects with varying degrees of sinusitis symptoms. We made diagnoses of these patients based on two types of evidence: symptoms alone or NIR images along. These diagnostic results were then compared to the gold standard diagnosis using computed tomography through sensitivity and specificity analysis. Our results indicate that diagnosis of mere presence of sinusitis that is, distinguishing between healthy individuals vs. diseased individuals did not improve much when using NIR imaging compared to the diagnosis based on symptoms alone (69% in sensitivity, 75% specificity). However, use of NIR imaging improved the differential diagnosis between mild and severe diseases significantly as the sensitivity improved from 75% for using diagnosis based on symptoms alone up to 95% for using diagnosis based on NIR images. Reported results demonstrate great promise for using NIR imaging system for management of chronic sinusitis patients in primary care settings without resorting to CT.
Doig, T N; McDonald, S W; McGregor, I A
Carcinomas arising in the maxillary sinus, occasionally present clinically in the oral cavity along the occlusal ridge of the upper alveolus. The mechanism of this spread has not been investigated but it may resemble invasion of the mandible by oral carcinomas, which tend to invade the soft tissues rather than eroding through bone. In Britain, such patients are usually edentulous. This project examines deficiencies in the bony walls of the maxillary sinus to determine possible routes of spread. Maxillae were obtained from one side of 17 dissecting room cadavers, aged 71-95 years; 15 were edentulous. The roof of the maxillary sinus was removed in all specimens. Five maxillae were each cut into six slices, 0.5 cm thick, in a vertical bucco-lingual plane. In all, soft tissues were removed by treatment in dilute bleach. Histological sections, cut in the horizontal plane, were prepared of a further three maxillae. Several possible routes were identified by which tumors could spread from the sinus to the oral cavity: 1) directly through foramina in its floor; 2) through numerous foramina in its floor to the marrow cavity of the alveolar process, which mostly contained fat amongst narrow bony trabeculae. (The marrow cavity, in turn, had numerous communications with the occlusal surface); 3) through foramina which carried branches of the superior alveolar nerves and vessels; 4) through deficiencies in the bony walls of the sinus at the neurovascular grooves and elsewhere.
Redondo-González, Luis-Miguel; Verrier-Hernández, Alberto
Introduction: Invasive aspergillosis of the paranasal sinuses is a rare disease and often misdiagnosed; however, its incidence has seen substancial growth over the past 2 decades. Definitive diagnosis of these lesions is based on histological examination and fungal culture. Case Report: An 81-year-old woman with a history of pain in the left maxillary region is presented. The diagnosis was invasive maxillary aspergillosis in immunocompetent patient, which was successfully treated with voriconazole and surgical debridement. Possible clinical manifestations, diagnostic imaging techniques and treatment used are discussed. Since the introduction of voriconazole, there have been several reports of patients with invasive aspergillosis who responded to treatment with this new antifungal agent. Conclusions: We report the importance of early diagnosis and selection of an appropriate antifungal agent to achieve a successful treatment. Key words:Invasive aspergillosis, voriconazole, fungal sinusitis, antifungal agent, open sinus surgery. PMID:25593673
Yamaguchi, Keiji; Matsunaga, Tsunenori; Hayashi, Yoshihiko
A gross extrusion of endodontic obturation materials occurred from tooth 3 into the right maxillary sinus. The patient had never been conscious of uncomfortable symptoms, both at tooth 3 or buccal regions. A computed tomographic (CT) scan showed cord-like foreign substances extruded from the apex of the tooth and the hyperplasticity of the sinal mucosa. The surgical removal of foreign substances and partial curettage of sinal mucosa were indicated to prevent the possibility of sinus infection. At the 4-month recall, the patient was symptom free. This case emphasizes that an open apex can become potentially dangerous when the vertical condensation method is used. If massive overfilling is recognized radiographically in molar regions, an examination using panoramic radiograph is indispensable to detect the gross extrusion into the maxillary sinus, such as in this case.
McIntosh, D L; Mahadevan, M
Acute bacterial sinusitis is common in the pediatric population. Intracranial spread of infection is a rare but life-threatening complication of acute sinusitis. Due to the infrequent presentation of this complication, there are no well-defined management protocols for the acute sinusitis. We present three pediatric cases where children presented with intracranial sepsis, and the underlying source of infection was from the paranasal sinuses. In all cases, endoscopic sinus surgery was performed in the acute setting, with the use of frontal sinus mini-trephines playing a significant role. We describe our experience and review the available literature.
Kim, Su-Gwan; Mitsugi, Masaharu; Kim, Byung-Ock
This article describes a procedure for performing simultaneous sinus lifting and alveolar distraction to augment an atrophic maxillary alveolus. This technique is a 1-stage operation that is indicated when the amount of native sinus floor bone is minimal (<5 mm). The technique is contraindicated when there is <2 mm of sinus floor,when a 2-stage operation is needed (sinus lifting, alveolar distraction osteogenesis). Postoperative complications are minimal.
Livas, Christos; Halazonetis, Demetrios J; Booij, Johan Willem; Pandis, Nikolaos; Tu, Yu-Kang; Katsaros, Christos
Our objective was to investigate potential associations between maxillary sinus floor extension and inclination of maxillary second premolars and second molars in patients with Class II Division 1 malocclusion whose orthodontic treatment included maxillary first molar extractions. The records of 37 patients (18 boys, 19 girls; mean age, 13.2 years; SD, 1.62 years) treated between 1998 and 2004 by 1 orthodontist with full Begg appliances were used in this study. Inclusion criteria were white patients with Class II Division 1 malocclusion, sagittal overjet of ≥4 mm, treatment plan including extraction of the maxillary first permanent molars, no missing teeth, and no agenesis. Maxillary posterior tooth inclination and lower maxillary sinus area in relation to the palatal plane were measured on lateral cephalograms at 3 time points: at the start and end of treatment, and on average 2.5 years posttreatment. Data were analyzed for the second premolar and second molar inclinations by using mixed linear models. The analysis showed that the second molar inclination angle decreased by 7° after orthodontic treatment, compared with pretreatment values, and by 11.5° at the latest follow-up, compared with pretreatment. There was evidence that maxillary sinus volume was negatively correlated with second molar inclination angle; the greater the volume, the smaller the inclination angle. For premolars, inclination increased by 15.4° after orthodontic treatment compared with pretreatment, and by 8.1° at the latest follow-up compared with baseline. The volume of the maxillary sinus was not associated with premolar inclination. We found evidence of an association between maxillary second molar inclination and surface area of the lower sinus in patients treated with maxillary first molar extractions. Clinicians who undertake such an extraction scheme in Class II patients should be aware of this potential association and consider appropriate biomechanics to control root
Background Although cone beam computed tomography (CBCT) images of the maxillofacial region allow the inspection of the entire volume of the maxillary sinus (MS), identifying anatomic variations and abnormalities in the image volume, this is frequently neglected by oral radiologists when interpreting images of areas at a distance from the dentoalveolar region, such as the full anatomical aspect of the MS. The aim of this study was to investigate maxillary sinus abnormalities in asymptomatic patients by using CBCT. Methods 1113 CBCT were evaluated by two examiners and identification of abnormalities, the presence of periapical lesions and proximity to the lower sinus wall were recorded. Data were analyzed using descriptive statistics, chi-square tests and Kappa statistics. Results Abnormalities were diagnosed in 68.2% of cases (kappa = 0.83). There was a significant difference between genders (p < 0.001) and there was no difference in age groups. Mucosal thickening was the most prevalent abnormality (66%), followed by retention cysts (10.1%) and opacification (7.8%). No association was observed between the proximity of periapical lesions and the presence and type of inflammatory abnormalities (p = 0.124). Conclusions Abnormalities in maxillary sinus emphasizes how important it is for the dentomaxillofacial radiologist to undertake an interpretation of the whole volume of CBCT images. PMID:22883529
Persson, L.; Andersson, M.; Svensson, T.; Cassel-Engquist, M.; Svanberg, K.; Svanberg, S.
We demonstrate a novel non-intrusive technique based on tunable diode laser absorption spectroscopy to investigate human maxillary sinuses in vivo. The technique relies on the fact that free gases have much sharper absorption features (typical a few GHz) than the surrounding tissue. Molecular oxygen was detected at 760 nm. Volunteers have been investigated by injecting near-infrared light fibre-optically in contact with the palate inside the mouth. The multiply scattered light was detected externally by a handheld probe on and around the cheek bone. A significant signal difference in oxygen imprint was observed when comparing volunteers with widely different anamnesis regarding maxillary sinus status. Control measurements through the hand and through the cheek below the cheekbone were also performed to investigate any possible oxygen offset in the setup. These provided a consistently non-detectable signal level. The passages between the nasal cavity and the maxillary sinuses were also non-intrusively optically studied, to the best of our knowledge for the first time. These measurements provide information on the channel conductivity which may prove useful in facial sinus diagnostics. The results suggest that a clinical trial together with an ear-nose-throat (ENT) clinic should be carried out to investigate the clinical use of the new technique.
Smith, Timothy D; Rossie, James B; Cooper, Gregory M; Carmody, Kelly A; Schmieg, Robin M; Bonar, Christopher J; Mooney, Mark P; Siegel, Michael I
The air filled cavities of paranasal sinuses are thought by some to appear opportunistically in spatial "gaps" within the craniofacial complex. Anthropoid primates provide excellent natural experiments for testing this model, since not all species possess a full complement of paranasal sinuses. In this study, two genera of monkeys (Saguinus and Cebuella) which form maxillary sinuses (MS) as adults were compared to squirrel monkeys (Saimiri spp.), in which a MS does not form. Using microCT and histomorphometric methods, the spatial position of paranasal spaces was assessed and size of the adjacent dental sacs was measured. In Saguinus, secondary pneumatization is underway perinatally, and the sinus extends alongside deciduous premolars (dp). The MS overlaps all permanent molars in the adult. In Saimiri, the homologous space (maxillary recess) extends no farther posterior than the first deciduous premolar at birth and extends no farther than the last premolar in the adult. Differences in dental size and position may account for this finding. For example, Saimiri has significantly larger relative dp volumes, and enlarged orbits, which encroach on the internasal space to a greater degree when compared to Saguinus. These factors limit space for posterior expansion of the maxillary recess. These findings support the hypothesis that secondary pneumatization is a novel, opportunistic growth mechanism that removes "unneeded" bone. Moreover, paranasal spaces occur in association with semiautonomous skeletal elements that border more than one functional matrix, and the spatial dynamics of these units can act as a constraint on pneumatic expansion of paranasal spaces.
Cortes, Arthur Rodriguez Gonzalez; Pinheiro, Lucas Rodrigues; Cavalcanti, Marcelo Gusmão Paraíso; Arita, Emiko Saito; Tamimi, Faleh
Extreme bone resorption in posterior maxilla may lead to absence of part of the sinus floor. This phenomenon has been termed sinus floor bone failure, and may compromise sinus floor augmentation. The present article aims to evaluate risk factors related to sinus floor bone failures and to evaluate the influence of these failures in sinus floor augmentation outcomes in patients with severely atrophic posterior maxilla. In this case-control study, patients were selected among those referred for sinus floor augmentation. Only patients presenting a ridge bone height of less than 3 mm were included. Cases were defined as presenting sinus floor bone failure, whereas controls did not present any interruption in the sinus floor bone. Information collected included clinical dental records and computed tomographic assessment of sinus width, septa, and schneiderian membrane. Risk estimates for sinus floor bone failures were calculated as adjusted odds ratios (AORs) with 95% confidence intervals (CIs) using conditional logistic regression analyses. A p value under 0.05 was considered statistically significant. In addition, sinus floor augmentation outcomes of both groups were also assessed. In all, 23 cases and 58 controls were included in the study. Sinus floor bone failures were significantly associated with the number of missing posterior teeth (AOR 3.67; 95% CI 0.86 to 15.63; p = .046) and a history of periodontitis (AOR 6.39; 95% CI 1.86 to 21.95; p = .002). Of the total, 15 cases and 27 controls underwent sinus floor augmentation. Schneiderian membrane perforation occurred during the surgery of two cases and of one control. No implants were lost during a mean postsurgical follow-up of 20 months. The number of missing posterior teeth and a history of periodontitis may be considered as risk factors for sinus floor bone failures. © 2013 Wiley Periodicals, Inc.
Sardana, Vijay; Mittal, Lal Chand; Meena, S R; Sharma, Deepti; Khandelwal, Girish
Chickenpox is one of the classic childhood diseases. Recently chicken pox has been reported in adults with more severe systemic and neurological complications. Cerebral venous thrombosis (CVT) is a life threatening disorder if not treated in time. We report a patient with post varicella CVT as a rare complication of primary Varicella zoster virus. Vasculitic arterial infarction is known while venous stroke has rarely been reported with Varicella-zoster virus infection. Here, we report an immunocompetent 30 yr old male who developed chickenpox after contact with his daughter two month back. He presented with acute neurological deficit, one week after onset of skin lesion. MR venography revealed non-visualisation of left transverse sinus and left sigmoid sinus suggestive of venous sinus thrombosis. Varicella infection is rarely associated with venous sinus thrombosis. Possibly hypercoagulable state produced by the infection or direct invasion of virus in venous endothelial wall with subsequent damage to endothelium leading to thrombosis could be the cause.
Toya, Takashi; Shinohara, Akihito; Tatsuno, Keita; Seo, Sachiko; Nannya, Yasuhito; Ichikawa, Motoshi; Makimura, Koichi; Moriya, Kyoji; Kurokawa, Mineo
Schizophyllum commune is a globally distributed basidiomycete fungus that is known as a rare cause of sinusitis, for which no prompt treatment has been established. We describe the first report of S. commune sinusitis following unrelated cord blood transplantation for acute lymphoblastic leukemia. Thirteen days after transplantation, a 23-year-old female developed maxillary and ethmoid sinusitis. The sinusitis was antimicrobial-resistant, and the sinus aspirate culture revealed white wooly mold, which was identified as S. commune by nucleotide sequencing. The patient was successfully treated with intravenous administration of liposomal amphotericin B for 2 months, followed by oral voriconazole. This report suggests the effectiveness of liposomal amphotericin B and voriconazole for S. commune infection in immunocompromised patients. Given the difficulty in distinguishing S. commune infection from aspergillosis by standard culture methods, the incidence of S. commune infection following allogeneic hematopoietic stem cell transplantation may be underestimated. Nucleotide sequencing may be useful in the diagnosis of S. commune infection.
Romero-Ruiz, Manuel M.; Torres-Lagares, Daniel; Pérez-Dorao, Beatriz; Wainwright, Marcel; Abalos-Labruzzi, Camilo; Gutiérrez-Pérez, José L.
Objectives: Placing implants in the posterior maxillary area has the drawback of working with scarce, poor quality bone in a significant percentage of cases. Numerous advanced surgical techniques have been developed to overcome the difficulties associated with these limitations. Subsequent to reports on the elevation of the maxillary sinus through the lateral approach, there were reports on the use of the crestal approach, which is less aggressive but requires a minimal amount of bone. Furthermore, it is more sensitive to operator technique, as the integrity of the sinus membrane is checked indirectly. The aim of this paper is to review the technical literature on minimally invasive sinus lift and compare the advantages of different techniques with Intralift™, a new technique. Study Design: The present study is a review of techniques used to perform minimally invasive sinus lift published in Cochrane, Embase and Medline over the past ten years and the description of the crestal sinus lift technique based on minimally invasive piezosurgery, with the example of a case report. Results: Only eight articles were found on minimally invasive techniques for sinus lift. The main advantage of this new technique, Intralift, is that it does not require a minimum amount of crestal bone (indeed, the smaller the width of the crestal bone, the better this technique is performed). The possibility of damage to the sinus membrane is minimised by using ultrasound based hydrodynamic pressure to lift it, while applying a very non-aggressive crestal approach. Conclusions: We believe that this technique is an advance in the search for less traumatic and aggressive techniques, which is the hallmark of current surgery. Key words: Sinus lift, surgical technique, minimally invasive surgery, ultrasound surgery. PMID:22143696
Hu, Ying Kai; Yang, Chi; Xu, Guang Zhou; Xie, Qian Yang
Traditional Caldwell-Luc approach needs modifications for odontogenic cysts intruding into the maxillary sinus, to preserve sinus mucosa and bony contour. Recently, digital technology has been widely applied to the field of maxillofacial surgery, guiding the surgical plan and improving its accuracy. This study attempted to present and evaluate the functional surgery of odontogenic cysts intruding into the maxillary sinus using a computer-assisted pre-surgical design. Consecutive patients with odontogenic cysts intruding into the posterior part of the maxillary sinus were enrolled. Method I "Bony wall reimplantation method" was performed for large lesions exceeding the zygomatic alveolar crest but without apparent bone destruction of the anterior wall of the sinus, while Method II "bone removal method" was more convenient for small lesions near to the zygomatic alveolar crest. The gap was filled with a pedicled Buccal Fat Pad (BFP) after lesion removal and all cases were without inferior meatal antrostomy. A total of 45 cases were included in the study. 22 were operated using method I while 23 were operated with method II. Operations were completed in 20min. Pain disappeared in 3.62 days on average, and swelling 6.47 days. Nasal bleeding occurred in 8 patients lasting 1-3 days. Suppurative inflammation was observed in 1 patient, and infection occurred after bone reposition. Other repositioned free bony wall was without resorption in CT images. Sinus mucosa and bony wall should be conserved. Preoperative digital design can guide osteotomy effectively during the surgery. Bone reposition is not suitable for suppurative inflammation. The pedicled BFP is enough for drainage and inferior meatal antrostomy is not necessary. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
Diago-Vilalta, Jose-Vicente; Melo, María; Bagán, Leticia; Soldini, Maria-Costanza; Di-Nardo, Chiara; Ata-Ali, Fadi; Mañes-Ferrer, José-Félix
Background When considering dental implant rehabilitation in atrophic posterior sectors, the maxillary sinuses must be evaluated in detail. Knowledge of the anatomical variations and of the potential lesions found in these structures conditions the outcome of sinus lift procedures and therefore of the dental implants. A systematic review is made to determine the frequency of anatomical variations and pathological findings in maxillary sinuses among patients subjected to cone beam computed tomography (CBCT). Material and Methods A PubMed (MEDLINE) literature search was made of articles published up until 20 December 2015. The systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The quality of the studies included in the review was assessed using the Methodological Index for Nonrandomized Studies (MINORS). Results The combinations of search terms resulted in a list of 3482 titles. Twenty-three studies finally met the inclusion criteria and were entered in the systematic review, comprising a total of 11,971 patients. The most common anatomical variations were pneumatization and sinus septa. The prevalence of maxillary sinus disease ranged from 7.5% to 66%. The most common pathological findings of the maxillary sinus were mucosal thickening, sinusitis and sinus opacification. Conclusions Although the main indication of CBCT of the maxillary sinus in dentistry is sinus floor elevation/treatment planning and evaluation prior to dental implant placement, this imaging modality is increasingly also used for endodontic and periodontal purposes. There is no consensus regarding the cutoff point beyond which mucosal thickening of the maxillary sinus should be regarded as pathological, and the definition of maxillary sinusitis moreover varies greatly in the scientific literature. In this regard, international consensus is required in relation to these concepts, with a clear distinction between healthy and
Tomomatsu, N; Uzawa, N; Aragaki, T; Harada, K
Odontogenic maxillary sinusitis (OMS) is an inflammatory disease caused by the spread of dental inflammation into the sinus. The long-term administration of antibiotic medicine and/or treatment of the causative tooth are the usual initial treatments. These initial treatments are not always effective, and the reason is not well understood. The purpose of this study was to identify factors of significance that may contribute to the results of the initial treatment of OMS. Thirty-nine patients were studied, divided into two groups according to the results of initial treatment: effective or non-effective. The effective group comprised 20 patients who were cured by initial treatment. The non-effective group comprised 19 patients who required an additional operation. The duration of symptoms, spread into the other sinuses, aperture width of the osteomeatal complex (OMC) on the side of the maxillary sinus, and anatomical variations in the sinuses were compared between the groups. The only significant difference found was in the aperture width of the OMC, which was significantly narrower in the non-effective group than in the effective group. The aperture width of the OMC may be a significant predictor of the effectiveness of initial treatment of OMS.
Baş, Burcu; Özden, Bora; Özdemir, Muhsin; Yüksel, Esra Pancar
To present a case of Herpes Zoster Ophtalmicus (HZO), which was reactivated postoperatively after a sinus lift operation. A 39-year-old male was referred to our clinic for implant-supported dental rehabilitation. He had maxillary missing teeth in positions 13, 14, 15 and 16 and a pneumatised right maxillary sinus with a bone height of 2 mm. Lateral sinus lifting and bone block grafting was performed before implant insertion. Twelve days after the sinus lift, the patient complained of pain and itching at the infraorbital area extending to the forehead. Clinical examination revealed no signs of infection or allergy. The patient received consultation from a dermatologist in order to rule out a possible dermatological disorder. Finally he was diagnosed with HZO. HZO was managed with systemic acyclovir treatment. Vesicular rashes and ptosis was seen 3 days after the medical treatment. After 1 month no postoperative skin or orbital sequela was seen. Three implants were inserted at the right posterior maxilla 5 months after sinus lift. One-year followup was uneventful. Dermatological diseases should always be kept in mind during the differential diagnosis of orofacial pain. In this case the proximity of the operation site and affected area gave rise to the idea that surgical trauma had a possible role in the reactivation of the virus. However, the process of reactivation is not entirely understood and requires further investigations. Early diagnosis is essential for HZO in order to avoid debilitating complications such as postherpetic neuralgia and blindness.
Kühl, S; Kirmeier, R; Platzer, S; Bianco, N; Jakse, N; Payer, M
Sinus floor augmentation using transalveolar techniques is a successful and predictable procedure. The aim of the study was to compare the performance of conventional hand instruments using mallets and osteotomes with that of piezoelectric-hydrodynamic devices for maxillary sinus floor elevation. In 17 undamaged cadaver heads on randomly allocated sites, Schneiderian membrane elevation was carried out transcrestally using piezosurgery and a hydrodynamic device or by conventional hand instrumentation. After simulation of sinus augmentation by the use of a radiopaque impression material, a post-operative CT scan was carried out and volumes were determined. Statistic significant differences between the two methods were evaluated by nonparametric Mann-Whitney U-test with P < 0.05. A mean graft volume of 0.29 ± 0.18 cm(3) (0.07-0.60 cm(3)) was measured for the Summers' technique compared to 0.39 ± 0.32 cm(3) (0.05-1.04 cm(3)) for the Sinus Physiolift(®) technique. There is no statistically significant difference with regard to trauma to the Schneiderian membrane or augmented volume. Both techniques generate expedient augmentation volume in the posterior atrophic maxilla. The piezoelectric technique can be recommended as an alternative tool to graft the floor of human maxillary sinuses. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Trianto, Herman Bagus; Wardhani, Shinta Oktya
Waldenstrom macroglobulinemia is a chronic, indolent, lymphoproliferative disorder, which is characterized by the presence of a high macroglobulin (IgM) level, elevated serum viscosity, and the presence of a lymphoplasmacytic infiltrate in the bone marrow. Clinical manifestations may be found due to the presence of IgM paraprotein and malignant lymphoplasmacytic cell infiltration of the bone marrow and other tissues. We reported a case of male patient with Waldenstrom macroglobulinemia and bilateral maxillary sinusitis. He had received symptomatic and antibiotic treatment for his sinusitis, FFP and PRC transfusion to improve his general condition and chemotherapy with CHOP regimen as definitive treatment.
Raghoebar, G M; Brouwer, T J; Reintsema, H; Van Oort, R P
Placement of endosseous implants in the atrophic maxilla is often restricted because of lack of supporting bone. In this article, experience with augmentation of the maxillary sinus floor with autogenous bone grafts to enable insertion of endosseous implants is described. The technique is aimed at providing a cortical layer on top of the graft to ensure a reliable seal of the maxillary sinus and to achieve optimal stability of the bone graft in case of simultaneously placement of dental implants. The procedure was used in 25 patients, using iliac crest grafts (22 patients, 86 implants), symphyseal bone grafts (two patients, six implants), or a maxillary tuberosity bone graft (one patient, one implant). Ninety-three Brånemark implants (Nobelpharma, Götenburg, Sweden) were inserted in 47 grafted maxillary sinuses. The mean follow-up was 16 months (range, 6 to 36 months). No inflammation of the bone grafts nor of the maxillary sinus occurred. The sinus membrane was perforated accidentally in eight cases during the surgical procedure. Five implants (5.4%), all inserted in iliac crest grafts, were lost during the healing period. The patients received implant supported overdentures (16 patients) or bone-anchored bridges (nine patients). From this preliminary study it is concluded that augmentation of the maxillary sinus floor with bone grafts for the insertion of endosseous implants is a promising solution for patients with atrophic maxillae and functional problems with their partial or full dentures.
Blomqvist, J E; Alberius, P; Isaksson, S; Linde, A; Obrant, K
The aim of this study was to determine whether bone quality, as assessed by osteometry and histologic parameters, can be used to predict implant integration in conjunction with maxillary sinus reconstruction. Twelve patients with severely atrophied maxillary alveolar processes were treated through use of a two-stage surgical reconstructive strategy with implant placement 4 months after bone grafting. Bone biopsy specimens taken from the iliac crest peroperatively and from the sinus inlay sites 1, 2, 4, 6, or 12 months postoperatively were analyzed by light microscopy and osteomorphometry. Bone mineral content was measured by osteometry. Osteometric and osteomorphometric data (trabecular bone volume [%], assessment of chromatin staining, and an osteocyte index) registered for the biopsy specimens were not statistically correlated with implant failure. Prognostic evaluation of implant survival is difficult. The tested methods did not contribute to the improvement of guidelines for the clinical handling of these patients.
Yokoi, Hidenori; Yazawa, Takuya; Matsumoto, Yuma; Ikeda, Tetsuya; Fujiwara, Masachika; Ohkura, Yasuo; Kohno, Naoyuki
We report a patient who had an inflammatory pseudotumor (IPT) that invaded to the maxillary sinus and orbital cavity, with the left pterygopalatine fossa as the principal site; this is a very rare case. The patient was an 83-year-old woman who suddenly became aware of impairment in the eyesight and visual field of the left eye. CT images showed a neoplastic lesion that invaded to the maxillary sinus and orbital cavity, with the left pterygopalatine fossa as the principal site, and also showed contrast effects. To obtain a definitive diagnosis from histopathological analysis, the lesion was biopsied, and she was diagnosed as the inflammatory pseudotumor with the immunohistochemical study and multiplex polymerase chain reaction-based clonality assays. The patient had a lymphoid-predominant lesion that responded to radiotherapy but corticosteroids were not effective. It is important to scrutinize the pathology to avoid unnecessary and mutilating surgery. PMID:26167321
Graham, S M; Launspach, J L; Welsh, M J; Zabner, J
Serial maxillary sinus aminoglycoside lavage is an adjunctive technique increasingly employed in a variety of areas in cystic fibrosis (CF). It may be helpful in reducing revision rates for sinus surgery, in lowering rates of bronchial pseudomonal colonization after lung transplantation and in the evolving field of gene therapy for CF. The goal of this study was to assess the utility of the maxillary sinus as a model for gene transfer in cystic fibrosis. We performed serial maxillary sinus lavage, in accordance with published protocols, using tobramycin in a randomized series of five CF subjects. Lavage was performed for up to 10 days and sequential magnetic resonance imaging (MRI) scans were taken at zero, 10, 30, 60, 120 and 180 days. The 30 MRI scans were blindly scored by two examiners on the parameters of maxillary sinus aeration, averaged over the five time intervals, was significantly improved (p < 0.05) in the lavaged sinus. This study provides the first systematic image-based measure of efficacy of maxillary sinus aminoglycoside lavage, a major element of a number of clinical protocols used in the treatment of CF. The prolonged increase in aeration after lavage suggests that any further improvement potentially achievable after gene transfer would be difficult to detect, limiting the value of this system as a model of clinical efficacy of gene transfer in CF.
Isler, Sabri Cemil; Demircan, Sabit; Soluk, Merva; Cebi, Zerrin
As a group, odontomas are the most common odontogenic neoplasms. This case report illustrates the benefits of cone beam computed tomography, in terms of treatment planning and surgical technique, to localize a large maxillary odontoma and accurately establish its relationship with the maxillary sinus and molar.
Velázquez-Cayón, R; Romero-Ruiz, M-M; Torres-Lagares, D; Pérez-Dorao, B; Wainwright, M; Abalos-Labruzzi, C; Gutiérrez-Pérez, J-L
Placing implants in the posterior maxillary area has the drawback of working with scarce, poor quality bone in a significant percentage of cases. Numerous advanced surgical techniques have been developed to overcome the difficulties associated with these limitations. Subsequent to reports on the elevation of the maxillary sinus through the lateral approach, there were reports on the use of the crestal approach, which is less aggressive but requires a minimal amount of bone. Furthermore, it is more sensitive to operator technique, as the integrity of the sinus membrane is checked indirectly. The aim of this paper is to review the technical literature on minimally invasive sinus lift and compare the advantages of different techniques with Intralift™, a new technique. The present study is a review of techniques used to perform minimally invasive sinus lift published in Cochrane, Embase and Medline over the past ten years and the description of the crestal sinus lift technique based on minimally invasive piezosurgery, with the example of a case report. Only eight articles were found on minimally invasive techniques for sinus lift. The main advantage of this new technique, Intralift, is that it does not require a minimum amount of crestal bone (indeed, the smaller the width of the crestal bone, the better this technique is performed). The possibility of damage to the sinus membrane is minimised by using ultrasound based hydrodynamic pressure to lift it, while applying a very non-aggressive crestal approach. We believe that this technique is an advance in the search for less traumatic and aggressive techniques, which is the hallmark of current surgery.
Laurikainen, E; Hujala, K; Suonpää, J; Mäki, J
Long-term draining tubes (LTD) have become a common treatment in complicated and prolonged forms of maxillary sinus empyema. Since not all patients show good recovery with this treatment we used sinus-manometry, mathematical calculations, and scanning electron microscopy (SEM) to critically analyze 6 cases with a prolonged history of the disease. Five out of the 6 patients recovered quickly after removal of the LTDs, normally performed sinus punctures, and an appropriate antibacterial treatment. One patient underwent functional endoscopic sinus surgery. Two of the 6 patients had uncommon bacterial cultures (Pseudomonas mirabilis, Klebsiella oxytoga) in their sinus secreta. Two of the removed LTDs were examined with SEM. The porous polyethylene was shown to have absorbed bacterial plague which, besides narrowing the lumen, can cause recurrent infections. In 5 other patients, the draining pressure (DP) was 0.9 +/- 0.16(M +/- SD) kg/cm2, as measured during irrigation with a No. 2 Lichtwitz needle (1.8 mm, i.d). Mathematical calculation using the Hagen-Boisseouille equation indicated that with our LTDs (0.7 mm, i.d.) the DP needs to be 40 times greater than the DP when using an ordinary Lichtwitz needle to get equal flushing capacity. We recommend i) LTD treatment of maxillary sinus empyema be closely followed up ii) that, in prolonged cases, the LTDs should be removed and the sinuses repeatedly irrigated with an ordinary needle or antrostomy, and iii) that a more suitable tubing material and insertion system (to allow a larger radius of the tube) be developed.
Manor, Yifat; Chaushu, Gavriel; Lorean, Adi; Mijiritzky, Eithan
To evaluate the survival rate of dental implants replacing failed implants in grafted maxillary sinuses using the lateral approach vs nongrafted posterior maxillae. A retrospective analysis was conducted to study the survival of secondary dental implants inserted in the posterior maxilla in previously failed implant sites between the years 2000 and 2010. The study group consisted of patients who had also undergone maxillary sinus augmentation, and the control group consisted of patients in whom implants in the posterior maxilla had failed. Clinical and demographic data were analyzed using a structured form. Seventy-five patients with a total of 75 replaced implants were included in the study. The study group comprised 40 patients and the control group, 35 patients. None of the replaced implants in the study group failed, resulting in an overall survival of 100%; three replaced implants in the control group failed (92% survival). The main reason for the primary implant removal was lack of osseointegration (35 [87.5%] of 40 study group implants and 23 [65.7%] of 35 control group implants [P = .027]). The difference between the groups with regard to the timing of primary implant failure was statistically significant. The study group had more early failures of the primary implant than did the control group (77% vs 62%; P = .038). Dental implants replaced in the posterior maxilla had a high survival rate. A higher rate of survival was found in augmented maxillary sinus sites. Within the limits of the present study, it can be concluded that previous implant failures in the grafted maxillary sinus should not discourage practitioners from a second attempt.
Wasserzug, Oshri; Kaffe, Israel; Lazarovici, Towy Sorel; Weissman, Tal; Yahalom, Ran; Fliss, Dan M; Yarom, Noam
The use of bisphosphonates is very common among patients with osteoporosis and multiple myeloma as well as those with bone metastases from various malignancies. The benefits of bisphosphonates are well recognized, but it became evident during the past decade that these medications portend the major adverse effect of osteonecrosis of the jaw, known as bisphosphonate-related osteonecrosis of the jaw. Our aim was to evaluate the specific manifestations of bisphosphonate use on the maxillary sinus in patients with documented bisphosphonate-related osteonecrosis of the jaw. A retrospective review of all the patients diagnosed between October 2003 to August 2014 as having bisphosphonate-related osteonecrosis of the jaw in a large university-affiliated tertiary care medical center. The records of 173 patients diagnosed as having bisphosphonate-related osteonecrosis of the jaw during the study period were retrieved. The available head and neck computed tomographic images were analyzed for cases of involvement of the maxilla. Manifestations of bisphosphonate-related osteonecrosis of the jaw as observed on physical examination and on imaging studies. Seventy-one patients (41%) had involvement of the maxilla, 86 patients (49%) had involvement of the mandible, and 16 patients (9%) had involvement of both the maxilla and the mandible. Computerized tomography studies were available for 50 patients with involvement of the maxilla: 36 (72%) had evidence of maxillary sinus opacification (in comparison, the incidence of maxillary sinus opacification as an incidental finding in the general population is reported to be 19%, p < 0.0001). Sixteen patients (32%) had evidence of oroantral fistula, and five patients (10%) had oronasal fistula. In addition to its well-established effects on the mandible and maxilla, bisphosphonate-related osteonecrosis of the jaw significantly affected the maxillary sinus. Its radiologic manifestations should be recognized by clinicians and especially by
Prabhat, Mukul; Rai, Shalu; Kaur, Mandeep; Prabhat, Kanika; Bhatnagar, Puneet; Panjwani, Sapna
Purpose: Identification of human body or remains after death is a forensic procedure, which is difficult to perform and is mandatory by law and in compliance with social norms. Sexing the recovered human remains is an integral part of the identification process. Maxillary sinus can be used for gender determination as it remains intact even when the skull and other bones may be badly damaged in casualties where the body is incinerated. Computed tomography (CT) provides an excellent method for examining maxillary sinuses. Materials and Methods: CT images were used to measure the mediolateral, superoinferior, and anteroposterior dimensions and the volume of the maxillary sinuses in 30 patients (15 males and 15 females) to investigate whether these parameters could be used to determine the gender of an individual for forensic identification. The t-test for independent samples was used to compare these values in males and females and the data were subjected to discriminative analysis using SPSS software. Results: Our method was able to predict the gender with an accuracy of 80.0% in males and 86.7% in females, with an overall accuracy rate of 83.3%. Conclusion: The accuracy rate in this study was comparable, if not higher than many other methods that have been used to predict the gender of an individual from skeletal remains. The length, width, height, and volume of the maxillary sinuses together with other bones could be used for gender determination with a fair degree of accuracy when the whole skeleton is not available. PMID:27051222
Silva, L deF; de Lima, V N; Faverani, L P; de Mendonça, M R; Okamoto, R; Pellizzer, E P
The purpose of this systematic review was to perform a comparative analysis of the use or not of graft material in maxillary sinus lift surgery. Relevant studies published in the last 10 years were identified through a search of the PubMed/MEDLINE, ScienceDirect, and Cochrane Library databases and were assessed against the study inclusion and exclusion criteria. The initial search resulted in 1037 articles. After applying the inclusion and exclusion criteria, 16 articles remained. Four hundred and thirty-six patients were followed up over a postoperative period ranging from 6 months to 11 years. In total, 868 implants were installed in 397 maxillary sinuses. The implant survival rate was 96.00% for surgeries performed without graft material and 99.60% for those in which biomaterial was used, within a follow-up period of 48 to 60 months. In conclusion, maxillary sinus lift surgery, with or without graft material, is a safe procedure with a low complication rate and predictable results.
BASSI, M. ANDREASI; ANDRISANI, C.; LICO, S.; ORMANIER, Z.; ARCURI, C.
SUMMARY Purpose In this article the Authors show a safe and predictable technique to remove displaced implants from the maxillary sinus. Materials and methods A 49-year-old female was referred, to this centre by a general dentist, for the retrieval of the ectopic dental implant. After a preliminary clinical and radiological evaluation of the case the surgical procedure was performed. A loco-regional anesthesia was carried out and then the Maxillary Sinus Retrieval Device (MSRD), proposed in this study, was inserted in the canine fossa, via a circular antrostomy 5,5mm wide, previous execution of a mucoperiosteal flap. The MSRD is a trocar, modified with a funnel-shaped cannula in order to allow the easy access of both an endoscope and a suction cannula or, in alternative, a straight forceps. The implant was easily found end retrieved thanks to the endoscopic control. The postoperative was uneventful and no nasal bleeding was reported by the patient. Conclusion The Authors recommend the use of the MSRD in order to minimize the biological sacrifice consequent to the implant retrieval in the maxillary sinus. PMID:28042433
Chung, Seung-Kyu; Jo, Gyehwan; Kim, Sung Kyun; Na, Yang
The effects of middle meatal antrostomy (MMA) on air and nitric oxide exchange in the human maxillary sinus were quantified using the computational fluid dynamics technique. One full period of respiration was considered in the anatomically correct numerical domain. The simulation results showed that MMA did not cause any noticeable change in the velocity or pressure fields at a global level but induced local velocity as high as 0.21m/s inside the maxillary. Therefore, enlargement of the ostium area by MMA allows inspiratory and expiratory nasal airflow to induce significant convective flows in the sinus, which in turn enhances gas exchange dramatically. At the end of the inspiration phase, NO concentration in the maxillary sinus decreased to about 54% of the initial value. NO concentration decreased only by about 30% during the expiration phase. This difference in reduction rate is thought to result from the difference in airflow velocity in the extended ostium during inspiration vs. expiration. Copyright © 2013 Elsevier B.V. All rights reserved.
de Molon, Rafael Scaf; de Paula, Wagner Nunes; Spin-Neto, Rubens; Verzola, Mario Henrique Arruda; Tosoni, Guilherme Monteiro; Lia, Raphael Carlos Comelli; Scaf, Gulnara; Marcantonio, Elcio
The aim of this study was to determine the pattern of bone remodeling after maxillary sinus lifting in humans by means of fractal dimension (FD) and histomorphometric analysis. Therefore, the correlation between FD and the histomorphometric findings was evaluated. Sixteen patients with posterior edentulous maxilla were enrolled in this study. Maxillary sinus lifting was performed using autogenous bone grafted from the mandibular retromolar area. Three direct digital panoramic radiographs were obtained: before surgery (Group 1), immediately postoperatively (Group 2) and after 6 months of healing (Group 3) for FD analysis. Biopsies were taken after 6 months, processed and submitted to histological and histomorphometric analysis. Data were analyzed by Shapiro-Wilk test and ANOVA test followed by a Tukey test (a = 0.05). The bone volume fraction of newly trabecular bone (TB) and medullary area (MA) was measured as 62.75% ± 17.16% and 37.25 ± 17.16%, respectively. Significant difference in FD analysis was measured between Group 1 and Group 3. No significant difference was found in the correlation between FD and histomorphometric analysis for TB and MA (p = 0.84). In conclusion, all performed analyses were effective in assessing the bone-remodeling pattern in the maxillary sinus, offering complementary information about healing and predictable outcomes. There were no correlations between FD and histomorphometric analysis.
Gultekin, B Alper; Cansiz, Erol; Borahan, Oguz; Mangano, Carlo; Kolerman, Roni; Mijiritsky, Eitan; Yalcin, Serdar
Extensive alveolar bone resorption because of pneumatized maxillary sinus is a common problem that limits dental implant placement. Maxillary sinus floor augmentation (MSFA) is an accepted treatment protocol that provides sufficient bone volume. The aim of this study was to evaluate the percentage of graft volume reduction following MSFA using cone beam computed tomography. In this retrospective study, cone beam computed tomography scans of MSFA were measured to evaluate the volume of the grafted sinus with deproteinized bovine bone (DBB), mineralized allograft (MA), or a mixture of MA and demineralized allograft as a composite. The volumetric changes in sinus augmentation between 2 weeks (T-I) and 6 months (T-II) after operation were analyzed. Thirty-nine patients were included in this study. The average percent volume reduction was 8.14 ± 3.76%, 19.38 ± 9.22%, and 24.66 ± 4.68% for DBB, MA, and composite graft, respectively. A significant graft volume reduction was found between T-I and T-II for all groups (P < 0.01). The DBB group showed the least volume reduction (P < 0.01). Biomaterials can influence the bone graft volume change before implant placement. Deproteinized bovine bone may offer greater volume stability during healing than mineralized and composite allografts.
Sakka, Salah; Krenkel, Christian
The aim of this study was to retrospectively evaluate the surgical technique of sinus floor elevation with autogenous parietal bone grafting in conjunction with immediate dental implants for the reconstruction of the maxilla in deficient maxillary alveolar ridges. Seventeen patients who underwent sinus floor elevation with bone graft from the parietal bone between 2005 and 2007 were included in the study. Cases of extremely deficient bone level in the alveolar ridge<4mm were included in the study. Seventy-seven implants (49 Staumann®, 24 Replace® and 4 Ankylos®) with different length and diameter were placed immediately after the graft was placed. Strict oral hygiene was required for the patients. Presurgical and postsurgical panoramic radiographs were taken. A high-quality reconstruction with an increase in lifted sinus bone height was achieved with parietal bone particulates. Seventy-three implants were clinically osseointegrated and four implants were lost giving a success rate 94.8%. No correlation was found between failure and the surgery. The encouraging results of this study suggest that the technique of reconstruction of the sinus floor and the resorbed alveolar ridge using an autogenous parietal bone graft is reliable, giving the surgeon the opportunity to successfully perform immediate implant placement in more difficult and deficient maxillary alveolar bone height. Copyright © 2010. Published by Elsevier Ltd.
Chaushu, Gavriel; Vered, Marilena; Mardinger, Ofer; Nissan, Joseph
Cancellous bone-block allografts may contribute to improved initial implant stability during sinus augmentation in cases with posterior atrophic maxillary ridge height < or =4 mm. The present study histologically and histomorphometrically evaluates the application of cancellous bone-block allografts for maxillary sinus-floor augmentation. Thirty-one consecutive patients, 16 females and 15 males (age range, 25 to 65 years; mean age: 54 +/- 9 years) underwent sinus augmentation with simultaneous implant placement with cancellous bone-block allografts. After 9 months, a second-stage surgery was performed. The previous window location was determined. A cylindrical sample core was collected. All specimens were prepared for histologic and histomorphometric examinations. Seventy-two of 76 implants were clinically osseointegrated (94.7%). All patients received a fixed implant-supported prosthesis. The mean t values of newly formed bone, residual cancellous bone-block allograft, marrow and connective tissue were 26.1% +/- 15% (range: 10% to 58%); 24.7% +/- 19.4% (range: 0.6% to 71%), and 49.2% +/- 20.4% (range: 14.9% to 78.9%), respectively. No statistically significant histomorphometric differences regarding newly formed bone were found between genders (27.02% in males versus 25.68% in females; P = 0.446), ages (29.82% in subjects < or =40 years old versus 24.43% in subjects >40 years old; P = 0.293), presence of membrane perforations (25.5% in non-perforated sinuses versus 27.3% in perforated sinuses; P = 0.427), and residual alveolar bone height (25.85% for residual alveolar bone height <2 mm versus 26.48% for residual alveolar bone height of 2 to 4 mm; P = 0.473). The cancellous bone-block allograft is biocompatible and osteoconductive and permits new bone formation in sinus augmentations with simultaneous implant-placement procedures in extremely atrophic posterior maxillae.
