Improvement of Implant Placement after Bone Augmentation of Severely Resorbed Maxillary Sinuses with 'Tent-Pole' Grafting Technique in Combination with rhBMP-2.

PubMed

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.

Clinical and Radiological Long-Term Outcome of a Tapered Implant System with Special Emphasis on the Influence of Augmentation Procedures.

PubMed

Schiegnitz, Eik; Al-Nawas, Bilal; Tegner, Alexander; Sagheb, Keyvan; Berres, Manfred; Kämmerer, Peer W; Wagner, Wilfried

2016-08-01

Tapered implant designs aim to improve primary stability and implant survival in soft bone. However, respective clinical long-term data are scarce. Therefore, a clinical and radiological evaluation of the long-term success of a transgingival-supracrestal inserted tapered implant system with special emphasis on the influence of augmentation procedures was conducted. In a retrospective study design, all in the Department of Oral and Maxillofacial Surgery of the University Medical Centre, Mainz, Germany, between May 2002 and March 2012, placed tapered implants (Straumann TE®, Basel, Switzerland) were analyzed. In this time period, a total of one hundred ninety-seven tapered implants were inserted in 90 patients. For patients available for clinical recall, success criteria according to Albrektsson and Buser were evaluated. The in situ rate was 96.3% after an average time in situ of 62 ± 31 months. In one hundred twenty-seven sites, bone augmentation procedures were performed. Hereof, 96 sites were sinus augmentation procedures and 31 sites were alveolar ridge augmentations. For patients with sinus augmentation procedures, implant survival was 97.9% and for patients with alveolar ridge augmentations, implant survival was 93.5% after 5 years, indicating a higher implant survival for sinus augmentation, however not statistically different (p = .194). Implant diameter and timing of implant placement had no significant impact on implant survival (p > .05). Mean marginal bone loss was -0.50 ± 1.54 mm for patients receiving maxillary sinus augmentation and -1.16 ± 1.13 mm for patients with alveolar ridge augmentations, indicating a lower marginal bone loss in patients receiving maxillary sinus augmentation (p = .046). Implant success rates ranged between 88% and 92% after a mean follow-up of 6 years. Within the limits of the retrospective character of this study, the tapered soft tissue level implant showed especially in maxillary sinus augmentation promising long-term survival and success rates and a low peri-implant bone resorption compared with the literature. © 2015 Wiley Periodicals, Inc.

The Effect of Alendronate on Various Graft Materials Used in Maxillary Sinus Augmentation: A Rabbit Study.

PubMed

Ayranci, Ferhat; Gungormus, Metin; Omezli, Mehmet Melih; Gundogdu, Betul

2015-12-01

Increasing sinus pneumatization and the accompanying alveolar bone resorption complicate dental implant placement. This problem can be overcome today by raising the maxillary sinus floor with graft materials. Bisphosphonates are commonly used to accelerate the recovery of the graft materials and to prevent resorption. The purpose of this study is to investigate whether systemic administration of a bisphosphonate (alendronate) would improve new bone formation and reduce fibrous tissue formation over a 6-week follow-up in rabbits treated with two different grafting materials for maxillary sinus floor augmentation. This experimental animal study was conducted at the Experimental Medical Application and Research Center at Erzurum/ Turkey. Twelve New Zealand rabbits, each weighing between 2.7 and 3.3 kg, were used. Twenty-four maxillary sinus floor elevation operations were performed, two on each animal (n = 24). Each elevation was repaired with either deproteinized bovine bone (xenograft) or autogenous bone graft obtained from the iliac crest. Both groups were divided into 2 subgroups: saline-treated and alendronate-treated. All groups underwent the same surgical procedures and evaluation, and were sacrificed at the 6th postoperative week. Sinuses augmented with deproteinized bovine bone (xenograft) and autogenous bone graft were examined histopathologically and histomorphometrically. At 6 weeks, the bone area was significantly larger in the Xenograft-Alendronate group (33.0% ± 5.0%) than in the Xenograft-Saline group (20.8% ± 4.9%) and the bone area was significantly larger in the Autogenous-Alendronate group (43.3% ± 3.8%) than in the Autogenous-Saline group (37.5% ± 6.6%) (P = 0.001). The histomorphometric and histopathological results consistently showed that alendronate stimulated bone formation and reduced fibrous tissue formation in maxillary sinus augmentation grafts, especially in the deproteinized bovine bone group (xenograft). Alendronate may be considered a therapeutic option for improving the bone formation process and reducing resorption in different bone grafting procedures. Further detailed studies should focus on dosage and time-dependent effects of alendronate on bone remodeling.