Kolhatkar, Shilpa; Bhola, Monish; Thompson-Sloan, Tamika N
When immediate implant placement is considered for teeth with close proximity to the sinus floor, apical extension of the osteotomy is significantly limited, and often a staged approach is used. Implant placement into fresh extraction sockets and sinus floor manipulation using bone-added osteotome sinus floor elevation with implant placement are techniques most often used independently or sequentially. Very few reports have described the combined use of immediate implant placement in fresh sockets and the bone-added osteotome sinus floor elevation technique. We present five cases in which a maxillary premolar was extracted and an implant placed into the extraction site with simultaneous abfracture of the sinus floor using osteotomes. All teeth were extracted atraumatically, and sockets carefully debrided and checked for integrity of the walls. After ideal osteotomy preparation, particulate bone graft was placed in the osteotomy and appropriately sized osteotomes were used for sinus floor elevation. After sufficient elevation, implant placement was completed and particulate bone was packed in the bone-implant gap when indicated. All implants were restored after a minimum healing period of 6 months. At the time of final restoration, bone was seen surrounding the implants from the apical portion to the most coronal thread. All five implants healed without complications and were in function for periods ranging from 6 to 12 months. Immediate implant placement with simultaneous osteotome sinus floor elevation is an advantageous combination of two successfully used techniques. This combined approach can significantly reduce the treatment time for implant therapy in teeth with close sinus proximity and provide the operator with the ability to place implants of desired length.
Krennmair, Gerald; Krainhöfner, Martin; Schmid-Schwap, Martina; Piehslinger, Eva
The aim of this study was to evaluate single-tooth implant-supported restorations placed in conjunction with several methods of maxillary sinus augmentation. A retrospective review was conducted of all consecutively treated patients who received single-implant tooth rehabilitation in combination with sinus augmentation. Implant survival rate and peri-implant conditions, such as marginal bone resorption (mm), pocket depth (mm), Plaque and Bleeding Indices, and Periotest values, were compared for the different augmentation procedures. Fifty-one patients were treated with 54 screw-type single implant-supported restorations in the posterior maxilla in combination with isolated sinus floor augmentation. Depending on the residual ridge height and the intended augmentation height, sinus lift elevation was performed either in a 1-stage lateral approach (25 patients, 28 implants), in a 2-stage lateral approach (12 patients, 12 implants), or with the osteotome technique (14 patients, 14 implants). The predominant use of long implants provided for a favorable implant-crown ratio (> 1.0) and produced an overall clinical survival rate of 100% over the observation period (44.5 +/- 22.7 months), with no differences between the augmentation procedures and implant types used. The most frequent site for single-tooth replacement in combination with sinus floor augmentation was the first molar region (61%). Implants with wider diameters (94% 2 4.3 mm) were used in this region. The most frequent intraoperative complication was tearing of the sinus membrane (58%) as a result of the restricted access for the lateral 1- or 2-stage approach, and the most frequent prosthetic complication was crown loosening. On the basis of this retrospective review, the following was observed: (1) Successful function and excellent peri-implant parameters may be anticipated for single implant-supported restorations placed in conjunction with sinus elevation procedures. (2) Clinical and radiographic
Harrison, Kevin; Iskandar, Irma; Chien, Hua-Hong
Summary Background: Guided bone regeneration (GBR) is an established and predictable procedure used to obtain adequate alveolar bone for the placement of dental implants. Anatomical challenges, such as the proximity of the maxillary sinus, may lead to complications during a GBR procedure. The purpose of this report is to present a unique and hitherto unreported complication of a GBR procedure, i.e., the penetration of a titanium fixation tack into the maxillary sinus. Case Report: A unique GBR is presented, where a titanium tack penetrated the maxillary sinus with subsequent migration and loss. Attempts to locate the tack visually during the procedure were unsuccessful. The GBR procedure was aborted and dental radiographs were immediately obtained. The patient was completely asymptomatic during the healing period. Eight weeks later a cone beam computed tomography revealed a non-inflamed sinus with no pathology evident. However, the tack could not be visualized. An otolaryngology consultation was requested and the ensuing sinus endoscopy did not reveal any evidence of the penetrated tack. It is thought that the loose tack migrated completely out of the sinus through the nasal passage. Conclusions: The use of a pre-operative cone beam computed tomography (CBCT) would have allowed the clinician to assess the exact thickness of the lateral wall of the maxillary sinus and better determine the ideal placement location and/or the feasibility of using a fixation tack in the posterior upper jaw. PMID:23569561
Dooley, Laura; Shah, Jatin
Purpose of Review To discuss and review the role for elective treatment of the neck in maxillary squamous cell carcinoma. Improvements in survival have been seen due to improved local therapies and control, therefore the treatment of the neck has become a topic of debate. Recent findings The risk of occult metastases in neck nodes is higher for T 3-4 tumors. The rate of nodal relapse in the N0 neck without elective treatment is 8-15%. With elective irradiation the nodal relapse rate decreases. However, most nodal relapses are accompanied by local failure or distant disease. Local failure remains the most common site of failure and cause of death in this patient population. Summary Treatment failure occurs overall in 62% of all patients, with local recurrence by far the most common site of treatment failure which is rarely amenable to salvage therapy. Therefore elective neck irradiation is not routinely indicated in the clinically N0 neck; those who recur only in the neck can be surgically salvaged more than 50% of the time. PMID:25692625
Esposito, Marco; Felice, Pietro; Worthington, Helen V
Insufficient bone volume is a common problem encountered in the rehabilitation of the edentulous posterior maxillae with implant-supported prostheses. Bone volume is limited by the presence of the maxillary sinus together with loss of alveolar bone height. Sinus lift procedures increase bone volume by augmenting the sinus cavity with autogenous bone or commercially available biomaterials, or both. This is an update of a Cochrane review first published in 2010. To assess the beneficial or harmful effects of bone augmentation compared to no augmentation when undertaking a sinus lift procedure. Secondly, to compare the benefits and harms of different maxillary sinus lift techniques for dental implant rehabilitation. We searched the Cochrane Oral Health Group's Trials Register (to 17 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 12), MEDLINE via OVID (1946 to 17 January 2014) and EMBASE via OVID (1980 to 17 January 2014). There were no language or date restrictions on the searches of the electronic databases. Randomised controlled trials (RCTs) of different techniques and materials for augmenting the maxillary sinus for rehabilitation with dental implants that report the outcome of implant success or failure at least to four months after initial loading. Screening of eligible studies, assessment of the risk of bias of the trials, and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed using fixed-effect models as there were either less than four studies or we used Peto odds ratios (ORs) for dichotomous data when there were zero cells in either the treatment or control or both arms and the number of trials was small. The statistical unit of the analysis was the patient. Eighteen RCTs out of 64 potentially eligible study reports met the inclusion criteria. They compared undertaking a sinus lift with not doing so, and the
Truedsson, A; Hjalte, K; Sunzel, B; Warfvinge, G
To estimate and compare the costs of maxillary sinus augmentation performed with autologous bone graft either from the iliac crest or from local bone harvested from the mandibula. To evaluate post-operative health-related quality-of-life parameters for patients subjected to sinus augmentation and iliac bone surgery. The hospital records of 14 patients subjected to sinus augmentation with iliac autograft, and 14 patients treated with local autograft, were analysed with regard to costs related to surgery, hospitalization and sick leave. Post-operative health parameters were assessed with a questionnaire. Mean hospital costs, administration excluded, for sinus augmentation with iliac autograft was €3447. Policlinic treatment alternatives e.g. local bone autograft with or without bone substitutes, rendered costs of approximately 42% thereof. The loss of production for a worker was 41% of the total cost (€9285). With regard to health-related quality-of-life and post-operative morbidity, most of the patients had recovered 14 days after the iliac graft surgery. The cost for a sinus augmentation with iliac surgery exceeds that of a policlinic procedure manifold. Provided that a policlinic operation with local bone, with or without bone substitute, renders an adequate end result, the economic gain would be substantial and post-operative morbidity would be greatly reduced. © 2012 John Wiley & Sons A/S.
Kao, Shou-Yen; Lui, Man-Tin; Cheng, Dong-Hui; Chen, Ta-Wei
One of the most challenging and technically sensitive surgical procedures in conjunction with dental implant rehabilitation is sinus membrane lifting to increase the bone height or volume from the maxillary sinus floor. This important preprosthetic surgical technique has been available for >15 years, making possible the creation of bone volume in the edentulous posterior maxilla for the placement of dental implants in surgically compromised cases. Substantial literature exists regarding the most efficacious way to increase the predictability of this surgical procedure, and reduce its associated complications. In this article, we describe the regional anatomy of the maxillary sinus, the evolution of the sinus membrane lifting procedure, the current surgical technique, its survival rate and associated complications, the need for bone graft or bone substitutes, and current advances in the lateral approach through a trap-door window for sinus membrane lifting for dental implants. Copyright © 2014. Published by Elsevier Taiwan.
Balaji, S M
Lack of sufficient bone height along maxillary sinus poses significant difficulty for placement of implants in edentulous maxillary jaw. Minimally invasive sinus augmentation is an effective solution for this problem. The manuscript intends to present long period results of such augmentation using direct (DSAT) and indirect (ISAT) minimally invasive sinus augmentation technique (SAT) from a single center. Records of patients who required minimally invasive sinus augmentation to increase residual bone height for implant placement fulfilling predetermined exclusion and inclusion criteria. Only patients with follow-up records for at least a year were considered. Both DSAT and ISAT were employed for sinus augmentation. The age, gender, period of edentulousness, alveolus thickness at crestal level during the pre- and postoperative assessment, implant length, and diameter of implants were collected from case histories. Descriptive statistics, Chi-square, paired test, and one way analysis of variance (ANOVA) was used appropriately. P ≤ 0.05 was considered as significant. There were 197 implants placed and mean age of the group was 40.2 ± 10.7 years. There was a slight male predilection (54.3%). The gain in bone height as expressed in percentage after a year was 134.6%. On comparing the length of residual alveolar bone (RAB) at start and end of study, ISAT had a mean preoperative height of 7.88 mm while postoperative height was 13.22 mm. For DSAT, the mean height at start of treatment was 3.94 mm while at the end it was 10.13 mm. The mean increase in height was 6.19 mm. For both cases, P was 0.000. Age, gender, and period of edentulism did not influence the outcome. The alveolar width appears to differ and influence the outcome. When alveolar width increases, wider diameter implants can be placed by compromising height. Thus it is a clinical acumen that would be extremely helpful to gauge the outcome of the condition.
Inokuchi, T.; Sano, K.; Kaminogo, M. )
A case of radionecrosis of sphenoid and temporal bones is reported. The patient received a combination of surgery, radiotherapy, and chemotherapy for his left maxillary sinus carcinoma. After the combined therapy, necrosis accompanying inflammation developed in the maxillary and temporal regions. Excision of the necrotic tissues was done, and the left ascending ramus of the mandible was resected because of persistent tumor mass at the left infratemporal fossa. Although the excision wound of the maxilla healed by epithelialization, an area of nonvital bone remained exposed in the temporal region, where progressive osteonecrosis with infection led to breakdown of the skin. The necrotic bones of the zygomatic arch and the sphenotemporal sutural region became visible through the skin defect, and computerized tomography scan revealed bone necrosis involving the inferolateral area and the base of the skull. Excision of the necrotic bone and reconstruction with sternocleidomastoid myocutaneous flap were performed.
Galindo-Bocero, J; Macías-Franco, S; Sánchez-García, S; Fonollá-Gil, M; García-Alonso, A
A 53-year old male presented with visual impairment in right eye after irradiation of right maxillary sinus carcinoma. Funduscopy shows radiation retinopathy: haemorrhages, exudates, macular oedema, and peripheral retinal ischaemia. A poor outcome was achieved despite laser treatment and intravitreal injections of bevacizumab, resulting in evisceration of the affected eye. Radiation retinopathy must be considered in any loss of vision after head and neck irradiation. Ophthalmological long-term follow-up of these patients is essential for an early diagnosis. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.
García de Hombre, Alina María; Pérez Peñate, Armando
The cholesterol granuloma is well known in the middle ear, in the mastoid antrum and the air cells of temporal bone, mostly related to a chronic infectious process. There are other localizations such as the pleura, lung, pericardium, kidneys, arterial wall, nerves, brain, testicles, lymphatic ganglion and in the paranasals sinuses. Its localization in the mediofacial area is very unfrequent, having only been described 44 cases up to the year 2002. We present a 42 year-old patient, who required surgical treatment because of a increase in the volume of area her left facial of one month's old. It resulted to be secundary to an expansion of the maxilar sinus, such as seen on the computerized tomography carried out on the patient. The diagnosis was cholesterol granuloma, performed, through the anatomo-pathology study. We review the litterature on this subject and analyse the possible etiologic cause of this lesion, its clinic, diagnostic methodology and treatment.
Gothberg, K A; Little, J W; King, D R; Bean, L R
Panorex radiographs taken during the past 5 years at the University of Kentucky College of Dentistry were reviewed for evidence of mucosal cysts of the maxillary sinus. Thirteen patients with this lesion were recalled for re-evaluation of their status. Ten of the patients had symptoms that could be related to the involved sinus. These included stuffiness, fullness, postnasal drip, gushing of yellow fluid from the nose, and headache. Radiographic examination revealed that three of the cysts had increased is size, three had decreased in size, three had not changed in size, and two had disappeared; no evaluation could be made on two. On the basis of radiographic, transillumination, history, and clinical findings, the nine cysts that could be evaluated were diagnosed as being of the nonsecretory type of mucosal cyst. We recommended periodic radiographic examination for this type of lesion. Surgical intervention is necessary only if destruction of surrounding bone has occurred or recurrence of disturbing symptoms is reported.
Tajima, Shogo; Ohkubo, Aki; Yoshida, Matsumi; Koda, Kenji; Nameki, Ichirota
There have been approximately 10 reports in English literature of cases of Ewing's sarcoma family of tumors (EFT) arising in the maxillary sinus. In this location, some tumors mimic EFT, and are more frequently encountered. Herein, we present an additional case of an EFT originating in the maxillary sinus. The patient was a 15-year-old boy complaining of a non-tender swelling of the left cheek. Laboratory tests showed no abnormalities. Computed tomography and magnetic resonance imaging revealed a mass centered in the maxillary sinus with degeneration of the surrounding bones. Pathological examination along with flow cytometry and G-banding enabled the prompt diagnosis of EFT with the EWS/FLI1 fusion gene. The patient is planned to undergo chemotherapy. An origin in the head and neck and the presence of the typical EWS/FLI1, in conjunction with an opportunity for immediate treatment, may predict a relatively better prognosis for EFT in our case.
A 63 year-old male with a huge odontogenic lesion of sinus maxillaris was treated with computer-assisted surgery. After resection of the odontogenic lesion, the sinus wall was reconstructed with a prebended 3D titanium-mesh using CAD/CAM technique. This work provides a new treatment device for maxillary reconstruction via rapid prototyping procedures. PMID:22070833
Choi, Kevin J; Jang, David W; Ellison, Matthew D; Frank-Ito, Dennis O
Maxillary antrostomy is commonly performed during endoscopic sinus surgery. Little is known about the association surrounding recalcitrant maxillary sinusitis, antrostomy size, and intranasal airflow changes. Furthermore, the interaction between sinus mucosa and airflow is poorly understood. This study used computational fluid dynamics (CFD) modeling to investigate postoperative airflow characteristics between diseased and nondiseased maxillary sinuses in subjects with recurrent disease. A retrospective review of patients from a tertiary-level academic rhinology practice was performed. Seven subjects with endoscopic evidence of postoperative maxillary sinus disease that presented as chronic unilateral crusting at least 1 year after bilateral maxillary antrostomies were selected. A three-dimensional model of each subject's sinonasal cavity was created from postoperative computed tomographies and used for CFD analysis. Although the variables investigated between diseased and nondiseased sides were not statistically significant, the diseased side in six subjects had a smaller antrostomy, and five of these subjects had both reduced nasal unilateral airflow and increased unilateral nasal resistance on the diseased side. The ratio of posterior wall shear stress (WSS) of the maxillary sinus to the total WSS was higher on the diseased side in six subjects. Results also showed strong correlations between antrostomy and CFD variables on the diseased side than on the nondiseased side. This pilot study showed that the majority of the simulated sinonasal models exhibited common characteristics on the side with persistent disease, such as smaller antrostomy, reduced nasal airflow, increased nasal resistance, and increased posterior WSS. Although statistical significance was not established, this study provided preliminary insight into variables to consider in a larger cohort study.
Sekerci, Ahmet Ercan; Sisman, Yildiray; Etoz, Meryem; Bulut, Duygu Goller
Most periapical lesions are associated with microorganisms from infected root canal systems. Maxillary sinus can pose a diagnostic dilemma radiographically because of its anatomical variation which can mimic a periapical pathosis. The aim of this study was to describe two cases of aberrant anatomical variation of the maxillary sinus that presented radiographic similarities to a periapical cyst in order to call the attention of clinicians to the fact that several different diseases are able to mimic endodontic periapical lesions. An accurate assessment of this morphology was made with the help of cone-beam computed tomography (CBCT).
Sekerci, Ahmet Ercan; Sisman, Yildiray; Etoz, Meryem; Bulut, Duygu Goller
Most periapical lesions are associated with microorganisms from infected root canal systems. Maxillary sinus can pose a diagnostic dilemma radiographically because of its anatomical variation which can mimic a periapical pathosis. The aim of this study was to describe two cases of aberrant anatomical variation of the maxillary sinus that presented radiographic similarities to a periapical cyst in order to call the attention of clinicians to the fact that several different diseases are able to mimic endodontic periapical lesions. An accurate assessment of this morphology was made with the help of cone-beam computed tomography (CBCT). PMID:23710374
Deshmukh, Aashish; Kalra, Rinku; Chhadva, Shruti; Shetye, Angad
The pneumatization of the maxillary sinus often results in a lack of sufficient alveolar bone for implant placement. In the last decades, maxillary sinus lift has become a very popular procedure with predictable results. Sinus floor augmentation procedures are generally carried out using autologous bone grafts, bone substitutes, or composites of bone and bone substitutes. However, the inherent limitations associated with each of these, have directed the attention of investigators to new technologies like bone tissue engineering. Bone marrow stromal cells have been regarded as multi-potent cells residing in bone marrow. These cells can be harvested from a person, multiplied outside his body using bioengineering principles and technologies and later introduced into a tissue defect. We present a case where tissue-engineered autologous osteoblasts were used along with demineralized freeze-dried bone for sinus floor augmentation. PMID:26097364
Bassi, A P F; Pioto, R; Faverani, L P; Canestraro, D; Fontão, F G K
A prospective clinical study of maxillary sinus lift procedures in the posterior region of the maxilla, using only blood clot as filling material, was conducted. Seventeen patients underwent a maxillary sinus lift procedure; 20 maxillary sinus regions were operated on and a total of 25 implants were placed. The sinus mucosa was lifted together with the anterior wall of the osteotomized maxilla and supported by the implants placed. Computed tomography (CT) scans were obtained immediately postoperative (T initial) and at 3 (T1) and 51 (T2) months postoperative for the measurement of linear bone height and bone density (by grey tones). Only one implant was lost in the first stage (96% success). After dental prosthesis placement and during up to 51 months of follow-up, no implant was lost (100% success, second stage). The difference in mean bone height between T initial (5.94 mm) and T1 (13.14 mm), and between T initial and T2 (11.57 mm), was statistically significant (both P<0.001); comparison between T1 and T2 also presented a statistical difference (P<0.001). Bone density had increased at the end of the period analyzed, but this was not statistically significant (P>0.05). Thus, the maxillary sinus lift technique with immediate implant placement, filling with blood clot only, may be performed with a high success rate. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Sverzut, Alexander T; Rodrigues, Danillo C; Lauria, Andrezza; Armando, Rogério S; de Oliveira, Paulo T; Moreira, Roger W F
The installation of dental implants in the posterior maxilla is often faced with resorbed alveolar processes, resulting from a combination of pneumatization of the maxillary sinus, the effects of periodontal disease, and physiological bone resorption. The sinus lift surgery has been practiced since 1980 with the aim to increase bone height in this region for an implant supported prosthetic rehabilitation, and various filling materials have been used for such. This study aimed to clinically, radiographically, and histologically evaluate a preparation of calcium phosphate cement (Bone Source(®), BS) used as filling material in maxillary sinus elevation surgery. Ten patients were operated requiring maxillary sinus graft for future placement of osseointegrated implants. After a period ranging from 9 to 16 months, a clinical evaluation and biopsy of the grafted area in the region adjacent to the axis of the implant to be inserted were performed. Clinically and radiographically, no evidence of resorption/substitution of BS was noticed. Although no patients have had postoperative complications and the material presented fully biocompatible characteristics with woven bone in intimate contact with BS, it was not possible to place any implants due to minimal bone formation and friability of the material. It was concluded that despite the osteoconductive capacity of BS, this conventional calcium phosphate preparation does not support sufficient amount of new bone formation that could allow its use as filling material for maxillary sinus floor lift and subsequent dental implant placement. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Ting, Miriam; Rice, Jeremy G; Braid, Stanton M; Lee, Cameron Y S; Suzuki, Jon B
The objective of this systemic review was to perform a comprehensive overview of systematic reviews and meta-analyses of the maxillary sinus augmentation procedure for implant rehabilitation in humans. The following were evaluated in this overview: (1) anatomic variables affecting sinus augmentation, (2) histomorphometric analysis of the grafted sinus, (3) volumetric changes after sinus grafting, and (4) implant survival beyond 1 year. Electronic databases were searched for systematic reviews and meta-analyses of implant-related sinus augmentation published from 1976 to September 2015. The studies selected must identify itself as a systemic review or meta-analysis in the title or abstract and must pertain to sinus augmentation. Thirty-three publications fulfilled the review criteria. The AMSTAR ratings for the 33 chosen reviews scored greater than 3 of 11, with 8 reviews scoring greater or equal to 8 of 11. The outcome of this overview suggested that the following will increase the success of sinus augmentation and survival of implants placed in the grafted sinus: (1) the use of barrier membranes over the lateral window when using a lateral approach to graft the sinus, (2) the use of particulate autogenous bone with or without other substitute graft materials, (3) sinus augmentation without the use of grafting materials may be considered provided that the space between the sinus membrane and floor can be maintained, (4) the use of rough-surfaced implants, (5) simultaneous implant placement with residual bone height greater than 4 mm, and (6) the cessation of smoking.
Smith, S L; Buschang, P H; Dechow, P C
Maxillary sinus volumetric and surface area data and growth models from longitudinal samples of children and adolescents are presented. Cone-beam radiographic CT scans from two small retrospective longitudinal samples, one from the Baylor College of Dentistry, Dallas, TX (N=17, 12 females, 5 males, 10.9-17.4 years) and one from a group private orthodontic practice in Nevada (N=15, 9 females, 6 males, 6.4-13.4 years) were used to collect maxillary sinus volumes and surface areas from each individual imaged at two times separated by variable intervals. Volume and surface area values were collected in Analyze(®) (Mayo Clinic) and growth models were produced in MLwiN(®), a multi-level modeling program. There is a large degree of inter-individual variation. Surface area and surface-area-to-volume ratio (SA:V) changes are particularly variable. Growth models suggest linear growth in both volume and surface area, without growth spurts. Copyright © 2016 Elsevier GmbH. All rights reserved.
Butaric, Lauren N; McCarthy, Robert C; Broadfield, Douglas C
Despite centuries of investigation, the function of the maxillary sinus (MS) and underlying patterns governing its form remain elusive. In this study, we articulate a methodology for collecting volumetric data for the MS and nasal cavity (NC) from computed tomography (CT) scans and report details for a small sample of 39 dried human crania of known ecogeographic provenience useful for assessing variation in MS size and shape. We use scaling analyses to preliminarily test the hypothesis that volumes of the nasal cavity (NCV) and maxillary sinus (MSV) are inversely correlated such that the NC covaries with size of the face, whereas the MS "fills in" the leftover space [proposed by Shea: Am J Phys Anthropol 47 (1977):289-300]. Against expectation, MSV is not significantly correlated with NCV or any cranial size variable. NCV, on the other hand, scales isometrically with facial size. The results of this pilot study suggest that NCV covaries with facial size, but that the MS does not simply fill in the leftover space in the face. The role, if any, of the MSs in midfacial function and architecture remains unclear. Larger sample sizes, additional environmental variables, and assessment of MS and NC shape are necessary to resolve this issue.
Donizeth-Rodrigues, Cleomar; Fonseca-Da Silveira, Márcia; Gonçalves-De Alencar, Ana H.; Garcia-Santos-Silva, Maria A.; Francisco-De-Mendonça, Elismauro
Objective: To evaluate the detection of mucous retention cyst of maxillary sinus (MRCMS) using panoramic radiography and cone beam computed tomography (CBCT). Study Design: A digital database with 6,000 panoramic radiographs was reviewed for MRCMS. Suggestive images of MRCMS were detected on 185 radiographs, and patients were located and invited to return for follow-up. Thirty patients returned, and control panoramic radiographs were obtained 6 to 46 months after the initial radiograph. When MRCMS was found on control radiographs, CBCT scans were obtained. Cysts were measured and compared on radiographs and scans. The Wilcoxon, Spearman and Kolmorogov-Smirnov tests were used for statistical analysis. The level of significance was set at 5%. Results: There were statistically significant differences between the two methods (p<0.05): 23 MRCMS detected on panoramic radiographs were confirmed by CBCT, but 5 MRCMS detected on CBCT images had not been identified by panoramic radiography. Eight MRCMS detected on control radiographs were not confirmed by CBCT. MRCMS size differences from initial to control panoramic radiographs and CBCT scans were not statistically significant (p= 0.617 and p= 0.626). The correlation between time and MRCMS size differences was not significant (r = -0.16, p = 0.381). Conclusion: CBCT scanning detect MRCMS more accurately than panoramic radiography. Key words:Mucous cyst, maxillary sinus, panoramic radiograph, cone beam computed tomography. PMID:23229251
Barakzai, Safia Z; Kane-Smyth, Justine; Lowles, Joanna; Townsend, Neil
To examine 2 rostral maxillary sinus (RMS) trephine sites for safety and efficacy using skulls of horses of varying age. Descriptive study. Cadaveric equine skulls (n=40). Two RMS trephination sites (rostral, caudal) were made in each skull. Radiographic projections using markers at each site were used to determine if sites were within the RMS and directly overlying a cheek tooth. Sinusotomy in 14 skulls was used to determine correlation between radiographic and anatomic location of trephine sites, and of the rostrolateral aspect of the maxillary septum. Age-related risk of trephine site being directly over a cheek tooth was determined using logistic regression. Trephine site was within the RMS in 98% of skulls using the rostral portal and 68% using the caudal portal. The rostral site was over a cheek tooth in 18% of skulls compared with 10% using the caudal site. There was a significant negative relationship between the trephine site overlying a tooth and horse age for rostral (P=.02) and caudal (P=.03) sites. The radiographic appearance of the maxillary septum correlated to the rostrolateral portion of the septum in 12 of 14 skulls that had sinusotomy. The rostral RMS trephine portal is more reliable than the caudal site for entering the RMS. Horses
Balaji, S. M.
Introduction: Lack of sufficient bone height along maxillary sinus poses significant difficulty for placement of implants in edentulous maxillary jaw. Minimally invasive sinus augmentation is an effective solution for this problem. The manuscript intends to present long period results of such augmentation using direct (DSAT) and indirect (ISAT) minimally invasive sinus augmentation technique (SAT) from a single center. Materials and Methods: Records of patients who required minimally invasive sinus augmentation to increase residual bone height for implant placement fulfilling predetermined exclusion and inclusion criteria. Only patients with follow-up records for at least a year were considered. Both DSAT and ISAT were employed for sinus augmentation. The age, gender, period of edentulousness, alveolus thickness at crestal level during the pre- and postoperative assessment, implant length, and diameter of implants were collected from case histories. Descriptive statistics, Chi-square, paired test, and one way analysis of variance (ANOVA) was used appropriately. P ≤ 0.05 was considered as significant. Results: There were 197 implants placed and mean age of the group was 40.2 ± 10.7 years. There was a slight male predilection (54.3%). The gain in bone height as expressed in percentage after a year was 134.6%. On comparing the length of residual alveolar bone (RAB) at start and end of study, ISAT had a mean preoperative height of 7.88 mm while postoperative height was 13.22 mm. For DSAT, the mean height at start of treatment was 3.94 mm while at the end it was 10.13 mm. The mean increase in height was 6.19 mm. For both cases, P was 0.000. Discussion: Age, gender, and period of edentulism did not influence the outcome. The alveolar width appears to differ and influence the outcome. When alveolar width increases, wider diameter implants can be placed by compromising height. Thus it is a clinical acumen that would be extremely helpful to gauge the outcome of the
Guerrero, Jaime S; Al-Jandan, Badr A
The aim of this study is to demonstrate the clinical applicability and efficacy of an allograft for maxillary sinus augmentations in patients requiring placement of dental implants. Sixty consecutive patients underwent a total of 90 sinus augmentations. Twenty-nine were women and 31 men, with a mean age of 54 years. Twenty-six patients received a bilateral procedure and 34 unilateral. All cases were treated with the lateral wall technique. Allograft consisted of demineralized freeze-dried blocks in 6 cases, particulate in 82 cases, and a combination of both in 2 cases. In 30 patients, it was combined with platelet-rich plasma. A total of 84 implants were inserted. Bone samples of grafted areas were obtained in two patients for histological examination. Seventy-three implants were clinically successful at the reentry time. Eleven implants in seven patients were removed between 15 days and 6 months after their placement. Seven of these implants were replaced and received prostheses as well, for an overall postloading success rate of 95.2%. Follow-up for all patients after final restoration was between 12 and 96 months. Specimen's histological evaluation revealed bone formation and evidence of inflammatory infiltrate. Based on the findings of this study, it can be suggested that the use of the demineralized freeze-dried bone allograft from the Banco de Huesos y Tejidos Fundación Cosme y Damian for sinus augmentation is effective and constitutes a feasible therapeutic alternative for implant placement.
Tanimoto, Yuko; Miyawaki, Shouichi; Imai, Mikako; Takeda, Ryoko; Takano-Yamamoto, Teruko
An eight-year-, four-month-old girl was brought to the orthodontic clinic of Okayama University Medical and Dental Hospital. The patient had an impacted upper left second premolar because of an odontogenic keratocyst and showed a skeletal Class II jaw base relationship. At the age of six years four months, marsupialization of a cyst was performed at the Okayama University Medical and Dental Hospital because the patient had shown a swelling of the left cheek because of the cyst. The upper left second premolar was located in the roof of the maxillary sinus. The cyst was histopathologically diagnosed as an odontogenic keratocyst. At the age of nine years 10 months and after regaining the space for eruption of the premolar, the impacted premolar erupted without traction. At the age of 12 years five months, edgewise treatment was initiated, which continued for three years. After removing the edgewise appliance, an optimum occlusion was achieved. The occlusion was maintained without recurrence of the keratocyst after a retention period of five years.
Scarano, Antonio; Mavriqi, Luan; Bertelli, Ilaria; Mortellaro, Carmen; Di Cerbo, Alessandro
The authors compared the efficacy of 2 different techniques for sinus membrane elevation for maxillary lining lifted using a lateral window approach: nasal suction technique and ultrasonic surgery approach versus traditional approach. Thirty partially edentulous patients, having bilaterally 1 to 5 mm of residual bone height and at least 5 mm bone width below the maxillary sinuses as measured on computed tomography scans, were randomized to receive two 2-stage sinus lift procedures using the lateral window approach. On one side, the sinus lining the membrane was elevated with nasal suction technique and ultrasonic surgery approach, whereas on the contralateral side the membrane was elevated after osteotomy prepared using a round oral surgery bur. No patient dropped out. Four small perforations of membrane (<5 mm) were observed in group 1 (control) but not in group 2 (test). A statistically significant difference was present between the incidence of sinus membrane perforation in group 1 versus 2 (control versus test) (P < 0.01). In conclusion, the sinus lift with ultrasonic surgery and nasal suction technique was used to prevent a perforation of sinus membrane.
Santos, Marcello Roter M; Servato, João Paulo S; Cardoso, Sérgio Vitorino; de Faria, Paulo Rogério; Eisenberg, Ana Lúcia A; Dias, Fernando Luiz; Loyola, Adriano Mota
Squamous cell carcinoma arising at maxillary sinus is a rare neoplasm, characterized by aggressive growth pattern and glooming prognosis. There are no studies describing specifically its epidemiology in the South America. The aim of the current paper is to characterize a Brazilian maxillary sinus squamous cell carcinoma sample and to compare such data with others worldwide relevant series. The records of the Brazilian National Cancer Institute (1997-2006) were gathered and plotted. Additionally, an extensive literature review was carry out using electronic database (PUBMED/MEDLINE and LILACS) over a period of 54 years. A descriptive statistics and univariate survival test (log rank) were employed. Maxillary sinus squamous cell carcinoma was the commonest malignancy of sinonasal epithelium found. It affected mainly mid-age white men and most of them were diagnosed at advanced stage. Surgery combined with radiotherapy was the most therapeutic modalities given. The overall mortality rate in our sample was of 65.5%. Overall 1-, 2- and 5-year survival rate was 57.9%, 44.8%, and 17.7%, respectively. Maxillary sinus squamous cell carcinoma is an aggressive tumor normally diagnosed at the advanced stage and most patients present an unfavorable prognosis and reduced survival rate.
Bande, Chandrashekhar R; Daware, Surendra; Lambade, Pravin; Patle, Bhaskar
Orbital wall fracture implies a situation where disruptions of the walls or floor have occurred. It is a blowout type fracture where bone fragments with torn periosteum are pushed outside of the original bony orbit. There is no intact bone even near the defect area except the thin bone rim surrounding the blowout fracture. The purpose of this defect repair is to support orbital contents, free entrapped tissue, and, especially, restore the original orbital volume. Ten patients (seven males and three females) who underwent repair of orbital floor factures with maxillary sinus bone grafts were included in this study. Surgical procedure for harvesting graft and its fixation was almost same in all operated cases. The collection in the maxillary sinus due to fracture of floor of orbit, blood and bony fragments collected in the maxillary sinus can be easily drained and removed after removal of anterior wall of maxillary sinus and through the same approach you can reduce the floor of orbit manually to the proper position which helps to decease the orbital floor defect.
Santos, Marcello Roter M; Servato, João Paulo S; Cardoso, Sérgio Vitorino; de Faria, Paulo Rogério; Eisenberg, Ana Lúcia A; Dias, Fernando Luiz; Loyola, Adriano Mota
Squamous cell carcinoma arising at maxillary sinus is a rare neoplasm, characterized by aggressive growth pattern and glooming prognosis. There are no studies describing specifically its epidemiology in the South America. The aim of the current paper is to characterize a Brazilian maxillary sinus squamous cell carcinoma sample and to compare such data with others worldwide relevant series. The records of the Brazilian National Cancer Institute (1997-2006) were gathered and plotted. Additionally, an extensive literature review was carry out using electronic database (PUBMED/MEDLINE and LILACS) over a period of 54 years. A descriptive statistics and univariate survival test (log rank) were employed. Maxillary sinus squamous cell carcinoma was the commonest malignancy of sinonasal epithelium found. It affected mainly mid-age white men and most of them were diagnosed at advanced stage. Surgery combined with radiotherapy was the most therapeutic modalities given. The overall mortality rate in our sample was of 65.5%. Overall 1-, 2- and 5-year survival rate was 57.9%, 44.8%, and 17.7%, respectively. Maxillary sinus squamous cell carcinoma is an aggressive tumor normally diagnosed at the advanced stage and most patients present an unfavorable prognosis and reduced survival rate. PMID:25674251
Ding, Xiaojun; Wang, Qing; Guo, Xuehua; Yu, Youcheng
Background: Dental implant placement in the posterior maxilla may be complicated by implant migration into the maxillary sinus. Purpose: To report the clinical and radiological characteristics of a patient who experienced dental implant displacement into the maxillary sinus following sinus floor elevation, and to compare our findings with those of other published reports of the displacement of dental implants. Materials and methods: Implant placement and maxillary sinus elevation were performed simultaneously. The location of the displaced implant was monitored for 8 years, until the ectopic implant was surgically removed using the lateral window approach. The contributing factors, treatment modality, and clinical outcome for our patient were compared with those of patients reported in the literature. Results: The clinical characteristics of our case were similar to those of patients with displaced implants who were also asymptomatic for long periods. The clinical outcome of our case was consistent with that of patients who underwent similar surgeries. Conclusions: Transnasal endoscopic removal of an ectopic implant may be suitable in cases in which the ectopic implant is accessible. Transoral direct approaches are adequate in most cases in which endoscopic approaches may be confounded. The bony-window transoral technique may allow the removal of large implants. PMID:26131057
Bjørndal, Lars; Amaloo, Catharina; Markvart, Merete; Rud, Vibe; Qvortrup, Klaus; Stavnsbjerg, Camilla; Bjarnsholt, Thomas
The aim was to present a case report of a full-length extrusion of an obturator's core carrier into the maxillary sinus, causing clinical symptoms from the nose region with differential diagnostics aspects, which, in turn, led to several surgical treatments of the nostrils before diagnosis and correct endodontic retreatment of a maxillary right first molar. A 36-year-old man presented in 2012 with complaints from the right nostril region. Medical treatment with antibiotics and surgical procedures because of nasal stenosis resulted only in partial improvement. Five years earlier, a root canal treatment was performed on the maxillary right first molar. Intraoral radiographs revealed 10-mm overfilling of root filling material into the maxillary sinus from the palatal root of tooth #3. Before surgical removal of the excess root filling material, orthograde revision was performed. Cone-beam computed tomographic imaging was used to localize the position of the root filling material, which protruded through the maxillary sinus and reached the inferior nasal wall. Surgical removal from the palatal aspect revealed that the root filling material was a core carrier of an obturator. Scanning electron microscopy and transmission electron microscopy showed evidence of microbial biofilm on the core carrier as well as remnants of sinus mucosa. At the long-term follow-ups, the tooth had healed apically, and symptoms of nasal stenosis were markedly reduced. This case report represents a challenging differential diagnostic topic urging the importance of a medical and dental interdisciplinary dialogue. The use of cone-beam computed tomographic imaging was crucial for the surgical retreatment. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Lin, Shengxiao; Feng, Yuan; Xie, Juan; Song, Yingliang; Xie, Chao; Li, Dehua
To evaluate the clinical and radiographic outcomes of placing dental implants in the posterior maxilla using the transalveolar technique. Between January 2005 and December 2009, a total of 94 cases, 55 males and 39 females, aged (46.9 ± 11.8) years, were consecutively enrolled in this study with maxillary sinus floor augmentation using the transalveolar technique. Radiographic evaluations were conducted on panoramic and periapical radiographs at each recall. The follow-up clinical examination included cumulative survival rate(CSR) of implants, peri-implant marginal bone loss (MBL) and the height of sinus floor augmentation and the endo-sinus bone gain (ESBG). Sinus membrane perforation was found in 4 cases.Finally 126 implants (90 cases) were placed. The perforation rate of this surgical procedure was 3.08% (4/130).Four implants lost during the healing time, the early success of implants was 96.80% (121/125). During a mean follow-up time of (34.4 ± 20.4) months, all the implants were successfully in function, with the cumulative survival rate after function loading of 100.00%. The mean MBL was (0.75 ± 0.51) mm during the healing time, and (0.48 ± 0.41) mm during the follow-up period. The mean residual bone height (RBH) was (7.27 ± 1.30) mm at the position of implants placement, the length of implant protruding into the sinus was (2.77 ± 1.15) mm, and the height of sinus floor augmentation was (4.52 ± 1.39) mm. At the loading time, the mean endo-sinus bone gain was (3.81 ± 1.60) mm. After the follow-up time of 34 months, the newly formed bone on the maxillary sinus floor underwent further remodeling with a median bone reduction value of 0.37 (0.10, 0.88) mm. Maxillary sinus floor augmentation using the transalveolar technique is a predictable treatment modality. The augmentation of the maxillary sinus floor using the transalveolar technique could lead to bone formation under the sinus. The newly formed bone showed slight absorbtion in the long term follow-up.
Sakkas, Andreas; Konstantinidis, Ioannis; Winter, Karsten; Schramm, Alexander; Wilde, Frank
Sinuslift is meanwhile an established method of bone augmentation in the posterior maxilla. Aim of the study was to evaluate the significance of intraoperative Schneiderian membrane perforations during maxillary sinus floor elevation surgery using autogenous bone harvested from two different donor sites using a Safescraper device on the success rate, graft survival and implant integration. The investigators conducted a retrospective cohort study at the Department of Oral and Maxillofacial Surgery of Military Hospital Ulm composed of patients with severe maxillary atrophy who underwent sinus augmentation from January 2011 until December 2011. Ninety-nine consecutive patients (89 men, 10 women) with a mean age of 43.1 years underwent sinus graft procedures in a 2-stage procedure using the lateral wall approach, as described by Tatum (1986). Data on patient age, smoking status, donor site and surgical complications were recorded and the relationship between Schneiderian membrane perforation and complication rate was evaluated. Dental implants were inserted 4 months after grafting. A total of 105 sinus lift procedures were performed in 99 patients. Sixty-one patients (61.6%) underwent sinus elevation with autogenous bone from the buccal sinus wall, while 38 patients (38.4%) bone harvesting from the iliac crest. Intraoperative perforation of the Schneiderian membrane was observed in 11 of the 105 sinuses (10.4%). These perforations resulted in 4 (36.3%) of the cases in major postoperative complications accompanied by swelling and wound infection. Membrane perforations were slightly associated with the appearance of postoperative complications (p=0.0762). In 2.4% of all cases, regarding 2 patients the final rehabilitation with dental implants was not possible because of extensive bone resorption. Intraoperative complications performing sinus augmentation may lead to postoperative complications. With careful clinical and radiographic evaluation and appropriate treatment
Sakkas, Andreas; Konstantinidis, Ioannis; Winter, Karsten; Schramm, Alexander; Wilde, Frank
Background: Sinuslift is meanwhile an established method of bone augmentation in the posterior maxilla. Aim of the study was to evaluate the significance of intraoperative Schneiderian membrane perforations during maxillary sinus floor elevation surgery using autogenous bone harvested from two different donor sites using a Safescraper device on the success rate, graft survival and implant integration. Methods: The investigators conducted a retrospective cohort study at the Department of Oral and Maxillofacial Surgery of Military Hospital Ulm composed of patients with severe maxillary atrophy who underwent sinus augmentation from January 2011 until December 2011. Ninety-nine consecutive patients (89 men, 10 women) with a mean age of 43.1 years underwent sinus graft procedures in a 2-stage procedure using the lateral wall approach, as described by Tatum (1986). Data on patient age, smoking status, donor site and surgical complications were recorded and the relationship between Schneiderian membrane perforation and complication rate was evaluated. Dental implants were inserted 4 months after grafting. Results: A total of 105 sinus lift procedures were performed in 99 patients. Sixty-one patients (61.6%) underwent sinus elevation with autogenous bone from the buccal sinus wall, while 38 patients (38.4%) bone harvesting from the iliac crest. Intraoperative perforation of the Schneiderian membrane was observed in 11 of the 105 sinuses (10.4%). These perforations resulted in 4 (36.3%) of the cases in major postoperative complications accompanied by swelling and wound infection. Membrane perforations were slightly associated with the appearance of postoperative complications (p=0.0762). In 2.4% of all cases, regarding 2 patients the final rehabilitation with dental implants was not possible because of extensive bone resorption. Conclusion: Intraoperative complications performing sinus augmentation may lead to postoperative complications. With careful clinical and
Jeon, Seung Hyuck; Han, Doo Hee; Won, Tae-Bin; Keam, Bhumsuk; Kim, Ji-Hoon; Wu, Hong-Gyun
For either neck irradiation or dissection, the indications for elective neck treatment (ENT) of maxillary sinus carcinoma are still unclear. The purpose of the present study was to investigate the relationship between the anatomic extent of the disease and lymph node metastasis in maxillary sinus carcinoma and to propose a recommendation regarding ENT. In the present retrospective cohort study, patients with squamous cell carcinoma (SCC) and undifferentiated carcinoma (UDC) of maxillary sinus treated with radical intent from January 1995 to June 2015 in a single institution were recruited by retrospective medical record review. The demographic and tumor characteristics of the patients and maxillary sinus wall invasion, verified on pretreatment volumetric imaging studies, were analyzed. The Cox proportional hazards model was used to find the risk factors for nodal relapse, distant metastasis, and survival. Among a total of 71 identified patients, 66 had SCC and 5 had UDC. In 55 patients with node-negative disease, the risk of ipsilateral nodal relapse was 25.1% without ENT. In contrast, no ipsilateral nodal relapse was reported after ENT. On multivariate analysis, no chemotherapy (hazard ratio [HR] = 7.25; P = .01), posterior wall invasion (HR = 6.51; P = .03), and local failure (HR = 6.42; P = .02) were identified to be the risk factors of nodal relapse. Nodal relapse influenced the risk of distant metastasis with marginal significance (HR = 3.95; P = .07) but did not have an effect on survival. The most common regions of lymph node metastasis, at both initial presentation and relapse, were ipsilateral levels I and II. For SCC and UDC of the maxillary sinus with posterior wall invasion, ENT involving ipsilateral levels I and II is recommended. Future studies with larger numbers of patients are needed to validate our conclusion. Copyright © 2016. Published by Elsevier Inc.
Mangano, Francesco G; Colombo, Marco; Veronesi, Giovanni; Caprioglio, Alberto; Mangano, Carlo
AIM: To investigate the effectiveness of mesenchymal stem cells (MSCs) in maxillary sinus augmentation (MSA), with various scaffold materials. METHODS: MEDLINE, EMBASE and SCOPUS were searched using keywords such as sinus graft, MSA, maxillary sinus lift, sinus floor elevation, MSC and cell-based, in different combinations. The searches included full text articles written in English, published over a 10-year period (2004-2014). Inclusion criteria were clinical/radiographic and histologic/ histomorphometric studies in humans and animals, on the use of MSCs in MSA. Meta-analysis was performed only for experimental studies (randomized controlled trials and controlled trials) involving MSA, with an outcome measurement of histologic evaluation with histomorphometric analysis reported. Mean and standard deviation values of newly formed bone from each study were used, and weighted mean values were assessed to account for the difference in the number of subjects among the different studies. To compare the results between the test and the control groups, the differences of regenerated bone in mean and 95% confidence intervals were calculated. RESULTS: Thirty-nine studies (18 animal studies and 21 human studies) published over a 10-year period (between 2004 and 2014) were considered to be eligible for inclusion in the present literature review. These studies demonstrated considerable variation with respect to study type, study design, follow-up, and results. Meta-analysis was performed on 9 studies (7 animal studies and 2 human studies). The weighted mean difference estimate from a random-effect model was 9.5% (95%CI: 3.6%-15.4%), suggesting a positive effect of stem cells on bone regeneration. Heterogeneity was measured by the I2 index. The formal test confirmed the presence of substantial heterogeneity (I2 = 83%, P < 0.0001). In attempt to explain the substantial heterogeneity observed, we considered a meta-regression model with publication year, support type (animal vs
A 41-year-old female with a history of uterine cancer and Celiac and Raynaud's Disease presented to our institution with frequent migraines and nasal congestion. She underwent functional endoscopic sinus surgery (FESS) and experienced acute unilateral vision loss postoperatively. Rapid recognition of the etiology and effective treatment are paramount given the permanent and irreversible vision loss that can result. Arterial vasospasm following FESS is rare. Patients with autoimmune diseases have perhaps an increased risk for vasospasm secondary to an increased vasoreactive profile. We present the first documented case of nitroglycerin sublingual therapy to successfully treat ophthalmic artery vasospasm following FESS. Nitroglycerin sublingual therapy is a promising treatment for ophthalmic vasospasm secondary to its ability to cross the blood-ocular barrier, its rapid onset of action, and its ability to promote relaxation of vascular smooth muscle. PMID:28286685
Introduction Brown tumors are rare focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. Brown tumors can affect the mandible, maxilla, clavicle, ribs, and pelvic bones. Therefore, diagnosis requires a systemic investigation for lesion differentiation. Case presentation We present a 42-year-old Greek woman, with a rare case of brown tumor of the maxillary sinus due to primary hyperparathyroidism. Primary hyperparathyroidism is caused by a solitary adenoma in 80% of cases and by glandular hyperplasia in 20%. Conclusions Differential diagnosis is important for the right treatment choice. It should exclude other giant cell lesions that affect the maxillae. PMID:19830212
Ghazizadeh, Matin; Alavi Amlashi, Hesamodin; Mehrparvar, Golfam
Introduction: Plasmacytoma is a monoclonal proliferation of plasma cells. It can be an isolated lesion, for which the term extramedullary plasmacytoma is used, or a representation of multiple myeloma.The upper respiratory tract is the most common site for an extramedullary plasmacytoma. Sinonasal plasmacytomas cause different symptoms depending on the sites of origins and the areas of involvement. The treatment of choice for extramedullary plasmacytoma is local radiotherapy. Although it is generally accepted that plasmacytomas are radiosensitive, there are reports of cases that do not respond to radiotherapy. Case Report: A case of a 24-year-old male diagnosed with radioresistant extramedullary plasmacytoma of the maxillary sinus, who responded to surgical treatment, is reported. Conclusion: It is reasonable to consider an interdisciplinary approach in the management of extramedullary plasmacytoma. Considering early surgical intervention in cases encompassing risk factors of radiotherapy resistance is especially recommended before debilitating complications emerge. PMID:26788481
Homma, Akihiro; Hayashi, Ryuichi; Matsuura, Kazuto; Kato, Kengo; Kawabata, Kazuyoshi; Monden, Nobuya; Hasegawa, Yasuhisa; Onitsuka, Tetsuro; Fujimoto, Yasushi; Iwae, Shigemichi; Okami, Kenji; Matsuzuka, Takashi; Yoshino, Kunitoshi; Nibu, Ken-Ichi; Kato, Takakuni; Nishino, Hiroshi; Asakage, Takahiro; Ota, Ichiro; Kitamura, Morimasa; Kubota, Akira; Ueda, Tsutomu; Ikebuchi, Kaichiro; Watanabe, Akihito; Fujii, Masato
The purpose of this study was to evaluate the incidence of lymph node metastasis among patients with T4 maxillary sinus squamous cell carcinoma (MS-SCC) as well as the delayed metastasis rate and the treatment outcome for untreated N0 neck in patients with T4 MS-SCC. Consecutive series of all patients (n = 128) with previously untreated T4 maxillary sinus SCC between 2006 and 2007 were obtained from 28 institutions belonging to or cooperating in the Head and Neck Cancer Study Group of the Japan Clinical Oncology Group. Of the 128 patients, 28 (21.9 %) had lymph node metastasis, and six patients (4.7 %) had distant metastasis at diagnosis. Among the 111 patients who were treated with curative intent, 98 had clinically N0 neck disease and did not receive prophylactic neck irradiation. A total of 11 patients (11.2 %) subsequently developed evidence of lymph node metastasis, of whom eight were among the 83 patients with an N0 neck and had not received elective neck treatment. There were 15 patients who received an elective neck dissection as part of the initial treatment, of whom three had pathologically positive for lymph node metastases. Of 11 patients, six patients with nonlateral retropharyngeal lymph node metastasis without primary or distant disease were successfully salvaged. This study identified the incidence of lymph node metastasis among patients with T4 MS-SCC as well as the delayed metastasis rate and the treatment outcome for untreated N0 neck in patients with T4 MS-SCC. These results will be of assistance in selecting treatment strategy for T4 MS-SCC in the future.
Asaumi, Rieko; Miwa, Yoko; Imura, Kosuke; Sunohara, Masataka; Kawai, Taisuke; Yosue, Takashi
The formation of the maxillary sinus (MS) is tied to the maturation of the craniofacial bones during development. The MS and surrounding bone matrices in Japanese foetal specimens were inspected using cone beam computed tomography relative to the nasal cavity (NC) and the surrounding bones, including the palatine bone, maxillary process, inferior nasal concha and lacrimal bone. The human foetuses analysed were 223.2 ± 25.9 mm in crown-rump length (CRL) and ranged in estimated age from 20 to 30 weeks of gestation. The amount of bone in the maxilla surrounding the MS increased gradually between 20 and 30 weeks of gestation. Various calcified structures that formed the bone matrix were found in the cortical bone of the maxilla, and these calcified structures specifically surrounded the deciduous tooth germs. By 30 weeks of gestation, the uncinate process of the ethmoid bone formed a border with the maxilla. The distance from the midline to the maximum lateral surface border of the MS combined with the width from the midline to the maximum lateral surface border of the inferior nasal concha showed a high positive correlation with CRL in Japanese foetuses. There appears to be a complex correlation between the MS and NC formation during development in the Japanese foetus. Examination of the surrounding bone indicated that MS formation influences maturation of the maxilla and the uncinate process of the ethmoid bone during craniofacial bone development. PMID:20490493
Mertens, Christian; Wiens, Daniel; Steveling, Helmut G; Sander, Anja; Freier, Kolja
Insufficient bone height in the posterior maxilla is caused by bone atrophy after tooth extraction and continued pneumatization of the maxillary sinus. To allow for implant placement in this area, external sinus-floor elevations are performed. For this indication, the application of various bone graft materials can be a reliable alternative to autologous bone. The aim of this study was to analyze a nanoporous bone graft material under the condition of early implant treatment in sinus floor elevations. Sixty-six patients received 94 individual external sinus-floor elevations as a precondition for implant surgery. As grafting material, a synthetic, nanoporous bone graft material consisting of a mixture of nano-hydroxyapatite and nano-β-tricalciumphosphate crystals, combined with blood from the defect side, was used. Depending on the remaining vertical bone height, implant placement was performed either simultaneously with bone augmentation or consecutively in a delayed approach. After a 4-month healing period, the patients received 218 implants and were followed up clinically, radiographically, and histologically. To quantify the bone situation at implant placement, immunohistochemical analysis using tenascin-C was performed. We achieved an average vertical bone increase of 8.28 mm (SD, 2.59) for the one-stage approach and 10.99 mm (SD, 1.73) for the two-stage approach after sinus-floor elevation. The augmented areas showed mean resorption rates of 10.32% (one stage) and 10.82% (two stages) of vertical graft during the observation period. Immunohistochemical analysis after 4 months of healing showed high tenascin activity, indicating bone growth. Good primary stability was achieved during implant placement. Mean peri-implant marginal bone loss was 0.45 mm (SD, 0.31). After a mean observation time of 21.45 months, the biomaterial showed good osseointegration and bone stability radiographically. Adding to this the positive histological and immunohistochemical findings
Zhou, Qian; Yu, Bo-Han; Liu, Wei-Cai; Wang, Zuo-Lin
Bone marrow-derived mesenchymal stem cells (BM-MSCs) have been recognized as a new strategy for maxillary sinus floor elevation. However, little is known concerning the effect of the biomechanical pressure (i.e., sinus pressure, masticatory pressure, and respiration) on the differentiation of BM-MSCs and the formation of new bone during maxillary sinus floor elevation. The differentiation of BM-MSCs into osteoblasts was examined in vitro under cyclic compressive pressure using the Flexcell® pressure system, and by immunohistochemical analysis, qRT-PCR, and Western blot. Micro-CT was used to detect bone formation and allow image reconstruction of the entire maxillary sinus floor elevation area. Differentiation of BM-MSCs into osteoblasts was significantly increased under cyclic compressive pressure. The formation of new bone was enhanced after implantation of the pressured complex of BM-MSCs and Bio-Oss during maxillary sinus floor elevation. The pressured complex of BM-MSCs and Bio-Oss promoted new bone formation and maturation in the rabbit maxillary sinus. Stem cell therapy combined with this tissue engineering technique could be effectively used in maxillary sinus elevation and bone regeneration.
Jiang, Xin-quan; Wang, Shao-yi; Zhao, Jun; Zhang, Xiu-li; Zhang, Zhi-yuan
Aim To evaluate the effects of maxillary sinus floor elevation by a tissue-engineered bone complex of β-tricalcium phosphate (β-TCP) and autologous osteoblasts in dogs. Methodology Autologous osteoblasts from adult Beagle dogs were cultured in vitro. They were further combined with β-TCP to construct the tissue-engineered bone complex. 12 cases of maxillary sinus floor elevation surgery were made bilaterally in 6 animals and randomly repaired with the following 3 groups of materials: Group A (osteoblasts/β-TCP); Group B (β-TCP); Group C (autogenous bone) (n=4 per group). A polychrome sequential fluorescent labeling was performed post-operatively and the animals were sacrificed 24 weeks after operation for histological observation. Results Our results showed that autologous osteoblasts were successfully expanded and the osteoblastic phenol-types were confirmed by ALP and Alizarin red staining. The cells could attach and proliferate well on the surface of the β-TCP scaffold. The fluorescent and histological observation showed that the tissue-engineered bone complex had an earlier mineralization and more bone formation inside the scaffold than β-TCP along or even autologous bone. It had also maximally maintained the elevated sinus height than both control groups. Conclusion Porous β-TCP has served as a good scaffold for autologous osteoblasts seeding. The tissue-engineered bone complex with β-TCP and autologous osteoblasts might be a better alternative to autologous bone for the clinical edentulous maxillary sinus augmentation. PMID:20690503
Jiang, Xin-quan; Wang, Shao-yi; Zhao, Jun; Zhang, Xiu-li; Zhang, Zhi-yuan
To evaluate the effects of maxillary sinus floor elevation by a tissue-engineered bone complex of beta-tricalcium phosphate (beta-TCP) and autologous osteoblasts in dogs. Autologous osteoblasts from adult Beagle dogs were cultured in vitro. They were further combined with beta-TCP to construct the tissue-engineered bone complex. 12 cases of maxillary sinus floor elevation surgery were made bilaterally in 6 animals and randomly repaired with the following 3 groups of materials: Group A (osteoblasts/beta-TCP); Group B (beta-TCP); Group C (autogenous bone) (n=4 per group). A polychrome sequential fluorescent labeling was performed post-operatively and the animals were sacrificed 24 weeks after operation for histological observation. Our results showed that autologous osteoblasts were successfully expanded and the osteoblastic phenol-types were confirmed by ALP and Alizarin red staining. The cells could attach and proliferate well on the surface of the beta-TCP scaffold. The fluorescent and histological observation showed that the tissue-engineered bone complex had an earlier mineralization and more bone formation inside the scaffold than beta-TCP along or even autologous bone. It had also maximally maintained the elevated sinus height than both control groups. Porous beta-TCP has served as a good scaffold for autologous osteoblasts seeding. The tissue-engineered bone complex with beta-TCP and autologous osteoblasts might be a better alternative to autologous bone for the clinical edentulous maxillary sinus augmentation.
Yildirim, Vedat; Pausch, Niels Christian; Halama, Dirk; Lübbers, Heinz-Theo; Yildirim, Ayhan
Sinonasal inverted papilloma is a locally aggressive tumor arising from the Schneiderian membrane which lines the nasal cavity and paranasal sinuses. Aggressive surgical approaches, such as lateral rhinotomy, were used until recently for complete removal of the inverted papilloma. Currently, endoscopic resection is the gold standard in the treatment of inverted papilloma. However, there are situations that justify an open approach. For example there are studies that report a higher postoperative recurrence rate after endonasal endoscopic resection, particularly in the treatment of recurrent diseases. While endoscopic resection performed by an experienced surgeon is definitely a minimally invasive therapy, an open approach is not necessarily associated with functional and aesthetic disadvantages. This case report describes the treatment of inverted papilloma by an open approach. This has been described before but the new gold standard of endoscopic resection has to be taken into account before any treatment decision is made nowadays. Contrast-enhanced magnetic resonance imaging of the head and neck area was indicated in a 72-year-old white German man who presented with suspected squamous cell carcinoma of his lower lip. Magnetic resonance imaging additionally revealed a 3×2 cm(2) polycyclic arranged mucosal thickening with cystic and solid contrast affine shares at the antral laterocaudal area of his right maxillary sinus, extending from his right lateral nasal wall to his maxillary sinus floor. He received antral polypectomy with medial maxillectomy via a unilateral LeFort I osteotomy approach. His pterygoid plate was preserved. A histological examination demonstrated a tumor composed of hyperplastic squamous epithelium protruding into the stroma (surface epithelial cells grew downward into the underlying supportive tissue), thus producing a grossly convoluted cerebriform appearance. Two weeks later, the patient regained a well-formed maxilla without any
Dimonte, M; Inchingolo, F; Minonne, A; Stefanelli, M
Presently nuclear medicine techniques are not very popular in oral implantology, but they can play an interesting role in this surgical field too. In particular bone scan with 99mTc-MDP allows to evaluate the function of oral implants and the survival of bone grafts. We report our experience with skull bone scan in maxillary sinus lifting. We performed a three-year follow-up on 13 patients treated with inlay-one stage uni- or bilateral sinus lifting with a mixture composed of 90% bovine bone powder and of 10% small bone splinters and autogenous fibrin glue. We performed imaging studies and quantitated implant MDP uptake from the mean values at the surgical site to the 5th neck vertebral ratio (M/V index). The M/V index was also statistically compared with the one measured in 13 patients with severe resorption of distal upper dental arches (bone height less than 0.5 cm) and in 63 patients with normal dental status. Scintigraphic data were interpreted in the light of clinical, radiological and histologic findings. All oral implants appeared to be fixed and radiographs showed good positioning and bone adhesion; bone height exceeded 1 cm. Peri implant biopsy material was formed by normal mature bone tissue without bovine bone granules, necrotic areas and inflammatory cells. The highest bone activity (M/V index: 1.54-2.57) was observed 1-4 months after sinus lifting. Then MDP uptake decreases and 18 months after surgery radionuclide uptake in maxillary arches is homogeneous, with M/V values of 0.81-0.88. The average M/V value in the 18 surgical sites was clearly higher than in the resorbed (1.44 vs 0.64; Kruskall-Wallis ANOVA test; Dunn's method; p < 0.05) and normal (1.44 vs 0.73; p < 0.05) maxillary arches. 99mTc-MDP can show the transformation of newformed into mature bone and then allows in vivo visualization of implant osteointegration. The importance of our work lies in the use of radionuclide imaging to assess both the function of oral implants inserted by a
Shahidi, Shoaleh; Zamiri, Barbad; Momeni Danaei, Shahla; Salehi, Setareh; Hamedani, Shahram
Statement of the Problem Anatomic variations of the maxillary sinus can be detected in cone-beam computed tomography (CBCT) and may assist to locate the posterior superior alveolar artery (PSAA) and define the maxillary sinus morphology more accurately for a more strict surgical treatment plan. Purpose The study aimed to determine normal variations of the maxillary sinus with the aid of CBCT in a sample population in south of Iran. Materials and Method This cross-sectional prevalence study was based on evaluation of 198 projection data of CBCT scans of some Iranian patients aged 18-45 who referred to a private oral and maxillofacial radiology center in Shiraz from 2011 to 2013. CBCT scans were taken and analyzed with NewTom VGi device and software. The anatomic variations which were evaluated in the axial images included the presence of alveolar pneumatization, anterior pneumatization, exostosis, and hypoplasia. Moreover the location and height of sinus septa, and the location of PSAA were assessed. SPSS software (version 17.0) was used to analyze the data. Results In a total of 396 examined sinuses, maxillary sinus alveolar pneumatization was the most common anatomic variation detected. Anterior pneumatization was detected in 96 sinuses (24.2%). Antral septa were found in 180 sinuses (45.4%) and were mostly located in the anterior region. Meanwhile, PSAA was mostly detected intra-osseous in 242 sinuses (65.7%). Conclusion Anatomic variations of the maxillary sinus were common findings in CBCT of the maxilla. Preoperative imaging with CBCT seems to be very helpful for assessing the location of PSAA and the maxillary sinus morphology, which may be used to adjust the surgical treatment plan to yield more successful treatments. PMID:26966702
Iwaki, Lilian Cristina Vessoni; Tolentino, Elen Souza; Lustosa, Rômulo Maciel; Jacomacci, Willian Pecin; Casaroto, Ana Regina; Leite, Pablo Cornelius; Iwaki-Filho, Liogi
The unicystic ameloblastoma (UA) presents the clinical and radiographic characteristics of a maxillary cyst, making early diagnosis difficult. A 30-year-old man had an extensive, asymptomatic lesion in the right maxillary sinus. Radiographic examinations demonstrated a retained tooth in association with a lesion. Histopathologic examination revealed the presence of UA with intraluminal and mural infiltration and a follicular pattern. Le Fort I access was chosen for enucleation of the lesion and curettage of the site, which were followed by cryotherapy. The treatment provided adequate intraoperative visibility, enabled the preservation of the surrounding bone, and eliminated postoperative complications. Follow-up over 5 years demonstrated no recurrence.
Fang, Andrea; England, Jasmin; Gausche-Hill, Marianne
Acute bacterial sinusitis (ABS) is a common complication of a simple upper respiratory infection. Acute bacterial sinusitis and an upper respiratory infection, however, have different management plans. This article will help clinicians establish when a diagnosis of ABS can be made based on the latest guidelines from the American Academy of Pediatrics. Also covered will be the pathophysiology of ABS, the role of diagnostic imaging, the recognition of complications of ABS, and treatment options.
Cadir, Bilge; Karahan, Nermin; Nasir, Serdar; Aydin, M. Asim; Turkaslan, S. Suha
Fibrosarcoma of the paranasal sinuses is extremely rare pathology and there is limited report in the literature. We report synchronous presentation of maxillary sinus fibrosarcoma and gemistocytic astrocytoma which is, to our knowledge, unique in the literature. Both tumors metastases to other organ rarely and the metastatic spread of gemistocytic astrocytoma to fibrosarcoma or vice versa have also not been reported in the literature yet. This report discusses the clinical course of the disease, outcome of the treatment approach and survival as well as an unusual occurrence of leukocytoclastic vasculitis during the course of radiotherapy in such unusual presentation. PMID:19756200
Kim, David M; Nevins, Myron; Camelo, Marcelo; Nevins, Marc L; Schupbach, Peter; Rodrigues, Vinicius S; Fiorellini, Joseph P
A proof-of-principle study was conducted to assess the safety and efficacy of dental putty as an alternative sinus augmentation biomaterial. Six healthy patients requiring a total of 10 sinus augmentations received sinus augmentations. All patients volunteered and signed an informed consent based on the Helsinki declaration of 1975, as revised in 2000. The sinus augmentation was performed under local anesthesia with a mucoperiosteal flap elevated to expose the buccal wall of the maxillary sinus. The space was then filled with the dental putty in several increments, and the window was covered with an absorbable collagen membrane. Biopsies were harvested from all 10 treated sinuses using a 3-mm trephine bur at the time of implant placement at either 6 or at 9 months after sinus augmentation. All patients completed the study without complications, except for 1 patient who reported fistulas at 1 and 2 months after the surgery. Clinical reentry revealed that regenerated bone on the osteotomy site was soft and immature. The ground sections of the biopsied cores revealed minimum amounts of trabeculation surrounded by an abundant array of irregular-shaped residual alloplastic particles embedded in loose connective tissue. The present study's findings revealed inadequate bone formation, although the material appears to be bioinert as there is no elicitation of inflammatory response.
Salcedo-Hernández, Rosa Angélica; Lino-Silva, Leonardo Saúl; Luna-Ortiz, Kuauhyama
The aim of this study was to report our experience with malignant soft tissue tumors of the maxillary sinus in the period between 1985 to 2010. This is a retrospective case study in a tertiary cancer center setting. Review of patient's records and new evaluation of pathological specimens were made for 20 patients (14 men and 6 women) still met present criteria. After review the most common histological diagnoses were malignant peripheral nerve sheath tumor and malignant fibrous histiocytoma. There are male sex predilection, the median age was 38.9 years; 95% of tumors were >5 cm, 80% were high grade, 0% have metastatic disease at the diagnosis and the tumors were initially treated by surgical resection had better survival (p = 0.02). We present the results of a one of the larger series published to date in maxillary sinus sarcomas where analyzed the clinicopathological characteristics of 20 cases.
Nishino, Hiroshi; Takanosawa, Minako; Kawada, Kazumi; Kanazawa, Takeharu; Ichimura, Keiichi; Takahashi, Satoru; Nakazawa, Masanori
Current goals for the treatment of maxillary sinus carcinoma include the preservation of vision, eating, communication, and appearance, as well as the achievement of a cure. Japanese patients (n = 121) with maxillary sinus carcinoma were analyzed retrospectively. All patients underwent multidisciplinary therapy including minimally invasive resection, 20 Gy irradiation, and intra-arterial infusion of 5-fluorouracil. The 5- and 10-year overall survival rates were 73% and 68%, respectively. In 97 patients with squamous cell carcinoma (SCC), the 5- and 10-year overall survival rates were 76% and 70%, respectively. All 29 patients with orbital invasion retained the orbital contents, and 21 of these patients demonstrated adequate visual acuity. There were 16 complications, including trismus (5 patients), double vision (5 patients), fistula formation (3 patients), and cataract (3 patients). A multidisciplinary therapy, consisting of minimally invasive resection, irradiation, and regional chemotherapy, can yield good patient prognosis and quality of life after treatment. Copyright © 2012 Wiley Periodicals, Inc.
Kulkarni, Maithili Mandar; Khandeparkar, Siddhi Gaurish Sinai; Joshi, Avinash R; Barpande, Chitrangi
Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) family of tumors is an uncommon group of malignant neoplasms that may present in both skeletal and extraskeletal sites. PNET outside the central nervous system is called peripheral PNET (pPNET) developing from migrating embryonal cells of the neural crest. Very few cases of pPNET of the maxilla are reported in English literature. These tumors may be difficult to diagnose due to their primitive morphology. These tumors occur predominantly in infancy or early childhood. The occurrence of extraskeletal ES/PNET in the maxillary sinus in an old age is very rare. We report a case of extraskeletal ES/PNET developing in maxillary sinus in a 60-year-old woman. The ES/PNET should be included in the differential diagnosis of a small round cell tumor and immunohistochemical analysis with a panel of immunomarkers should be done for correct diagnosis and proper treatment.
Shaikh, Nader; Wald, Ellen R
The efficacy of decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated. To determine the efficacy of decongestants, antihistamines or nasal irrigation in improving symptoms of acute sinusitis in children. We searched CENTRAL (2014, Issue 5), MEDLINE (1950 to June week 1, 2014) and EMBASE (1950 to June 2014). We included randomized controlled trials (RCTs) and quasi-RCTs, which evaluated children younger than 18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic sinusitis and allergic rhinitis. Two review authors independently assessed each study for inclusion. Of the 662 studies identified through the electronic searches and handsearching, none met all the inclusion criteria. There is no evidence to determine whether the use of antihistamines, decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.
Smeets, Ralf; Grosjean, Maurice B; Jelitte, Gerd; Heiland, Max; Kasaj, Adrian; Riediger, Dieter; Yildirim, Murat; Spiekermann, Hubertus; Maciejewski, Oliver
The range of bone regeneration materials suitable for maxillar bone augmentation has increased steadily in the past few years and there is now a wide variety of materials being used. In the present case report, we analyzed the state of bone regeneration after sinus floor augmentation using a nanocrystalline in-phase synthetic anorganic hydroxyapatite bone grafting material (Ostim). A 60-year-old female patient underwent maxillary sinus floor elevation and the cavity was filled with Ostim three years before. Actually, she presented herself with loosening of the dental implant at position 17, as a result of parafunction. At the time of the insertion of a second implant at position 17, bone samples were taken by using a trepan drilling device from the previously augmented area. These samples were analyzed histologically to determine the extent of bone remodeling around the deposits of Ostim. We found that the Ostim deposits were surrounded largely by woven bone and, in parts, by lamellar bone and had facilitated osteoconductive bone regeneration. The adjacent implant, at position 16, which beared a crown exposed to proper biting forces without parafunction, showed proper clinical and radiological characteristics of complete and firm integration into the area which was also filled with Ostim three years ago. We conclude that the use of the nanocrystalline hydroxyapatite Ostim with its stable volume properties appears to be suitable for maxillary sinus floor augmentation. Furthermore, we even found osteoconductive bone regeneration under Ostim near the site of the loosened implant.
Săndulescu, M; Rusu, M C; Ciobanu, Iulia Camelia; Ilie, Angela; Jianu, Adelina Maria
The sphenoid sinus is one of the most morphologically variable and surgically important structures of the skull base. Located below the sella turcica, neighbored by parasellar regions, such as the orbital apex, pterygopalatine fossa and lateral sellar region (cavernous sinus), it is clinically related to these and surgically relevant as corridor for various approaches. Moreover, at the sphenoethmoidal junction, important variations occur, most of these related to the presence of the Onodi cells and the intrasinusal protrusions of the optic nerve. That is why any identified and previously undescribed morphological variation at that level must be added to the well-established protocols, clinical and surgical. During a retrospective CT study of the sphenoid sinus anatomical features a previously unreported morphology was encountered and is reported here. It refers to a unilateral sphenoethmoid cell (SEC), Onodi-positive, not only overriding the superior aspect of the sphenoid but also its lateral side to get intimately related to the maxillary nerve. As that SEC expanded medially to the cavernous sinus apex, it altered the usual endosinusal morphological correlations and also added itself within the limits of the Mullan's triangle. It appears so that such postero-infero-lateral extended pneumatization of an Onodi cell alters the surgical landmarks and also can blur clinical pictures, by adding maxillary and pterygopalatine signs and symptoms.
Cossellu, G; Farronato, G; Farronato, D; Ceschel, G; Angiero, F
Several techniques have been proposed to achieve sinus floor elevation and the formation of new bone through the grafting of autologous, heterologous, or alloplastic materials. The grafted materials act as a scaffold for bone formation inside the maxillary sinus. This study investigated a non-graft sinus lifting procedure using a resorbable polymeric thermo-reversible gel. A space-maintaining approach to sinus lifting, using a resorbable polymeric thermo-reversible gel, was applied in 11 patients undergoing implant treatment in the atrophic posterior maxilla. After a healing period of 6 months, a total of 14 implants were placed; biopsies were taken and evaluated histologically and histomorphometrically. The parameters evaluated included the percentages of new bone formation, residual gel, and fibrous tissue. Histological examination showed the formation of new bone with no fibrous tissue or severe inflammatory cellular infiltration. The percentage of newly formed bone was in the range of 54-60%; this consisted of both lamellar and woven bone. No foreign-body reaction was observed. The mean quantities of both residual gel and connective tissue were small. This non-graft sinus lifting procedure using a space-maintaining gel appears to stimulate predictable bone formation; it is thus a useful technique for promoting bone formation in the sinus.
Alayan, Jamil; Vaquette, Cedryck; Saifzadeh, Siamak; Hutmacher, Dietmar; Ivanovski, Saso
To assess the impact of a hydrophilic implant surface (SLActive(®) ) placed into augmented maxillary sinuses on bone-to-implant contact (BIC) and surrounding tissue composition when compared to a hydrophobic surface (SLA(®) ). Four sheep underwent bilateral sinus augmentation. Each sinus received anorganic bovine bone mineral + autogenous bone (ABBM + AB). Sixteen implants were subsequently placed 12 weeks postgrafting with each sinus receiving a control (SLA(®) ) and test implant (SLActive(®) ). Two animals were sacrificed at 2 weeks and another two animals were sacrificed at 4 weeks postimplantation. The eight sinuses and 16 implants were processed for histomorphometry, which assessed bone-to-implant contact (%BIC) and tissue elements (woven bone - WB, lamellar bone - LB, soft tissue - ST) in the interthread region of implants within the augmented sinus. There was a statistically significant increase in %BIC at week 4 compared to the week 2 animals in both test (P < 0.005) and control (P < 0.005) groups. There was a statistically significant greater %BIC around test implants when compared to control implants in both week 2 (P < 0.05) and week 4 animals (P < 0.05). Greater %WB (11.17% ±6.82) and %LB (11.06% ±3.67) were seen in the test implants when compared to the control implants independent of time. This was only statistically significant for %LB (P < 0.05). A statistically significant reduction of 16.78% (±6.19) in %ST was noted in test implants when compared to control implants (P < 0.05) independent of time. Both time and the use of hydrophilic implant surface had a positive impact on %BIC around implants placed into augmented maxillary sinuses. Hydrophilic implant surfaces also had a positive impact on surrounding tissue composition. Larger trials are needed to better assess and detect differences between these two surfaces in augmented maxillary sinuses. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Barboni, Barbara; Mangano, Carlo; Valbonetti, Luca; Marruchella, Giuseppe; Berardinelli, Paolo; Martelli, Alessandra; Muttini, Aurelio; Mauro, Annunziata; Bedini, Rossella; Turriani, Maura; Pecci, Raffaella; Nardinocchi, Delia; Zizzari, Vincenzo Luca; Tetè, Stefano; Piattelli, Adriano; Mattioli, Mauro
Background Evidence has been provided that a cell-based therapy combined with the use of bioactive materials may significantly improve bone regeneration prior to dental implant, although the identification of an ideal source of progenitor/stem cells remains to be determined. Aim In the present research, the bone regenerative property of an emerging source of progenitor cells, the amniotic epithelial cells (AEC), loaded on a calcium-phosphate synthetic bone substitute, made by direct rapid prototyping (rPT) technique, was evaluated in an animal study. Material And Methods Two blocks of synthetic bone substitute (∼0.14 cm3), alone or engineered with 1×106 ovine AEC (oAEC), were grafted bilaterally into maxillary sinuses of six adult sheep, an animal model chosen for its high translational value in dentistry. The sheep were then randomly divided into two groups and sacrificed at 45 and 90 days post implantation (p.i.). Tissue regeneration was evaluated in the sinus explants by micro-computer tomography (micro-CT), morphological, morphometric and biochemical analyses. Results And Conclusions The obtained data suggest that scaffold integration and bone deposition are positively influenced by allotransplantated oAEC. Sinus explants derived from sheep grafted with oAEC engineered scaffolds displayed a reduced fibrotic reaction, a limited inflammatory response and an accelerated process of angiogenesis. In addition, the presence of oAEC significantly stimulated osteogenesis either by enhancing bone deposition or making more extent the foci of bone nucleation. Besides the modulatory role played by oAEC in the crucial events successfully guiding tissue regeneration (angiogenesis, vascular endothelial growth factor expression and inflammation), data provided herein show that oAEC were also able to directly participate in the process of bone deposition, as suggested by the presence of oAEC entrapped within the newly deposited osteoid matrix and by their ability to switch
Romano, Marcelo M.; Smanio, Júlia A.; Ferreira, Lorraine B.; Arana-Chavez, Victor E.; Soares, Mário S.
The objective of this study is to report a clinical case of maxillary sinus with lyophilized, xenogeneic graft, in which, despite a large perforation of the sinus membrane, the surgery was not aborted and the results of histological examinations indicate bone neoformation in the surgical area. Results. This case showed that the biomaterials evaluated in this study and the procedure used to place them proved to be biocompatible and presented high osteogenic potential, leading to a successful surgery and osseointegration implant. Conclusion. Positioning Schneider's membrane and filling it with the graft biomaterial helped to achieve the desired osteoconduction and proliferation of bone cells even though the patient had a large perforation of the sinus membrane. PMID:25258686
Aghaghazvini, Leila; Sharifian, Hashem; Rasuli, Bahman
Primary hyperparathyroidism is an endocrine disorder recognized by hyperfunction of parathyroid gland, which can result in persistent bone absorption and brown tumor. Facial involvement of brown tumor is rare and usually involves the mandible. Giant cell tumor ( GCT) is an expansile osteolytic bone tumor which is very similar in clinical, radiological and histological features to brown tumor. Herein, we present a 35-year-old woman with an 11-month history of gradually swelling of the right maxilla and buccal spaces began during pregnancy two years ago. No other clinical or laboratory problems were detected. Postpartum CT scan demonstrated a lytic expansile multi-septated mass lesion containing enhancing areas, which initially described as GCT of the right maxillary sinus following surgery. Four months later, gradual progressive swelling of the bed of tumor was recurred and revised pathological slices were compatible with GCT. Regarding patient recent paresthesia, repeated laboratory tests were performed. Finally, according to laboratory results (elevation of serum calcium and parathyroid hormone), ultrasonographic findings and radioisotope scan (Sestamibi), probable parathyroid mass and brown tumor of maxilla was diagnosed. Pathology confirmed hyperplasia of right inferior parathyroid gland. Our case was thought-provoking due to its interesting clinical presentation and unusual presentation of brown tumor in parathyroid hyperplasia. PMID:27127572
Mori, Futoshi; Hanida, Sho; Kumahata, Kiyoshi; Miyabe-Nishiwaki, Takako; Suzuki, Juri; Matsuzawa, Teruo; Nishimura, Takeshi D
The nasal passages mainly adjust the temperature and humidity of inhaled air to reach the alveolar condition required in the lungs. By contrast to most other non-human primates, macaque monkeys are distributed widely among tropical, temperate and subarctic regions, and thus some species need to condition the inhaled air in cool and dry ambient atmospheric areas. The internal nasal anatomy is believed to have undergone adaptive modifications to improve the air-conditioning performance. Furthermore, the maxillary sinus (MS), an accessory hollow communicating with the nasal cavity, is found in macaques, whereas it is absent in most other extant Old World monkeys, including savanna monkeys. In this study, we used computational fluid dynamics simulations to simulate the airflow and heat and water exchange over the mucosal surface in the nasal passage. Using the topology models of the nasal cavity with and without the MS, we demonstrated that the MS makes little contribution to the airflow pattern and the air-conditioning performance within the nasal cavity in macaques. Instead, the inhaled air is conditioned well in the anterior portion of the nasal cavity before reaching the MS in both macaques and savanna monkeys. These findings suggest that the evolutionary modifications and coetaneous variations in the nasal anatomy are rather independent of transitions and variations in the climate and atmospheric environment found in the habitats of macaques. © 2015. Published by The Company of Biologists Ltd.
Netto, Henrique Duque; Miranda Chaves, Maria das Graças Alfonso; Aatrstrup, Beatriz; Guerra, Renata; Olate, Sergio
SUMMARY The aim of this study is to compare the bone formation in maxillary sinus lift with an autogenous bone graft in histological evaluation at 2 or 6 months. A comparative study was designed where 10 patients with missing teeth bilaterally in the posterior zone of the maxilla were selected. Patients received a particulate autogenous bone graft under the same surgical conditions, selecting a site to collect a biopsy and histological study at two months and another at six months postoperatively. Histomorphometry was performed and were used Kolmogorov-Smirnov test, student’s t-test and Spearman’s correlation coefficient, considering a value of p<0.05. Differences were observed in inflammatory infiltrate and vascularization characteristics; however, the group analyzed at two months presented 38.12% ± 6.64 % of mineralized tissue, whereas the group studied at 6 months presented an average of 38.45 ± 9.27 %. There were no statistical differences between the groups. It is concluded that the bone formation may be similar in intrasinus particulate autogenous bone grafts in evaluations at two or six months; under these conditions, early installation of implants is viable. PMID:27867255
Netto, Henrique Duque; Miranda Chaves, Maria das Graças Alfonso; Aatrstrup, Beatriz; Guerra, Renata; Olate, Sergio
The aim of this study is to compare the bone formation in maxillary sinus lift with an autogenous bone graft in histological evaluation at 2 or 6 months. A comparative study was designed where 10 patients with missing teeth bilaterally in the posterior zone of the maxilla were selected. Patients received a particulate autogenous bone graft under the same surgical conditions, selecting a site to collect a biopsy and histological study at two months and another at six months postoperatively. Histomorphometry was performed and were used Kolmogorov-Smirnov test, student's t-test and Spearman's correlation coefficient, considering a value of p<0.05. Differences were observed in inflammatory infiltrate and vascularization characteristics; however, the group analyzed at two months presented 38.12% ± 6.64 % of mineralized tissue, whereas the group studied at 6 months presented an average of 38.45 ± 9.27 %. There were no statistical differences between the groups. It is concluded that the bone formation may be similar in intrasinus particulate autogenous bone grafts in evaluations at two or six months; under these conditions, early installation of implants is viable.
Background We report a case of a spray painter who developed malignant fibrous histiocytoma (MFH) of the maxillary sinus following long-term exposure to chromium, nickel, and formaldehyde, implying that these agents are probable causal agents of MFH. Case report The patient developed right-sided prosopalgia that began twenty months ago. The symptom persisted despite medical treatment. After two months, he was diagnosed with MFH through imaging studies, surgery, and pathological microscopic findings at a university hospital in Seoul. His social, medical, and family history was unremarkable. The patient had worked for about 18 years at an automobile repair shop as a spray painter. During this period, he had been exposed to various occupational agents, such as hexavalent chromium, nickel, and formaldehyde, without appropriate personal protective equipment. He painted 6 days a week and worked for about 8 hours a day. Investigation of the patient’s work environment detected hexavalent chromium, chromate, nickel, and formaldehyde. Conclusions The study revealed that the patient had been exposed to hexavalent chromium, formaldehyde, and nickel compounds through sanding and spray painting. The association between paranasal cancer and exposure to the aforementioned occupational human carcinogens has been established. We suggest, in this case, the possibility that the paint spraying acted as a causal agent for paranasal cancer. PMID:24472378
Radulesco, Thomas; Michel, Justin; Mancini, Julien; Dessi, Patrick; Adalian, Pascal
Sex estimation is a key objective of forensic science. We aimed to establish whether maxillary sinus volumes (MSV) could assist in estimating an individual's sex. One hundred and three CT scans were included. MSV were determined using three-dimensional reconstructions. Two observers performed three-dimensional MSV reconstructions using the same methods. Intra- and interobserver reproducibility were statistically compared using the intraclass correlation coefficient (ICC) (α = 5%). Both intra- and interobserver reproducibility were perfect regarding MSV; both ICCs were 100%. There were no significant differences between right and left MSV (p = 0.083). No correlation was found between age and MSV (p > 0.05). We demonstrated the existence of sexual dimorphism in MSV (p < 0.001) and showed that MSV measurements gave a 68% rate of correct allocations to sex group. MSV measurements could be useful to support sex estimation in forensic medicine. © 2017 American Academy of Forensic Sciences.