The Effect of Alendronate on Various Graft Materials Used in Maxillary Sinus Augmentation: A Rabbit Study

PubMed Central

Ayranci, Ferhat; Gungormus, Metin; Omezli, Mehmet Melih; Gundogdu, Betul

2015-01-01

Background: Increasing sinus pneumatization and the accompanying alveolar bone resorption complicate dental implant placement. This problem can be overcome today by raising the maxillary sinus floor with graft materials. Bisphosphonates are commonly used to accelerate the recovery of the graft materials and to prevent resorption. Objectives: The purpose of this study is to investigate whether systemic administration of a bisphosphonate (alendronate) would improve new bone formation and reduce fibrous tissue formation over a 6-week follow-up in rabbits treated with two different grafting materials for maxillary sinus floor augmentation. Materials and Methods: This experimental animal study was conducted at the Experimental Medical Application and Research Center at Erzurum/ Turkey. Twelve New Zealand rabbits, each weighing between 2.7 and 3.3 kg, were used. Twenty-four maxillary sinus floor elevation operations were performed, two on each animal (n = 24). Each elevation was repaired with either deproteinized bovine bone (xenograft) or autogenous bone graft obtained from the iliac crest. Both groups were divided into 2 subgroups: saline-treated and alendronate-treated. All groups underwent the same surgical procedures and evaluation, and were sacrificed at the 6th postoperative week. Sinuses augmented with deproteinized bovine bone (xenograft) and autogenous bone graft were examined histopathologically and histomorphometrically. Results: At 6 weeks, the bone area was significantly larger in the Xenograft-Alendronate group (33.0% ± 5.0%) than in the Xenograft-Saline group (20.8% ± 4.9%) and the bone area was significantly larger in the Autogenous-Alendronate group (43.3% ± 3.8%) than in the Autogenous-Saline group (37.5% ± 6.6%) (P = 0.001). The histomorphometric and histopathological results consistently showed that alendronate stimulated bone formation and reduced fibrous tissue formation in maxillary sinus augmentation grafts, especially in the deproteinized bovine bone group (xenograft). Conclusions: Alendronate may be considered a therapeutic option for improving the bone formation process and reducing resorption in different bone grafting procedures. Further detailed studies should focus on dosage and time-dependent effects of alendronate on bone remodeling. PMID:26756022

Effect of Porous Titanium Granules on Bone Regeneration and Primary Stability in Maxillary Sinus: A Human Clinical, Histomorphometric, and Microcomputed Tomography Analyses.

PubMed

Dursun, Ceyda Kanli; Dursun, Erhan; Eratalay, Kenan; Orhan, Kaan; Tatar, Ilkan; Baris, Emre; Tözüm, Tolga Fikret

2016-03-01

The aim of this randomized controlled study was to comparatively analyze the new bone (NB), residual bone, and graft-bone association in bone biopsies retrieved from augmented maxillary sinus sites by histomorphometry and microcomputed tomography (MicroCT) in a split-mouth model to test the efficacy of porous titanium granules (PTG) in maxillary sinus augmentation. Fifteen patients were included in the study and each patient was treated with bilateral sinus augmentation procedure using xenograft (equine origine, granule size 1000-2000 μm) and xenograft (1 g) + PTG (granule size 700-1000 μm, pore size >50 μm) (1 g), respectively. After a mean of 8.4 months, 30 bone biopsies were retrieved from the implant sites for three-dimensional MicroCT and two-dimensional histomorphometric analyses. Bone volume and vital NB percentages were calculated. Immediate after core biopsy, implants having standard dimensions were placed and implant stability quotient values were recorded at baseline and 3 months follow-up. There were no significant differences between groups according to residual bone height, residual bone width, implant dimensions, and implant stability quotient values (baseline and 3 months). According to MicroCT and two-dimensional histomorphometric analyses, the volume of newly formed bone was 57.05% and 52.67%, and 56.5% and 55.08% for xenograft + PTG and xenograft groups, respectively. No statistically significant differences found between groups according to NB percentages and higher Hounsfield unit values were found for xenograft + PTG group. The findings of the current study supports that PTG, which is a porous, permanent nonresorbable bone substitute, may have a beneficial osteoconductive effect on mechanical strength of NB in augmented maxillary sinus.