Rudack, C; Stoll, W; Bachert, C
Cytokines are potent biologic factors involved in the regulation of inflammation, immune defense, and wound healing. Recently, growing interest has developed in the role of cytokines in chronic sinusitis and nasal polyposis. In the present study, we investigated the cytokine profile of different types of rhinosinusitis in order to evaluate whether a specific form of rhinosinusitis is associated with the expression of a certain cytokine profile. Sinus mucosa from patients with acute sinusitis (n = 10), chronic sinusitis (n = 7), antrochoanal polyp (n = 10), nasal polyps (n = 8) and controls of turbinate mucosa (n = 7) were sampled. The cytokine protein content (IL-1 beta, IL-3, IL-4, IL-5, IL-6, IL-8, IL-13, GM-CSF, interferon-gamma) of tissue homogenates was measured using ELISA technique. In acute sinusitis, the synthesis of proinflammatory cytokines and of the neutrophil chemokine IL-8 and IL-3 appeared to be upregulated. Chronic sinusitis mucosa demonstrated no significantly increased concentrations of the measured cytokines. In bilateral nasal polyposis, but not in antrochoanal polyps, the eosinophil related cytokine IL-5 was strongly upregulated. From these findings, it appears that specific cytokine patterns are found in different forms of sinusitis, and that IL-5 may represent the most important cytokine responsible for tissue eosinophilia in nasal polyposis.
Wolf, Michael; Wurm, Alexander; Heinemann, Friedhelm; Gerber, Thomas; Reichert, Christoph; Jäger, Andreas; Götz, Werner
Maxillary sinus floor augmentation is a treatment that has been proposed for patients in whom the alveolar bone height is insufficient. This procedure is commonly used in patients aged 40 to 70 years and older. However, little information exists whether the factor of age might influence the outcome of augmentation procedures. The aim of this study was to investigate whether the patient's age has an effect on bone formation and incorporation in maxillary sinus floor augmentation procedures. A fully synthetic nanocrystalline bone augmentation material (NanoBone, Artoss) was used for sinus floor augmentation in patients with a subantral vertical bone height of at least 3 mm and maximum of 7 mm. After 7 months healing time, biopsy specimens were taken and were divided into two groups according to the patient's age. Exclusion criteria were poor general health (eg, severe renal/and or liver disease), history of a radiotherapy in the head region, chemotherapy at the time of surgical procedure, noncompensated diabetes mellitus, symptoms of a maxillary sinus disease, active periodontal or systemic diseases, smoking, and poor oral hygiene. Histologic analyses with hematoxylin-eosin stain were performed. Multinucleated osteoclast-like cells were identified by histochemical staining (tartrate-resistant acid phosphatase [TRAP]). Quantitative and age-dependent assessment of bone formation, residual bone grafting material, and soft tissue formation following sinus augmentation was performed using histomorphometric analysis and the Bonferroni adjustment of the Student t test. Twenty biopsy specimens from 17 patients were taken and divided into two groups according to age (group 1: 41 to 52 years; group 2: 66 to 71 years) containing 10 specimens each, which were analyzed in triplicate resulting in a total of 30 specimens per group. A regeneration process with varying amounts of newly formed bone surrounded by marrow-like tissue was present in all augmented regions. No signs of
Okşayan, Rıdvan; Sökücü, Oral; Yeşildal, Seher
This study aimed to compare sinus volume and dimensions in patients with high-, low-, and normal-angle vertical growth patterns using cone-beam computed tomography (CBCT). According to skeletal vertical face growth patterns, 60 adults (31 female, 29 male, average age: 29.90 ± 10.91 years) were divided into three groups equally: high-angle, low-angle, and normal-angle groups. Cephalometric tracings were obtained from CBCT images and SN-GoGn (angle between Sella-Nasion line and Gonion-Gnathion line) cephalometric angular measurements used for the classification of skeletal vertical pattern evaluations. Morphological and dimensional changes in the maxillary sinuses were evaluated on CBCT images. Data were analyzed using the one-way ANOVA, Kruskall-Wallis, and Mann-Whitney U statistical tests. There were no statistically significant differences among the groups in terms of age (p > .05). The low-angle vertical growth pattern group showed significantly better results than the high-angle group in the right maxillary sinus length parameter (p < .05). According to the results, the high-angle subjects showed statistically lower values in terms of maxillary sinus length and width than the low-angle subjects. There were no effects of vertical face development on right and left maxillary sinus volumes. The results of this study may be useful in maxillary sinus evaluation when planning for orthognathic surgery and orthodontic mini screw application in various vertical face patterns.
Flam, Juliette O; Platt, Michael P; Sobel, Rachel; Devaiah, Anand K; Brook, Christopher D
Acute and chronic sinusitis in children and adults can spread to the orbit. Oral flora has been seen in orbital infections, but the extent of synergy between pathogens in such infections remains unknown. A retrospective case series of patients with complicated sinusitis that involved the orbit from acute sinusitis who were admitted to a tertiary care hospital from January 2000 to December 2014 and who had surgical cultures obtained. Patients were identified by the International Classification of Diseases, Ninth Revision code for periorbital cellulitis, subperiosteal abscess, or orbital abscess. Sixteen patients underwent surgical drainage via external drainage or endoscopic sinus surgery of an orbital infection associated with sinusitis and had cultures obtained. Nine patients (56%) grew organisms that exist in oral flora, whereas seven patients (44%) grew common respiratory pathogens. The most common organisms recovered were viridans group streptococcus (VGS) (50%), Staphylococcus aureus (31%), Eikenella corrodens (25%), and Prevotella species (19%). Oral flora anaerobes were cultured alongside a VGS species in seven of eight patients (88%) as opposed to the respiratory pathogens, which were less frequently associated with concomitant VGS infection (29%) (p = 0.04). There are two main sources for infectious orbital complications from acute sinusitis: respiratory pathogens and oral flora. The high prevalence of concurrent anaerobic oral flora and VGS infection supports a suspected synergy between VGS and other oral organisms.
Ghasemi, Samaneh; Fotouhi, Akbar; Moslemi, Neda; Chinipardaz, Zahra; Kolahi, Jafar; Paknejad, Mojgan
This meta-analysis and systematic review focused on the following question: Does tobacco smoking increase the risk of intra- or postoperative complications of lateral maxillary sinus floor elevation? The following electronic databases were searched up to and including November 2015 without language restriction: CENTRAL, MEDLINE, Google Scholar, Scopus, Sirous, and Doaj. Studies were included if rates of intra-or postoperative complications of sinus floor elevation in smokers and nonsmokers were recorded separately. The following complications were assessed: sinus membrane perforation, bleeding, wound dehiscence, wound infection, sinusitis, hematoma, and oroantral fistula. The Critical Appraisal Skills Programme was used to assess the risk of bias in included studies. Random-effects meta-analyses were used to assess the number of each complication in smokers and nonsmokers. Out of 929 eligible publications, 11 articles were included. Meta-analysis of the studies revealed a significantly increased risk of developing wound dehiscence after sinus floor elevation among smokers compared with nonsmokers (Risk Ratio [RR]: 7.82; 95% confidence interval [CI]: 2.38, 25.74; P = .0007). Moreover, risk of developing wound infection was greater in smokers when prospective studies were included in the meta-analysis (RR: 5.33; 95% CI: 1.34, 21.25; P = .02). However, the meta-analysis of included studies did not show significant differences between smokers and nonsmokers concerning risk of sinus membrane perforation and bleeding during sinus floor elevation (P = .46 and P = .33, respectively). Considering the lack of randomized controlled trials and the small number of included studies, the results indicate that smoking seems to be associated with increased risk of wound dehiscence and infection after the sinus augmentation procedure.
Araujo, Danilo Barral; de Jesus Campos, Elisângela; Oliveira, Marcos André Matos; Lima, Max José Pimenta; Martins, Gabriela Botelho; Araujo, Roberto Paulo Correia
Realize the surgery of sinus lifting floor to allow the installation of osseointegrated implants for oral rehabilitation, with the combination of different biomaterials, autogenous bone and lyophilized bovine bone. Oral rehabilitation using the installation of osseointegrated implants is an alternative surgical approach that results in the satisfactory form, function and esthetics of the dental units. After clinical, dental and laboratory assessment, a 47-year-old female patient underwent full maxillary oral rehabilitation involving the installation of osseointegrated implants to allow her to meet the physiological demands of occlusion and mastication. It was found that the patient had fully pneumatized maxillary sinuses with insufficient height to anchor implants, with a loss of the vertical dimension of the occlusal and masticatory functions due to general dental loss, compounded by the use of ill-fitting dentures; hence, the choice was made to take autogenous bone from the patient's chin area and supplement it with lyophilized bovine bone as collateral for larger areas to be grafted. It was also decided to avulse the remaining tooth units due to their impairment by periodontal disease. Bone grafts do not constitute suitable alternatives in the cosmetic and functional rehabilitation of the maxilla in patients requiring bilateral sinus elevation. The chin region provides bone tissue that, when complemented by lyophilized bovine bone grafts, ensures greater volume and less invasive surgery. In the case described here, a height gain of approximately 550% was obtained, making it possible to anchor seven implants. In this study, the surgical procedures used for grafting a combination of autogenous and lyophilized bovine bone, aimed to elevate the maxillary sinus floor to allow the installation of osseointegrated implants for oral rehabilitation.
Slater, Nicola; Dasmah, Amir; Sennerby, Lars; Hallman, Mats; Piattelli, Adriano; Sammons, Rachel
To investigate the presence and composition of residual bone graft substitute material in bone biopsies from the maxillary sinus of human subjects, following augmentation with calcium sulphate (CaS). Bone cores were harvested from the maxillary sinus of patients who had undergone a sinus lift procedure using CaS G170 granules 4 months after the initial surgery. Samples from seven patients, which contained residual biomaterial particles, were examined by field emission scanning electron microscopy and energy dispersive X-ray spectroscopy was used to determine the composition of the remaining bone graft substitute material. Residual graft material occurred in isolated areas surrounded by bone and consisted of individual particles up to 1 mm in length and smaller spherical granules. On the basis of 187 separate point analyses, the residual material was divided into three categories (A, B and C) consisting of: A, mainly CaS (S/P atomic% ratio > or =2.41); B, a heterogeneous mixture of CaS and calcium phosphate (S/P=0.11-2.4) and C, mainly calcium phosphate (S/P< or =0.11; C), which had a mean Ca : P ratio of 1.63+/-0.2, consistent with Ca-deficient hydroxyapatite. Linescans and elemental maps showed that type C material was present in areas which appeared dense and surrounded, or were adjacent to, more granular CaS-containing material, and also occurred as spherical particles. The latter could be disintegrating calcium phosphate in the final stages of the resorption process. CaS resorption in the human maxillary sinus is accompanied by CaP precipitation which may contribute to its biocompatibility and rapid replacement by bone.
Chitsazi, Mohammad-Taghi; Faramarzi, Masoumeh; Esmaieli, Farzad; Chitsazi, Shadi
Background The aim of the present study was to evaluate the diameter, relationship and position of the posterior superior alveolar artery and its relationship with the alveolar ridge, the medial wall of the maxillary sinus, the prevalence of pathologic conditions and the maxillary sinus septa on CBCT images. Material and Methods A total of 200 CBCT images (400 maxillary sinuses) of patients over 20 years of age were evaluated. The distances between the lower border of the artery and the alveolar crest and between the artery and the medial wall of the sinus and the diameter of the artery were measured. The position of the artery, the presence of pathologic conditions and septa were recorded in the posterior region in: a) males edentulous in the posterior region; b) males having teeth in the posterior region; c) females edentulous in the posterior region; and d) females having teeth in the posterior region. Results The mean distance between the artery and the alveolar crest, irrespective of groupings, was 16.17±1.63 mm, with significant differences between the groups (P<0.05). The mean distance between the artery and the medial wall of the sinus was 11.65±1.21 mm, with no significant differences between the groups (P=0.796). The mean diameter of the canal was 1.37±0.44 mm, with no significant differences between the 4 groups (P=0.570). The position of the artery was intraosseous in 73.2%, beneath the sinus membrane in 21.7% and external to the lateral wall of the sinus in 4.9% of the cases. The overall prevalence rates of pathologic conditions and septa in the maxillary sinus were 45.7% and 26%, respectively. Conclusions CBCT technique is useful for such evaluations and for possible variations in maxillary sinuses and presence of septa and pathologic entities in maxillary sinuses. Key words:Maxillary sinus, maxillary artery, Cone-Beam computed tomography. PMID:28298981
...: Developing Drugs for Treatment; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice... entitled ``Acute Bacterial Sinusitis: Developing Drugs for Treatment.'' This guidance addresses FDA's... an indication for the treatment of acute bacterial sinusitis (ABS). This guidance finalizes...
Belleggia, Fabrizio; Ippoliti, Stefano; DeVilliers, Patrica; Stefanelli, Luigi Vito; Di Carlo, Stefano; Pompa, Giorgio
ABSTRACT Objectives The aim of this study was to evaluate the clinical, radiographic and histologic results when a highly purified xenogenic bone (Laddec®) was used as grafting material in maxillary sinuses. Material and Methods In fifteen patients requiring unilateral maxillary sinus augmentation, the grafting procedure was performed with Laddec®. Forty-two implants were installed after a 6 month healing period. The height of the augmented sinus was measured radiographically immediately after augmentation and postoperatively up to 36 months. At the time of implant placement, a bone core was harvested in each patient for histological examination. Results The cumulative implant survival rate was 97.6%. The original height was 3.65 (SD 0.7) mm and the augmented sinus height was 13.8 (SD 1.4) mm after the surgery. The reduced height of grafted xenogenic material (RDL) at the implant insertion was 0.83 (SD 0.38) mm, and at the final postoperative visit was 0.91 (SD 0.25) mm, showing no significant correlation with the follow-up periods by Spearman’s test (P = 0.118). In addition, no significant difference in the RDL was observed according to the site of implantation (P = 0.682). The mean implant marginal bone loss was 0.38 (SD 0.24) mm. Histological analysis showed the bone cores were composed of 64.72 (SD 3.44)% newly formed bone, 17.41 (SD 2.02)% connective tissue, 16.93 (SD 2.83)% residual graft particles, and 0.94 (SD 0.11)% inflammatory cells. Conclusions According to our data, the highly purified xenogenic bone (Laddec®), used as graft material in the sinus lift procedure, may create adequate bone volume, and appropriate osseointegration of dental implants. PMID:27099697
Bristol, Ian J. . E-mail: email@example.com; Ahamad, Anesa; Garden, Adam S.; Morrison, William H.; Hanna, Ehab Y.; Papadimitrakopoulou, Vassiliki A.; Rosenthal, David I.; Ang, K. Kian
Purpose: To determine the effects of three changes in radiotherapy technique on the outcomes for patients irradiated postoperatively for maxillary sinus cancer. Methods and Materials: The data of 146 patients treated between 1969 and 2002 were reviewed. The patients were separated into two groups according to the date of treatment. Group 1 included 90 patients treated before 1991 and Group 2 included 56 patients treated after 1991, when the three changes were implemented. The outcomes were compared between the two groups. Results: No differences were found in the 5-year overall survival, recurrence-free survival, local control, nodal control, or distant metastasis rates between the two groups (51% vs. 62%, 51% vs. 57%, 76% vs. 70%, 82% vs. 83%, and 28% vs. 17% for Groups 1 and 2, respectively). The three changes were to increase the portals to cover the base of the skull in patients with perineural invasion, reducing their risk of local recurrence; the addition of elective neck irradiation in patients with squamous or undifferentiated histologic features, improving the nodal control, distant metastasis, and recurrence-free survival rates (64% vs. 93%, 20% vs. 3%, and 45% vs. 67%, respectively; p < 0.05 for all comparisons); and improving the dose distributions within the target volume, reducing the late Grade 3-4 complication rates (34% in Group 1 vs. 8% in Group 2, p = 0.014). Multivariate analysis revealed advancing age, the need for enucleation, and positive margins as independent predictors of worse overall survival. The need for enucleation also predicted for worse local control. Conclusion: The three changes in radiotherapy technique improved the outcomes for select patients as predicted. Despite these changes, little demonstrable overall improvement occurred in local control or survival for these patients and additional work must be done.
Zhu, Jian Hua; Lim, Kian Meng; Thong, Kim Thye Mark; Wang, De Yun; Lee, Heow Pueh
In this study, we evaluated the effects of targeted sinonasal surgery on nasal and maxillary sinus airflow patterns. A patient, who underwent right balloon sinuplasty and left uncinectomy for recurrent maxillary sinus barometric pressure, and concomitant septoplasty and bilateral inferior turbinate reduction for deviated nasal septum and inferior turbinate hypertrophy, was selected. Two 3D models representing both pre- and post-operative sinonasal morphology were constructed. The models were then used to evaluate nasal and maxillary sinus airflow patterns during respiration at ventilation rates of 7.5 L/min, 15 L/min and 30 L/min using computational fluid dynamics. The results showed that septoplasty and inferior turbinate reduction increased the nasal volume by 13.6%. The airflow patterns in the nasal cavity showed reasonably decreased resistance and slightly more even flow partitioning after the operation. Maxillary sinus ventilation significantly increased during inspiration in the left sinus after uncinectomy, and during expiration in right sinus after balloon sinuplasty. This study demonstrates computational fluid dynamics simulation is a tool in the investigation of outcomes after targeted, minimally invasive sinonasal surgery. Copyright © 2014. Published by Elsevier B.V.
Lin, Lin; Zhou, Ni; Chen, Zisong
To investigate the clinical features of fungal rhino-sinusitis. Clinical data of 189 patients suffering from fungal rhino-sinusitis treated by functional endoscopic sinus surgery was analyzed retrospectively. The analyzed data included clinical type, age of onset, predilectionsite, reason, and surgical outcome. Among the 189 patients with fungal rhino-sinusitis,181 cases were fungal ball,6 cases were allergic fungal rhino-sinusitis, 1 case was acute invasive fungnal rhino-sinusitis, 1 case was chronic invasive fungnal rhino-sinusitis. One hundred and twenty-eight cases were in the maxillary sinus (123 cases were unilateral, 5 cases were bilateral). Nineteen cases were in the ethmoid sinus. 31 cases were in the sphenoid sinus. Two cases were both in the maxillary sinus and ethmoid sinus, 1 case was both in the maxillary sinus and sphenoid sinus. Two cases invasive fungnal rhino-sinusitis had diabetes history. All the patients treated by functional endoscopic sinus surgery, 184 cases without recurrence, 5 cases suffered re-operation. The incidence of fungal rhinosinusitis is showing a rising trend, fungal ball is the highest. The sinusitis patients whom we highly doubt for fungal infection should be confirmed by using sinonasal secretion smear, cultivation and histopathological examination. Surgical treatment should completely remove the fungal masses, to avoid reoperation.
Nishimura, Takeshi D; Ito, Tsuyoshi
The skull of an adult female Tibetan macaque, Macaca thibetana, was found to completely lack the maxillary sinus (MS). This absence was accompanied by a slight lateral concavity where the ostium should have formed in the MS, a slight drop of the orbital floor, posterior and medial displacement of the zygomaxillary suture, an unusual position of the lacrimal canal, malocclusion with severely worn cheek teeth, and abnormalities in the temporomandibular joints. The facial component was disproportionally large compared with the neurocranium and mandible. This hypertrophic face probably caused the malocclusion and associated anatomical disorders and simultaneously displaced the lacrimal canal posterior to other nasal structures to preclude the possibility of maxillary pneumatization. These modifications in the spatial relationships to nasal structures might help explain the evolutionary loss and reacquisition of the MS in some primate lineages displaying great variations in facial anatomy.
Hassani, R; Aderdour, L; Maliki, O; Boumed, A; Elfakiri, M M; Bouchoua, F; Raji, A
Nasal septal abscess is a rare complication of acute sinusitis in children. We report the case of a 9-year-old girl who presented at the emergency unit with a bilateral eyelid edema evolving over 2 days, associated with bilateral rhinorrhea and nasal obstruction. Clinical examination found a tumefied nasal septum and nasal obstruction. A computed tomography scan of the nose and paranasal sinuses showed pansinusitis with an abscess of the nasal septum. Treatment consisted in the evacuation of the abscess associated with a triple antibiotic therapy. Progression was favorable. Acute sinusitis is seldom complicated by an abscess of the nasal septum, and very few cases are reported in the literature. Early diagnosis and treatment can avoid complications, which engage not only the functional but also the vital prognosis.
Thorn, David; Mamot, Christoph; Krasniqi, Fatime; Metternich, Frank; Prestin, Sven
The Ewing sarcoma family of tumors (ESFT) encompasses a group of highly aggressive, morphologically similar, malignant neoplasms sharing a common spontaneous genetic translocation that affect mostly children and young adults. These predominantly characteristic, small round-cell tumors include Ewing's sarcoma of the bone and soft tissue, as well as primitive neuroectodermal tumors (PNETs) involving the bone, soft tissue, and thoracopulmonary region (Askin's tumor). Extraosseous ESFTs are extremely rare, especially in the head and neck region, where literature to date consists of sporadic case reports and very small series. We hereby present a review of the literature published on ESFTs reported in the maxilla and maxillary sinus region from 1968 to 2016.
Kaigler, Darnell; Avila-Ortiz, Gustavo; Travan, Suncica; Taut, Andrei D; Padial-Molina, Miguel; Rudek, Ivan; Wang, Feng; Lanis, Alejandro; Giannobile, William V
Bone engineering of localized craniofacial osseous defects or deficiencies by stem cell therapy offers strong prospects to improve treatment predictability for patient care. The aim of this phase 1/2 randomized, controlled clinical trial was to evaluate reconstruction of bone deficiencies of the maxillary sinus with transplantation of autologous cells enriched with CD90+ stem cells and CD14+ monocytes. Thirty human participants requiring bone augmentation of the maxillary sinus were enrolled. Patients presenting with 50% to 80% bone deficiencies of the maxillary sinus were randomized to receive either stem cells delivered onto a β-tricalcium phosphate scaffold or scaffold alone. Four months after treatment, clinical, radiographic, and histologic analyses were performed to evaluate de novo engineered bone. At the time of alveolar bone core harvest, oral implants were installed in the engineered bone and later functionally restored with dental tooth prostheses. Radiographic analyses showed no difference in the total bone volume gained between treatment groups; however, density of the engineered bone was higher in patients receiving stem cells. Bone core biopsies showed that stem cell therapy provided the greatest benefit in the most severe deficiencies, yielding better bone quality than control patients, as evidenced by higher bone volume fraction (BVF; 0.5 versus 0.4; p = 0.04). Assessment of the relation between degree of CD90+ stem cell enrichment and BVF showed that the higher the CD90 composition of transplanted cells, the greater the BVF of regenerated bone (r = 0.56; p = 0.05). Oral implants were placed and restored with functionally loaded dental restorations in all patients and no treatment-related adverse events were reported at the 1-year follow-up. These results provide evidence that cell-based therapy using enriched CD90+ stem cell populations is safe for maxillary sinus floor reconstruction and offers potential to accelerate and enhance
Kolerman, Roni; Samorodnitzky-Naveh, Gili R; Barnea, Eitan; Tal, Haim
Deproteinized bovine bone mineral (DBBM) and human freeze-dried bone allograft (FDBA) were compared in five patients undergoing bilateral maxillary sinus floor augmentation using DBBM on one side and FDBA on the contralateral side. After 9 months, core biopsy specimens were harvested. Mean newly formed bone values were 31.8% and 27.2% at FDBA and DBBM sites, respectively (P = .451); mean residual graft particle values were 21.5% and 24.2%, respectively (P = .619); and mean connective tissue values were 46.7% and 48.6%, respectively (P = .566). Within the limits of the present study, it is suggested that both graft materials are equally suitable for sinus augmentation.
Starch-Jensen, Thomas; Schou, Søren
To compare implant treatment outcome after maxillary sinus membrane elevation with simultaneous installation of implants with or without the use of graft material applying the lateral window technique. MEDLINE/PubMed, Cochrane Library, and Embase search in combination with a hand-search of relevant journals was conducted from January 1, 2004 to January 1, 2016. Thirteen studies fulfilled the inclusion criteria. Survival of suprastructures has not been compared within the same study. Short-term implant survival without graft material varied between 96% and 100% compared to 100% for autogenous bone or bone substitutes. No significant difference in bone gain was reported without graft material compared to autogenous bone. The density of newly formed bone increased significantly during the observation period. Bone density was significantly higher in sinuses augmented with blood clot compared to bone substitute, whereas no significant difference was found when compared to autogenous bone. Noncomparative studies demonstrated high long-term implant survival and new bone formation after sinus membrane elevation without graft material. Sinus membrane elevation without the use of a graft material seems to enhance new bone formation with high implant survival, but long-term comparative studies are missing.
Balk, Ethan M; Zucker, Deborah R; Engels, Eric A; Wong, John B; Williams, John W; Lau, Joseph
OBJECTIVE Symptoms suggestive of acute bacterial sinusitis are common. Available diagnostic and treatment options generate substantial costs with uncertain benefits. We assessed the cost-effectiveness of alternative management strategies to identify the optimal approach. DESIGN For such patients, we created a Markov model to examine four strategies: 1) no antibiotic treatment; 2) empirical antibiotic treatment; 3) clinical criteria-guided treatment; and 4) radiography-guided treatment. The model simulated a 14-day course of illness, included sinusitis prevalence, antibiotic side effects, sinusitis complications, direct and indirect costs, and symptom severity. Strategies costing less than $50,000 per quality-adjusted life year gained were considered “cost-effective.” MEASUREMENTS AND MAIN RESULTS For mild or moderate disease, basing antibiotic treatment on clinical criteria was cost-effective in clinical settings where sinusitis prevalence is within the range of 15% to 93% or 3% to 63%, respectively. For severe disease, or to prevent sinusitis or antibiotic side effect symptoms, use of clinical criteria was cost-effective in settings with lower prevalence (below 51% or 44%, respectively); empirical antibiotics was cost-effective with higher prevalence. Sinus radiography-guided treatment was never cost-effective for initial treatment. CONCLUSIONS Use of a simple set of clinical criteria to guide treatment is a cost-effective strategy in most clinical settings. Empirical antibiotics are cost-effective in certain settings; however, their use results in many unnecessary prescriptions. If this resulted in increased antibiotic resistance, costs would substantially rise and efficacy would fall. Newer, expensive antibiotics are of limited value. Additional testing is not cost-effective. Further studies are needed to find an accurate, low-cost diagnostic test for acute bacterial sinusitis. PMID:11679039
Olwoch, Ian Paul
A retrospective chart review study at two referral hospitals identified 226 consecutive surgical patients with acute complicated sinusitis. One hundred and fifty-nine male and 67 female patients, with a mean age of 16.5 (standard deviation 0.7) years, underwent external fronto-ethmoidectomy with maxillary sinus washout and 13 had a concurrent craniotomy. A total of 233 micro-organisms were isolated from 163 patients(72.1%), and 63 (27.9%) were culture-negative. Positive isolates included Streptococcus milleri (18.5%), Staphylococcus aureus (12.4%), beta-haemolytic streptococci (10.8%), coagulase-negative staphylococci (8.6%), Haemophilus influenzae (8.6%) and the anaerobes, Peptostreptococcus (6.4%) and Prevotella (4.7%) species. The prevalences of S. pneumoniae (2.6%), methicillin-resistant S. aureus (MRSA) (1.3%) and Moraxella catarrhalis (0.4%) were low. Polymicrobial disease was present in 56 patients (34.4%). There was a significant difference between the two hospitals in the prevalences of some bacteria (p<0.05). Antibiotic resistance was highest towards the penicillins (64.3%) and cephalosporins (12.5%). Effective empiric treatment was achieved with metronidazole and a choice of amoxicillin-clavulanate or ampicillin plus cloxacillin or penicillin plus chloramphenicol. The polymicrobial nature and severity of complicated sinusitis warrants a de-escalation approach to antimicrobial therapy. The combination of beta-lactamase-resistant penicillins and metronidazole is a reasonable choice for initial empiric antibacterial therapy. Selection of drugs for empirical antibiotic therapy in patients with acute complicated sinusitis should be supported by knowledge of the local prevalence and antimicrobial susceptibilities of bacteria isolated from patients.
Toscano, Paolo; Toscano, Calogero; Del Fabbro, Massimo
The aim of this retrospective study was to report preliminary outcomes of a modified technique for transcrestal sinus floor elevation with simultaneous implant placement. A total of 165 implants were placed in 110 patients using a modified Summers technique. During implant site preparation, after fracturing the sinus floor, a small perforation of the membrane was made using the first osteotome. After grafting with anorganic bovine bone mixed with venous blood, standard-length implants were inserted. The prosthetic phase occurred after 4 to 5 months. Patients were followed for at least 2 years after loading. During the follow-up, sinus condition was assessed by cone beam computed tomography. Periapical radiographs were taken to assess graft height and peri-implant bone levels. Three implants failed within 2 months of placement, yielding an overall implant survival of 98.2%. The mean follow-up was 38.3 months (range: 28 to 60 months) from placement. All other implants were stable and peri-implant soft tissues were healthy throughout the observation period. Peri-implant bone loss averaged 0.62 ± 0.26 mm after 1 year of function. No biologic or biomechanical complications occurred. No evidence of graft material dispersion into the sinus space was detected, except for two cases that resolved spontaneously. After 1 year of loading the graft height averaged 4.8 ± 1.3 mm above the sinus floor level. In the presence of sinus membrane perforation, the proposed modified osteotome technique may allow a predictable rehabilitation of the atrophic posterior maxilla by means of standard length implants without the occurrence of adverse events.
Noman, Samer Abduljabar; Shindy, Mostafa Ibrahim
We report a case of complete dislocation of the globe into the maxillary sinus, with immediate repositioning of the globe. This report highlights the importance of early surgical repair of orbital fracture and globe repositioning to regain the maximum amount of ocular functions. A review of literature found 19 cases of globe dislocation into the maxillary sinus: One case was enucleated 2 months after misdiagnosis as traumatic enucleation, six cases were documented no vision or no light perception, three cases did not have reported vision (patients did not survive), and nine cases with postoperative vision. We recommend early surgical intervention to restore the cosmetic and visual function of the dislocated eye.
Dimonte, M; Inchingolo, F; Dipalma, G; Stefanelli, M
To evaluate the efficacy of bone scintigraphy in the long-term follow-up of maxillary sinus lift by a mixture of bovine hydroxyapatite and autologous fibrin glue in conjunction with the insertion of endosseous implants. A three-years follow-up study involved 18 surgical interventions performed on 14 edentulous patients (4 F; 10 M; mean age 49 yrs) suffering from mono or bilateral severe distal maxillary resorbtion. The bone scintigraphy of the skull was performed before, 1-18 months and 36 months post-intervention. Perimplant bone metabolism was quantified by a parameter called M/V index, used to statistically compare normal, atrophic and regenerate maxillary bone. Conventional radiographies were performed every six months; CT dental-scan 12 months post-intervention. Bone perimplant metabolism showed top values 1-4 months post-intervention (M/V%2-2.2); then it showed a decreasing trend and the lowest values 36 months post-intervention. M/V index in the atrophic (0.6) and normal (0.7) maxillary bone was lower (p<0.05) than in the new formed one (0.8). Radiologically a good integration of the dental implants was found in the new formed bone; the CT-measured average maxillary height was equal to 1 cm. The combination of several bioactive components in the mixture used didn't allow to detect the bone inductive role of the single products. Instead, quantitative bone scintigraphy confirmed its efficacy to gain important data about natural history of the endosseous implants and the value of the surgical technique. In particular we observed complete osseous integration of dental implants inserted in the mix of bovine hydroxyapatite and autologous fibrin glue is achieved 2-3 years after the intervention. After this period, possible pathological aspects suggest an early treatment to save the implants.
Padia, Reema; Thomas, Andrew; Alt, Jeremiah; Gale, Craig; Meier, Jeremy D
Review costs for pediatric patients with complicated acute sinusitis. A retrospective case series of patients in a pediatric hospital was created to determine hospital costs using a standardized activity-based accounting system for inpatient treatment between November 2010 and December 2014. Children less than 18 years of age who were admitted for complicated acute sinusitis were included in the study. Demographics, length of stay, type of complication and cost of care were determined for these patients. The study included 64 patients with a mean age of 10 years. Orbital cellulitis (orbital/preseptal/postseptal cellulitis) accounted for 32.8% of patients, intracranial complications (epidural/subdural abscess, cavernous sinus thrombosis) for 29.7%, orbital abscesses (subperiosteal/intraorbital abscesses) for 25.0%, potts puffy tumor for 7.8%, and other (including facial abscess and dacryocystitis) for 4.7%. The average length of stay was 5.7 days. The mean cost per patient was $20,748. Inpatient floor costs (31%) and operating room costs (18%) were the two greatest expenditures. The major drivers in variation of cost between types of complications included pediatric intensive care unit stays and pharmacy costs. Although complicated acute sinusitis in the pediatric population is rare, this study demonstrates a significant financial impact on the health care system. Identifying ways to reduce unnecessary costs for these visits would improve the value of care for these patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Gorla, L F de O; Spin-Neto, R; Boos, F B D J; Pereira, R dos S; Garcia-Junior, I R; Hochuli-Vieira, E
The correction of bone defects can be performed using autogenous or alloplastic materials, such as beta-tricalcium phosphate (β-TCP). This study compared the changes in bone volume (CBV) after maxillary sinus lifting using autogenous bone (n = 12), autogenous bone associated with β-TCP 1:1 (ChronOS; DePuy Synthes, Paoli, CA, USA) (n = 9), and β-TCP alone (n = 11) as grafting material, by means of cone beam computed tomography (CBCT). CBV was evaluated by comparing CBCT scans obtained in the immediate postoperative period (5-7 days) and at 6 months postoperative in each group using OsiriX software (OsiriX Foundation, Geneva, Switzerland). The results showed an average resorption of 45.7 ± 18.6% for the autogenous bone group, 43.8 ± 18.4% for the autogenous bone+β-TCP group, and 38.3 ± 16.6% for the β-TCP group. All bone substitute materials tested in this study presented satisfactory results for maxillary sinus lifting procedures regarding the maintenance of graft volume during the healing phase before the insertion of implants, as assessed by means of CBCT. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Mitsui, Takeki; Mawatari, Momoko; Koiso, Hiromi; Yokohama, Akihiko; Uchiumi, Hideki; Saitoh, Takayuki; Handa, Hiroshi; Hirato, Junko; Karasawa, Masamitsu; Murakami, Hirokazu; Kojima, Masaru; Nakamura, Shigeo; Nojima, Yoshihisa; Tsukamoto, Norifumi
We report a rare case of age-related Epstein-Barr virus (EBV)-positive B-cell lymphoproliferative disorder (aEBVBLPD) primarily involving the orbit and maxillary sinus. Lesions in the left orbit and maxillary sinus were observed in a 59-year-old man presenting with pain in the left orbit and maxilla. Owing to the presence of Reed-Sternberg-like cells, the initial diagnosis was nodular sclerosis-type Hodgkin's lymphoma. Clinical stage was IIAE, and response to chemotherapy and radiotherapy was favorable. Further immunohistochemical and in situ hybridization analyses of the Reed-Sternberg-like giant cells revealed CD30, CD15, CD20, Bob-1, Oct-2, EBV-encoded RNAs (EBERs) and latent membrane protein-1 (LMP-1) expression. The characteristics of the present case, which included immunohistochemical findings, sites of primary lesions, absence of other lymph node lesions and relatively old age, suggested aEBVBLPD. Owing to the similarity in morphology, higher frequency at extranodal sites and poor prognosis, aEBVBLPD represents a differential diagnostic issue from classical Hodgkin's lymphoma when Reed-Sternberg cells are positive for EBV.
Kharel Sitaula, R; Gautam, V; Kc, Krishna; Shah, D N
Open globe injury is one of the commonest ophthalmic emergencies, and when accompanied by intraocular foreign bodies, the condition carries a poorer prognosis. To report a rare case of perforating injury of the globe with an iron nail which got lodged in the maxillary sinus. A ten-year-old boy presented with the history of sudden painful loss of vision in his right eye. He reported that he was hit forcefully by the tail of a cow a day before the presentation. There was no perception of light in that eye. The ocular examination revealed a full thickness corneo-scleral perforation with prolapsed uveal tissue. The X-ray of the right orbit showed an impacted foreign body in the inferior orbit and computed tomography scan of the orbit confirmed the presence of a vertically impacted metal piece in the right orbit and right maxillary sinus. The repair of the perforation and removal of the impacted nail was done in two stages. The globe anatomy was maintained but the vision could not be restored due to the grave nature of the trauma. Perforating globe injury is an important cause of monocular blindness. © NEPjOPH.
Estrela, Carlos; Porto, Olavo César Lyra; Costa, Nádia Lago; Garrote, Marcel da Silva; Decurcio, Daniel Almeida; Bueno, Mike R; Silva, Brunno Santos de Freitas
Inflammatory injuries in the maxillary sinus may originate from root canal infections and lead to bone resorption or regeneration. This report describes the radiographic findings of 4 asymptomatic clinical cases of large reactional osteogenesis in the maxillary sinus (MS) associated with secondary root canal infection detected using cone-beam computed tomographic (CBCT) imaging. Apical periodontitis, a consequence of root canal infection, may lead to a periosteal reaction in the MS and osteogenesis seen as a radiopaque structure on imaging scans. The use of a map-reading strategy for the longitudinal and sequential slices of CBCT images may contribute to the definition of diagnoses and treatment plans. Root canal infections may lead to reactional osteogenesis in the MS. High-resolution CBCT images may reveal changes that go unnoticed when using conventional imaging. Findings may help define initial diagnoses and therapeutic plans, but only histopathology provides a definitive diagnosis. Surgical enucleation of the periapical lesion is recommended if nonsurgical root canal treatment fails to control apical periodontitis.
Liu, Yi; Chen, Fei; Feng, Yuan; Xie, Chao; Song, Ying-liang; Li, De-hua
To evaluate new bone formation and preliminary clinical outcomes following maxillary sinus floor augmentation with Bio-Oss alone. Nine patients were treated with ten maxillary sinus floor augmentations using Bio-Oss alone, and eighteen Straumann implants were placed. After five to eleven-month healing period at implant placement, cylindrical specimens were biopsied from the augmented area. The new bone formation of specimens was analyzed by histology and micro-computed tomography. Cone beam computed tomography (CBCT) scans were performed for measurements of residual crestal bone height under the sinus, the amount of increased height immediate after the augmentation and before implant insertion. To monitor stability changes, resonance frequency analysis was performed and implant stability quotient (ISQ) values were collected at implant placements (baseline,0 month), one month, three months and six months after placements. All implants were loaded six months after insertion and no failures were recorded. Compared to adjacent native bone, no significant differences of bone volume fraction were found in augmented area (P > 0.05), together with lower trabecular number (P < 0.05) and trabecular thickness (P < 0.01) as well as higher trabecular separation (P < 0.01) by microradiographic analysis.Histomorphometrically, there was no significant difference in the amount of new bone formation between the adjacent native bone and augmented area (P > 0.05). CBCT showed a bone height gain of (14.19 ± 2.02) mm immediate after augmentation, which stabilized at (13.68 ± 1.95) mm after bone healing period. Mean ISQ value was 71.94 ± 6.51 at baseline, decreased to 70.19 ± 6.38 at 1 month, and increased to 78.17 ± 3.83 at 3 month and 82.56 ± 3.20 at 6 month. The use of Bio-Oss as the sole graft is reliable and can lead to satisfactory bone formation and clinical outcome.
Gray, C F; Staff, R T; Redpath, T W; Needham, G; Renny, N M
To calculate sinus and bone graft volumes and vertical bone heights from sequential magnetic resonance imaging (MRI) examinations in patients undergoing a sinus lift operation. MRI scans were obtained pre-operatively and at 10 days and 10 weeks post-operatively, using a 0.95 tesla MRI scanner and a three-dimensional (3D) magnetisation prepared, rapid acquisition gradient-echo (MP-RAGE) sequence. Estimates of the bone graft volumes required for a desired vertical bone height were made from the pre-operative MRI scan. Measurements of the graft volumes and bone heights actually achieved were made from the post-operative scans. The MRI appearance of the graft changed between the 10 day and 10 week scans. We have proposed a technique which has the potential to give the surgeon an estimate of the optimum volume of graft for the sinus lift operation from the pre-operative MRI scan alone and demonstrated its application in a single patient. Changes in the sequential MRI appearance of the graft are consistent with replacement of fluid by a matrix of trabecular bone.
Lin, Guo-Hao; Lim, Glendale; Chan, Hsun-Liang; Giannobile, William V; Wang, Hom-Lay
To study the effect of the recombinant human bone morphogenetic protein 2 (rhBMP-2) on sinus volumetric and histometric changes after sinus floor augmentation compared to a conventional approach of non-biologic bone grafting materials. An electronic search of 4 databases (January 1990-February 2015), including PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Central, and a hand search of peer-reviewed journals for relevant articles were performed. Human clinical trials with data on comparison of sinus volumetric and/or histometric outcomes with and without the use of rhBMP-2 in sinus grafting procedures, with ≥10 augmentation sites in each study group, and with a follow-up period of at least 6 months, were included. Random-effects meta-analyses were performed to analyze weighted mean difference (WMD) and confidence interval (CI) for the recorded variables according to PRISMA guidelines. Six randomized controlled trials (RCTs) were included. The results of the meta-analyses showed that the WMD of vertical bone height gain was -0.14 mm (95% CI = -1.91 to 1.62 mm, P = 0.87), the WMD of bone density was -142.42 mg/cm(3) (95% CI = -310.62-25.78 mg/cm(3) , P = 0.10), the WMD of the percentage of vital bone was -4.59% (95% CI = -11.73-2.56%, P = 0.21), and the WMD of the percentage of residual bone grafting materials was -9.90% (95% CI = -26.38-6.58%, P = 0.21). The comparison of implant survival rate presented an overall risk ratio of 1.00 (95% CI = 0.94-1.07). The two approaches (conventional bone grafting compared to BMPs) demonstrated comparable effectiveness for both clinical and histomorphometric measures. This systematic review revealed that the use of rhBMP-2 in maxillary sinus floor augmentation achieved similar clinical and histometric outcomes when compared to conventional sinus grafting procedures after a healing period of 6-9 months. However, previous studies showed the morbidity and other patient-reported outcomes were improved
Horowitz, Gilad; Koren, Ilan; Carmel, Narin Nard; Balaban, Sagi; Abu-Ghanem, Sara; Fliss, Dan M; Kleinman, Shlomi; Reiser, Vadim
There are numerous surgical approaches for oro-antral-fistula (OAF) closure. Secondary sinus disease is still considered by many experts a relative contra indication for primary closure. To describe a single-stage combined endoscopic sinus surgery and per-oral buccal fat pad (BFP) flap approach for large OAF causing chronic maxillary sinusitis. The records of all the patients with OAF and chronic manifestations of secondary rhinosinusitis that were treated between 2010 and 2013 in our tertiary care medical center were reviewed. The exclusion criteria were: OAF ≤ 5 mm, resolved sino-nasal disease, OAF secondary to malignancy, recurrent fistula, medical history that included radiotherapy to the maxillary bone and age <18 years. Each procedure was performed by a team consisting of a rhinologist and a maxillofacial surgeon. The surgical approach included an endoscopic middle antrostomy with maxillary sinus drainage, and a per-oral BFP regional flap for OAF closure. Total OAF closure, complications and need for revision surgeries. Forty-five patients that underwent OAF closure together with sinus surgery using a combined endoscopic sinus surgery (ESS) and BFP flap approach met the inclusion criteria. There were 28 males and 17 females with a mean ± SD age of 53.5 ± 14.9 years (range 22-80 years). The presenting signs and symptoms included purulent rhinorrhea (n = 22, 48.9 %), foreign body in sinus (n = 10, 22.2 %) nasal congestion (n = 7, 15.5 %), halitosis (n = 6, 13.3 %) and pain (n = 5, 12.2 %). Surgical complications included local pain (n = 2, 4.4 %), persistent rhinitis (n = 2, 4.4 %) and synechia (n = 1, 2.2 %). One patient required revision surgery due to an unresolved OAF. The OAF of all the other 44 patients (97.8 %) was closed after the first procedure and the paranasal sinuses on the treated side were completely recovered. The mean follow-up time for the group was 7.6 ± 4.3 months (7-21 months), and no untoward sequelae or recurrence were reported
The significance of cone beam computed tomography for the visualization of anatomical variations and lesions in the maxillary sinus for patients hoping to have dental implant-supported maxillary restorations in a private dental office in Japan
Objectives The purpose of the present study was to elucidate the significance of cone bean computed tomography (CBCT) for patients hoping to undergo implant-supported restorations of the maxilla. Therefore, two studies were planned. One was to compare the prevalence of anatomic variations and lesions in the maxillary sinus on CBCT of patients hoping to undergo implant-supported restorations of the maxilla with that in patients with other chief complaints in a private dental office in Japan. The other study was to elucidate the limitations of panoramic radiographs in the detection of anatomic variations and lesions in the maxillary sinus. Study design Sixty-one pairs of panoramic radiographs and CBCT were retrospectively analyzed in two groups of patients, those who hoped to undergo implant-supported restorations in the maxilla (Implant group) and those who did not (Non-implant group). The presence of anatomic variations and lesions in the maxillary sinus were analyzed. Results The detection rate of mucosal thickening was significantly higher in the Implant group than in the Non-implant group. The detection rates for the features analyzed were significantly lower on panoramic radiographs. In particular, the detection rates of internal and anterior locations of some features were noticeably lower on panoramic radiographs. A significant relationship was found between the change in the detection rate on panoramic radiographs and the widths of mucosal thickening or the lengths of the major axis of SOLs in the maxillary sinus. If the width of mucosal thickening or the length of the major axis of SOLs was <3 mm or <4 mm, respectively, the detection rate on panoramic radiographs was significantly decreased. Conclusion CBCT is important for patients hoping to undergo implant-supported restorations of the maxilla because of the mucosal thickening in the maxillary sinus in such patients and their lower detection rates on panoramic radiographs. PMID:24884983
Alekseeva, I S; Rachinskaia, O A; Volkov, A V; Kulakov, A A; Gol'dshteĭn, D V
The effectiveness of bone tissue formation by transplantation of tissue-engineering scaffold and frequently used osteoplastic material «Bio-Oss» combined construction in maxillary sinus floor was evaluated and marked differences in regeneration terms by this treatment mode were found out.
Dugar, Deepak R; Lander, Lina; Mahalingam-Dhingra, Aditya; Shah, Rahul K
To determine variations in resource utilization in the management of pediatric acute sinusitis. Retrospective analysis of a publicly available national dataset. The Kids' Inpatient Database 2006 was analyzed using ICD-9 codes for acute sinusitis. A total of 8,381 patients (55% male, mean age 8.5 years [SE = 0.2]) were admitted with acute sinusitis. Mean total charges was $20,062 (SE = 1,159.1). Mean length of stay was 4.2 days (SE = 0.12), with 4.8 diagnoses (SE = 0.06) and 0.85 procedures (SE = 0.06). Thirty-six percent had concomitant respiratory diseases, 11% otitis media, and 8% orbital symptoms. A total of 703 patients underwent operations on the upper aerodigestive tract (534 were nasal sinusectomies); 582 patients underwent lumbar puncture and 162 underwent orbital surgery. The primary payer was private insurance in 50% and Medicaid in 41%. Predictors of increased total charges were male gender (P =.028), being a teaching hospital (P < .0001), metropolitan patient location (P < .0001), hospitals in the western region (P < .0001), admission source from another hospital (P < .0001), and discharge status to another inpatient hospital or home healthcare (P < .0001). There is a large geographic variation in resource utilization (range = $5,837 [Arkansas] to $48,327 [California]). Race, primary payer, admission type, and urgency were not significant predictors of increased resource utilization. Despite being a common diagnosis, there exists a large national variation in management of acute pediatric sinusitis. Predictors of increased resource utilization included male gender, teaching hospital status, metropolitan patient location, western hospital region, admission source, and discharge status. Knowledge of these variables may allow interventions and potentially facilitate benchmarking to reduce the economic burden of this entity while ensuring optimal outcomes.
Shaikh, Nader; Wald, Ellen R.; Jeong, Jong H.; Kurs-Lasky, Marcia; Bowen, A’Delbert; Flom, Lynda L.; Hoberman, Alejandro
Objective To determine prognostic factors that independently predict response to antimicrobial therapy in children with acute sinusitis. Study design 206 children meeting a priori clinical criteria for acute sinusitis who were given antimicrobial therapy by their primary care provider were included. The severity of symptoms in the 8 to 12 days after treatment was initiated was followed using a validated scale. We examined the univariate and multivariate association between factors present at the time of diagnosis (symptoms, signs, nasopharyngeal culture result, radiograph results) and time to resolution of symptoms. This study was conducted 8 to 10 years after 7-valent pneumococcal conjugate vaccination was introduced, but before introduction of the 13-valent pneumococcal conjugate vaccination. Results Children with proven nasopharyngeal colonization with Streptococcus pneumoniae improved more rapidly (6.5 vs. 8.5 median days to symptom resolution) than those who were not colonized with S. pneumoniae. Age and radiograph findings did not predict time to symptom resolution. Conclusions In children with acute sinusitis, proven nasopharyngeal colonization with S. pneumoniae at presentation independently predicted time to symptom resolution. Future randomized, placebo-controlled trials could investigate the usefulness of testing for the presence of nasopharyngeal pathogens as a predictor of response to treatment. PMID:24367985
Damante, J H; Sant'Ana, E; Soares, C T; Moreira, C R
Actinomycosis of the paranasal sinuses is a rare occurrence and its clinical presentation does not suggest a specific diagnosis. Therefore, actinomycosis should be included in the differential diagnosis of neoplasms and granulomatous lesions of the head and neck region. However, the differentiation from a malignant neoplasm is not easy because the radiological findings are frequently similar and positive cultures are difficult to obtain. This report highlights the clinical progress of paranasal actinomycosis associated with some computed tomography findings that can be extremely helpful in the correct diagnosis. The characteristics of the disease are described and the relevant literature is discussed.
Dutta, M; Ghatak, S; Biswas, G; Sen, A
Nonosseous or soft tissue Ewing's sarcoma is a rare form of Ewing's sarcoma/primitive neuroectodermal tumour that seldom affects the head and neck region. Involvement of the nose and paranasal sinuses is extremely uncommon, with only eight of such patients being reported to date, mostly affecting adolescents and young adults. To our knowledge, this study is the first comprehensive report of primary soft tissue Ewing's sarcoma involving the paranasal sinuses in an elderly patient who successfully completed treatment. We herein discuss the pathogenesis, management and factors affecting the prognosis of this rare group of tumours involving the nose and paranasal sinuses, in relation to the available literature.
... to decrease swelling, especially if there are nasal polyps or allergies Surgery to enlarge the sinus opening and drain the ... each year. Most fungal sinus infections need surgery. Surgery to repair ... or nasal polyps may prevent the condition from returning.
Ansari, Noureddin Nakhostin; Naghdi, Soofia; Farhadi, Mohammad; Jalaie, Shohreh
Sinusitis is a very common acute or chronic illness that affects a significant percentage of individuals. Recently, therapeutic ultrasound was reported as a treatment for chronic sinusitis. The purpose of this study was twofold: 1) to evaluate the effectiveness of low-intensity pulsed ultrasound (US) in chronic sinusitis using a pretest-posttest research design and 2) to determine the level of association between the independent variables of initial presence of symptoms, age, gender, and duration of disease and the dependent variable of improvement of symptoms. Patients with chronic sinusitis were treated with low-intensity pulsed US, 3 days per week for 15 sessions. Fifty-seven patients (18 females and 39 males; mean age, 35 years) were included in the study. The results of the McNemar test showed a significant change in proportions of post nasal drip and nasal obstruction, two common leading symptoms of patients with chronic sinusitis (p < 0.001). Most of the major and minor symptoms showed significant changes after US therapy (p < 0.05). The total improvement of symptoms was 81.3%. The greatest improvement in symptoms was observed in nasal discharge (100%), followed by facial pain (95.4%) and postnasal drip (82.7%), three major factors in sinusitis. There was a significant, low association between the initial presence of symptoms and the improvement of symptoms after US therapy (chi(2) = 30.352; df = 12; p = 0.002; phi value = 0.356). A significant, low association was also noted between the age and the improvement of symptoms after intervention (chi(2) = 17.548; df = 6; p = 0.007; phi value = 0.270). It may be concluded that low-intensity pulsed US has a significant effect on chronic sinusitis and improves patient symptoms in our study group.
Taschieri, Silvio; Corbella, Stefano; Weinstein, Roberto; Di Giancamillo, Alessia; Mortellaro, Carmen; Del Fabbro, Massimo
Maxillary sinus floor elevation procedure has the objective of augmenting available bone in atrophic posterior maxilla to allow dental implants placement. The main aim of this prospective study was to evaluate clinically and histomorphometrically the performance of biphasic calcium phosphate (BCP) used in conjunction with platelet-rich plasma (PRP) compared with demineralized bovine bone matrix (DBBM) and PRP in sinus floor elevation surgery. Patients candidate to sinus floor elevation were treated using either BCP and PRP or DBBM and PRP. Biopsies were retrieved using trephine bur during implant placement surgery 6 months after grafting. Clinical success of implants was evaluated 1 year after prosthesis delivery. Histomorphometric analysis was performed assessing the relative volume of newly formed bone. A total of 20 patients were recruited, and 20 sinus augmentation procedures were performed, 10 for each group. A total of 42 implants were placed. One year after prosthetic loading a 100% implant survival rate was reported in both groups. Histomorphometric analysis revealed that the mean amount of new bone formation was 18.6 ± 3.3% in BCP group and it was 21.9 ± 4.9% in DBBM group, without statistically significant difference. In BCP group a greater amount of collagen type I was found with respect to DBBM group. Both grafting materials led to an excellent performance regarding implant survival rate after 1 year follow-up, without any significant adverse sequelae. A similar capability of inducing new bone formation was observed in both groups, even though the higher quantity of collagen type I in BCP group may suggest a greater potential for bone formation over time as compared with DBBM.
Zhang, Qun; Lin, Shi-Rong; He, Fang; Kang, De-Hua; Chen, Guo-Zhang; Luo, Wei
Postoperative radiotherapy is a major treatment for patients with maxillary sinus carcinoma. However, the irregular resection cavity poses a technical difficulty for this treatment, causing uneven dose distribution to target volumes. In this study, we evaluated the dose distribution to target volumes and normal tissues in postoperative intensity-modulated radiotherapy (IMRT) after placing a water-filled balloon into the resection cavity. Three postoperative patients with advanced maxillary sinus carcinoma were selected in this trial. Water-filled balloons and supporting dental stents were fabricated according to the size of the maxillary resection cavity. Simulation CT scans were performed with or without water-filled balloons, IMRT treatment plans were established, and dose distribution to target volumes and organs at risk were evaluated. Compared to those in the treatment plan without balloons, the dose (D98) delivered to 98% of the gross tumor volume (GTV) increased by 2.1 Gy (P = 0.009), homogeneity index (HI) improved by 2.3% (P = 0.001), and target volume conformity index (TCI) of 68 Gy increased by 18.5% (P = 0.011) in the plan with balloons. Dosimetry endpoints of normal tissues around target regions in both plans were not significantly different (P > 0.05) except for the optic chiasm. In the plan without balloons, 68 Gy high-dose regions did not entirely cover target volumes in the ethmoid sinus, posteromedial wall of the maxillary sinus, or surgical margin of the hard palate. In contrast, 68 Gy high-dose regions entirely covered the GTV in the plan with balloons. These results suggest that placing a water-filled balloon in the resection cavity for postoperative IMRT of maxillary sinus carcinoma can reduce low-dose regions and markedly and simultaneously increase dose homogeneity and conformity of target volumes. PMID:22035860
Zou, Derong; Guo, Lian; Lu, Jiayu; Zhang, Xiuli; Wei, Jie; Liu, Changsheng; Zhang, Zhiyuan; Jiang, Xinquan
The aim of this study was to explore the effects of maxillary sinus floor elevation and simultaneous dental implantation with a tissue-engineered bone complex of calcium phosphate cement (CPC) scaffolds combined with bone marrow stromal cells (BMSCs). A large animal goat model is used with the tissue engineering method. Eighteen bilateral maxillary sinus of nine goats were randomly allocated into three groups; the CPC/BMSC complex (n=6) was used to elevate maxillary sinus floor with a simultaneous implant placement; the effects were compared with those treated with CPC alone (n=6) or autogenous bone (n=6). After a healing period of 3 months, sequential triad-color fluorescence labeling, micro-CT, as well as histological and histomorphometric analyses indicated that the tissue-engineered BMSC/CPC complex could promote earlier bone formation and mineralization, and maximally maintain the volume and height of the augmented maxillary sinus. By comparison, CPC-alone or autogenous bone achieved less bone formation and later mineralization. Besides, the average bone-implant contact value reflecting the osseointegration was 35.63%±9.42% in the BMSCs/CPC group, significantly higher than 22.47%±4.28% in the CPC-alone group or 28.26%±8.03% in the autogenous bone group. In conclusion, CPC serves as a potential substrate for BMSCs for the maxillary sinus floor augmentation and simultaneous implantation. The tissue-engineered bone might enhance the stability of implants and thus be of great significance to achieve improved quality to restore the oral function in clinic.
Treatment outcomes of implants performed after regenerative treatment of absorbed alveolar bone due to the severe periodontal disease and endoscopic surgery for maxillary sinus lift without bone grafts.
Kiyokawa, Kensuke; Rikimaru, Hideaki; Kiyokawa, Munekatsu; Fukaya, Hajime; Sakaguchi, Shinji
We have developed a regenerative medicine therapy for the alveolar bone and endoscopic surgery for maxillary sinus lift without bone grafts, in patients experiencing severe periodontal disease with significant absorption of the maxillary alveolar bone, in which more than 10 mm of bone thickness in the maxillary bone was attained, with satisfactory results. The objective of this study was to examine the treatment outcomes of implants that were performed after these therapies. The participants were 36 patients with severe periodontal disease, who cannot be cured with any other treatments except the extirpation of all teeth. The 36 patients are all patients who underwent regenerative treatment of the alveolar bone through tooth replantation and transplantation of the iliac cancellous bone (the bone marrow) as well as endoscopic surgery for maxillary sinus lift from May 2003 to July 2007 in our clinic. A total of 120 implants were placed in these patients when the replanted teeth fell out because of root resorption, and the success rate was examined. The success rates of the implants were 16 of 33 (48%) in the group when surveyed less than 2 years after the surgery and 84 of 87 (96.5%) in the group when surveyed more than 2 years after the surgery. A statistically significant difference was found between the 2 groups (Chi-squared test, P < 0.001). It was believed that it takes approximately 2 years for the bones in the maxillary sinus floor, augmented through endoscopic surgery for maxillary sinus lift, to attain the thickness and hardness required for implant placement. Therefore, although the implant treatment should be performed later than 2 years after surgery, chewing is possible during this period, with the replanted teeth that were used for regenerative treatment of the alveolar bone. It is believed that this is an extremely effective treatment method to improve the patients' quality of life.
Cassetta, Michele; Ricci, Laura; Iezzi, Giovanna; Calasso, Sabrina; Piattelli, Adriano; Perrotti, Vittoria
The aim of this study was to evaluate the performance of piezoelectric devices during sinus elevation to determine the percentage of sinus membrane perforation and the time required to perform the antrostomy and elevation of the membrane. A total of 35 patients and 40 grafted sinuses were included. The parameters recorded were bony window length and height, bone thickness, osteotomy area, operative time, and number of perforations. Seven (17.5%) membrane perforations were observed, which were repaired with resorbable membranes. The mean length, height, and thickness of the osteotomy were 13.8 ± 2.9 mm, 6.9 ± 1.4 mm, and 1.4 ± 0.4 mm, respectively. The mean osteotomy area was 96.8 ± 32.2 mm(2), and the mean operative time was 10.3 ± 2.1 minutes. This study demonstrated that a piezoelectric device could be an attractive alternative for successful sinus augmentation.
Sisti, Angelo; Canullo, Luigi; Mottola, Maria Pia; Iannello, Giuliano
This case series aimed to explore the clinical outcome of sinus floor elevation surgery using a crestal approach technique in case of severely resorbed maxillae. Seventeen edentulous patients received 20 implants and sinus floor elevation in posterior maxillae with residual crestal height of 1.2-5.0 mm and >7 mm. Drilling perforation was performed until the sinus floor was felt; the sinus mucosa was then lifted and magnesium-enriched hydroxyapatite granules (Mg-e HAP) were placed; and implants were immediately inserted. Four months later, definitive crowns were cemented, and patients were followed up for 24 months. Implant failures and complications 24 months after prosthetic loading were noted, and radiographic regenerated bone height was measured. No patient dropped out, and all implants were successfully osseointegrated. There was minimal postoperative patient discomfort, and the only complication was a minimal perforation of the sinus membrane with no negative consequences. At the time of implant insertion, the residual crestal height mean value was 4.12 mm. After surgery and at the last follow-up, the mean heights of bone were 13.51 and 12.98 mm, respectively. The procedure was able to obtain sinus elevation and implant osseointegration.
Leclerc, Lara; Pourchez, Jérémie; Aubert, Gérald; Leguellec, Sandrine; Vecellio, Laurent; Cottier, Michèle; Durand, Marc
Improvement of clinical outcome in patients with sinuses disorders involves targeting delivery of nebulized drug into the maxillary sinuses. We investigated the impact of nebulization conditions (with and without 100 Hz acoustic airflow), particle size (9.9 μm, 2.8 μm, 550 nm and 230 nm) and breathing pattern (nasal vs. no nasal breathing) on enhancement of aerosol delivery into the sinuses using a realistic nasal replica developed by our team. After segmentation of the airways by means of high-resolution computed tomography scans, a well-characterized nasal replica was created using a rapid prototyping technology. A total of 168 intrasinus aerosol depositions were performed with changes of aerosol particle size and breathing patterns under different nebulization conditions using gentamicin as a marker. The results demonstrate that the fraction of aerosol deposited in the maxillary sinuses is enhanced by use of submicrometric aerosols, e.g. 8.155 ± 1.476 mg/L of gentamicin in the left maxillary sinus for the 2.8 μm particles vs. 2.056 ± 0.0474 for the 550 nm particles. Utilization of 100-Hz acoustic airflow nebulization also produced a 2- to 3-fold increase in drug deposition in the maxillary sinuses (e.g. 8.155 ± 1.476 vs. 3.990 ± 1.690 for the 2.8 μm particles). Our study clearly shows that optimum deposition was achieved using submicrometric particles and 100-Hz acoustic airflow nebulization with no nasal breathing. It is hoped that our new respiratory nasal replica will greatly facilitate the development of more effective delivery systems in the future.
Shaikh, Nader; Hoberman, Alejandro; Colborn, D Kathleen; Kearney, Diana H; Jeong, Jong H; Kurs-Lasky, Marcia; Barbadora, Karen A; Bowen, A'delbert; Flom, Lynda L; Wald, Ellen R
The diagnosis of acute bacterial sinusitis can be challenging because symptoms of acute sinusitis and an upper respiratory tract infection (URI) overlap. A rapid test, if accurate in differentiating sinusitis from URI, could be helpful in the diagnostic process. We examined the utility of nasopharyngeal cultures in identifying the subgroup of children with a clinical diagnosis of acute sinusitis who are least likely to benefit from antimicrobial therapy (those with completely normal sinus radiographs). Nasopharyngeal swabs were collected from 204 children meeting a priori clinical criteria for acute sinusitis. All children had sinus X-rays at the time of diagnosis. To determine if negative nasopharyngeal culture results could reliably identify the subgroup of children with normal radiographs, we calculated negative predictive values and negative likelihood ratios. Absence of pathogens in the nasopharynx was not helpful in identifying this low-risk subgroup.
Mamot, Christoph; Krasniqi, Fatime; Metternich, Frank
The Ewing sarcoma family of tumors (ESFT) encompasses a group of highly aggressive, morphologically similar, malignant neoplasms sharing a common spontaneous genetic translocation that affect mostly children and young adults. These predominantly characteristic, small round-cell tumors include Ewing's sarcoma of the bone and soft tissue, as well as primitive neuroectodermal tumors (PNETs) involving the bone, soft tissue, and thoracopulmonary region (Askin's tumor). Extraosseous ESFTs are extremely rare, especially in the head and neck region, where literature to date consists of sporadic case reports and very small series. We hereby present a review of the literature published on ESFTs reported in the maxilla and maxillary sinus region from 1968 to 2016. PMID:27413360
Hosseini, Soudabeh; Ansari, Shahla; Vosough, Parvaneh; Bahoush, Gholamreza; Hamidieh, Amir Ali; Chahardouli, Bahram; Shamsizadeh, Morteza; Mehrazma, Mitra; Dorgalaleh, Akbar
Isolated extramedullary relapse of chronic myelogenous leukemia (CML) after allogeneic stem cell transplant is rare. There is a case report of a child who developed a granulocytic sarcoma of the maxillary and sphenoid sinuses and lumbosacral spinal cord mass 18 months after allogeneic bone marrow transplant for CML. He was presented with per orbital edema and neurological deficit of lower extremities and a mass lesion was found on spinal cord imaging. No evidence of hematologic relapse was identified at that time by bone marrow histology or cytogenetic. The patient died 1 month later with a picture of pneumonia, left ventricular dysfunction and a cardiopulmonary arrest on a presumed underlying sepsis with infectious etiology. Granulocytic sarcoma should be considered in the differential diagnosis of mass lesions presenting after allogeneic bone marrow transplantation for CML, even if there is no evidence of bone marrow involvement. PMID:27252811
Levin, Daphne Menhel, Janna; Alezra, Dror; Pfeffer, Raphael
We compared 9-field, equispaced intensity modulated radiation therapy (IMRT), 4- to 5-field, directionally optimized IMRT, and 3-dimensional (3D) noncoplanar planning approaches for tumors of the maxillary sinus. Ten patients were planned retrospectively to compare the different treatment techniques. Prescription doses were 60 to 70 Gy. Critical structures contoured included optic nerves and chiasm, lacrimal glands, lenses, and retinas. As an aid for plan assessment, we introduced a new tool: Critical Organ Scoring Index (COSI), which allows quantitative evaluation of the tradeoffs between target coverage and critical organ sparing. This index was compared with other, commonly used conformity indices. For a reliable assessment of both tumor coverage and dose to critical organs in the different planning techniques, we introduced a 2D, graphical representation of COSI vs. conformity index (CI). Dose-volume histograms and mean, maximum, and minimum organ doses were also compared. IMRT plans delivered lower doses to ipsilateral structures, but were unable to spare them. 3D plans delivered less dose to contralateral structures, and were more homogeneous, as well. Both IMRT approaches gave similar results. In cases where choice of optimal plan was difficult, the novel 2D COSI-CI representation gave an accurate picture of the tradeoffs between target coverage and organ sparing, even in cases where other conformity indices failed. Due to their unique anatomy, maxillary sinus tumors may benefit more from a noncoplanar approach than from IMRT. The new graphical representation proposed is a quick, visual, reliable tool, which may facilitate the physician's choice of best treatment plan for a given patient.
Costan, Victor Vlad; Popescu, Eugenia; Stratulat, Sorin Ioan
Maxillary sinus mucocele, known as a rare condition, can cause major therapeutic difficulties, especially when it invades the orbit leading to exophthalmia. Treatment is very difficult because the eye globe has to be repositioned, and the facial symmetry needs to be reconstructed as a result of malar bone invasion. This article reports the case of a 54-year-old patient with unilateral exophthalmia caused by the evolution of a maxillary mucocele that extended toward the orbit after destroying the malar bone and the orbital floor. The treatment consisted of a 1-step restoration of both the orbit floor and the malar bone using a temporomandibular flap composed of 2 bone fragments. Lipostructure and a titanium mesh to reconstruct the calvarial defect were necessary to restore facial aesthetics after placing back the eye globe in its initial site. After surgery, the patient followed a complex rehabilitation program including massage kinesiotherapy and psychological consultation and support. These had an essential contribution to the successful final outcome in terms of psychological impact, functionality, and aesthetics.
Park, Yong Kyun; Kim, Kyung Soo
Organizing hematoma of the paranasal sinuses is a diagnostic dilemma clinically and radiographically, mimicking benign or malignant neoplastic processes. Although the diagnostic rate of this disease has increased as characteristic imaging findings are somewhat elucidated, endoscopic examination, preoperative biopsy, and computed tomography (CT) imaging do not give helpful information in differentiating these lesions from malignant neoplastic processes. A 55-year-old man presented with a 4-month history of recurrent nasal bleeding. He also complained of a left-sided nasal obstruction. CT findings were highly suggestive of a malignant tumor of the maxillary sinus. However, based on fluorodeoxyglucose F18 positron-emission tomography (PET/CT) and magnetic resonance imaging (MRI), the provisional diagnosis of benign tumor rather than malignancy was made. Complete resection of the mass was achieved by simple transnasal endoscopic surgery using the Caldwell-Luc approach. Organizing hematoma of the maxillary sinus was diagnosed by histopathologic evaluation. The clinical, radiological, and histopathologic findings of the patient are presented. In this report, we have presented 18FDG-PET findings of organized hematoma of the maxillary sinus (OHMS) that showed an increased FDG uptake in the peripheral rim of the mass with central photopenia. To our knowledge, this is the first case report in the literature reporting FDG-PET/CT findings of OHMS. Careful interpretation of metabolic (FDG-PET/CT) and anatomic (CT and MRI) images should be performed to accurately characterize the expansile lesion of the maxillary sinus in order to increase specificity and reduce equivocal findings significantly. PMID:26587203
Abzug, Mark J
Bacteria can be recovered from paranasal sinuses in the majority of patients given the diagnosis of acute bacterial sinusitis (ABS), and bacteriologic cure can be achieved with appropriate antibiotic treatment. The critical question is whether bacteriologic cure correlates with meaningful clinical endpoints such as clinical improvement, reduction in recurrent disease, or prevention of complications. Of the 4 pediatric placebo-controlled randomized clinical trials (PCRCTs), 2 suggest superiority of antibiotic treatment and 2 suggest lack of superiority. PCRCTs in adults are mixed as to clinical benefit. Pediatric and adult meta-analyses demonstrate modest benefit of antibiotic therapy and rates of spontaneous recovery without antibiotics of 60-65%. Although retrospective studies indicate that some patients who develop orbital or neurologic complications of sinusitis were pre-treated with antibiotic therapy, a low rate of complications precludes determination of whether antibiotic treatment prevents complications in some proportion of patients. Like the literature evidence, expert guideline recommendations are mixed. Although the evidence base is incomplete and conflicting, the limited data suggest that antibiotics probably do have a role in the treatment of pediatric ABS. The most compelling rationale is prevention of serious complications, but proof for this rationale is lacking.
Del Mar, Chris
Sore throat and acute sinusitis are not straightforward diagnoses. Trying to guess the responsible pathogen may not be the best approach. Being guided by empirical evidence may be more useful. It suggests some, but very few, benefits for antibiotics. This has to be balanced with some, but few, harms from antibiotics, including diarrhoea, rash and thrush. Prescribers should also be aware of the risk of antibiotic resistance for the individual, as well as for the population as a whole. GPs should explain the evidence for the benefits and the harms of antibiotics to patients within a shared decision-making framework.
Sheikhi, Mahnaz; Pozve, Nasim Jafari; Khorrami, Ladan
Background: Maxillary sinuses are covered by a 1 mm thick mucous membrane that when this membrane becomes inflamed, the thickness may increase 10-15 times. The common causes of odontogenic sinusitis are dental abscesses and periodontal disease. Computed tomography (CT) is considered the gold standard for sinus diagnosis. Recently, cone beam computed tomography (CBCT) has been introduced for dental and maxillofacial imaging, which has several advantages over traditional CT, including lower radiation dose and chairside process. This study aims to find the association between mucosal thickening (MT) of the sinus and periodontal bone loss (PBL) and pulpoperiapical condition. Materials and Methods: A total of 180 CBCT images were reviewed. PBL was assessed in six points under each sinus at the mesial and distal sides of the upper second premolar and first and second molars by measuring the distance from the alveolar crest to the point 2 mm under the cemento-enamel junction (CEJ). The MT was assessed at six points in the floor of the sinus precisely over the mentioned points. To assess the possible role of pulpoperiapical condition on the sinus MT, the existing teeth were classified into five groups due to the probable effect of each condition on the pulp and peri-apex. The statistical association between MT of sinus and PBL and pulpoperiapical condition was assessed using SPSS software (SPSS Inc., version 16.0, Chicago, IL, USA) and bivariate correlation and binary linear regression statistical tests (P < 0.05). Results: MT was observed in 39.4% of patients (mean = 4.68 ± 5.25 mm). PBL was seen in 33% of the patients (mean = 1.87 ± 1.63 mm). Linear regression test showed that there is an association between both PBL and pulpoperiapical condition and MT, but the effect of PBL was about 4 times stronger. Conclusion: This study showed that MT of the maxillary sinus was common among patients with PBL and MT of the maxillary sinus was significantly associated with PBL
Pandak, Nenad; Pajić-Penavić, Ivana; Sekelj, Alen; Tomić-Paradžik, Maja; Cabraja, Ivica; Miklaušić, Božana
The aim of this study was the determination of bacteria present in maxillary and ethmoid cavities in patients with chronic sinusitis and to correlate these findings with bacteria simultaneously present in their nasopharynx. The purpose of this correlation was to establish the role of bacteria found in chronically inflamed sinuses and to evaluate if the bacteria present colonized or infected sinus mucosa. Nasopharyngeal and sinus swabs of 65 patients that underwent functional endoscopic sinus surgery were cultivated and at the same time the presence of leukocytes were determined in each swab. The most frequently found bacteria in nasopharynx were Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp., Streptococcus viridans and Streptococcus pneumoniae. Maxillary or ethmoidal sinus swabs yielded bacterial growth in 47 (72.31%) patients. The most frequently found bacteria in sinuses were Staphylococcus epidermidis, Staphylococcus aureus, Klebsiella spp. and Streptococci (pneumoniae, viridans and spp.). The insignificant number of leukocytes was present in each sinus and nasopharyngeal swab. Every published microbiology study of chronic sinusitis proved that sinus mucosa were colonized with bacteria and not infected, yet antibiotic therapy was discussed making no difference between infection and colonization. Chronic sinusitis should be considered a chronic inflammatory condition rather than bacterial infection, so routine antibiotic therapy should be avoided. Empiric antibiotic therapy should be prescribed only in cases when the acute exacerbation of chronic sinusitis occurs and the antibiotics prescribed should aim the usual bacteria causing acute sinusitis. In case of therapy failure, antibiotics should be changed having in mind that under certain circumstances any bacteria colonizing sinus mucosa can cause acute exacerbation of chronic sinusitis.
Jensen, Thomas; Schou, Søren; Svendsen, Patricia A; Forman, Julie Lyng; Gundersen, Hans Jørgen G; Terheyden, Hendrik; Holmstrup, Palle
The objective of the present study was to learn about the volumetric changes of the graft after maxillary sinus floor augmentation with Bio-Oss and autogenous bone from the iliac crest or the mandible in different ratios in minipigs. Bilateral maxillary sinus floor augmentation was performed in 40 minipigs with: (A) 100% autogenous bone, (B) 75% autogenous bone and 25% Bio-Oss, (C) 50% autogenous bone and 50% Bio-Oss, (D) 25% autogenous bone and 75% Bio-Oss, and (E) 100% Bio-Oss. The autogenous bone graft was harvested from the iliac crest or the mandible and the graft composition was selected at random and placed concomitant with implant placement. Computed tomographies of the maxillary sinuses were obtained preoperatively, immediately postoperatively, and at euthanasia after 12 weeks. The volumetric changes of the graft were estimated using the Cavalieri principle and expressed as mean percentage with a 95% confidence interval (CI). The mean volume of the graft was reduced by (A) 65% (95% CI: 60-70%), (B) 38% (95% CI: 35-41%), (C) 23% (95% CI: 21-25%), (D) 16% (95% CI: 12-21%), and (E) 6% (95% CI: 4-8%). The volumetric reduction was significantly influenced by the ratio of Bio-Oss and autogenous bone (P<0.001), but not by the origin of the autogenous bone graft (P=0.2). The volume of autogenous bone grafts from the iliac crest and the mandible is reduced significantly after maxillary sinus floor augmentation in minipigs. The graft volume is better preserved after the addition of Bio-Oss and the volumetric reduction is significantly influenced by the ratio of Bio-Oss and autogenous bone. However, further studies are needed addressing the amount of new bone formation and bone-to-implant contact before the final conclusion can be made about the optimal ratio of Bio-Oss and autogenous bone. © 2011 John Wiley & Sons A/S.
Kim, Tae-Young; Choi, Jin-Woo; Huh, Kyung-Hoe; Yi, Won-Jin; Heo, Min-Suk; Choi, Soon-Chul
Purpose The aim of this study was to evaluate the effect of liquid crystal display (LCD) monitor type and observer experience on the diagnostic performance in soft-copy interpretations of maxillary sinus inflammatory lesions on panoramic radiographs. Materials and Methods Ninety maxillary sinuses on panoramic images were grouped into negative and positive groups according to the presence of inflammatory lesions, using CT for confirmation. Monochrome and color LCDs were used. Six observers participated and ROC analysis was performed to evaluate the diagnostic performance. The reading time, fatigue score, and inter-/intra-observer agreements were assessed. Results The interpretation of maxillary sinus inflammatory lesions was affected by the LCD monitor type used and by the experience of the observer. The reading time was not significantly different, however the fatigue score was significantly different between two LCD monitors. Inter-observer agreement was relatively good in experienced observers, while the intra-observer agreement for all observers was good with monochrome LCD but not with color LCD. Conclusion The less experienced observers showed lowered diagnostic ability with a general color LCD. PMID:21977468
Duttenhoefer, Fabian; Souren, Cyriel; Menne, Dieter; Emmerich, Dominik; Schön, Ralf; Sauerbier, Sebastian
Background A prevalent modality to increase the amount of available bone prior to implantation is grafting of the maxillary sinus. Multiple factors such as the surgical technique, moment of implant placement as well as grafting materials and membranes are known to affect implant survival. However, the role of different factor combinations and associated reciprocal effects remain unclear. Conventional statistical methods do not consider inconsistency of study designs and do not take covariables into account. Hence, a systematic research and meta-analysis was conducted to investigate the influence of various treatment modalities on implant survival in the grafted maxillary sinus. Materials and Methods A meta-analysis was conducted according to the PRISMA guidelines. Articles published from 1980 through January 2013 were electronically and manually searched in MEDLINE (Ovid), the Cochrane Register of Controlled Trials, the Database of Abstracts of Effects, and the Cochrane Database of Systematic Reviews. Clinical reports on single intervention sinus augmentation with root-form implants, a minimum of 10 patients and 6 months of loading were eligible for inclusion if implant survival was stated or calculable. Results were calculated by non-parametric univariate Kaplan-Meier analysis and Bayesian multivariate interval-censored Cox regression. Results A total of 122 publications on 16268 endosseous implants placed in grafted maxillary sinus were included. The treatment parameters surgical approach, grafting material and implant type showed no selective preference. However, application of membranes showed a significantly reduced hazard-ratio, independent of other co-factors. Conclusions The use of membranes is the most significant factor to achieve long-term implant survival in sinus augmentation procedures. More data exceeding 3 years follow-up are needed to address prospective confounding and improve clinical evidence. PMID:24058679
Iezzi, Giovanna; Piatelli, Adriano; Giuliani, Alessandra; Mangano, Carlo; Barone, Antonio; Manzon, Licia; Degidi, Marco; Scarano, Antonio; Filippone, Antonella; Perrotti, Vittoria
Various grafts or combination of bone substitute materials have been used in sinus lift procedures. Currently, ongoing developments in several disciplines, from molecular biology and chemistry to computer science and engineering, have contributed to the understanding of biological processes leading to bone healing after the use of bone substitute materials (BSBs) and therefore of the behavior of BSBs. The understanding of the properties of each graft enables individual treatment concepts and therefore allows shift from a simple replacement material to the modern concept of an individually created composite biomaterial. Indeed, the choice of the best BSB still remains crucial for success in maxillary sinus augmentation procedures. The present article provides an overview of most of the materials currently available for sinus lift, with a specific focus on their histological, molecular, cellular and pharmaceutical aspects.
Shaikh, Nader; Hoberman, Alejandro; Kearney, Diana H; Colborn, D Kathleen; Kurs-Lasky, Marcia; Jeong, Jong H; Haralam, Mary Ann; Bowen, A'Delbert; Flom, Lynda L; Wald, Ellen R
Differentiating acute bacterial sinusitis from viral upper respiratory tract infection (URI) is challenging; 20% to 40% of children diagnosed with acute sinusitis based on clinical criteria likely have an uncomplicated URI. The objective of this study was to determine which signs and symptoms could be used to identify the subgroup of children who meet current clinical criteria for sinusitis but who nevertheless have a viral URI. We obtained sinus radiographs in consecutive children meeting a priori clinical criteria for acute sinusitis. We considered the subgroup of children with completely normal sinus radiographs to have an uncomplicated URI despite meeting the clinical diagnostic criteria for sinusitis. We examined the utility of signs and symptoms in identifying children with URI. Of 258 children enrolled, 54 (20.9%) children had completely normal radiographs. The absence of green nasal discharge, the absence of disturbed sleep and mild symptoms were associated with a diagnosis of URI. No physical exam findings were particularly helpful in distinguishing between children with normal versus abnormal radiographs. Among children meeting current criteria for the diagnosis of acute sinusitis, those with mild symptoms are significantly more likely to have a URI than those with severe symptoms. In addition to assessing overall severity of symptoms, practitioners should ask about sleep disturbance and green nasal discharge when assessing children with suspected sinusitis; their absence favors a diagnosis of URI.
Shaikh, Nader; Hoberman, Alejandro; Kearney, Diana H.; Colborn, D. Kathleen; Kurs-Lasky, Marcia; Jeong, Jong H.; Haralam, Mary Ann; Bowen, A’Delbert; Flom, Lynda L.; Wald, Ellen R.
Objective Differentiating acute bacterial sinusitis from viral upper respiratory tract infection (URI) is challenging; 20% to 40% of children diagnosed with acute sinusitis based on clinical criteria likely have an uncomplicated URI. The objective of this study was to determine which signs and symptoms could be used to identify the subgroup of children who meet current clinical criteria for sinusitis but who nevertheless have a viral URI. Methods We obtained sinus radiographs in consecutive children meeting a priori clinical criteria for acute sinusitis. We considered the subgroup of children with completely normal sinus radiographs to have an uncomplicated URI despite meeting the clinical diagnostic criteria for sinusitis. We examined the utility of signs and symptoms in identifying children with URI. Results Of 258 children enrolled, 54 (20.9%) children had completely normal radiographs. The absence of green nasal discharge, the absence of disturbed sleep, and mild symptoms were associated with a diagnosis of URI. No physical exam findings were particularly helpful in distinguishing between children with normal vs. abnormal radiographs. Conclusions Among children meeting current criteria for the diagnosis of acute sinusitis, those with mild symptoms are significantly more likely to have a URI than those with severe symptoms. In addition to assessing overall severity of symptoms, practitioners should ask about sleep disturbance and green nasal discharge when assessing children with suspected sinusitis; their absence favors a diagnosis of URI. PMID:23694838
Gao, Wanbao; Raeside, David E.
Dose distributions that result from treating a patient with orthovoltage beams are best determined with a treatment planning system that uses the Monte Carlo method, and such systems are not readily available. In the present work, the Monte Carlo method was used to develop a computer code for determining absorbed dose distributions in orthovoltage radiation therapy. The code was used in planning treatment of a patient with a neuroendocrine carcinoma of the maxillary sinus. Two lateral high-energy photon beams supplemented by an anterior orthovoltage photon beam were utilized in the treatment plan. For the clinical case and radiation beams considered, a reasonably uniform dose distribution is achieved within the target volume, while the dose to the lens of each eye is 4 - 8% of the prescribed dose. Therefore, an orthovoltage photon beam, when properly filtered and optimally combined with megavoltage beams, can be effective in the treatment of cancers below the skin, providing that accurate treatment planning is carried out to establish with accuracy and precision the doses to critical structures.
Zinser, Max J; Randelzhofer, Peter; Kuiper, Luit; Zöller, Joachim E; De Lange, Gert L
To assess the predictors of implant failure after grafted maxillary sinus (GMS). A total of 1045 implants were inserted in 224 patients/347 GMS during a period of 14 years. Kaplan-Meyer and multivariate log-regression analysis were used to assess the following variates: patient's age, gender, smoker/nonsmoker, American Society of Anesthesiologists (ASA) class, one/two-stage surgery, merged/submerged healing, membrane, antibiotics, auto/allo/xenogenic bone grafts, implant's lengths/surface/diameter, crestal bone atrophy/quality, implant region, prosthetics, opposing dentition, and implant proximity to evaluate the predictors and relative risk (hazard ratio [HR]) of implant failure. Significant implant failure predictors were the graft material (HR = 4.7), with superior results for autogenic bone, residual crestal bone height (HR = 3.51), ASA class (HR = 2.73), surgical technique (HR = 2.56), implant proximity (HR = 2.07), smoker (HR = 1.98), and age (>60/HR=1.39). All other factors were insignificant. Overall survival rate was 93.3%. GMS is effective when the predictors are considered. Patient selection, including the ASA status, smoking, residual bone height, and the graft material are the predominant predictors. In highly atrophic situations, autogenic bone grafts showed superiority; however, in less atrophic cases, nonautogenic bone-grafts are equivalent. Copyright © 2013 Elsevier Inc. All rights reserved.
Introduction To date intracranial complication caused by tooth extractions are extremely rare. In particular parietal subdural empyema of odontogenic origin has not been described. A literature review is presented here to emphasize the extreme rarity of this clinical entity. Case presentation An 18-year-old Caucasian man with a history of dental extraction developed dysarthria, lethargy, purulent rhinorrhea, and fever. A computed tomography scan demonstrated extensive sinusitis involving maxillary sinus, anterior ethmoid and frontal sinus on the left side and a subdural fluid collection in the temporal-parietal site on the same side. He underwent vancomycin, metronidazole and meropenem therapy, and subsequently left maxillary antrostomy, and frontal and maxillary sinuses toilette by an open approach. The last clinical control done after 3 months showed a regression of all symptoms. Conclusions The occurrence of subdural empyema is an uncommon but possible sequela of a complicated tooth extraction. A multidisciplinary approach involving otolaryngologist, neurosurgeons, clinical microbiologist, and neuroradiologist is essential. Antibiotic therapy with surgical approach is the gold standard treatment. PMID:25146384
Schmitt, Christian Martin; Doering, Hendrik; Schmidt, Thomas; Lutz, Rainer; Neukam, Friedrich Wilhelm; Schlegel, Karl Andreas
This investigation focused on a comparison of clinical and histological characteristics after sinus floor augmentation with biphasic calcium phosphate (BCP, Straumann BoneCeramic(®) ), anorganic bovine bone (ABB, Geistlich Bio-Oss(®) ), mineralized cancellous bone allograft (MCBA, Zimmer Puros(®) ), or autologous bone (AB). Thirty consecutive patients with a posterior edentulous maxillary situation and a vertical bone height less than or equal to 4 mm were included in this study. A two-stage procedure was carried out. After augmentation of the maxillary sinus with ABB, BCP, MCBA, or AB followed by a healing period of 5 months, biopsies were taken with simultaneous implant placement. The samples were analyzed using microradiography and histology. Ninety-four implants were placed in the augmented positions and 53 bone biopsies were taken and evaluated. The bone volume fraction of newly formed bone was measured as 30.28 ± 2.16% for BCP, 24.9 ± 5.67% for ABB, 41.74 ± 2.1% for AB, and 35.41 ± 2.78% for MCBA with significant increases in bone volume of AB vs. BCP and ABB, and MCBA vs. ABB samples. Significantly different residual bone substitute material was measured as 15.8 ± 2.1% in the BCP group and 21.36 ± 4.83% in the ABB group. As it provides the highest rate of de novo bone formation, AB can be considered to remain the gold standard in sinus floor augmentation. All tested control materials showed comparable results and are suitable for maxillary sinus augmentation. © 2012 John Wiley & Sons A/S.