Systematic Review and Meta-Analysis of Recombinant Human Bone Morphogenetic Protein-2 in Localized Alveolar Ridge and Maxillary Sinus Augmentation.

PubMed

Kelly, Mick P; Vaughn, Olushola L Akinshemoyin; Anderson, Paul A

2016-05-01

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 well as the autograft or allograft in maxillary sinus floor augmentation. Long-term clinical success and adverse events need to be reported with more consistency before definitive conclusions can be made. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Clinical recommendation for treatment planning of sinus augmentation procedures by using presurgical CAT scan images: a preliminary report.

PubMed

Kutkut, Ahmad M; Andreana, Sebastiano; Kim, Hyeong-Ll; Monaco, Edward

2011-12-01

To propose a clinical recommendation based on anatomy of maxillary sinus before sinus augmentation procedure using presurgical computerized axial tomography (CAT) scan images. CAT scan images were randomly selected from previous completed implant cases. Proposed area for the lateral window osteotomy was outlined on the panorex image of the CAT scan. Sagittal section on the CAT scan that was in the center of the outlined window was selected for sinus measurement analysis. On CAT scan, 2 lines were drawn to measure the dimensions of sinus. One line measured the horizontal width and the other line measured the vertical height. Based on the measurement data, a classification of the maxillary sinus anatomy was proposed. Narrow sinus cavity indicates favorable type anatomy in terms of bone regeneration healing and wide sinus cavity as less favorable anatomy for patient treatment planning. A narrow sinus and greater exposure to the blood supply should require shorter healing times after grafting. Conversely, wider sinus cavities and less exposure to the blood supply would require a longer healing time before implant placement.

Clinical and biological analysis in graftless maxillary sinus lift.

PubMed

Parra, Marcelo; Olate, Sergio; Cantín, Mario

2017-08-01

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.

A prospective randomized controlled trial of the two-window technique without membrane versus the solo-window technique with membrane over the osteotomy window for maxillary sinus augmentation.

PubMed

Yu, Huajie; He, Danqing; Qiu, Lixin

2017-12-01

Maturation of the grafted volume after lateral sinus elevation is crucial for the long-term survival of dental implants. To compare endo-sinus histomorphometric bone formation between the solo- and two-window maxillary sinus augmentation techniques with or without membrane coverage for the rehabilitation of multiple missing posterior teeth. Patients with severely atrophic posterior maxillae were randomized to receive lateral sinus floor elevation via the solo-window technique with membrane coverage (Control Group) or the two-window technique without coverage (Test Group). Six months after surgery, bone core specimens harvested from the lateral aspect were histomorphometrically analyzed. Ten patients in each group underwent 21 maxillary sinus augmentations. Histomorphometric analysis revealed mean newly formed bone values of 26.08 ± 16.23% and 27.14 ± 18.11%, mean connective tissue values of 59.34 ± 12.42% and 50.03 ± 17.13%, and mean residual graft material values of 14.6 ± 14.56% and 22.78 ± 10.83% in the Test and Control Groups, respectively, with no significant differences. The two-window technique obtained comparative maturation of the grafted volume even without membrane coverage, and is a viable alternative for the rehabilitation of severely atrophic posterior maxillae with multiple missing posterior teeth. © 2017 Wiley Periodicals, Inc.

Crestal Sinus Augmentation with Recombinant Human Bone Morphogenetic Protein 2: Clinical and Radiographic Outcomes of 2-Year Pilot Trial.