Felice, Pietro; Pistilli, Roberto; Piattelli, Maurizio; Soardi, Elisa; Pellegrino, Gerardo; Corvino, Valeria; Esposito, Marco
To compare the efficacy of 1-stage versus 2-stage lateral maxillary sinus lift procedures. Sixty partially edentulous patients requiring 1 to 3 implants and having 1 to 3 mm of residual bone height and at least 5 mm of bone width below the maxillary sinus, as measured on CT scans, were randomised into two equal groups to receive either a 1-stage lateral window sinus lift with simultaneous implant placement or a 2-stage procedure with implant placement delayed by 4 months using a bone substitute in 3 different centres. Implants were submerged for 4 months and loaded with reinforced provisional prostheses, which were replaced, after 4 months, by definitive prostheses. Outcome measures were augmentation procedure failures, prosthesis failures, implant failures, complications and marginal peri-implant bone loss assessed by a blinded outcome assessor. Patients were followed up to 4 months after loading. Only data of implants placed in 1 to 3 mm of bone height were reported. Two patients dropped out from the 1-stage group and none from the 2-stage group. No sinus lift procedure failed in the 1-stage group but 1 failed in the 2-stage group, the difference was not statistically significant (P = 1.00). Two prostheses failed or could not be placed in the planned time in the 1-stage group and 1 in the 2-stage group, the difference was not statistically significant (P = 0.51). Three implants failed in 3 patients of the 1-stage group versus 1 implant in the 2-stage group, the difference was not statistically significant (P = 0.28). Two complications occurred in the 1-stage group and 1 in the 2-stage group, the difference was not statistically significant (P = 0.61). There were no statistically significant differences in bone loss between groups at loading (0.05 mm). Sites treated in 1 stage lost an average of 0.56 mm (SD: 0.36; 95% CI: -0.70 to -0.42; P < 0.001) of peri-implant bone and 2-stage sites approximately 0.61 mm (SD: 0.34; 95% CI: -0.74 to -0.48; P < 0.001). No
Revai, Krystal; Dobbs, Laura A; Nair, Sangeeta; Patel, Janak A; Grady, James J; Chonmaitree, Tasnee
Infants and young children are prone to developing upper respiratory tract infections, which often result in bacterial complications such as acute otitis media and sinusitis. We evaluated 623 upper respiratory tract infection episodes in 112 children (6-35 months of age) to determine the proportion of upper respiratory tract infection episodes that result in acute otitis media or sinusitis. Of all upper respiratory tract infections, 30% were complicated by acute otitis media and 8% were complicated by sinusitis. The rate of acute otitis media after upper respiratory tract infection declined with increasing age, whereas the rate of sinusitis after upper respiratory tract infection peaked in the second year of life. Risk for acute otitis media may be reduced substantially by avoiding frequent exposure to respiratory viruses (eg, avoidance of day care attendance) in the first year of life.
Acocella, Alessandro; Sacco, Roberto; Niardi, Paolo; Agostini, Tommaso
Effectively restoring a grossly atrophic maxilla can be difficult for the implant surgeon. The placement of dental implants in patients who are edentulous in the posterior maxilla can present difficulties because of deficient posterior alveolar ridge and increased pneumatization of the maxillary sinus, resulting in a minimal hard tissue bed. Implant placement requires adequate quality and quantity of bone, especially in the posterior maxilla. Insufficient bone height and width in this area of the maxilla, because of expansion of the maxillary sinus and atrophic reduction of the alveolar ridge, represents a contraindication for conventional insertion of dental implants. The reconstruction of edentulous patients with adequate bone volume and density by the use of bone graft and, subsequently, the placement of dental implants has become a viable treatment option with high predictability. It is commonly shared that autologous bone graft is the gold standard grafting method in the augmentation of Higmoro antrum and in any kinds of guided bone regeneration. In this article, the authors report a case of severe maxillary atrophy that is augmented by block bone graft harvested from iliac crest. An early placement of implants is possible due to the quick healing of the site, as proven by histologic examinations.
Lo Giudice, G; Iannello, G; Terranova, A; Lo Giudice, R; Pantaleo, G; Cicciù, M
Aim. The aim of this study was to assess the success and the survival rate of dental implants placed in augmented bone after sinus lifting procedures. Material and Methods. 31 patients were mainly enrolled for a residual upper jaw crest thickness of 3 mm. CBCT scans were performed before and after the augmentation technique and at the follow-up appointments, at 3, 6, 12, 24, and up to 60 months. The follow-up examination included cumulative survival rate of implants, peri-implant marginal bone loss, and the height of sinus floor augmentation. Results. This retrospective study on 31 patients and 45 implants later inserted in a less than 3 mm crest showed excellent survival rates (99.5%), one implant was lost before loading due to an acute infection after 24 days, and two implants did not osteointegrate and were removed after 3 months. The radiological evaluation showed an average bone loss of 0.25 mm (±0.78 mm) at the first follow-up appointment (3 months) up to 0.30 mm (±1.28 mm) after 60-month follow-up. Conclusion. In this study it was reported how even in less than 3 mm thick crest a transcrestal technique can predictably be used with a long-term clinical and radiological outcome, giving patients excellent stability of the grafted material and healthy clinical results.
Silva, Adalberto Novaes; Oliveira, José Américo de; Jamur, Maria Célia; Junqueira, José Ari Gualberto; Correa, Vani Maria; Lima, Wilma Terezinha Anselmo
Few studies has been done using guided bone regeneration in maxillary sinus defects. To assess the bone repair process in surgical defects on the alveolar wall of the monkey maxillary sinus, which communicates with the sinus cavity, by using collagen membranes: Gen-derm--Genius Baumer, Pro-tape--Proline and autologous temporal fascia. In this prospective and experimental study, orosinusal communications were performed in four tufted capuchin monkeys (Cebus apella) and histologic analysis was carried out 180 days after. In the defects without a cover (control), bone proliferation predominated in two animals and fibrous connective tissue predominated in the other two. In defects repaired with a temporal fascia flap, fibrous connective tissue predominated in three animals and bone proliferation predominated in one. In the defects repaired with Gen-derm or Pro-tape collagen membranes there was complete bone proliferation in three animals and fibrous connective tissue in one. Surgical defect can be repaired with both bone tissue and fibrous connective tissue in all study groups; collagen membranes was more beneficial in the bone repair process than temporal fascia or absence of a barrier.
Rong, Q; Li, X; Chen, S L; Zhu, S X; Huang, D Y
A titanium membrane was used to isolate the Schneiderian membrane of the bony walls of the sinus so that we could investigate their role on the formation of bone after sinus lifts compared with a control group (conventional raising of the sinus floor) in which we did not use a membrane to isolate any area. Three canine models of lifting the sinus floor using the lateral window technique were established: conventional lifting of the floor (control group), raising of the floor with the mucosa shielded (mucosal shielding group), and raising of the floor with the bony wall shielded (bony wall shielding group). The formation of bone one and three months after the sinus floor had been lifted was compared in each group both grossly and by histopathological examination. An appreciable amount of new bone had formed in the control group, with abundant areas near the inferior bony wall, and some near the raised Schneiderian membrane. Similarly, new bone had also formed in the mucosal shielding group, with abundant new bone near the inferior bony wall, but none near the raised Schneiderian membrane. However, there was considerably less new bone in the bony wall shielding group, with none in tissues adjacent to the inferior bony wall and little in tissues near the raised Schneiderian membrane. The Schneiderian membrane has osteogenic capability and participates in the formation of bone after the sinus floor has been lifted. However, its osteogenic role is weaker than that of the surrounding bony wall of the maxillary sinus. Copyright © 2015. Published by Elsevier Ltd.
Linder, Jeffrey A; Singer, Daniel E; van den Ancker, Melissa; Atlas, Steven J
CONTEXT Symptoms suggestive of acute sinusitis are a common reason for patients to visit primary care providers. Since objective measures of outcome have not been shown to be related to patient reported outcomes, measures of treatment success have focused on symptom relief and improved health-related quality of life (HRQL). Assessing the appropriate role of treatment — for example, antibiotics for patients with acute sinusitis — requires valid, reliable, and responsive measures of outcome. We identified symptom scores and HRQL instruments for adults with sinusitis and assessed their performance characteristics. DATA SOURCES Articles identified through computer searches of the medline, premedline, and embase databases, the Cochrane Library, and internet documents; inquiries to experts in sinusitis and outcomes assessment; and review of reference lists. STUDY SELECTION Studies that used HRQL instruments or evaluated the performance characteristics of symptom scores in adults with sinusitis, published in English after 1966. DATA EXTRACTION Two reviewers independently extracted data on study design, setting, and patient characteristics; instrument length and format; and instrument validity, reliability, responsiveness to change, and interpretability. Study quality was assessed using a 10-point score. DATA SYNTHESIS Of 1,340 articles in the original search, 29 articles using 16 HRQL instruments and 5 symptoms scores met inclusion and exclusion criteria. The overall quality of these studies was low; only 4 studies scored higher than 4 of 10 points. Four studies included patients with acute sinusitis, but only 2 included exclusively acute sinusitis patients. Three instruments have been shown to meet basic requirements for validity, reliability, and responsiveness: the Chronic Sinusitis Survey, the Rhinosinusitis Outcome Measure-31, and the Sinonasal Outcome Test-16. No instrument has been validated in a primary care setting or for patients with acute sinusitis
Doucette-Preville, Stephane; Tamm, Alexander; Khetani, Justin; Wright, Erin; Emery, Derek
Pathologic dilatation of the maxillary sinus by air is a rare condition with unclear etiology. We present a case of a 17 year old male with a maxillary air cyst diagnosed by computed tomography. The CT demonstrated air-filled expansion of the maxillary sinus beyond the normal anatomical limits with associated cortical bone thinning. The case report highlights the pathognomonic computed tomography findings of this rare entity and discusses the perplexing nomenclature, proposed etiologies and various treatment options.
Zhang, Qiao; Zhang, Li Li; Yang, Yang; Lin, Yi Zhen; Miron, Richard J; Zhang, Yu Feng
To study the clinical effect of short implant placement using osteotome sinus floor elevation technique and tent-pole grafting technique with recombinant human bone morphogenetic protein 2 (rhBMP-2) in severely resorbed maxillary area. Eleven patients with insufficient bone height in the posterior maxillary area were included. According to the native bone height and crown height space (CHS), the patients were divided into two groups: immediate placement of short implants with simultaneous bone augmentation (group A, 5 patients) and delayed dental implant placement (4 to 6 months) after bone augmentation. The rhBMP-2 was added into a deproteinised bovine bone mineral (DBBM) bone grafting material to shorten the treatment procedure and enhance the final effect of bone augmentation in both groups. Tent-pole grafting technique was applied for vertical bone augmentation in group B (6 patients). The success rate of the implants placed was 100% in both groups. In group A, the short implants treatment was successful, with a vertical gain of 1.5 to 6.4 mm in bone height after 4 to 6 months. In group B, the tent-pole grafting procedure in combination with DBBM and rhBMP-2 increased vertical bone height between 3.1 and 8.1 mm, an optimistic and adequate increase for implant placement. This bone increase was maintained following implant placement and final crown placement in the maxillary region (3.5 to 7.3 mm). The tent-pole grafting technique was a viable alternative choice to lateral sinus floor elevation in cases with excessive CHS. The application of rhBMP-2 with a shortened treatment time demonstrated positive outcomes in sinus floor augmentation procedures.
Pynnonen, Melissa A; Lynn, Shana; Kern, Hayley E; Novis, Sarah J; Akkina, Sarah R; Keshavarzi, Nahid R; Davis, Matthew M
Our objectives were to characterize the quality of acute sinusitis care and to identify nonclinical factors associated with antibiotic use for acute sinusitis. We hypothesized that we would identify provider-level factors associated with antibiotic use. Retrospective cohort at a single academic institution. We developed and clinically annotated an administrative dataset of adult patients diagnosed with acute sinusitis between January 1, 2005, and December 31, 2006. We used identify factors associated with receipt of antibiotics. We find that 66.0% of patients with mild symptoms of short duration are given antibiotics, and that nonclinical factors, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence antibiotic use. Relative to internal medicine providers, family medicine providers use fewer antibiotics, and emergency medicine providers use more antibiotics for acute sinusitis. Antibiotics continue to be overused for patients with mild acute sinusitis of short duration. Nonclinical characteristics, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence use of antibiotics for acute sinusitis. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Pynnonen, Melissa A; Lynn, Shana; Kern, Hayley E; Novis, Sarah J; Akkina, Sarah R; Keshavarzi, Nahid R; Davis, Matthew M.
Objectives and Hypothesis Our objectives were to characterize the quality of acute sinusitis care and to identify non-clinical factors associated with antibiotic use for acute sinusitis. We hypothesized that we would identify provider level factors associated with antibiotic use. Study Design Retrospective cohort at a single academic institution. Methods We developed and clinically annotated an administrative dataset of adult patients diagnosed with acute sinusitis between January 1, 2005 and December 31, 2006. We used identify factors associated with receipt of antibiotics. Results We find that 66.0% of patients with mild symptoms of short duration are given antibiotics and that non-clinical factors, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence antibiotic use. Relative to internal medicine providers, family medicine providers use fewer antibiotics and emergency medicine providers use more antibiotics for acute sinusitis. Conclusions Antibiotics continue to be over used for patients with mild acute sinusitis of short duration. Non-clinical characteristics, including the individual provider, the provider's specialty, and the presence of a medical trainee significantly influence use of antibiotics for acute sinusitis. PMID:26010534
Frenken, J W F H; Bouwman, W F; Bravenboer, N; Zijderveld, S A; Schulten, E A J M; ten Bruggenkate, C M
In this study, we evaluated the quality and quantity of bone formation in maxillary sinus floor elevation procedure using a new fully synthetic biphasic calcium phosphate (BCP) consisting of a mixture of 60% hydroxyapatite and 40% of beta-tricalcium phosphate (Straumann Bone Ceramic). A unilateral maxillary sinus floor elevation procedure was performed in six patients using 100% BCP. Biopsy retrieval for histological and histomorphometric analysis was carried out before implant placement after a 6-month healing period. In this study, the maxillary sinus floor elevation procedure with the use of BCP showed uneventful healing. Radiological evaluation after 6 months showed maintenance of vertical height gained immediately after surgery. Primary stability was achieved with all Straumann SLA dental implants of 4.1 mm diameter and 10 or 12 mm length. The implants appeared to be osseointegrated well after a 3-month healing period. Histological investigation showed no signs of inflammation. Cranial from the native alveolar bone, newly formed mineralized tissue was observed. Also, osteoid islands as well as connective tissue were seen around the BCP particles, cranial from the front of newly formed mineralized tissue. Close bone-to-substitute contact was observed. Histomorphometric analysis showed an average bone volume/total volume (BV/TV) of 27.3% [standard deviation (SD) 4.9], bone surface/total volume (BS/TV) 4.5 mm(2)/mm(3) (SD 1.1), trabecula-thickness (TbTh) 132.1 mum (SD 38.4), osteoid-volume/bone volume (OV/BV) 7.5% (SD 4.3), osteoid surface/bone surface (OS/BS) 41.3% (SD 28.5), osteoid thickness (O.Th) 13.3 mum (SD 4.7) and number of osteoclasts/total area (N.Oc/Tar) 4.4 1/mm (SD 5.7). Although a small number of patients were treated, this study provides radiological and histological evidence in humans confirming the suitability of this new BCP for vertical augmentation of the atrophied maxilla by means of a maxillary sinus floor elevation procedure allowing
Kelly, Mick P; Vaughn, Olushola L Akinshemoyin; Anderson, Paul A
Recombinant human bone morphogenetic protein-2 (rhBMP-2) is approved by the Food and Drug Administration as a viable alternative to bone graft in spinal fusion and maxillary sinus lift. The research questions for meta-analysis were: Is rhBMP-2 an effective bone graft substitute in localized alveolar ridge augmentation and maxillary sinus floor augmentation? What are the potential adverse events? A search of MEDLINE from January 1980 to January 2014 using PubMed, the Cochrane Database of Systematic Reviews and Controlled Trials, CINAHL, and EMBASE was performed. Searches were performed from Medical Subject Headings. The quality of each study included was graded by Review Manager software. The primary outcome variable was bone formation measured as change in bone height on computed tomogram. A systematic review of adverse events also was performed. A random-effects model was chosen. Continuous variables were calculated using the standardized mean difference and 95% confidence intervals (CIs) comparing improvement from baseline of the experimental group with that of the control group. Change in bone height was calculated using logarithmic odds ratio. Test of significance used the Z statistic with a P value of .05. Ten studies met the criteria for systematic review; 8 studies were included in the meta-analysis. Five studies assessed localized alveolar ridge augmentation and resulted in an overall standardized mean difference of 0.56 (CI, 0.20-0.92) in favor of BMP; this result was statistically important. Three studies assessed maxillary sinus floor augmentation and resulted in an overall standardized mean difference of -0.50 (CI, -0.93 to -0.09), which was meaningfully different in favor of the control group. Adverse events were inconsistently reported, ranging from no complications to widespread adverse events. For localized alveolar ridge augmentation, this meta-analysis showed that rhBMP-2 substantially increases bone height. However, rhBMP-2 does not perform as
Jiang, Fei-Fei; Hou, Yan; Lu, Li; Ding, Xiao-Xu; Li, Wei; Yan, Ai-Hui
To evaluate the facial profiles and functional recovery of 18 patients treated by a computer-aided designed/manufactured hollow obturator prosthesis (CAD/CAM prosthesis) after total maxillectomy for malignant maxillary sinus tumor. A retrospective observational study was performed to evaluate the facial profiles and functional recovery of 18 patients with T3-4a N0 M0 maxillary sinus cancer, who were treated by total maxillectomy and simultaneous implantation of a computer-aided designed/manufactured hollow obturator prosthesis (CAD/CAM prosthesis). Follow-ups were performed 1, 3, 6, and 12 months after surgery. Facial measurements, speech intelligibility, and chewing and swallowing functions were examined. Thirteen patients converted to a permanent prosthesis 6 months after surgery. Comparisons were made between patients with and without the CAD/CAM or permanent prosthesis at various times using SPSS13.0 statistical software (SPSS Inc., Chicago, IL, USA). Speech intelligibility, facial depression, and eyeball prolapse results showed improvements with prosthesis use at 1, 3, and 6 months after surgery (p < 0.05). Swallowing function improved from level V to level II-IV with prosthesis use at 1, 3, and 6 months, and reached level I or II with permanent prosthesis use at 12 months after surgery. Simultaneous CAD/CAM prosthesis implantation recovered the facial profile, enhanced the speaking, swallowing, and chewing functions, and improved the quality of life of patients. Tumor recurrence can be detected by direct observation of the postoperative maxillary cavity. Therefore, this operation is recommended for simultaneous excision repair and functional reconstruction after total maxillectomy. This surgical treatment of maxillary sinus cancer is applied rarely in China, but it has a good effect based on our observation. Simultaneous CAD/CAM prosthesis implantation after total maxillectomy can recover the facial profile, enhance the speaking, swallowing, and chewing
Klossek, J M
Sinusitis or acute rhinosinusitis, is defined as an acute viral or bacterial infection characterised by inflammation of the mucosa of the nose and paranasal sinuses. Although antibiotics are routinely prescribed for the treatment of acute sinusitis, most cases are caused by viral infections and will resolve without antibiotic therapy. Given concerns about global antibacterial resistance, evidence-based clinical practice guidelines recommend a conservative approach to antibiotic treatment, with mild or moderately severe acute sinusitis managed symptomatically. Intranasal corticosteroids act on the nasal mucosa to relieve inflammation and its associated symptoms, and may be a useful symptomatic treatment option. Two randomised, placebo-controlled trials have demonstrated that the corticosteroid mometasone furoate, administered as a nasal spray (MFNS), is effective as an adjunct to antibiotics in acute sinusitis. The design of these studies show a therapeutic approach known in Europe, but this attitude is still different from the current French guidelines. Furthermore, the efficacy and safety of MFNS monotherapy has been compared with antibiotic therapy in a randomised, double-blind, placebo-controlled trial in adults with acute uncomplicated sinusitis and probably viral. In this study, twice-daily (BID) MFNS 200 microg produced statistically greater improvements in overall symptoms and most individual symptoms compared with amoxicillin or placebo, even though Amoxicillin is not the one recommended by the French guidelines for this indication. These findings suggest that MFNS may play an important role in the management of acute sinusitis, either as monotherapy or as adjunctive treatment to antibiotics. These results lead also to think over its interest in the treatment of uncomplicated common forms of sinusitis, where antibiotics are still widely prescribed in daily practice.
Schmitt, Christian M; Moest, Tobias; Lutz, Rainer; Neukam, Friedrich W; Schlegel, Karl Andreas
This investigation focused on histological characteristics and 5-year implant survival after sinus floor augmentation with anorganic bovine bone (ABB, Bio-Oss) and ABB plus autologous bone (AB) with a ratio of 1/1. Nineteen consecutive patients with bony atrophy of the posterior edentulous maxilla and a vertical bone height ≤4 mm were prospectively included in this study. In the first surgical stage, the maxillary sinus was non-randomized either augmented with ABB alone (n = 12) or a 1/1 mixture of ABB and AB (n = 7). After a mean healing period of 167 days, biopsies were harvested in the region of the grafted sinus with a trephine burr and implants were placed simultaneously, ABB n = 18 and ABB + AB n = 12. The samples were microradiographically and histomorphometrically analyzed judging the newly formed bone (bone volume, BV), residual bone substitute material volume (BSMV), and intertrabecular volume (soft tissue volume, ITV) in the region of the augmented maxillary sinus. Implant survival was retrospectively evaluated from patient's records. No significant difference in residual bone substitute material (BSMV) in the ABB group (31.21 ± 7.74%) and the group with the mixture of ABB and AB (28.41 ± 8.43%) was histomorphologically determined. Concerning the de novo bone formation, also both groups showed statistically insignificant outcomes; ABB 26.02 ± 5.23% and ABB + AB 27.50 ± 6.31%. In all cases, implants were installed in the augmented sites with sufficient primary stability. After a mean time in function of 5 years and 2 months, implant survival was 93.75% in the ABB and 92.86% in the ABB + AB group with no statistically significant differences. The usage of ABB plus AB to a 1/1 ratio leads to an amount of newly formed bone comparable with the solitary use of ABB after grafting of the maxillary sinus. Considering that ABB is a non-resorbable bone substitute, it can be hypothesized that this leads to stable bone over time and long-term implant success
Riben, Christopher; Thor, Andreas
Background. Long-term edentulism may in many cases result in resorption of the alveolar process. The sinus lift procedure aims to create increased bone volume in the maxillary sinus in order to enable installation of dental implants in the region. The method is over 30 years old, and initially autogenous bone grafts were used and later also different bone substitutes. Since 1997, a limited number of studies have explored the possibility of a graftless procedure where the void under the sinus membrane is filled with a blood clot that enables bone formation. Aim. To describe the evolution of the sinus-lift technique and to review the literature related to the technique with a focus on long-term studies related to the graft-less technique. Methods. The electronic database PubMed was searched, and a systematic review was conducted regarding relevant articles. Results. A relatively few long-term studies using the described technique were found. However, the technique was described as reliable considering the outcome of the existing studies. Conclusion. All investigated studies show high implant survival rates for the graftless technique. The technique is considered to be cost-effective, less time-consuming, and related to lower morbidity since no bone harvesting is needed. PMID:22754569
Kiliç, Songül Cömert; Güngörmüş, Metin
The aim of this study was to evaluate and compare the long-term clinical and radiographic outcomes between a bone graft substitute mixture (beta-tricalcium phosphate [β-TCP] and plateletrich plasma [PRP]) and β-TCP bone graft substitute alone used for sinus floor elevation. This randomized clinical trial included patients with an atrophic maxilla referred for maxillary sinus floor elevation. The elevated sinus cavities of patients were randomly filled with β-TCP plus PRP (study group) or β-TCP alone (control group). Residual bone crest height, vertical bone height gain, and bone graft resorption were measured on cone beam computed tomography (CBCT) images at 10 days and 6 months postoperatively. Incidence of sinus membrane perforations and maxillary sinus infections were recorded. Paired t and Student t tests were used for intragroup and intergroup comparisons, respectively. The sample was composed of 18 subjects: nine subjects in the control group (mean age, 31.51 years) and nine subjects in the study group (mean age, 34.01 years). The mean residual bone crest height was found to be < 5 mm in both groups (4.88 mm in the control group and 2.70 mm in the study group, with no significant difference). From the 10-day to 6-month postoperative visit, mean vertical bone height gains were changed from 12.48 to 11.59 mm in the study group and from 14.77 to 13.19 mm in the control group, with no significant difference. The mean vertical bone graft resorption was -1.58 mm in the study group and -0.89 mm in the control group, with no significant difference. Sinus membrane perforation was observed in 3 of 18 patients. In this study, PRP plus β-TCP graft substitute did not produce significantly more vertical bone height gain or significantly less vertical bone graft resorption compared with β-TCP graft substitute alone. Within the limitations of this study, however, it can be concluded that both grafting materials produced sufficient vertical bone height gain for safe
Schulten, Engelbert A J M; Prins, Henk-Jan; Overman, Janice R; Helder, Marco N; ten Bruggenkate, Christiaan M; Klein-Nulend, Jenneke
Calcium phosphates are used in maxillary sinus floor elevation (MSFE) procedures to increase bone height prior to dental implant placement. Whether a collagenous barrier membrane coverage of the lateral window affects bone formation within a bone substitute augmentation is currently an important matter of debate, since its benefit has not been irrefutably proven. Therefore, in this clinical study twelve patients underwent an MSFE procedure with β-tricalcium phosphate (β-TCP). The lateral window was either left uncovered, or covered with a resorbable collagenous barrier membrane. After a 6-months healing period, bone biopsies were retrieved during implant placement. Consecutive 1 mm regions of interest of these biopsies were assessed for bone formation, resorption parameters, as well as bone architecture using histology, histomorphometry and micro-computed tomography. Comparable outcomes between the groups with and without membrane were observed regarding osteoconduction rate, bone and graft volume, osteoclast number and structural parameters of newly formed bone per region of interest. However, osteoid volume in grafted maxillary sinus floors without membrane was significantly higher than with membrane. In conclusion, our results - obtained with a novel method employed using 1 mm regions of interest - demonstrate that the clinical application of a bioresorbable collagenous barrier membrane covering the lateral window, after an MSFE procedure with β-TCP, was not beneficial for bone regeneration and even decreased osteoid production which might lead to diminished bone formation in the long run.
Mignogna, Michele D; Fortuna, Giulio; Leuci, Stefania; Adamo, Daniela; Ruoppo, Elvira; Siano, Maria; Mariani, Umberto
To review the current literature on mucormycosis in immunocompentent/otherwise healthy individuals, to which five new cases with maxillary sinus involvement have been added. We searched in the PudMed database all articles in the English language related to human infections caused by fungi of the order Mucorales, in immunocompetent/otherwise healthy patients, starting from January 1978 to June 2009. In addition, we updated the literature by reporting five new cases diagnosed and treated at the oral medicine unit of our institution. The literature review showed at least 126 articles published from 35 different countries in the world, to a total of 212 patients described. The most affected country was India with 94 (44.3%) patients and the most representative clinical form was the cutaneous/subcutaneous with 90 (42.5%) patients. Our five immunocompetent patients with a diagnosed infection of Mucorales localized at the maxillary sinus completely healed with lyposomial amphotericin B. The literature analysis revealed that even in immunocompetent/otherwise healthy individuals mucormycosis infection has a worldwide distribution. What might be the real predisposing factors involved in its pathogenesis in such patients and the real causes of this peculiar geographic distribution still remains unknown. It is likely that, in our cases, a chronic insult of a well-defined and localized body area might have resulted in a local immunocompromission, thus fostering the development of an invasive fungal infection. Copyright © 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Iezzi, Giovanna; Piattelli, Adriano; Giuliani, Alessandra; Mangano, Carlo; Manzon, Licia; Degidi, Marco; Iaculli, Flavia; Scarano, Antonio; Filippone, Antonella; Perrotti, Vittoria
Sinus augmentation procedure has been demonstrated to be a highly predictable treatment in posterior maxilla atrophy. All the surgical interventions in the maxillary region require deep knowledge of anatomy and possible anatomical variations. In this article, pre-operative and post- operative assessments of sinus cavity as well as novel approaches to deepen our knowledge of the behavior of bone substitute materials are described. The awareness of the patient's morphologic conditions enables exact planning of invasive surgery and aids to avoid complications. Pre- operative radiologic evaluation of the region before sinus lift is advisable both for a planning of the sinus augmentation and for selection and alignment of the optimum placement of implants. On the orthopantomography it is possible to measure the vertical dimension of graft, but not the volume and 3D changes. Cone-beam computed tomography (CBCT) has become the "gold standard" to plan a comprehensive implant treatment and to achieve a post-operative assessment. A computer-aided design/computer-aided manufacturing (CAD/CAM) technique is proposed to produce custom-made block grafts for sinus lift procedure, and a customized cutting guide to accurately place the lateral wall and ease membrane elevation. This procedure allows to reduce intervention time, to precisely adapt the scaffold, to reduce risk of complications and to improve operation quality. Recently, a novel approach has been used to deepen our knowledge of the behavior of BSBs: by means of synchrotron micro-tomography (SCT). It is a 3-D analyzing method, suitable to examine the dynamic and spatial arrangement of regenerative phenomena in complex anatomical structures such as bone, where tissues with several morphologies (alveolar process, unmineralized extracellular matrix, regenerated vessels, etc.) compete to achieve the final goal of bone regeneration. Copyright© Bentham Science Publishers; For any queries, please email at firstname.lastname@example.org.
Birdane, Leman; Cingi, Cemal; Muluk, Nuray Bayar; San, Turhan; Burukoglu, Dilek
We investigated the possible beneficial effects of curcumin (CMN) in the treatment of sinusitis. An experimentally induced sinusitis model was created in rats, and the results were evaluated histologically. Thirty-two healthy, female Sprague Dawley rats weighing 270 to 310 g each, were randomly divided into four groups. Group 1 was the control group. In Groups 2 to 4, experimentally induced acute sinusitis was developed, and the rats in those groups were given saline, sulbactam-ampicillin, and CMN, respectively, for 10 days. Then all rats were dissected, and samples of sinus mucosa were taken. Histologic examination was performed via light microscopy. In the sinusitis + antibiotic group, values of inflammation, vascular congestion, vascular dilatation, and subepithelial glandular atrophy were significantly higher; and values of mucosal damage and cilia loss, and hyperplasia of goblet cells, were not significantly different from those in the control group. In the sinusitis + CMN group, values of inflammation, vascular congestion, and vascular dilatation were significantly higher; and values of mucosal damage and cilia loss, hyperplasia of goblet cells, and subepithelial glandular atrophy were not significantly different from those of the control group. Histologic examination revealed that in the sinusitis + CMN group, a nearly normal appearance of the epithelial tissue and reduced cellular inflammation in connective tissue were observed. Minimal vascular congestion in connective tissue remained. The efficacy of CMN in acute sinusitis may be related to its potent anti-inflammatory effects on modulation of various inflammatory cytokines. When low side effects are taken into account, CMN therapy may be a promising option in the treatment of acute sinusitis.
Steele, Toby O; Detwiller, Kara Y; Mace, Jess C; Strong, E Bradley; Smith, Timothy L; Alt, Jeremiah A
We sought to evaluate preoperative and postoperative productivity losses and quality of life (QOL) impairment reported by patients with recurrent acute rhinosinusitis (RARS) as compared to patients with chronic rhinosinusitis without nasal polyposis (CRSsNP). Prospective, multi-institutional, nested case-control. Participants with RARS (n = 20) and CRSsNP (n = 20) undergoing endoscopic sinus surgery (ESS) were enrolled as part of a prospective cohort study. For comparison, participants diagnosed with RARS cases were age/gender-matched to control participants diagnosed with CRSsNP using a 1:1 ratio. RARS and CRSsNP participants were followed for ∼14 months postoperatively. Productivity losses were reported as the number of days missed from normal productive activities out of the previous 90 days. RARS participants reported similar baseline productivity losses (12.6 ± 27.1 [standard deviation]) as participants with CRSsNP (11.7 ± 20.9; P = .314). Postoperatively, improvement in productivity losses was similar between RARS participants and CRSsNP controls (-6.7 ± 20.0 vs. -9.8 ± 19.1; P = .253). Preoperative and postoperative disease-specific QOL measures (Sino-Nasal Outcomes Test-22 and Rhinosinusitis Disability Index) were similar between the two groups. RARS participants reported a significant decrease in days of previous antibiotic (P = .009) and nasal decongestant (P = .004) use following ESS, whereas participants with CRSsNP reported a significant decrease in antibiotic (P = .002) and oral corticosteroid use (P = .002). RARS patients report baseline productivity losses and disease-specific QOL impairment to levels that parallel those with CRSsNP. Patients with RARS report improvement in QOL following ESS in all disease-specific QOL measures and in several medication measures. Productivity losses and postoperative improvements are similar between patients with RARS and CRSsNP. 3b Laryngoscope, 126:1046-1053, 2016. © 2015 The American Laryngological
Lemos, C A A; Mello, C C; dos Santos, D M; Verri, F R; Goiato, M C; Pellizzer, E P
This systematic review evaluated the effect on bone formation and implant survival of combining platelet-rich plasma (PRP) with bone grafts in maxillary augmentation. A comprehensive review of articles listed in the PubMed/MEDLINE, Embase, and Cochrane Library databases covering the period January 2000 to January 2015 was performed. The meta-analysis was based on bone formation for which the mean difference (MD, in millimetres) was calculated. Implant survival was assessed as a dichotomous outcome and evaluated using the risk ratio (RR) with 95% confidence interval (CI). The search identified 3303 references. After inclusion and exclusion criteria were applied, 17 studies were selected for qualitative analysis and 13 for quantitative analysis. A total of 369 patients (mean age 51.67 years) and 621 maxillary sinus augmentations were evaluated. After the data analysis, additional analyses were performed of the implant stability quotient, marginal bone loss, and alveolar bone height measured by MD. The results showed no significant difference in implant stability (P=0.32, MD 1.00, 95% CI -0.98 to 2.98), marginal bone loss (P=0.31, MD 0.06, 95% CI -0.05 to 0.16), alveolar bone height (P=0.10, MD -0.72, 95% CI -1.59 to 0.14), implant survival (P=0.22, RR 1.95, 95% CI 0.67-5.69), or bone formation (P=0.81, MD -0.63, 95% CI -5.91 to 4.65). In conclusion, the meta-analysis indicates no influence of PRP with bone graft on bone formation and implant survival in maxillary sinus augmentation.
Griffa, Alessandro; Dumas, Georges; Perottino, Flavio
Fungus ball of maxillary sinus generally affects immunocompetent and nonatopic subjects. Although endoscopic removal is the current gold standard treatment, removal is at times difficult due to an accumulation of fungal elements in the anterior ad inferior recesses. Aim. To present our experience of maxillary fungus ball treated by the “gauze technique” that avoids these removal difficulties. Materials and Methods. A retrospective, cross-sectional, and descriptive study of 25 patients affected by maxillary fungus ball was carried out: 19 were treated by the “gauze technique” and 6 were treated without “gauze technique.” Results. A comparison was made between the two groups for surgery procedure time, length of hospitalization, time from surgery to nasal unpacking, complications, and postsurgical patient satisfaction. The only statistically significant difference observed was a shorter surgical procedure time (p < 0.05) for the “gauze technique.” Conclusions. The data obtained in this study demonstrated that the “gauze technique” is a safe, simple, and quick technique, able to reduce surgery procedure time whilst providing excellent functional outcomes and patient satisfaction. PMID:28083071
Yin, Xiuyun; Liang, Yuying; Zeng, Lijun; Chen, Shuiping
Schizophyllum commune infections have been rarely reported. Here we reported a rare case of sinusitis in an acute myelocytic leukemia patient, who was co-infected by Escherichia coli, Stenotrophomonas maltophilia, and basidiomycetous fungi (Schizophyllum commune) in sinuses. Considering the in vitro and in vivo anti-fungal activity of voriconazole, it might be a good option to treat Schizophyllum commune infections when antifungal susceptibility testing is not available. When severe side effects occur, amphotericin B or itraconazole might be subsequent choice.
Freedman, A; Horowitz, I
This study was designed to enumerate the number of perforations to the maxillary sinus while performing apicoectomy on maxillary premolar and molar teeth and to evaluate possible complications as a result of these perforations. A total of 472 apicoectomies were performed in 440 patients; perforations occurred in 10.4% of teeth, 23% in molars, 13% in second premolars and 2% in first premolars. No cases of acute or chronic sinusitis were recorded. It was concluded that apicoectomy, carried out using a meticulous surgical technique and proper postoperative care, should be considered as a treatment option before contemplating extraction.
Mangano, Carlo; Sinjari, Bruna; Shibli, Jamil A; Mangano, Francesco; Hamisch, Sabine; Piattelli, Adriano; Perrotti, Vittoria; Iezzi, Giovanna
By mixing hydroxyapatite (HA) and tricalcium phosphate (TCP), biphasic calcium phosphate ceramics can be obtained, and by varying their ratio it is possible to tailor the characteristics of the biomaterial. The aim of the present human study was to evaluate the histological and radiographical aspects of bone formation in maxillary sinus augmentation using a 30/70 HA-beta-TCP with a reticular structure. A total of 12 patients, undergoing two-stage sinus augmentation procedure using HA-beta-TCP at a ratio of 30/70, were included in the present study. After a 6-month healing period, during implant insertion, radiographical analysis was performed, and then the bone core biopsies were harvested and processed for histology. At radiographic evaluation, the bone gain was on average 6.85 ± 0.60 mm. HA-beta-TCP 30/70 appeared to be lined by newly formed bone, with no gaps at the interface. The histomorphometric analysis revealed 26 ± 2% of residual grafted biomaterial, 29 ± 3% of newly formed bone, and 45 ± 2% of marrow spaces. The present results indicate histologically the high biocompatibility and osteoconductivity of HA-beta-TCP 30/70, and clinically its successful use for sinus augmentation procedures. © 2013 Wiley Periodicals, Inc.
Zhang, Yu; Tangl, Stefan; Huber, Christian D; Lin, Ye; Qiu, Lixin; Rausch-Fan, Xiaohui
The potential effect of Choukroun's platelet-rich fibrin (PRF) in combination with allograft on promoting bone regeneration has been discussed in previous publications. This study aims to evaluate an influence of PRF on bone regeneration in sinus augmentation in combination with a xenograft, deproteinised bovine bone. Eleven sinuses from 10 patients with posterior maxillary bone atrophy were selected for the study. As a test group, six sinus floor elevations were grafted with a Bio-Oss and PRF mixture, and as control group, five sinuses were treated with Bio-Oss alone. Clinical and radiographic examinations were performed pre- and postoperatively. After 6 months of sinus augmentation, bone biopsies were obtained from the grafted posterior maxilla, and un-decalcified ground sections were prepared. Bone characteristics were evaluated using histological observation and histomorphometric analyses. No adverse effect was observed in any case within the follow-up period of 6 months after sinus augmentation. Histological observation showed similar morphological characteristics for both the PRF and control groups. The percentage of new bone formation in the PRF group was about 1.4 times of that in control (18.35%±5.62% vs. 12.95%±5.33%), while the percentage of residual bone substitute in the control group was about 1.5 times higher as that in the PRF group (28.54%±12.01% vs. 19.16%±6.89%). The percentage of contact length between newly formed bone and bone substitute in the PRF group was 21.45%±14.57% vs. 18.57%±5.39% in the control. No significant statistical differences between the two groups were found in these observed parameters. Our preliminary result demonstrated neither an advantage nor disadvantage of the application of PRF in combination with deproteinised bovine bone mineral in sinus augmentation after a healing period of 6 months. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
Patel, Ruchin G.; Daramola, Opeyemi O.; Linn, David; Flanary, Valerie A.; Chun, Robert H.