PubMed

Kuchler, Ulrike; Rudelstorfer, Claudia M; Barth, Barbara; Tepper, Gabor; Lidinsky, Dominika; Heimel, Patrick; Watzek, Georg; Gruber, Reinhard

Recombinant human bone morphogenetic protein 2 (rhBMP-2) together with an absorbable collagen carrier (ACS) was approved for augmentation of the maxillary sinus prior to implant placement. The original registration trial was based on a lateral window approach. Clinical outcomes of crestal sinus augmentation with rhBMP-2 have not been reported so far. An uncontrolled pilot trial in which seven patients with a residual maxillary height below 5 mm were enrolled to receive crestal sinus augmentation with rhBMP-2/ACS was conducted. Elevation of the sinus mucosa was performed by gel pressure. Primary endpoints were the gain in augmentation height and volume measured by computed tomography after 6 months. Evaluation of bone quality at the time of implant placement was based on histology. Secondary endpoints were the clinical and radiologic evaluation of the implants and patient satisfaction by visual analog scale (VAS) at the 2-year follow-up. Median gain in augmentation height was 7.2 mm (range 0.0 to 17.5 mm). Five patients gained at least 5 mm of bone height. Two patients with a perforation of the sinus mucosa failed to respond to rhBMP-2/ACS and underwent lateral window augmentation. The median gain in augmentation volume of the five patients was 781.3 mm³ (range 426.9 to 1,242.8 mm³). Biopsy specimens showed a cancellous network consisting of primary plexiform bone with little secondary lamellar bone. After 2 years, implants were in function with no signs of inflammation or peri-implant bone loss. Patients were satisfied with the esthetic outcomes and chewing function. This pilot clinical trial supports the original concept that rhBMP-2/ACS supports bone formation, also in crestal sinus augmentation, and emphasizes the relevance of the integrity of the sinus mucosa to predict the bone gain.

Management of acute maxillary sinusitis after sinus bone grafting procedures with simultaneous dental implants placement - a retrospective study.

PubMed

Chirilă, Lucian; Rotaru, Cristian; Filipov, Iulian; Săndulescu, Mihai

2016-03-08

The sinus lift was first described in 1974 and it has proven to be a predictable procedure ever since. The complications of this surgical procedure are reported in the literature to be low, and can include acute maxillary sinusitis, scattering of the grafting material into the sinus cavity, wound dehiscence and Schneiderian membrane perforations. We aimed to evaluate the rate of acute maxillary sinusitis after sinus lift procedures and the appropriate management strategies. Between 2013 and 2015, 245 dental implants were placed in 116 patients (76 males and 40 females) with concomitant bone augmentation of the maxillary sinus floor. The sinus lifting procedure was bilateral in 35 patients and unilateral in 81 patients (a total of 151 sinuses). Maxillary sinusitis occurred in 5 patients (4.3 %). The clinical signs of infection were: headache, locoregional pain, cacosmia, inflammation of the oral buccal mucosa and rhinorrhea or unilateral nasal discharge. A mucosal fistula was observed during inspection in one patient. The management included only the removal of the grafting material in 3 patients, in 1 patient the grafting material was removed together with all the implants, and in 1 patient only 2 implants and the grafting material were removed, 1 implant being left in place. The sinus cavity was irrigated with metronidazole solution and antibiotic therapy with clindamycin and metronidazole was prescribed for 10 days. Subsequently, all signs of infection disappeared within 5 to 7 days and normal sinus function and drainage were restored. Although sinus lift is regarded as a safe and reliable procedure, acute sinusitis is a possible complication which has to be managed immediately in order to reduce the risk of further complications like pansinusitis, osteomyelitis of the maxillary bone, and spreading of the infection in the infratemporal space or orbital cavity. To minimize risk, caution must be taken with all the steps of the procedure, in order not to obliterate the ostium, impairing maxillary sinus clearance.

Clinical and biological analysis in graftless maxillary sinus lift

PubMed Central

2017-01-01

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

Histomorphometric and immunohistochemical analysis of human maxillary sinus-floor augmentation using porous β-tricalcium phosphate for dental implant treatment.

PubMed

Miyamoto, Shinji; Shinmyouzu, Kouhei; Miyamoto, Ikuya; Takeshita, Kenji; Terada, Toshihisa; Takahashi, Tetsu

2013-08-01

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.

Maxillary sinus floor elevation via crestal approach: the evolution of the hydraulic pressure technique.