Objective There are many studies that evaluate the role of surgery in the treatment of complications of pediatric acute sinusitis; however there are few studies, if any, that report the incidence of surgery following recovery from acute complicated sinusitis. The goal of this study was to report the incidence and indications for surgical intervention after recovery from complications of pediatric acute sinusitis. Methods We reviewed the records of all children admitted to a tertiary care children’s hospital between January 2005 to September 2010 with a diagnosis of sinusitis and an orbital or intracranial complication. Eighty-six patients met inclusion criteria. Charts were reviewed for type of complication, initial treatment (medical or surgical), type of procedure, secondary procedures, age, and comorbidities. Statistical analysis was completed using independent samples student t-tests and Mann-Whitney tests. Results A total of 86 patients with a mean age of 6.38 years (2 months to 18 years) were identified. Eighty patients had orbital complications while six presented with intracranial complications. Twenty-seven patients (31%) underwent sinus surgery during the acute phase of their illness whereas 59 patients (69%) were treated medically. After hospitalization and recovery for acute complicated sinusitis, surgery was performed on nine patients (mean age 4.86 years) within 1 month to 2 years post hospitalization. Of the nine patients who required secondary surgery following resolution of the initial complicated sinusitis, four patients were following initial surgical intervention and five patients had initially resolved their complication with medical therapy alone. Indications for subsequent surgery included failure of medical therapy for persistent rhinosinusitis (8 patients) and second complication (1 patient). Conclusions This study suggests that following resolution of complicated pediatric rhinosinusitis, very few patients may need further surgical
Patel, Ruchin G; Daramola, Opeyemi O; Linn, David; Flanary, Valerie A; Chun, Robert H
There are many studies that evaluate the role of surgery in the treatment of complications of pediatric acute sinusitis; however there are few studies, if any that report the incidence of surgery following recovery from acute complicated sinusitis. The goal of this study was to report the incidence and indications for surgical intervention after recovery from complications of pediatric acute sinusitis. We reviewed the records of all children admitted to a tertiary care children's hospital between January 2005 and September 2010 with a diagnosis of sinusitis and an orbital or intracranial complication. Eighty-six patients met inclusion criteria. Charts were reviewed for type of complication, initial treatment (medical or surgical), type of procedure, secondary procedures, age, and comorbidities. Statistical analysis was completed using independent samples student t-tests and Mann-Whitney tests. A total of 86 patients with a mean age of 6.38 years (2 months to 18 years) were identified. Eighty patients had orbital complications while six presented with intracranial complications. Twenty-seven patients (31%) underwent sinus surgery during the acute phase of their illness whereas 59 patients (69%) were treated medically. After hospitalization and recovery for acute complicated sinusitis, surgery was performed on nine patients (mean age 4.86 years) within 1 month to 2 years post hospitalization. Of the nine patients who required secondary surgery following resolution of the initial complicated sinusitis, four patients were following initial surgical intervention and five patients had initially resolved their complication with medical therapy alone. Indications for subsequent surgery included failure of medical therapy for persistent rhinosinusitis (8 patients) and second complication (1 patient). This study suggests that following resolution of complicated pediatric rhinosinusitis, very few patients may need further surgical intervention. Subsequent intervention is best
Ariza, Horacio; Rojas, Ramon; Johnson, Peter; Gower, Richard; Benson, Alice; Herrington, Janet; Perroncel, Renee; Pertel, Peter
Background Acute bacterial sinusitis (ABS) is a common infection in clinical practice. Data on time to bacteriologic eradication after antimicrobial therapy are lacking for most agents, but are necessary in order to optimize therapy. This was a prospective, single-arm, open-label, multicenter study to determine the time to bacteriologic eradication in ABS patients (maxillary sinusitis) treated with moxifloxacin. Methods Adult patients with radiologically and clinically confirmed ABS received once-daily moxifloxacin 400 mg for 10 days. Middle meatus secretion sampling was performed using nasal endoscopy pre-therapy, and repeated on 3 consecutive days during treatment. Target enrollment was 30 bacteriologically evaluable patients (pre-therapy culture positive for Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis and evaluable cultures for at least Day 2 and Day 3 during therapy visits), including at least 10 each with S. pneumoniae or H. influenzae. Results Of 192 patients enrolled, 42 were bacteriologically evaluable, with 48 pathogens isolated. Moxifloxacin was started on Day 1. Baseline bacteria were eradicated in 35/42 (83.3%) patients by day 2, 42/42 (100%) patients by day 3, and 41/42 (97.6%) patients by day 4. In terms of individual pathogens, 12/18 S. pneumoniae, 22/23 H. influenzae and 7/7 M. catarrhalis were eradicated by day 2 (total 41/48; 85.4%), and 18/18 S. pneumoniae and 23/23 H. influenzae were eradicated by day 3. On Day 4, S. pneumoniae was isolated from a patient who had negative cultures on Days 2 and 3. Thus, the Day 4 eradication rate was 47/48 (97.9%). Clinical success was achieved in 36/38 (94.7%) patients at the test of cure visit. Conclusion In patients with ABS (maxillary sinusitis), moxifloxacin 400 mg once daily for 10 days resulted in eradication of baseline bacteria in 83.3% of patients by Day 2, 100% by Day 3 and 97.6% by Day 4. PMID:16646958
Kroll, Katherine E; Camacho, Marc A; Gautam, Shiva; Levenson, Robin B; Edlow, Jonathan A
Headache is a common complaint in emergency department (ED) patients. Nearly 15% of ED headache patients will have brain computed tomography (CT) done. One frequent finding on these scans is "chronic sinusitis." Assuming that "chronic sinusitis" is the cause of the patient's headache is a potential source of mis-diagnosis. We hypothesized that CT findings of chronic sinusitis occur with equal frequency in patients with atraumatic headache as in control patients with minor head injury. This is a retrospective, single-center medical record review of consecutive discharged patients who received noncontrast head CT scans in an urban ED for either minor closed head injury or atraumatic headache. Each patient's head CT radiologic report was reviewed for findings of sinusitis and classified as chronic sinusitis, indeterminate for sinusitis, air-fluid levels, or no findings of sinusitis. We enrolled 500 patients (234 in the atraumatic headache group, 266 in the minor head injury group). The two groups were similar except that more women were enrolled in the atraumatic headache group. CT findings of chronic sinusitis in the atraumatic headache group (22.2%) and the minor head injury group (17.7%; difference 4.5%; 95% confidence interval of -2.5-11.6%). Prevalence of CT findings of sinusitis in ED patients with atraumatic headaches and mild head injury are similar. This strongly suggests that CT findings of chronic sinusitis in patients with atraumatic headache may be incidental, and are rarely the cause of a patient's acute headache. Copyright © 2014 Elsevier Inc. All rights reserved.
Zeng, Deliang; Xia, Lunguo; Zhang, Wenjie; Huang, Hui; Wei, Bin; Huang, Qingfeng; Wei, Jie; Liu, Changsheng; Jiang, Xinquan
The objective of this study was to assess the effects of maxillary sinus floor elevation with a tissue-engineered bone constructed with bone marrow stromal cells (bMSCs) and calcium-magnesium phosphate cement (CMPC) material. The calcium (Ca), magnesium (Mg), and phosphorus (P) ions released from calcium phosphate cement (CPC), magnesium phosphate cement (MPC), and CMPC were detected by inductively coupled plasma atomic emission spectroscopy (ICP-AES), and the proliferation and osteogenic differentiation of bMSCs seeded on CPC, MPC, and CMPC or cultured in CPC, MPC, and CMPC extracts were measured by MTT analysis, alkaline phosphatase (ALP) activity assay, alizarin red mineralization assay, and real-time PCR analysis of the osteogenic genes ALP and osteocalcin (OCN). Finally, bMSCs were combined with CPC, MPC, and CMPC and used for maxillary sinus floor elevation in rabbits, while CPC, MPC, or CMPC without cells served as control groups. The new bone formation in each group was detected by histological finding and fluorochrome labeling at weeks 2 and 8 after surgical operation. It was observed that the Ca ion concentrations of the CMPC and CPC scaffolds was significantly higher than that of the MPC scaffold, while the Mg ions concentration of CMPC and MPC was significantly higher than that of CPC. The bMSCs seeded on CMPC and MPC or cultured in their extracts proliferated more quickly than the cells seeded on CPC or cultured in its extract, respectively. The osteogenic differentiation of bMSCs seeded on CMPC and CPC or cultured in the corresponding extracts was significantly enhanced compared to that of bMSCs seeded on MPC or cultured in its extract; however, there was no significant difference between CMPC and CPC. As for maxillary sinus floor elevation in vivo, CMPC could promote more new bone formation and mineralization compared to CPC and MPC, while the addition of bMSCs could further enhance its new bone formation ability significantly. Our data suggest that
Bone formation at the maxillary sinus floor following simultaneous elevation of the mucosal lining and implant installation without graft material: an evaluation of 20 patients treated with 44 Astra Tech implants.
Thor, Andreas; Sennerby, Lars; Hirsch, Jan Michael; Rasmusson, Lars
Restoration of lost dentition in the severely artrophic posterior maxilla has for the last 2 decades been successfully treated with various sinus augmentation techniques and installation of dental implants. The use of graft material is anticipated to be necessary; however, recent studies have demonstrated that the mere lifting of the sinus mucosal lining and simultaneous placement of implants result in bone formation. This study was conducted in order to evaluate simultaneous sinus mucosal lining elevation and installation of dental implants without any graft material. Twenty patients were consecutively included from November 2001 to June 2004. Forty-four Astra ST dental implants (Astra Tech AB, Mölndal, Sweden) with a diameter of 4.5 mm or 5 mm were installed in 27 sinuses. A sinus lift was performed where a cortical window was removed from the maxillary anterior sinus wall. The sinus mucosal lining was elevated and implants installed in the residual subantral bone. The cortical window was thereafter replaced and the incision closed. The remaining bone height was recorded during surgery as well as perforations of the sinus mucosal lining. After 6 months of healing, abutments were connected (the series included 5 1-stage procedures). Clinical and radiological follow-up after loading was performed up to 4 years after implant installation. Patients tolerated the procedure well as few complications were observed. Firm primary stability was achieved for all implants at installation with bone levels in residual bone of 2 to 9 mm. Perforations of the maxillary sinus mucosal lining occurred in 11 of the 27 operated sinuses (41%). One implant was lost during a mean follow-up of 27.5 months (range, 14 to 45 months) giving an implant survival rate of 97.7%. The average gain of bone at the sinus floor was 6.51 mm (SD = 2.49, 44 implants) including all measured implants after a minimum of 1 year follow-up. Marked bone formation was observed around long implants and also when
Ohe, Joo-Young; Kim, Gyu-Tae; Lee, Jung-Woo; Al Nawas, Bilal; Jung, Junho; Kwon, Yong-Dae
The purpose of this study was to confirm volume stability of biphasic calcium phosphate (BCP) through the changes of grafted volume over the time by 3D CT analyzing software program. Fifteen patients, 16 sinuses who were scheduled a staged implantation through sinus floor elevation (SFE)-lateral window technique from 2009 to 2011 were included in the study. Of the 15 patients, eight were male and seven were female (mean age 50.1). For sinus floor augmentation, BCP with local blood was packed loosely into the maxillary sinus and the grafted site was covered with a collagen membrane. For the evaluation of volume change, 3D CBCT scans were taken five times at pre-operatively (To), post-op 1 week (T1), 1 month (T2), 3 months (T3), and 6 months (T4). 3D image processing software (OnDemand3DTM software) was used for this study. The time sequential change was statistically evaluated. 84.32% grafted BCP is maintained until post-op 6 month (T4), and the average volume loss is 207.7 mm(3) (about 0.21 cc). Statistically, a significant volume change (decreasing) was observed in three groups (T2-T1, T3-T2, T4-T3). Biphasic calcium phosphate, as a synthetic material, has high volume stability and is a predictable graft material for the successful SFE. Although some limitations of the 3D analyzing software program, it is a fast, simple, relatively accurate and promising approach to quantifying long-term changes in the grafted area. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Miyamoto, Shinji; Shinmyouzu, Kouhei; Miyamoto, Ikuya; Takeshita, Kenji; Terada, Toshihisa; Takahashi, Tetsu
This study utilized the constitution and expression of Runx2/Cbfa1 to conduct 6-month-post-operation histomorphometrical and histochemical analysis of osteocalcin in bone regeneration following sinus-floor augmentation procedures using β-tricalcium phosphate (β-TCP) and autogenous cortical bone. Thirteen sinuses of nine patients were treated with sinus-floor augmentation using 50% β-TCP and 50% autogenous cancellous bone harvested from the ramus of the mandible. Biopsies of augmented sinuses were taken at 6 months for histomorphometric and immunohistochemical measurements. Runx2/Cbfa1- and osteocalcin-positive cells were found around TCP particles and on the bone surface. Approximately 60% of cells found around TCP particles stained positive for Runx2/Cbfa1. Fewer cells stained positive for osteocalcin. These positive cells decreased apically with increasing vertical distance from the maxillary bone surface. Histomorphometric analysis showed that the augmented site close to residual bone and periosteum contained approximately 42% bony tissue and 42% soft connective tissue, and the remaining 16% consisted of TCP particles. On the other hand, the augmented bone far from residual bone and periosteum contained 35% bony tissue and 50% soft connective tissue. Our data suggest that TCP particles attract osteoprogenitor cells that migrate into the interconnecting micropores of the bone-substitute material by 6 months. The augmented site close to residual bone contained a higher proportion of bony tissue and a lower proportion of soft connective tissue than did the augmented site far from residual bone. © 2012 John Wiley & Sons A/S.
Mehta, Viraj J; Ling, Jeanie D; Mawn, Louise A
Acute bacterial sinusitis is a common disease in the pediatric population that typically resolves without significant complications. Children who do suffer from complications involving the orbit or the brain often experience significant morbidity and potential mortality, typically requiring hospitalization for management. Numerous studies have demonstrated that children from low-income families with public or no insurance are less likely to receive adequate preventative care, are more likely to present with later disease stages, and ultimately endure worse health outcomes. We review the literature to examine if there are socioeconomic disparities in the presentation of complications of acute bacterial sinusitis in the pediatric population.
Khanna, Maneesh; Buddhavarapu, Shanker Rao; Hussain, Sheik Akbar; Amir, Emran
Fibro-osseous lesions of the face and paranasal sinuses are relatively uncommon. These lesions have overlapping clinical, radiologic and pathologic features causing difficulty in diagnosis. Neoplastic fibro-osseous paranasal sinus lesions can be benign or malignant. The benign fibro-osseous lesions described are: ossifying fibroma (and its histologic variants) and fibrous dysplasia. The variants of ossifying fibroma differ in the nature of calcified material (i.e. cementum versus bone), in the location of the lesion (oral versus paranasal sinus or orbital), other morphologic variations (presence of psammomatoid concretions) and biologic behavior (aggressive versus stable). Presence of cementum or bone classifies the lesion as cementifying fibroma or ossifying fibroma respectively while lesions with mixture of both cementum and bone are called cemento-ossifying fibroma. We describe a case of a young adult male with cemento-ossifying fibroma of paranasal sinus presenting acutely as left orbital cellulitis with proptosis. PMID:22470655
Khanna, Maneesh; Buddhavarapu, Shanker Rao; Hussain, Sheik Akbar; Amir, Emran
Fibro-osseous lesions of the face and paranasal sinuses are relatively uncommon. These lesions have overlapping clinical, radiologic and pathologic features causing difficulty in diagnosis. Neoplastic fibro-osseous paranasal sinus lesions can be benign or malignant. The benign fibro-osseous lesions described are: ossifying fibroma (and its histologic variants) and fibrous dysplasia. The variants of ossifying fibroma differ in the nature of calcified material (i.e. cementum versus bone), in the location of the lesion (oral versus paranasal sinus or orbital), other morphologic variations (presence of psammomatoid concretions) and biologic behavior (aggressive versus stable). Presence of cementum or bone classifies the lesion as cementifying fibroma or ossifying fibroma respectively while lesions with mixture of both cementum and bone are called cemento-ossifying fibroma. We describe a case of a young adult male with cemento-ossifying fibroma of paranasal sinus presenting acutely as left orbital cellulitis with proptosis.
Lim, K H; Thomas, G; van Beers, E J; Hosman, A E; Mourits, M P; van Noesel, C J M; Kater, A P; Reinartz, S M
Chronic lymphocytic leukaemia (CLL) is the most frequent form of leukaemia among adults in the Western world, presenting at a median age of 65 years. The diagnosis is usually made incidentally during routine blood examination while the disease is still in its early phase. We report a case of blindness of 24 hours due to acute sinusitis based on CLL localisation in a patient with undiagnosed CLL. Emergency endoscopic sinus surgery and intra- and extra-ocular orbital decompression were performed. The sinusitis resolved after surgery and intravenous antibiotics. Her vision improved within 24 hours and eventually recovered completely after six months. Her CLL remained in an indolent state, needing no active treatment. This case illustrates that blindness from a lymphoproliferative disorder may be treated with emergency endoscopic sinus surgery instead of conventional chemotherapy in order to salvage the vision first, even if the vision is lost for more than 24 hours.
Scala, Alessandro; Lang, Niklaus P; Velez, Joaquin Urbizo; Favero, Riccardo; Bengazi, Franco; Botticelli, Daniele
To assess the influence of a collagen membrane placed subjacent to a pristine sinus mucosa on the healing outcome of a sinus floor elevation procedure. Eight Pelibuey sheep (Cubano rojo) underwent sinus floor elevation on both sides of the maxilla. At a randomly selected side (test), a collagen membrane was placed subjacent to the sinus mucosa, while the contralateral side (control) was left without the placement of a membrane. Deproteinized bovine bone mineral (DBBM) was used to fill the space created. A collagen membrane was placed bilaterally to cover the access osteotomy. After 4 months, biopsies were harvested and ground sections prepared. Morphometric analysis was performed in four different regions, three within the elevated area and one at the site of the osteotomy. The total percentages of mineralized new bone within the elevated area were 29.4 ± 16.2% and 30.9 ± 9.2% and of marrow spaces 44.0 ± 23.0% and 45.6 ± 14.1%, at the Non-membrane and at the Membrane sites, respectively. A low content of connective tissue within the elevated area was noticed. A higher content of connective tissue was found in the osteotomy region, however. Remnants of DBBM granules were found at a percentage of 17-19%. No statistically significant differences were observed between test and control sites. The application of a collagen membrane subjacent to the Schneiderian mucosa in a sinus floor elevation procedure did not influence the healing outcomes at all. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Pardiñas López, Simón; Froum, Stuart; Khouly, Ismael
To evaluate the histologic and histomorphometric data 10 years after grafting of maxillary sinus in a case using anorganic bovine bone matrix (ABBM) and plasma rich in growth factors (PRGF). Histomorphometric measures were performed for newly formed bone, ABBM particles remnants, marrow spaces, and the presence of osteoblastic and osteoclastic activity. Histologic analysis showed ABBM particles surrounded by new compact and mature vital bone. Osteocytes were noted within lacunae. Some osteoblastic and osteoclastic activity could be identified. The histomorphometric results were 21.7% of newly formed bone, 33.9% of ABBM, and 44% was composed of marrow spaces. After 10 years postoperatively, the histologic evaluation of this case report demonstrated slow replacement of the ABBM particles by newly formed bone, even with the addition of PRGF. The residual ABBM particles were found in close contact to the newly formed bone.
Shapiro, Daniel J.; Gonzales, Ralph; Cabana, Michael D.
OBJECTIVE: The heptavalent pneumococcal conjugate vaccine contributed to a substantial decrease in the number of ambulatory visits attributable to acute otitis media (AOM) and amoxicillin use for AOM increased after publication of American Academy of Pediatrics guidelines regarding AOM. Our objective was to determine whether similar trends occurred for children with acute sinusitis. METHODS: We analyzed data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (1998–2007), which are nationally representative surveys of office and emergency department visits. For children younger than 18 years with diagnosed acute sinusitis (N = 538), we examined time trends in visit rates and antibiotic prescribing. Multivariate logistic regression analyses were used to identify factors associated with narrow-spectrum antibiotic prescribing. RESULTS: Between 1998 and 2007, the annual visit rate for acute sinusitis remained stable, ranging from 11 to 14 visits per 1000 children (P = .67). No change occurred in the proportion of visits with receipt of an antibiotic (82%; P = .71); however, the proportion with receipt of amoxicillin increased from 19% to 58% during the study period (P < .01). Prescriptions for broader-spectrum agents, especially macrolides (18% overall), remained common. CONCLUSIONS: Unlike the visit rate for AOM, the visit rate for acute sinusitis among children did not decrease after introduction of the pneumococcal conjugate vaccine. Although prescriptions for amoxicillin increased in accordance with the guidelines, reducing unnecessary prescriptions for macrolides remains an important target for campaigns promoting judicious antibiotic use. PMID:21187311
Ecevit, Mustafa Cenk; Sarıoğlu, Sülen; Sütay, Semih
Ameloblastic fibroodontoma (AFO) is a rare entity of mixed odontogenic tumors and frequently arises from posterior portion of the maxilla or mandible in first two decades of life. Herein, a 35-year-old woman with a noncontributory medical history who presented with a progressive left maxillary toothache, left maxillary first molar tooth mobility, and swelling in the left maxillary molar area for the last 2 months was reported. Radiologically, a tumor that originated from periapical area of the second mature molar teeth of maxilla was seen and additively unerupted tooth was not detected. The histopathologic examination revealed AFO. The patient is disease-free for five years after treated with limited segmental alveolectomy combining with Caldwell-Luc procedure. PMID:27891277
Caubet, Jorge; Ramis, Joana M; Ramos-Murguialday, Mikel; Morey, Miguel Á; Monjo, Marta
Although the clinical success of Bio-Oss(®) and BoneCeramic(®) has been corroborated by histologic and histomorphometric findings, the biological events that occur during healing after maxillary sinus floor elevation (MSFE) are unknown. Here, we evaluated biopsies of grafted bone with a mixture of autologous bone and Bio-Oss(®) or BoneCeramic(®) after two different healing time periods to understand the molecular process underlying bone formation after MSFE. Seven patients, following a bilateral split-mouth design model and needing a MSFE to allow implant placement, were recruited for this study. Right or left sinuses were grafted with autologous maxillary bone combined either with Bio-Oss(®) or BoneCeramic(®) , respectively. Twenty biopsies were taken at the time of implant insertion after 4-5 months or 6-8 months of MSFE, and analyzed by micro-computed tomography (microCT) and gene-expression analysis. MicroCT analysis revealed no differences in the morphometric parameters or BMD either after 4-5 months or 6-8 months of MSFE between Bio-Oss(®) and BoneCeramic(®) . At molecular level, a higher expression of bone forming gene Runx2 was observed after 4-5 months of MSFE in the Bio-Oss(®) compared with the BoneCeramic(®) group. Our results indicate that differences found at the molecular level between Bio-Oss(®) and BoneCeramic(®) are not translated to important differences in the 3D microstructure and BMD of the grafted bone. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Taxy, Jerome B; El-Zayaty, Shady; Langerman, Alexander
Acute fungal sinusitis is a life-threatening infection affecting immunocompromised patients. Historically, the most commonly recovered fungi are Aspergillus and Mucor. The extent of potentially disfiguring debridement surgery is grossly determined by the appearance of bleeding at the margins, signifying viable tissue and the absence of fungus. Requests for frozen section may concern the initial diagnosis and the intraoperative verification of margin status. In 12 patients with acute fungal sinusitis, frozen section was used in 8. Routine H&E stains demonstrated fungal hyphae in necrotic debris in 5 cases, often associated with vascular and perineural invasion. All patients underwent extensive sinus debridement, including orbital exenteration in 2 cases. All 12 patients died, 9 of fungal sepsis. Autopsy in 3 patients showed pulmonary involvement (2 cases), intracranial spread (1 case), and no residual fungus (1 case). Inexperience with organism recognition is surmountable. Frozen section has a role in the management of this devastating disease.
Kumar, Namineni Kiran; Shaik, Mahaboob; Nadella, Koteswara Rao; Chintapalli, Balakrishna Manohar
The aim of this study was to evaluate changes in alveolar bone height by means of radiographic examination and Straumann implant survival rate following maxillary sinus lift augmentation using autogenous bone in combination with platelet rich plasma (PRP) versus venous blood (VB). Fifty patients requiring sinus lift augmentation procedure included in the study were divided into two groups (n = 25). During the procedure the sub antral sinus cavity was augmented using autogenous bone taken from mandibular ramus area and mixed with PRP in one group and autogenous bone mixed with VB in the other group. Orthopantomograms were taken preoperatively, immediate, at 6 months and 1 year postoperatively. Height of alveolar bone at the site of sinus augmentation was measured on the radiographs. One hundred and twenty-one Straumann dental implants were placed after healing period. Age of the patients in the study groups ranged from 36 to 69 years. Differences in mean values of bone height measurements recorded in the PRP series revealed significant differences among the three subgroups (P = 0.001). Significant differences were noted between immediate postop and 6 month (P < 0.01), immediate postop and year (P < 0.01). In the VB series also significant differences were revealed among the three subgroups (P = 0.0280). Significant differences were noted between immediate postop and 6 month (P < 0.05). Comparison of results of subgroups of the two series at the three intervals revealed significant differences at 'immediate postop' values (P = 0.0002) and 'sixmon' values (P = 0.0435). Differences between 'year' values were not significant. Two implants were lost in PRP group. The results of this limited study reveals that both groups recorded a good increase in the alveolar bone height after sinus augmentation and showed no significant differences between these groups when compared to each other at 1 year postoperatively. When both sub groups compared with
Kawasumi, Yusuke; Kawabata, Tomoyoshi; Sugai, Yusuke; Usui, Akihito; Hosokai, Yoshiyuki; Sato, Miho; Saito, Haruo; Ishibashi, Tadashi; Hayashizaki, Yoshie; Funayama, Masato
Recent studies have reported that drowning victims frequently have fluid accumulation in the paranasal sinuses, most notably the maxillary and sphenoid sinuses. However, in our previous study, many non-drowning victims also had fluid accumulation in the sinuses. Therefore, we evaluated the qualitative difference in fluid accumulation between drowning and non-drowning cases in the present study. Thirty-eight drowning and 73 non-drowning cases were investigated retrospectively. The fluid volume and density of each case were calculated using a DICOM workstation. The drowning cases were compared with the non-drowning cases using the Mann-Whitney U-test because the data showed non-normal distribution. The median fluid volume was 1.82 (range 0.02-11.7) ml in the drowning cases and 0.49 (0.03-8.7) ml in the non-drowning cases, and the median fluid density was 22 (-14 to 66) and 39 (-65 to 77) HU, respectively. Both volume and density differed significantly between the drowning and non-drowning cases (p=0.001, p=0.0007). Regarding cut-off levels in the ROC analysis, the points on the ROC curve closest (0, 1) were 1.03ml (sensitivity 68%, specificity 68%, PPV 53%, NPV 81%) and 27.5 HU (61%, 70%, 51%, 77%). The Youden indices were 1.03ml and 37.8 HU (84%, 51%, 47%, 86%). When the cut-off level was set at 1.03ml and 27.5HU, the sensitivity was 42%, specificity 45%, PPV 29% and NPV 60%. When the cut-off level was set at 1.03ml and 37.8HU, sensitivity was 58%, specificity 32%, PPV 31% and NPV 59%. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Hayward, Gail; Heneghan, Carl; Perera, Rafael; Thompson, Matthew
PURPOSE Acute sinusitis is a common condition in ambulatory care, where it is frequently treated with antibiotics, despite little evidence of their benefit. Intranasal corticosteroids might relieve symptoms; however, evidence for this benefit is currently unclear. We performed a systematic review and meta-analysis of the effects of intranasal corticosteroids on the symptoms of acute sinusitis. METHODS We searched MEDLINE, EMBASE, the Cochrane Central register of Controlled Trials (CENTRAL), and Centre for Reviews and Dissemination databases until February 2011 for studies comparing intranasal corticosteroids with placebo in children or adults having clinical symptoms and signs of acute sinusitis or rhinosinusitis in ambulatory settings. We excluded chronic/allergic sinusitis. Two authors independently extracted data and assessed the studies’ methodologic quality. RESULTS We included 6 studies having a total of 2,495 patients. In 5 studies, antibiotics were prescribed in addition to corticosteroids or placebo. Intranasal corticosteroids resulted in a significant, small increase in resolution of or improvement in symptoms at days 14 to 21 (risk difference [RD] = 0.08; 95% CI, 0.03–0.13). Analysis of individual symptom scores revealed most consistently significant benefits for facial pain and congestion. Subgroup analysis by time of reported outcomes showed a significant beneficial effect at 21 days (RD = 0.11; 95% CI, 0.06–0.17), but not at 14 to 15 days (RD = 0.05; 95% CI, −0.01 to 0.11). Meta-regression analysis of trials using different doses of mometasone furoate showed a significant dose-response relationship (P=.02). CONCLUSIONS Intranasal corticosteroids offer a small therapeutic benefit in acute sinusitis, which may be greater with high doses and with courses of 21 days’ duration. Further trials are needed in antibiotic-naïve patients. PMID:22585889
Kao, Daniel W K; Kubota, Atsushi; Nevins, Myron; Fiorellini, Joseph P
Sinus augmentation with various bone graft materials may be required in the posterior maxilla. This study compared bone formation in a lateral window sinus augmentation with recombinant human bone morphogenetic protein 2/acellular collagen sponge (rhBMP-2/ACS) combined with Bio-Oss or Bio-Oss graft alone. Patients were assigned to treatment with either rhBMP-2/ACS + Bio-Oss or Bio-Oss alone. After a healing period, bone cores were harvested. Histologic specimens demonstrated that new bone formation was less in those who received rhBMP-2/ACS + Bio-Oss than those with Bio-Oss alone. This study indicated that the addition of rhBMP-2/ACS to Bio-Oss has a negative effect on bone formation.
Background. One of the most problematic regions for endosseous implants is the posterior maxilla, not only having poor bone density, but also lacking adequate vertical height as a result of sinus pneumatization. The purpose of the present study was a radiologic, histological, and histomorphometrical evaluation, in humans, of specimens retrieved from sinuses augmented with decellularized bovine compact particles, after a healing period of 6 months. Methods. Four patients, with atrophic resorbed maxillas, underwent a sinus lift augmentation with decellularized bovine compact bone from bovine femur. The size of the particles used was 0.25–1 mm. A total of four grafts and 5 biopsies were retrieved and processed to obtain thin ground sections with the Precise 1 Automated System. Results. The mean volume after graft elevation calculated for each of the 4 patients was 2106 mm3 in the immediate postoperative period (5–7 days), ranging from 1408.8 to 2946.4 mm3. In the late postoperative period (6 months) it was 2053 mm3, ranging from 1339.9 to 2808.9 mm3. Histomorphometry showed that newly formed bone was 36 ± 1.6% and marrow spaces were 34 ± 1.6%, while the residual graft material was 35 ± 1.4%. Conclusion. In conclusion, based on the outcome of the present study, Re-Bone® can be used with success in sinus augmentation procedures and 6 months are considered an adequate time for maturation before implant placement. PMID:28349056
Aguirre Zorzano, Luis Antonio; Rodríguez Tojo, María José; Aguirre Urizar, José Manuel
Rehabilitation with implants in the upper maxilla often implies a challenge due to the shortage and quality of the remaining bone. Different kinds of grafts have been described in an endeavour to solve these problems. The purpose of this study was to assess the osteoconduction potential of an autogenous bone and B-Tricalcium Phosphate mixture, in the treatment of atrophic upper maxillae. 22 patients were treated using the "sinus lift" technique. All patients had residual bone equal to or greater than 5 mm, the sinus was lifted, bone grafted and implants installed during the same surgical procedure (autologous bone and B- Tricalcium Phospahate). During the implant exposure after the osseointegration period, samples of regenerated bone were taken using a trephine from 5 patients. Paraffin-embedded sections were analysed the structure and tissues percentages. Data were estimated statistically. Clinical results showed integration of the 42 fixtures installed. Histological analysis showed good integration of the B-Tricalcium Phosphate in the newly formed bone likewise absence of inflammation. Histomorphometric analysis showed a mean bone proportion of 30.7% (range 22.8%-50.6%). Results suggest the osteoconductive material B-Tricalcium Phosphate associated with autologous bone obtained through filtration is an appropriate graft for implant treatment of atrophic maxillae, in combination with the sinus lift procedure.
Pasquali, Paulo José; Teixeira, Marcelo Lucchesi; de Oliveira, Thiago Altro; de Macedo, Luis Guilherme Scavone; Aloise, Antonio Carlos; Pelegrine, André Antonio
Purpose. To investigate the regenerative results obtained with the association of bone marrow aspirate concentrate using the Bone Marrow Aspirate Concentrate (BMAC) method to a xenogeneic bone graft (Bio-Oss) in sinus floor elevation. Materials and Methods. Using a randomized controlled study design in eight consecutive patients (age of 55.4 ± 9.2 years), 16 sinus floor lift procedures were performed with Bio-Oss alone (control group, CG, n = 8) or combined with bone marrow aspirate concentrate obtained via the BMAC method (test group, TG, n = 8). Six months after the grafting procedures, bone biopsies were harvested during implant placement and were analyzed by histomorphometry. Results. Histomorphometric analysis revealed a significantly higher amount (p < 0.05) of vital mineralized tissue in TG when compared to the CG (55.15 ± 20.91% and 27.30 ± 5.55%, resp.). For nonvital mineralized tissue, TG presented a statistically higher level of Bio-Oss resorption (p < 0.05) when compared with the CG (6.32 ± 12.03% and 22.79 ± 9.60%, resp.). Both groups (TG and CG) showed no significantly different levels (p > 0.05) of nonmineralized tissue (38.53 ± 13.08% and 49.90 ± 7.64%, resp.). Conclusion. The use of bone marrow concentrate obtained by BMAC method increased bone formation in sinus lift procedures. PMID:26543482
Pasquali, Paulo José; Teixeira, Marcelo Lucchesi; de Oliveira, Thiago Altro; de Macedo, Luis Guilherme Scavone; Aloise, Antonio Carlos; Pelegrine, André Antonio
Purpose. To investigate the regenerative results obtained with the association of bone marrow aspirate concentrate using the Bone Marrow Aspirate Concentrate (BMAC) method to a xenogeneic bone graft (Bio-Oss) in sinus floor elevation. Materials and Methods. Using a randomized controlled study design in eight consecutive patients (age of 55.4 ± 9.2 years), 16 sinus floor lift procedures were performed with Bio-Oss alone (control group, CG, n = 8) or combined with bone marrow aspirate concentrate obtained via the BMAC method (test group, TG, n = 8). Six months after the grafting procedures, bone biopsies were harvested during implant placement and were analyzed by histomorphometry. Results. Histomorphometric analysis revealed a significantly higher amount (p < 0.05) of vital mineralized tissue in TG when compared to the CG (55.15 ± 20.91% and 27.30 ± 5.55%, resp.). For nonvital mineralized tissue, TG presented a statistically higher level of Bio-Oss resorption (p < 0.05) when compared with the CG (6.32 ± 12.03% and 22.79 ± 9.60%, resp.). Both groups (TG and CG) showed no significantly different levels (p > 0.05) of nonmineralized tissue (38.53 ± 13.08% and 49.90 ± 7.64%, resp.). Conclusion. The use of bone marrow concentrate obtained by BMAC method increased bone formation in sinus lift procedures.
Implant placement immediately after the lateral approach of the trap door window procedure to create a maxillary sinus lift without bone grafting: a 2-year retrospective evaluation of 47 implants in 33 patients.
Chen, Ta-Wei; Chang, Haw-Sheng; Leung, Kam-Wing; Lai, Yu-Lin; Kao, Shou-Yen
The present study was undertaken to retrospectively evaluate the status of implants in patients subjected to a maxillary sinus lift and immediate implant placement without bone grafting. Seventy-five implants were placed in 47 patients from 2000 to 2006. Lateral approach for the trap-door, open-window method for sinus lifting without placement of either autogenous bone grafts or allogeneic bone substitute was carried out. A 5-mm of the bone level was required in the alveolar ridge for all. All implants were placed synchronously with sinus lifting procedure. Patients underwent strict oral hygiene instruction, periodontal charting, presurgical/postsurgical panoramic radiographs, and postsurgical computed tomographic scan during the follow-up. The implant survival was defined when the prosthesis had been delivered and followed for 2 years without infection, pain, or more than 2-mm peri-implant bone loss. Thirty-three patients (23 males, 10 females) having an average age of 55 years old, with a total of 47 fixtures were followed for more than 2 years after prosthesis delivery. No patients developed sinusitis or other complications leading to loss of an implant subsequent to performance of the sinus lifting-combined immediate implant surgery. The 2-year survival of fixture was 100%. Increases in lifted sinus bone height ranged from 3 mm to 9 mm with an average of 4.5 mm. The peri-implant health was judged to be good with a peri-implant sulcus depth of 2.7 +/- 0.5 mm at 2-year follow-up. A good survival rate was observed in the immediate implant placement synchronously with the lateral approach for maxillary sinus lift without bone grafting.
Karun, Vinayak; Mishra, Amit Kumar; Saikhedkar, Rashmi
Calcifying epithelial odontogenic cyst (CEOC) is an odontogenic cyst with epithelial lining. CEOC is a rare entity that occurs in a wide age range, does not show any gender predilection, and accounts for only 1% of all jaw cysts. The lesion generally occurs in the region anterior to maxillary and mandibular molars and either intraosseously or extraosseusly. This entity might present as a cystic or solid lesion. Enucleation is the recommended treatment for a simple, unicystic CEOC. A case of recurring CEOC in the right maxilla antrum is presented here. The patient presented to the authors after postsurgical recurrence. The case was evaluated thoroughly, and the cyst was resolved.
Wang, Feng; Zhou, Wenjie; Monje, Alberto; Huang, Wei; Wang, Yueping; Wu, Yiqun
To investigate the influence of maturation timing upon histological, histomorphometric and clinical outcomes when deproteinized bovine bone mineral (DBBM) was used as a sole biomaterial for staged maxillary sinus floor augmentation (MSFA). Patients with a posterior edentulous maxillary situation and a vertical bone height ≤ 4 mm were included in this study. A staged MSFA was carried out. After MSFA with DBBM as a sole grafting material, biopsy cores were harvested with simultaneous implant placement followed by a healing period of 5, 8, and 11 months, respectively. Micro-CT, histologic and histomorphometric analyses were performed. Forty-one patients were enrolled and 38 bone core biopsies were harvested. Significantly greater BV/TV was observed between 5- and 8-month healing from micro-CT analysis. Histomorphometric analyses showed the ratio of mineralized newly formed bone increased slightly from 5 to 11 months; however, no statistically significant difference was reached (p = .409). Residual bone substitute decreased from 37.3 ± 5.04% to 20.6 ± 7.45%, achieving a statistical significant difference from of 5 up to 11 months (p < .01). Moreover, no implant failure, biological or technical complication occurred after 12-month follow-up of functional loading. DBBM utilized as sole grafting material in staged MSFA demonstrated to be clinically effective regardless of the healing period. Histomorphometrical and micro-CT assessments revealed that at later stages of healing (8 and 11 months) there is a higher proportion of newly-bone formation compared to earlier stages (5 months). Moreover, the longer the maturation period, the substantially lesser remaining biomaterial could be expected. Even though, these facts did not seem to negatively impact on the implant prognosis 1-year after loading. © 2016 Wiley Periodicals, Inc.
Thévoz, F; Arza, A; Jaques, B
Unilateral chronic maxillary sinusitis is frequently attributed to dental origin. The goal of this retrospective study is to determine the frequency of maxillary sinusitis due to a foreign body of dental origin and its characteristics. Review of 197 sinusitis cases with maxillary sinus involvement operated in our department from 1991 to 1999. Selection of the 17 cases preoperatively suspect to be due to a foreign body of dental origin. 9% of the 197 maxillary sinusitis were classified "odontogenic". Intra-sinusal foreign bodies were identified in 5%: 2% of dental origin, 1% dental or radicular remnants, 2% of "pseudo" foreign bodies of mycotic origin. Chronic maxillary sinusitis attributable to a dental foreign body is rare and overestimated. There exists an important disproportion between the number of intra-sinusal dental foreign bodies and the number of patients who are symptomatic. Treatment is surgical by oral antrotomy and/or endonasal meatotomy. Only a prospective study could give a real estimation of the proportion of symptomatic cases and determine the predisposing factors.
Peña, Maria T; Preciado, Diego; Orestes, Michael; Choi, Sukgi
The widespread use of the 7-valent pneumococcal conjugate vaccine (PVC7), developed to combat invasive Streptococcus pneumoniae infections, has the potential to influence the prevalence and antibiotic resistance patterns of pathogens associated with orbital complications from acute sinusitis. Given the significant morbidity that may result from inadequate treatment of orbital infections related to acute sinusitis, determining the impact of PCV7 on the bacteriology and drug resistance of the pathogens associated with these infections may provide critical information needed to accurately guide optimal clinical management. To determine if the characteristics of orbital complications from acute sinusitis in children have changed in the post-PCV7 era. Review of clinical data. Tertiary care children's hospital. Patients with a diagnosis of orbital cellulitis and/or subperiosteal abscess from January 1, 1996, to December 31, 2009. Patients with immune deficiency or orbital trauma were excluded. Patients were divided into pre-PCV7 (before 2003 [n = 128]) and post-PCV7 (2003 and after [n = 145]) groups. Statistical analyses were used to compare the 2 groups. Differences in patient demographics, signs and symptoms, laboratory study results, computed tomography scan findings, and microbiological analyses between the pre-PCV7 and post-PCV7 groups. A total of 273 children met the inclusion criteria. The post-PCV7 group was older (71.4 months vs 88.8 months [P = .007]) than the pre-PCV7 group. A significant decrease in S pneumoniae and Streptococcus viridans -positive sinus or blood cultures were observed (22.4% vs 0% [P < .001] and 12.24% vs 0% [P = .005], respectively). An increase in Staphylococcus aureus was seen in the post-PCV7 group (20.4% vs 42.37% [P = .02]). Methicillin-resistant S aureus (MRSA) was isolated only in the post-PCV7 group (P = .002). The pre-PCV7 group had a significantly longer hospital stay than the post-PCV7 group (7.15 days vs 5.47 days [P = .004
Smith, M M; Duncan, W J; Coates, D E
The aim of this pilot study was to characterize surface morphology and to evaluate resorption and osseous healing of two deproteinated bovine bone graft materials after sinus grafting in a large animal model. Surfaces of a novel particulate bovine bone graft, Moa-Bone(®) were compared with Bio-Oss(®) using scanning electron microscopy. Six sheep then had maxillary sinus grafting bilaterally, covered with BioGide(®) . Grafted maxillae were harvested after 4, 6 and 12 weeks. Healing was described for half of each site using resin-embedded ground sections. For the other half, paraffin-embedded sections were examined using tartrate resistant acid phosphatase staining for osteoclast activity, runt-related transcription factor2 immunohistochemistry for pre-osteoblasts and osteoblasts and proliferating cell nuclear antigen for proliferative cells. Moa-Bone(®) had a smoother, more porous fibrous structure with minimal globular particles compared with Bio-Oss(®) . After 4 weeks, woven bone formed on both grafts and the Moa-Bone(®) particles also showed signs of resorption. After 12 weeks, Moa-Bone(®) continued to be resorbed, however Bio-Oss(®) did not; both grafts were surrounded by maturing lamellar bone. Moa-Bone(®) was associated with earlier evidence of runt-related transcription factor 2-positive cells. Moa-Bone(®) but not Bio-Oss(®) was associated with strong tartrate resistant acid phosphatase-positive osteoclasts on the graft surface within resorption lacunae at both 4 and 6 weeks post-grafting. Both materials supported osseous healing and maturation without inflammation. Moa-Bone(®) showed marked osteoclast activity after 4 and 6 weeks and demonstrated positive attributes for grafting, if complete remodeling of the graft within the site is desired. Further optimization of Moa-Bone(®) for maxillofacial applications is warranted. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Lehnerdt, G; Peraud, A; Berghaus, A; Hoffmann, T K; Sommer, K; Rotter, N; Lang, S
Orbital and intracranial complications of acute sinusitis occur more frequently in the pediatric population compared to adults due to anatomic differences. Since the introduction of antibiotics the frequency of such complications has been dramatically reduced. Nevertheless, even in the era of modern antibiotics these complications continue to occur and it is therefore of utmost importance not only to know about these complications but also to include them in the differential diagnosis. Appropriate diagnosis mainly based on CT scanning or magnetic resonance tomography is the basis for a rapid and sufficient and if necessary interdisciplinary treatment. In this CME article the diagnostic and therapeutic interventions in four young patients suffering from orbital or intracranial complications due to acute sinusitis are described and discussed in the context of the current literature and a clinical algorithm is introduced.
Giordano, Davide; Gradoni, Paolo; Oretti, Gabriele; Cerasti, Davide; Ferri, Teore
Enlargement of the nasolacrimal duct (NLD) in the absence of neoplasm is rare. As there are few reports on this condition in the literature, its pathologic significance and proper management remain unclear. We report a case of asymptomatic NLD enlargement incidentally discovered on high resolution computed tomography scan performed for a complicated acute sinusitis. Case report and literature review. NLD enlargement, defined as a truly isolated asymptomatic dilatation of the NLD, is rarely encountered. Etiology and clinical significance are unclear although the absence of nasolacrimal pathway or sinonasal disease and radiological findings of bone remodelling suggest that it may be congenital. In such cases, diagnosis may be incidental and based on imaging studies, and the term NLD ectasia seems to be more appropriate to describe this distinct entity. NLD enlargement may favour osteomeatal complex obstruction, thus leading to severe acute sinusitis.