PubMed

Lopez, Michele Antonio; Andreasi Bassi, Mirko; Confalone, Luca; Carinci, Francesco

2014-01-01

The current study describes an innovative protocol for the surgical maxillary sinus augmentation via a crestal approach that uses hydraulic pressure to lift the Schneiderian membrane and simultaneously fill the subantral space with a biomaterial for bone regeneration (nanocrystalline hydroxyapatite in aqueous solution). The technique in question combines the advantages of large amounts of grafted biomaterial with reduced trauma, high precision, and predictability.

Schneider Membrane Elevation in Presence of Sinus Septa: Anatomic Features and Surgical Management

PubMed Central

Beretta, Mario; Cicciù, Marco; Bramanti, Ennio; Maiorana, Carlo

2012-01-01

Maxillary sinus floor elevation via a lateral approach is a predictable technique to increase bone volume of the edentulous posterior maxilla and consequently for dental implants placement. The sinus floor is elevated and it can be augmented with either autologous or xenogeneic bone grafts following an opening bone window created on the facial buccal wall. Maxillary septa are walls of cortical bone within the maxillary sinus. The septa shape has been described as an inverted gothic arch arising from the inferior or lateral walls of the sinus and may even divide the sinus into two or more cavities. Some authors have reported a higher prevalence of septa in atrophic edentulous areas than in nonatrophic ones. Radiographic identification of these structures is important in order to perform the right design of the lateral window during sinus lift. Aim of this investigation is to highlight the correct steps for doing sinus lift surgery in presence of those anatomic variations. Clinicians should always perform clinical and radiographic diagnosis in order to avoid complications related to the sinus lift surgery. PMID:22848223

Maxillary sinus floor augmentation using a beta-tricalcium phosphate (Cerasorb) alone compared to autogenous bone grafts.

PubMed

Zijderveld, Steven A; Zerbo, Ilara R; van den Bergh, Johan P A; Schulten, Engelbert A J M; ten Bruggenkate, Chris M

2005-01-01

A prospective human clinical study was conducted to determine the clinical and histologic bone formation ability of 2 graft materials, a beta-tricalcium phosphate (Cerasorb; Curasan, Kleinostheim, Germany) and autogenous chin bone, in maxillary sinus floor elevation surgery. Ten healthy patients underwent a bilateral (n = 6) or unilateral (n = 4) maxillary sinus floor elevation procedure under local anesthesia. In each case, residual posterior maxillary bone height was between 4 and 8 mm. In cases of bilateral sinus floor elevation, the original bone was augmented with a split-mouth design with 100% beta-tricalcium phosphate on the test side and 100% chin bone on the contralateral control side. The unilateral cases were augmented with 100% beta-tricalcium phosphate. After a healing period of 6 months, ITI full body screw-type implants (Straumann, Waldenburg, Switzerland) were placed. At the time of implant surgery, biopsy samples were removed with a 3.5-mm trephine drill. Sixteen sinus floor elevations were performed. Forty-one implants were placed, 26 on the test side and 15 on the control side. The clinical characteristics at the time of implantation differed, especially regarding clinical appearance and drilling resistance. The increase in height was examined radiographically prior to implantation and was found to be sufficient in all cases. After a mean of nearly 1 year of follow-up, no implant losses or failures had occurred. The promising clinical results of the present study and the lack of implant failures are probably mainly the result of requiring an original bone height of at least 4 mm at the implant location. Although autogenous bone grafting is still the gold standard, according to the clinical results, the preimplantation sinus floor elevation procedure used, which involved a limited volume of beta-tricalcium phosphate, appeared to be a clinically reliable procedure in this patient population.

Challenges associated with reentry maxillary sinus augmentation.

PubMed

Mardinger, Ofer; Moses, Ofer; Chaushu, Gavriel; Manor, Yifat; Tulchinsky, Ze'ev; Nissan, Joseph

2010-09-01

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.

Feasibility of Shape-Memory Ni/Ti Alloy Wire Containing Tube Elevators for Transcrestal Detaching Maxillary Sinus Mucosa: Ex Vivo Study.

PubMed

Li, Yanfeng; Wang, Fuli; Hu, Pin; Fan, Jiadong; Han, Yishi; Liu, Bin; Liu, Tao; Yang, Chunhao; Gu, Xiangmin

2016-01-01

Osteotome sinus floor elevation is a less invasive approach to augment an insufficient alveolar bone at the posterior maxilla for dental implantation. However, this approach has some limitations due to the lack of sinus lift tools available for clinical use and the small transcrestal access to the maxillary sinus floor. We recently invented shape-memory Ni/Ti alloy wire containing tube elevators for transcrestal detaching maxillary sinus mucosa, and developed goat ex vivo models for direct visualizing the effectiveness of detaching sinus mucosa in real time during transcrestal maxillary sinus floor elevation. We evaluated our invented elevators, namely elevator 012 and elevator 014, for their effectiveness for transcrestal detaching maxillary sinus mucosa using the goat ex vivo models. We measured 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 using the invented elevators. Elevator 012 had a shape-memory Ni/Ti alloy wire with a diameter of 0.012 inch, while elevator 014 had its shape-memory Ni/Ti alloy wire with a diameter of 0.014 inch. Elevator 012 could detach the goat maxillary sinus mucosa in the mesial or distal direction for 12.1±4.3 mm, while in the buccal or palatal direction for 12.5±6.7 mm. The elevator 014 could detach the goat maxillary sinus mucosa for 23.0±4.9 mm in the mesial or distal direction, and for 19.0±8.1 mm in the buccal or palatal direction. An average space volume of 1.7936±0.2079 ml was created after detaching the goat maxillay sinus mucosa in both mesial/distal direction and buccal/palatal direction using elevator 012; while the average space volume created using elevator 014 was 1.8764±0.2366 ml. Both two newly invented tube elevators could effectively detach the maxillary sinus mucosa on the goat ex vivo sinus models. Moreover, elevator 014 has advantages over the elevator 012 for the capability to detach sinus mucosa. © 2016 The Author(s) Published by S. Karger AG, Basel.

A 10-year clinical and radiographic study of implants placed after maxillary sinus floor augmentation with an 80:20 mixture of deproteinized bovine bone and autogenous bone.

PubMed

Mordenfeld, Arne; Albrektsson, Tomas; Hallman, Mats

2014-06-01

There is a need for prospective, long-term follow-up studies of implants placed after maxillary sinus floor augmentation (MSFA). The aim of the present study was to determine whether deprotenized bovine bone (DPBB) used for MSFA may result in long-term stability of placed dental implants. Fourteen of the 20 patients included in the study were followed throughout the 10 years study period. These patients had 53 implants placed in 22 (6 unilateral and 8 bilateral) maxillary sinuses augmented with a mixture of 80% DPBB and 20% autogenous bone (80:20), and 15 implants placed in non-grafted sites. Clinical and radiographic examinations of the implants and grafts were performed. After 10 years of functional loading 15 of the initially placed 108 implants had been lost giving a cumulative survival rate of 86%. The mean marginal bone loss was 1.6 ± 1.0 mm. There were no statistically significant differences in marginal bone level, pocket depth, or ISQ-values between implants placed in residual or grafted bone or between smokers or non-smokers at 10 years follow-up. There was a statistically significant reduction (p < .01) in graft height between 3 months and 2 years but no further significant reduction up to 10 years. The first 2 years after placement of implants with turned surfaces placed in sites after sinus floor augmentation with DPBB and autogenous bone seem to be critical for implant survival. At 10 years follow-up, the remaining implants presented excellent clinical and radiological results regardless of smoking habits or implant sites (augmented or residual bone). © 2012 Wiley Periodicals, Inc.

Histomorphologic findings on human bone samples six months after bone augmentation of the maxillary sinus with Algipore.

PubMed

Schopper, C; Moser, D; Wanschitz, F; Watzinger, F; Lagogiannis, G; Spassova, E; Ewers, R

1999-01-01

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.

A Retrospective Analysis of Dental Implants Replacing Failed Implants in Grafted Maxillary Sinus: A Case Series.

PubMed

Manor, Yifat; Chaushu, Gavriel; Lorean, Adi; Mijiritzky, Eithan

2015-01-01

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.

Bone Formation Following Sinus Augmentation with an Equine-Derived Bone Graft: A Retrospective Histologic and Histomorphometric Study with 36-Month Follow-up.