Asano, Takeshi; Uchikoba, Yoko; Zhi, Cai Ling; Kawahigashi, Yutaka; Maeda, Miho; Shimizu, Kazuo; Fukunaga, Yoshitaka
A 7 year-old girl was admitted to our hospital with high grade fever and redness, swelling and tenderness in left neck. CT scan revealed cyst formation (4.5x3 cm) in left lobe of thyroid with swelling of surrounding lymphonodes. We diagnosed her as acute suppurative thyroiditis and treated her with intravenous antibiotics infusion and incisional drainage. After the treatment, the clinical course was uneventful. Pharyngograph revealed left piriform sinus fistula.
Quadri, Nuz; Lloyd, Andrew; Keating, Karen N; Nafees, Beenish; Piccirillo, Jay; Wild, Diane
To validate the Sinonasal Outcome Test-16 and Activity Impairment Assessment in patients with acute bacterial sinusitis. Data were used from a phase III clinical trial designed to evaluate the efficacy and safety of moxifloxacin 400 mg once daily for 5 consecutive days in the treatment of acute bacterial sinusitis. The psychometric properties and factor structure of the 2 measures were assessed. Participants were given the measures to self-complete using either a telephone voice response system or a paper-and-pencil format. Three hundred seventy-four patients with acute bacterial sinusitis were used in the analysis. Patients received either a placebo or 400 mg moxifloxacin once daily. Patients were then reviewed at test of cure and follow-up. All analyses were conducted on a combined sample of placebo and active treatment patients. The Sinonasal Outcome Test-16 was associated with minimal missing data at baseline but a higher proportion by test of cure. There was no evidence of floor or ceiling effects and no significant skew. The Activity Impairment Assessment also had low missing data at baseline and no obvious floor or ceiling effects, but the data were not normally distributed. Both measures had good internal consistency. Convergent and divergent validity as well as sensitivity and the minimally important difference are also reported. The measures both have good psychometric properties and are suitable for use with patients with acute bacterial sinusitis. Both instruments are sensitive. The minimal important difference estimates for the Sinonasal Outcome Test-16 are quite high but are similar to estimates reported previously.
Zhang, Wenjie; Wang, Xiuli; Wang, Shaoyi; Zhao, Jun; Xu, Lianyi; Zhu, Chao; Zeng, Deliang; Chen, Jake; Zhang, Zhiyuan; Kaplan, David L.; Jiang, Xinquan
Sonication-induced silk hydrogels were previously prepared as an injectable bone replacement biomaterial, with a need to improve osteogenic features. Vascular endothelial growth factor (VEGF165) and bone morphogenic protein-2 (BMP-2) are key regulators of angiogenesis and osteogenesis, respectively, during bone regeneration. Therefore, the present study aimed at evaluating in situ forming silk hydrogels as a vehicle to encapsulate dual factors for rabbit maxillary sinus floor augmentation. Sonication-induced silk hydrogels were prepared in vitro and the slow release of VEGF165 and BMP-2 from these silk gels was evaluated by ELISA. For in vivo studies for each time point (4 and 12 weeks), 24 sinus floors elevation surgeries were made bilaterally in 12 rabbits for the following four treatment groups: silk gel (group Silk gel), silk gel/VEGF165 (group VEGF), silk gel/BMP-2 (group BMP-2), silk gel/VEGF165/BMP-2 (group V+B) (n=6 per group). Sequential florescent labeling and radiographic observations were used to record new bone formation and mineralization, along with histological and histomorphometric analysis. At week 4, VEGF165 promoted more tissue infiltration into the gel and accelerated the degradation of the gel material. At this time point, the bone area in group V+B was significantly larger than those in the other three groups. At week 12, elevated sinus floor heights of groups BMP-2 and V+B were larger than those of the Silk gel and VEGF groups, and the V+B group had the largest new bone area among all groups. In addition, a larger blood vessel area formed in the remaining gel areas in groups VEGF and V+B. In conclusion, VEGF165 and BMP-2 released from injectable and biodegradable silk gels promoted angiogenesis and new bone formation, with the two factors demonstrating an additive effect on bone regeneration. These results indicate that silk hydrogels can be used as an injectable vehicle to deliver multiple growth factors in a minimally invasive approach to
Suhaili, D N Pengiran; Goh, B S; Gendeh, B S
Acute sinusitis is most often a mild self-limiting disease. However, it may progress into severe and life threatening complications. One of the commonest being orbital complication of which visual loss is a direct consequence. In this 10 year retrospective study, the nature of orbital complication, clinical presentation and treatment modalities and outcome seen in children with acute sinusitis in a tertiary referral institute were reviewed. Of six patients, there was a case of preseptal cellulitis, 4 cases of subperiosteal abscess and one case of orbital abscess. Periorbital swelling was a common presenting feature. In 5 cases this was associated with proptosis with one case of impending optic nerve compression. The value of computed tomography and opthalmological examination as a component in the management plan is highlighted. All patients were treated with intravenous antibiotics but evidence of abscess collection warranted urgent surgical drainage in 5 patients, 3 being endoscopic drainage while external approach was done for the remaining 2 patients. Thus a child exhibiting orbital complication of acute sinusitis, prompt diagnosis and treatment is essential in obtaining the best outcome for the child.
German, Iris Jasmin Santos; Buchaim, Daniela Vieira; Andreo, Jesus Carlos; Shinohara, Elio Hitoshi; Capelozza, Ana Lúcia Alvares; Shinohara, Andre Luis; Pereira, Mizael; Buchaim, Rogerio Leone
The aim of this study was to identify the shape and route of the bony canal of the posterior superior alveolar artery (PSAA) and posterior superior alveolar nerve (PSAN) using different identification methods, including computed tomography (CT), panoramic radiograph, and macroscopic evaluation (corpse and dry skull). Twenty-four patients were analyzed by CT and panoramic and posterior anterior (PA) radiographs; additionally, 90 dry skulls and 21 dissected anatomical specimens were examined. Three-dimensional-CT revealed that the lateral wall of the maxillary sinus resembled a tunnel format in 60% of the treated patients. Out of all 24 patients, the panoramic radiograph identified the bony canal in only one patient; whereas the PA radiograph identified it in 80% of the patients. The dry skulls showed tunnellike routes of the PSAA and PSAN in 65% of the cases. Moreover, the pathway was also visibly observed in the dissected anatomical specimens as a straight shape in 85% of the cases. Thus, our results demonstrated that the most common shape of the bony canal of the PSAA and PSAN is the tunnel format with a straight route by 3D-CT, posterior anterior radiography, and macroscopic evaluation. However, in the panoramic radiographs, it was difficult to identify this canal. PMID:25861685
Jensen, T; Schou, S; Stavropoulos, A; Terheyden, H; Holmstrup, P
The objective of the present systematic review was to test the hypothesis of no differences between the use of Bio-Oss or Bio-Oss mixed with autogenous bone as graft for maxillary sinus floor augmentation (MSFA) applying the lateral window technique, as evaluated in animals. A MEDLINE (PubMed), Embase, and Cochrane Library search in combination with a hand-search of relevant journals was conducted by including animal studies published in English from 1 January 1990 to 1 June 2010. The search provided 879 titles and 14 studies fulfilled the inclusion criteria. The volumetric stability of the graft improved significantly with increased proportion of Bio-Oss. Bone regeneration, bone-to-implant contact (BIC), biomechanical implant test values, and biodegradation of Bio-Oss after MSFA with Bio-Oss or Bio-Oss mixed with autogenous bone have never been compared within the same study in animals. Thus, the hypothesis of no differences between the use of Bio-Oss and Bio-Oss mixed with autogenous bone as graft for MSFA could neither be confirmed nor rejected based on existing animal studies. Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Jensen, Thomas; Schou, Søren; Stavropoulos, Andreas; Terheyden, Hendrik; Holmstrup, Palle
The objective of the present systematic review was to test the hypothesis of no differences in the implant treatment outcome when Bio-Oss or Bio-Oss mixed with autogenous bone is used as graft for the maxillary sinus floor augmentation (MSFA) applying the lateral window technique. A MEDLINE (PubMed) search in combination with a hand search of relevant journals was conducted by including human studies published in English from January 1, 1990 to June 1, 2010. The search provided 879 titles and 35 studies fulfilled the inclusion criteria. Considerable variation in the included studies prevented meta-analysis from being performed and no long-term study comparing MSFA with the two treatment modalities was identified. Also, the survival of suprastructures after the two augmentation procedures was not compared within the same study. The 1-year implant survival was compared in one study demonstrating no statistically significant difference. The implant survival was 96% with Bio-Oss and 94% with a mixture of 80% Bio-Oss and 20% autogenous mandibular bone. Addition of a limited amount of autogenous bone to Bio-Oss seemed not to increase the amount of new bone formation and bone-to-implant contact compared with Bio-Oss. Therefore, the hypothesis of no differences between the use of Bio-Oss or Bio-Oss mixed with autogenous bone as graft for MSFA could neither be confirmed nor rejected. © 2011 John Wiley & Sons A/S.
Pascaretti-Grizon, Florence; Guillaume, Bernard; Terranova, Lisa; Arbez, Baptiste; Libouban, Hélène; Chappard, Daniel
Sinus lift elevation restores bone mass at the maxilla in edentulate patients before the placement of dental implants. It consists of opening the lateral side of the sinus and grafting beta-tricalcium phosphate granules (β-TCP) under the olfactory membrane. Bone biopsies were obtained in five patients after 60 weeks. They were embedded undecalcified in poly(methyl methacrylate) (pMMA); blocks were analyzed by nanocomputed tomography (nanoCT); specific areas were studied by Raman microspectroscopy. Remnants of β-TCP were osseointegrated and covered with mineralized bone; osteoid tissue was also filling the inner porosity. Macrophages having engulfed numerous β-TCP grains were observed in marrow spaces. β-TCP was identified by nanoCT as osseointegrated particles and as granules in the cytoplasm of macrophages. Raman microspectroscopy permitted to compare the spectra of β-TCP and bone in different areas. The ratio of the ~820 cm(-1) band of pMMA (-CH2 groups) on the ν1 phosphate band at 960 cm(-1) reflected tissue hydration because water was substituted by MMA during histological processing. In bone, the ratio of the ~960 cm(-1) phosphate to the amide 1 band and the ratio ν2 phosphate band by the 1240-1250 amide III band reflect the mineralization degree. Specific bands of β-TCP were found in osseointegrated β-TCP granules and in the grains phagocytized by the macrophages. The hydration degree was maximal for β-TCP phagocytized by macrophages. Raman microspectroscopy associated with nanoCT is a powerful tool in the analysis of the biomaterial degradation and osseointegration.
Raz, Eytan; Win, William; Hagiwara, Mari; Lui, Yvonne W; Cohen, Benjamin; Fatterpekar, Girish M
Fungal sinusitis is characterized into invasive and noninvasive forms. The invasive variety is further classified into acute, chronic and granulomatous forms; and the noninvasive variety into fungus ball and allergic fungal sinusitis. Each of these different forms has a unique radiologic appearance. The clinicopathologic and corresponding radiologic spectrum and differences in treatment strategies of fungal sinusitis make it an important diagnosis for clinicians and radiologists to always consider. This is particularly true of invasive fungal sinusitis, which typically affects immuno compromised patients and is associated with significant morbidity and mortality. Early diagnosis allows initiation of appropriate treatment strategies resulting in favorable outcome. Published by Elsevier Inc.
Orsini, Giovanna; Traini, Tonino; Scarano, Antonio; Degidi, Marco; Perrotti, Vittoria; Piccirilli, Marcello; Piattelli, Adriano
Biological interactions occurring at the bone-biomaterial interface are critical for long-term clinical success. Bio-Oss is a deproteinized, sterilized bovine bone that has been extensively used in bone regeneration procedures. The aim of the present study was a comparative light, scanning, and electron microscopy evaluation of the interface between Bio-Oss and bone in specimens retrieved after sinus augmentation procedures. Under light microscopy, most of the particles were surrounded by newly formed bone, while in a few cases, at the interface of some particles it was possible to observe marrow spaces and biological fluids. Under scanning electron microscopy, in most cases, the particle perimeter appeared lined by bone that was tightly adherent to the biomaterial surface. Transmission electron microscopy showed that the bone tissue around the biomaterial showed all the phases of the bone healing process. In some areas, randomly organized collagen fibers were present, while in other areas, newly formed compact bone was present. In the first bone lamella collagen fibers contacting the Bio-Oss surface were oriented at 243.73 +/- 7.12 degrees (mean +/- SD), while in the rest of the lamella they were oriented at 288.05 +/- 4.86 degrees (mean +/- SD) with a statistically significant difference of 44.32 degrees (p < 0.001). In the same areas the intensity of gray value was 172.56 +/- 18.15 (mean +/- SD) near the biomaterial surface and 158.71 +/- 21.95 (mean +/- SD) in the other part of the lamella with an unstatistically significant difference of 13.79 (p = 0.071). At the bone-biomaterial interface there was also an electron-dense layer similar to cement lines. This layer had a variable morphology being, in some areas, a thin line, and in other areas, a thick irregular band. The analyses showed that Bio-Oss particles do not interfere with the normal osseous healing process after sinus lift procedures and promote new bone formation. In conclusion, this study serves as a
Correll, Daniel P; Luzi, Scott A; Nelson, Brenda L
A 42 year old male presents with worsening pain and an increase in thick chronic drainage of the left sinus. Image studies show complete opacification of the left frontal sinus, left sphenoid sinus, and the left maxillary sinus. The patient was taken to the operating room and tissue for microscopic evaluation was obtained. The microscopic findings were classic for allergic fungal sinusitis: areas of alternating mucinous material and inflammatory cell debris and abundant Charcot-Leyden crystals. Cultures were performed and the patient began steroid therapy and desensitization therapy.
Schmitt, Christian; Karasholi, Tarek; Lutz, Rainer; Wiltfang, Jörg; Neukam, Friedrich-Wilhelm; Schlegel, Karl Andreas
This investigation focused on long-term changes in graft height, implant survival rate, and peri-implant tissue conditions of dental implants placed in alveolar ridges after augmentation procedures with a follow-up of 10 years. We conducted a retrospective cohort study with prospective long-term follow-up of 25 patients with edentulous severe atrophic maxillary situations who received a vertical augmentation procedure with autologous bone prior to implant placement. The participants were divided into three groups according to whether they underwent sinus elevation, onlay grafting, or a combination of both techniques. After a four-month healing period, 127 implants were inserted in the corresponding regions. Following a six-month healing period, the participants underwent prosthodontic rehabilitation, incorporating a fixed or removable implant denture. The cohort was clinically and radiographically followed up 1, 5, and 10 years after augmentation. The following parameters were measured: radiographic vertical bone changes, implant loss, peri-implant pocket depth (PD), width of keratinized mucosa (KM), sulcus fluid flow rate (SFFR), and the radiographic distance between the implant shoulder and the first visible bone-to-implant contact (DIB). Seven implants were lost during the observation period, resulting in a cumulative 10-year survival rate of 94.48%. Significant bone loss occurred during the first 12 months, after which the resorption slowed down and bone height eventually stabilized. After 10 years, the total vertical bone loss was 27.51% after onlay grafting, 28.14% after sinus elevation, and 30.24% in the combination group, with no statistically significant between-group differences. Peri-implant follow-up examinations revealed a positive correlation between SFFR and PD, respectively, DIB, and a negative correlation between SFFR and KM. The treatment method does not seem to impact vertical bone loss following augmentation using autologous grafts. This
Kfir, Efraim; Goldstein, Moshe; Abramovitz, Itzhak; Kfir, Vered; Mazor, Ziv; Kaluski, Edo
Membrane pathology tends to complicate the postprocedural course of open sinus lift by ostio-meatal complex (OMC) obstruction and consequent acute sinusitis. The objective of this study was to evaluate the outcome of subjects with considerable sinus membrane pathology undergoing maxillary sinus floor augmentation and simultaneous implant placement using the minimal invasive antral membrane balloon elevation (MIAMBE) method. This study was a retrospective chart review of MIAMBE procedures performed in the presence of significant sinus membrane pathology. Sixteen patients with maxillary sinus membrane thickening in well-ventilated OMC as determined by dental computerized tomography underwent sinus augmentation and simultaneous implant placement using the MIAMBE technique. All 16 procedures were successfully concluded without significant procedural or postprocedural complications or implant failure. Post MIAMBE membrane pathology regressed or disappeared in 8 patients (50%) or remained unchanged in 6 patients (37.5%), while in 2 patients the sinus membrane pathology was limited to evaluation by periapical X rays. Sinus augmentation using the MIAMBE technique can be performed safely in asymptomatic patients in the presence of sinus membrane pathology if the OMC is not obstructed. In a significant proportion of these cases, complete resolution of the membrane pathology after MIAMBE is observed. When compared to open sinus lift, OMC obstruction is less likely to occur when employing the MIAMBE method.
Allensworth, Jordan J; Troob, Scott H; Weaver, Tyler S; Gonzalez, Javier D; Petrisor, Daniel; Wax, Mark K
Acute invasive fungal sinusitis (AIFS) is a frequently fatal infection for which extensive and debilitating surgical debridement is a mainstay of therapy. Resulting defects are often composite in nature, mandating free tissue-transfer reconstruction. Outcomes data for free flap reconstruction are limited. The purpose of this study was to examine surgical outcomes and survival in patients undergoing free flap transfer following invasive fungal sinusitis. Retrospective case series. Between 1995 and 2015, patients undergoing operative debridement for AIFS were identified. Surgical records were used to identify survivors of acute infection who subsequently underwent free flap reconstructive surgery. Patient demographics, cause of immune compromise, defect description, flap type, perioperative complications, indications for revision surgery, functional outcomes, and long-term survival were reviewed. Forty-four patients were treated for AIFS, of those, 30 (68%) survived acute infection. Ten patients underwent maxillectomy, six with orbital exenteration, and were designated candidates for reconstruction. Eight patients underwent reconstruction. Median time from debridement to reconstruction was 67.5 days. Flap types included latissimus dorsi, scapula, anterolateral thigh, rectus, radial forearm, and fibula. Median follow-up was 7.7 months. No perioperative complications were encountered, and all subjects remained disease-free, able to speak and eat normally without prosthetic supplementation. Seven patients (87%) are currently alive. Reconstruction of defects left by invasive fungal sinusitis using free-tissue transfer resulted in successful flap survival, with no disease recurrence for all defects and flap types reviewed. Survivors of AIFS are able to tolerate midface reconstruction, with favorable functional outcomes and survival rates. 4. Laryngoscope, 127:815-819, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Sharma, Saurabh; Josephson, Gary D
Orbital infections from acute sinusitis are rare in neonates and infants and can lead to devastating complications. To our knowledge, no prior dedicated review exists for evaluation, treatment, and outcomes of orbital complications in this age group. To perform a systematic review over the past 50 years on the diagnosis and treatment of orbital complications secondary to acute sinusitis in neonates and infants and report a case. A systematic review of the literature was performed searching PubMed to collect all the pertinent case reports and series in the English language with subperiosteal orbital abscess (SPOA) or orbital abscess in neonates or infants (date range, 1959-2012). Eleven cases of SPOA in infants were identified, including our current case. Ages ranged from 10 to 74 days. There were 6 female and 5 male infants. The right eye was affected in 5 cases, the left in 5, and both in 1. There was 1 mortality in this series for which surgical drainage was not performed. Staphylococcus aureus was the most common organism isolated in 9 of 11 cases. Seven of the cases had open surgical drainage, 2 had endoscopic procedures (including our case), and 1 had spontaneous rupture of the abscess. An orbital complication due to acute sinusitis is rare in infants and neonates. Drainage in this patient population appears to be paramount, since the only infant in this series who did not receive drainage had died. Modern telescopes and equipment have allowed endoscopic drainage to be a safe and effective surgical treatment in this age group.
Wang, Yun-Hu; Ku, Min-Sho; Sun, Hai-Lun; Lue, Ko-Huang
Nasal irrigation has been used as adjunctive therapy for sinonasal disease but is under-researched in children. The study aim was to evaluate the effectiveness of nasal irrigation with normal saline in the management of acute sinusitis in atopic children. We enrolled 60 atopic children with acute sinusitis, of whom 29 received nasal irrigation with normal saline and 31 did not receive nasal irrigation. All participants underwent a nasal peak expiratory flow rate (nPEFR) test, a nasal smear examination, and radiography (Water's projection) and were requested to complete a Pediatric Rhinoconjunctivitis Quality-of-Life Questionnaire (PRQLQ) during the baseline visit. All participants were requested to record symptoms in a daily diary and were followed up at 1-week intervals. A physical examination, nasal smear, and nPEFR were performed at each visit, and all daily diaries were collected. At the final visit (after 3 weeks), the symptom diaries were reviewed and participants were requested to complete the PRQLQ again. nPEFR, radiography, and a nasal smear were also repeated. There were significant improvements in mean PRQLQ and nPEFR values (p < 0.05) for the irrigation compared to the non-irrigation group. There was no significant difference in radiographic findings between the groups (p > 0.05). The irrigation group recorded significant improvements in eye congestion, rhinorrhea, nasal itching, sneezing, and cough symptoms compared with the non-irrigation group. Nasal irrigation is an effective adjunctive treatment for acute sinusitis in atopic children. Copyright © 2012. Published by Elsevier B.V.
Kanazawa, T; Inoue, R; Ohta, Y; Watanabe, Y; Iino, Y
We report an extremely rare case of maxillary haemangioma. Case report and review of the literature concerning haemangioma arising from the nasal cavity and paranasal sinuses. Maxillary haemangioma is rare and sometimes requires wider resection than nasal haemangioma if a large tumour is found. We present a case of maxillary haemangioma in a 37-year-old Japanese woman, which was completely resected by pre-operative embolisation and endoscopic sinus surgery. Our findings suggest that if a large maxillary haemangioma is diagnosed pre-operatively, the treatment of choice is pre-operative embolisation followed by endoscopic sinus surgery, in order to avoid the surgical complications associated with wide resection.
Mokin, Maxim; Ciambella, Chelsey C.; Masud, Muhammad W.; Levy, Elad I.; Snyder, Kenneth V.; Siddiqui, Adnan H.
Background Acute cerebral venous sinus thrombosis (VST) can be difficult to diagnose because of its diverse clinical presentation. The utility of perfusion imaging for diagnosing VST is not well understood. Summary We retrospectively reviewed cases of acute VST in patients who underwent whole-brain (320-detector-row) computed tomographic (CT) perfusion imaging in combination with craniocervical CT venography. Perfusion maps that were analyzed included cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time, and time to peak. Among the 10 patients with acute VST included in this study, 9 had perfusion abnormalities. All perfusion abnormalities were localized in areas adjacent to the occluded sinus and did not match typical anterior or posterior circulation arterial territories. Bilateral perfusion deficits were seen in 4 cases. In 2 cases, parenchymal hemorrhage was diagnosed on noncontrast CT imaging; in those cases, focal CBV and CBF were reduced. Key Messages Whole-brain CT perfusion imaging with 320-detector-row scanners can further assist in establishing the diagnosis of VST by detecting perfusion abnormalities corresponding to venous and not arterial territories. CT perfusion could assist in the differentiation between focal reversible changes, such as those caused by vasogenic edema, and irreversible changes due to infarction. PMID:27051406
Smith, Michael J
In 2001, the American Academy of Pediatrics published clinical practice guidelines for the management of acute bacterial sinusitis (ABS) in children. The technical report accompanying those guidelines included 21 studies that assessed the diagnosis and management of ABS in children. This update to that report incorporates studies of pediatric ABS that have been performed since 2001. Overall, 17 randomized controlled trials of the treatment of sinusitis in children were identified and analyzed. Four randomized, double-blind, placebo-controlled trials of antimicrobial therapy have been published. The results of these studies varied, likely due to differences in inclusion and exclusion criteria. Because of this heterogeneity, formal meta-analyses were not performed. However, qualitative analysis of these studies suggests that children with greater severity of illness at presentation are more likely to benefit from antimicrobial therapy. An additional 5 trials compared different antimicrobial therapies but did not include placebo groups. Six trials assessed a variety of ancillary treatments for ABS in children,and 3 focused on subacute sinusitis. Although the number of pediatric trials has increased since 2001, there are still limited data to guide the diagnosis and management of ABS in children. Diagnostic and treatment guidelines focusing on severity of illness at the time of presentation have the potential to identify those children most likely to benefit from antimicrobial therapy and at the same time minimize unnecessary use of antibiotics
Cosway, Ben; Tomkinson, Alun; Owens, David
Rhinosinusitis is a common condition with adults experiencing 2-5 episodes per year. The European Positional Paper on Rhinosinusitis and Nasal Polyps (EP3OS) published in 2005 and updated in 2007 provided evidence-based guidelines on the management of sinus disease promoting a conservative approach to treatment. This study examines the effect of EP3OS on sinus surgery uptake and acute admissions for sinusitis in England and Wales. A retrospective study using the national electronic health databases of England (Hospital Episodes Statistics, HES online) and Wales (Patient Episodes Database of Wales, PEDW) was undertaken from 2000 to 2010 using the OPCS-4 codes E12-E17 (sinus surgery) and ICD10 code J01 (acute admission for sinusitis). Data were analysed for effect following the introduction of the EP3OS in 2005 using linear regression and Chi squared analysis. 116,370 sinus procedures and 10,916 acute admissions for sinusitis were made during the study period. No significant decrease in sinus surgery procedures occurred following the introduction of the EP3OS as may have been expected (p > 0.05), although subgroup analysis suggested a significant increase in Wales (p < 0.05). In addition, significant increases in acute admissions for sinusitis were observed following the introduction of EP3OS (p < 0.05). However, subgroup analysis suggested this was not the case in Wales (p > 0.05). The EP3OS appears to have had little impact on the rates of sinus surgery but more conservative approaches to managing of sinus disease may have led to an increase in acute admissions. Further research is required to investigate whether changes in practice were adopted.
Occult peri-implant oroantral fistulae: posterior maxillary peri-implantitis/sinusitis of zygomatic or dental implant origin. Treatment and prevention with bone morphogenetic protein-2/absorbable collagen sponge sinus grafting.
Jensen, Ole T; Adams, Mark; Cottam, Jared R; Ringeman, Jason
Sinus floor grafting with bone morphogenetic protein-2 for transsinus implant placement or as a salvage technique for sinus-involved peri-implantitis has been found to be successful. Transsinus implants for All-on-Four treatment, zygomatic implants including quad zygomatics, and infected transsinus implants underwent peri-implant grafting, which was found to seal off the sinus cavity from the oral cavity in an effort to prevent or treat sinusitis/peri-implantitis.
Šuchaň, M; Horňák, M; Kaliarik, L; Krempaská, S; Koštialová, T; Kovaľ, J
Orbital complications categorised by Chandler are emergency. They need early diagnosis and agresive treatment. Stage and origin of orbital complications are identified by rhinoendoscopy, ophtalmologic examination and CT of orbite and paranasal sinuses. Periorbital cellulitis and early stage of orbital cellulitis can be treated conservatively with i. v. antibiotics. Monitoring of laboratory parameters and ophtalmologic symptoms is mandatory. Lack of improvement or worsening of symptoms within 24-48 hours and advanced stages of orbital complications are indicated for surgery. The purpose of the study is to evaluate epidemiology, clinical features and management of sinogenic orbital complications. Retrospective data of 8 patients with suspicion of orbital complication admited to hospital from 2008 to 2013 were evaluated. Patients were analyzed in terms of gender, age, CT findings, microbiology, clinical features, stage and treatment. Male and female were afected in rate 1,66:1. Most of patients were young adult in 3rd. and 4th. decade of life (62,5 %). Acute and chronic sinusitis were cause of orbital complication in the same rate. The most common origin of orbital complication was ethmoiditis (62,5 %), than maxillary (25 %) and frontal (12,5 %) sinusitis. Polysinusitis with affection of ethmoidal, maxillary and frontal sinuses (75 %) was usual CT finding. Staphylococcus epidermidis and Staphylococcus aureus were etiological agens in half of cases. Periorbital oedema (100 %), proptosis, chemosis (50 %), diplopia and glaucoma (12,5 %) were observed. Based on examinations, diagnosis of periorbital oedema/preseptal cellulitis was made in 3 (37,5 %), orbital cellulitis in 3 (37,5 %) and subperiosteal abscess in 2 cases (25 %). All patients underwent combined therapy - i. v. antibiotics and surgery within 24 hours. Eradication of disease from ostiomeatal complex (OMC), drainage of affected sinuses and drainage of subperiosteal abscess were done via fuctional endonasal
Wald, Ellen R; Applegate, Kimberly E; Bordley, Clay; Darrow, David H; Glode, Mary P; Marcy, S Michael; Nelson, Carrie E; Rosenfeld, Richard M; Shaikh, Nader; Smith, Michael J; Williams, Paul V; Weinberg, Stuart T
To update the American Academy of Pediatrics clinical practice guideline regarding the diagnosis and management of acute bacterial sinusitis in children and adolescents. Analysis of the medical literature published since the last version of the guideline (2001). The diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection (URI) presents with (1) persistent illness (nasal discharge [of any quality] or daytime cough or both lasting more than 10 days without improvement), (2) a worsening course (worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement), or (3) severe onset (concurrent fever[temperature ≥39°C/102.2°F] and purulent nasal discharge for at least 3 consecutive days). Clinicians should not obtain imaging studies of any kind to distinguish acute bacterial sinusitis from viral URI, because they do not contribute to the diagnosis; however, a contrast-enhanced computed tomography scan of the paranasal sinuses should be obtained whenever a child is suspected of having orbital or central nervous system complications. The clinician should prescribe antibiotic therapy for acute bacterial sinusitis in children with severe onset or worsening course. The clinician should either prescribe antibiotic therapy or offer additional observation for 3 days to children with persistent illness. Amoxicillin with or without clavulanate is the firstline treatment of acute bacterial sinusitis. Clinicians should reassess initial management if there is either a caregiver report of worsening(progression of initial signs/symptoms or appearance of new signs/symptoms) or failure to improve within 72 hours of initial management.If the diagnosis of acute bacterial sinusitis is confirmed in a child with worsening symptoms or failure to improve, then clinicians may change the antibiotic therapy for the child initially managed with antibiotic or initiate antibiotic treatment of the child initially
Teinzer, Fabian; Stammberger, Heinz; Tomazic, Peter Valentin
Orbital complications of acute sinusitis can be severe. Nowadays, surgical drainage of intraorbital abscess formations is performed endoscopically in the majority of cases. This study aims to illustrate the Graz experience in the endoscopic treatment of orbital complications and to present our treatment algorithm. In a retrospective study, 53 patients were examined who were referred to the Department of General Otorhinolaryngology of the ENT-University Hospital Graz from 2000 to 2011. Of 53 patients, men were affected more frequently than women (n=37, 69.81% vs n=16, 30.19%). The following diagnoses were obtained: 9 preseptal cellulitis, 7 orbital cellulitis, 14 subperiosteal abscesses, and 23 orbital abscesses. In 16 patients, a conservative therapy was administered; 37 patients underwent surgery, most of them purely endoscopically (n=31, 83.78%). Two of the patients who underwent conservative treatment and 7 of those who underwent surgery experienced a recurrence (n=9, 16.98%). Based on analysis of our recurrences, we have tried to create the optimal treatment algorithm as a point of reference in the management of orbital complications of acute sinusitis. In this way, 7 of 9 recurrences could have been avoided, equaling a hypothetical recurrence rate of 3.77% instead of 16.98% (hypothetical success rate 96.23%). © The Author(s) 2014.
Zhanel, George G; Hisanaga, Tamiko; Wierzbowski, Aleksandra; Hoban, Daryl J
Acute bacterial sinusitis (ABS), acute exacerbations of chronic bronchitis (AECB), and community-acquired pneumonia (CAP) are common conditions and constitute a substantial socioeconomic burden. The ketolides are a new class of antibacterials with a targeted spectrum of antibacterial activity. In vitro, telithromycin is active against common bacterial pathogens that cause upper and lower respiratory tract infections, including some isolates that are resistant to other antibiotic classes. In 2004, telithromycin was the first ketolide antibiotic approved for clinical use by the US Food and Drug Administration for the treatment of adult outpatients with ABS, AECB, and mild-to-moderate CAP. This review discusses the use of telithromycin in the treatment of these infections, providing an overview of its antibacterial activity, pharmacokinetic and pharmacodynamic properties, clinical efficacy, and tolerability–safety, and concludes that telithromycin is an appropriate option for the treatment of community-acquired ABS, AECB, and mild-to-moderate CAP. PMID:18360582
Jensen, Thomas; Schou, Søren; Gundersen, Hans Jørgen G; Forman, Julie Lyng; Terheyden, Hendrik; Holmstrup, Palle
The objective was to test the hypotheses: (i) no differences in bone-to-implant contact formation, and (ii) no differences between the use of autogenous mandibular or iliac bone grafts, when autogenous bone, Bio-Oss mixed with autogenous bone, or Bio-Oss is used as graft for the maxillary sinus floor augmentation. Bilateral sinus floor augmentation was performed in 40 mini pigs with: (A) 100% autogenous bone, (B) 75% autogenous bone and 25% Bio-Oss, (C) 50% autogenous bone and 50% Bio-Oss, (D) 25% autogenous bone and 75% Bio-Oss, or (E) 100% Bio-Oss. Autogenous bone was harvested from the iliac crest or the mandible and the graft composition was selected at random and placed concomitant with the implant placement. The animals were euthanized 12 weeks after surgery. Bone-to-implant contact was estimated by stereological methods and summarized as median percentage with 95% confidence interval (CI). Bone-to-implant contact formation was evaluated by fluorochrome labelling and assessed by median odds ratios (OR) with 95% (CI). Median bone-to-implant contact was: (A) 42.9% (95% CI: 32.1-54.5%), (B) 37.8% (95% CI: 27.1-49.9%), (C) 43.9% (95% CI: 32.6-55.9%), (D) 30.2% (95% CI: 21.6-40.3%), and (E) 13.9% (95% CI: 11.4-16.9%). Bone-to-implant contact was significantly higher for A, B, C, D as compared to E (P < 0.0001). Bone-to-implant contact was not significantly influenced by the ratio of Bio-Oss and autogenous bone (P = 0.19) or the origin of the autogenous bone (P = 0.72). Fluorochrome labelling revealed extensive variation in bone-to-implant contact formation over time. The labelling at weeks 2-3 was significantly increased with A compared to E (OR = 8.1 CI: 5.0-13.1, P < 0.0001), whereas E showed a significantly increased labelling at weeks 8-9 compared to A (OR = 0.5 CI: 0.3-0.7, P = 0.0028). The hypothesis of no differences in bone-to-implant contact between the various treatment modalities was rejected since the bone-to-implant contact was
Purpose This study investigated the relationship between the roots of the maxillary molars and the maxillary sinus using cone beam computed tomography (CBCT), and measured the distances between the roots of the maxillary molars and the sinus floor as well as the thickness of the bone between the root and the alveolar cortical plate. Materials and Methods The study sample consisted of 83 patients with normally erupted bilateral maxillary first and second molars. A total of 332 maxillary molars were examined using CBCT images. The vertical relationship of each root with the maxillary sinus was classified into four types on CBCT cross-sectional images. The distance between the sinus floor and root and the bone thickness between the root and alveolar cortical plate were measured. Results In the buccal roots of the maxillary molars, a root protruding into the sinus occurred most frequently. A root projecting laterally along the sinus cavity was most common in the palatal roots of the maxillary first molars. The mesiobuccal roots of the maxillary second molar were closest to the sinus. The mesiobuccal roots of the first molars were closest to the cortical plate. Conclusion The relationship between the roots of the maxillary molars and the sinus differed between the buccal and palatal roots. A root protruding into the sinus occurred more frequent in the buccal roots of the maxillary molars. The mesiobuccal root of the maxillary second molar was closest to the maxillary sinus floor and farthest from the alveolar cortical plate. PMID:23301207
Melancon, C Claire; Clinger, John D
Objectives Acute invasive fungal sinusitis (AIFS) remains a significant cause of morbidity and mortality in the immunocompromised patient population. Early diagnosis is key to improving patient outcomes. Frozen section biopsies have been shown to decrease time to diagnosis when compared with permanent pathology. However, its accuracy has not been adequately described in the literature, specifically in regard to AIFS. The aim of this study is to evaluate the statistical diagnostic accuracy of frozen sections and to review the etiology, clinical presentation, and current diagnostic protocols in management of AIFS. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Retrospective review included 67 pathologic records in Co-Path, with search criteria including invasive fungal, clinical history, frozen section, and final diagnosis between the dates of 2006 and 2015. Results Sixty-seven cases were reviewed per the search criteria in Co-Path. Of these, 31 met further criteria of having had frozen section analysis. Variables such as sensitivity, specificity, positive predictive value, and negative predictive value were assessed. All 21 positive frozen sections correlated with positive permanent pathology, giving a positive predictive value of 100%. Frozen section biopsies were 87.5% sensitive and 100% specific. Conclusion Early diagnosis of AIFS has been shown to decrease morbidity and mortality. Frozen section biopsies remain key in obtaining an early diagnosis among patients with a high clinical suspicion for invasive fungal sinusitis. Frozen section biopsies positive for invasive fungal pathology were universally consistent with definitive diagnosis.
Geminiani, Alessandro; Weitz, Daniel S; Ercoli, Carlo; Feng, Changyong; Caton, Jack G; Papadimitriou, Dimitrios E V
Sonic instruments may reduce perforation rates of the schneiderian membrane during lateral window sinus augmentation procedures. This study compares the incidence of membrane perforations using a sonic handpiece with an oscillating diamond insert versus a turbine handpiece with a conventional rotary diamond stone during lateral window sinus augmentation procedures. A retrospective chart analysis identified all lateral window sinus augmentation procedures done during a defined period. Among these procedures, those performed with a sonic handpiece and an oscillating diamond insert (experimental) and those performed with a conventional turbine and rotary diamond stone (conventional) were selected for this study. Reported occurrences of sinus membrane perforations during preparation of the osteotomy and elevation of the sinus membrane, as well as postoperative complications, were recorded and compared between treatment groups. Ninety-three consecutive patients were identified for a total of 130 sinus augmentation procedures (51 conventional, 79 experimental). Schneiderian membrane perforations were noted during preparation of the lateral window osteotomy in 27.5% of the sinuses in the conventional group and 12.7% of sinuses in the experimental group. During membrane elevation, perforations were noted in 43.1% of the sinuses in the conventional group and 25.3% of sinuses in the experimental group. Both differences in perforation rates were statistically significant (p < .05). There was no statistically significant difference in postoperative complications. In this study, the use of a sonic instrument to prepare the lateral window osteotomy during sinus elevation procedures resulted in a reduced perforation rate of the Schneiderian membrane compared with the conventional turbine instrument. © 2013 Wiley Periodicals, Inc.
Rahpeyma, Amin; Khajehahmadi, Saeedeh
Bone suture in lateral sinus lift has four indications. Three of them depend on creating a hole in the lateral maxillary sinus wall above the antrostomy window for securing the elevated medial maxillary sinus membrane to manage perforated Schneiderian membrane. Covering the buccal antrostomy window with the buccal fat pad (BFP) for better nourishment of the inserted graft and as an alternative for bone tags in fixation of collagen membrane has been reported previously. A new indication for firmly anchoring the BFP to the medial maxillary sinus wall as the last resort for the management of perforated Schneiderian membrane is explained in this article.
Paling, M.R.; Roberts, R.L.; Fauci, A.S.
The authors report 14 cases of Wegener granulomatosis in which one or more paranasal sinuses were obliterated by bone. The maxillary antra were involved in all cases, with the other sinuses being affected less frequently. These changes are thought to result from chronic bacterial sinusitis superimposed on the granulomatous vasculitic process. Computed tomography dramatically demonstrated the bone changes, consisting of a combination of sinus wall thickening and trabeculated new bone formation within the sinuses.
Loftus, Patricia Anne; Lin, Juan; Tabaee, Abtin
The incidence and potential disease impact of paranasal sinus anatomic variants in patients with recurrent acute rhinosinusitis (RARS) has important implications for management, including surgery, but is incompletely defined. A retrospective review of 26 patients with RARS who had undergone computed tomography (CT) was performed. Patient demographics, RARS severity and comorbidities were reviewed. CT scans were reviewed for the incidence of anatomic variants in all patients. The pattern of inflammatory changes was explored in the subset of patients with acute rhinosinusitis at the time of CT. Potential correlation between the presence of anatomic variants and disease severity were investigated. In the patient cohort who met inclusion criteria, the most common variants included agger nasi cell (88.5%), concha bullosa (53.8%), infraorbital cell (50%), and deviated nasal septum with middle meatus obstruction (42%). In exploring correlations with RARS severity, type 2 frontal cells correlated with a greater number of years with RARS (0.0363). In the 23 patients who underwent CT at the time of an acute infection, no statistically significant correlation was found between severity or location of inflammatory changes and the presence of anatomic variants. This study describes the incidence of anatomic variants in a cohort of patients with RARS. A correlation between the presence of anatomic variants and the pattern of inflammatory changes was not identified. © 2015 ARS-AAOA, LLC.
Terminal Posterior Tilted Implants Planned as a Sinus Graft Alternative for Fixed Full-Arch Implant-Supported Maxillary Restoration: A Case Series with 10- to 19-Year Results on 44 Consecutive Patients Presenting for Routine Maintenance.
Fortin, Yvan; Sullivan, Richard M
Posterior maxillary tilted implants are gaining prevalence as an alternative to sinus grafts supporting fixed maxillary restorations. This paper reports long-term results after loading using this technique. Consecutive patients presenting for either routine hygiene maintenance or unplanned emergency care who had received tilted implants as a sinus graft alternative to support fixed fully implant-supported restoration of an edentulous maxilla and were followed for a minimum of 10 years from initial implant placement were included in this evaluation. Forty-four patients were identified: 40 with bilateral tilted implants and 4 with one tilted and one axial posterior implant. Eight patients received one-piece fixed porcelain-to-gold screw-retained restorations, and thirty-six patients received a fully implant-supported patient-removable Marius Bridge. Seventy-nine out of 84 originally loaded posterior tilted implants survived a minimum of 10 years loading; one tilted implant was lost at 10 years. Eight additional posterior implants were placed for either these lost tilted posterior implants or as proactive supplemental support; one of these replacement tilted implants survived for at least 10 years and is included in the data. All patients have maintained continuous fixed function throughout the follow-up period. Forty-one out of 44 patients continue with the original restoration, 33 without modification or removal of the fixed restoration or implant-connecting bar. One porcelain-to-gold and seven Marius Bridges had framework modifications to accommodate additional implants; 3 Marius Bridge restorations were replaced with a newer generation. Within the limits of this retrospective study, the results show that continuous fixed function of fully implant-supported maxillary restorations using posterior tilted implants in terminal positions of support as a sinus graft alternative combined with axial anterior implants is possible over a prolonged period. Loss of a posterior
Heusser, Karsten; Tank, Jens; Brinkmann, Julia; Menne, Jan; Kaufeld, Jessica; Linnenweber-Held, Silvia; Beige, Joachim; Wilhelmi, Mathias; Diedrich, André; Haller, Hermann; Jordan, Jens
Bilateral bipolar electric carotid sinus stimulation acutely reduced muscle sympathetic nerve activity (MSNA) and blood pressure (BP) in patients with resistant arterial hypertension but is no longer available. The second-generation device uses a smaller unilateral unipolar disk electrode to reduce invasiveness while saving battery life. We hypothesized that the second-generation device acutely lowers BP and MSNA in treatment-resistant hypertensive patients. Eighteen treatment-resistant hypertensive patients (9 women/9 men; 53±11 years; 33±5 kg/m(2)) on stable medications have been included in the study. We monitored finger and brachial BP, heart rate, and MSNA. Without stimulation, BP was 165±31/91±18 mm Hg, heart rate was 75±17 bpm, and MSNA