PubMed

Di Stefano, Danilo Alessio; Gastaldi, Giorgio; Vinci, Raffaele; Polizzi, Elisabetta Maria; Cinci, Lorenzo; Pieri, Laura; Gherlone, Enrico

2016-01-01

The aim of this study was to investigate bone formation over time following maxillary sinus augmentation with an enzyme-deantigenic, bone collagen-preserving equine bone graft by retrospective assessment of histomorphometric data. Records of patients with atrophic ridges who underwent maxillary sinus augmentation with the enzyme-deantigenic equine bone graft and two-step implant placement between 3 and 12 months after the sinus-augmentation surgery were assessed retrospectively. The histomorphometric data were clustered in three classes according to time of collection from the augmentation surgery and analyzed to assess newly formed bone deposition and residual biomaterial degradation rates. Data concerning the 36-month clinical follow-up were also assessed. Records of 77 patients and 115 biopsy specimens were retrieved, and histomorphometric data were clustered (3 to 5 months, n = 33; 6 to 8 months, n = 57; 9 to 12 months, n = 25). Mean minimum atrophic ridge thickness was 4.9 ± 0.5 mm (range, 4.0 to 7.1 mm). The amount of newly formed bone and residual biomaterial did not significantly differ among the three clusters. Qualitative analysis showed a denser trabecular structure in late (> 8 months) samples. At the 36-month clinical follow-up, no differences were found among the implant success rates in the three groups, according to the Albrektsson and Zarb criteria for success. The overall implant success rate was 98.3%. Based upon this retrospective human study of 77 patients with 4 to 7 mm of residual bone, when enzyme-deantigenic equine bone is used for sinus augmentation, new bone formation occurs at an early time (< 3 months) after the grafting, and implant placement can be safely carried out as soon as 3 to 5 months after the augmentation surgery.

Maxillary sinus augmentation by crestal access: a retrospective study on cavity size and outcome correlation.

PubMed

Spinato, Sergio; Bernardello, Fabio; Galindo-Moreno, Pablo; Zaffe, Davide

2015-12-01

Cone-beam computed tomography (CBCT) and radiographic outcomes of crestal sinus elevation, performed using mineralized human bone allograft, were analyzed to correlate results with maxillary sinus size. A total of 60 sinus augmentations in 60 patients, with initial bone ≤5 mm, were performed. Digital radiographs were taken at surgical implant placement time up to post-prosthetic loading follow-up (12-72 months), when CBCT evaluation was carried out. Marginal bone loss (MBL) was radiographically analyzed at 6 months and follow-up time post-loading. Sinus size (BPD), implant distance from palatal (PID) and buccal wall (BID), and absence of bone coverage of implant (intra-sinus bone loss--IBL) were evaluated and statistically evaluated by ANOVA and linear regression analyses. MBL increased as a function of time. MBL at final follow-up was statistically associated with MBL at 6 months. A statistically significant correlation of IBL with wall distance and of IBL/mm with time was identified with greater values in wide sinuses (WS ≥ 13.27 mm) than in narrow sinuses (NS < 13.27 mm). This study is the first quantitative and statistically significant confirmation that crestal technique with residual ridge height <5 mm is more appropriate and predictable, in terms of intra-sinus bone coverage, in narrow than in WS. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A Human Clinical, Histological, Histomorphometrical, and Radiographical Study on Biphasic HA-Beta-TCP 30/70 in Maxillary Sinus Augmentation.

PubMed

Mangano, Carlo; Sinjari, Bruna; Shibli, Jamil A; Mangano, Francesco; Hamisch, Sabine; Piattelli, Adriano; Perrotti, Vittoria; Iezzi, Giovanna

2015-06-01

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.

Radiographic and Histologic Evaluation of a Bone Void that Formed After Recombinant Human Bone Morphogenetic Protein-2-Mediated Sinus Graft Augmentation: A Case Report.

PubMed

Kang, Hyun-Joo; Jun, Choong-Man; Yun, Jeong-Ho

2016-01-01

In the present case report, the authors describe radiographic and histologic observations of a bone void that formed after a sinus augmentation using a graft material that contained recombinant human bone morphogenetic protein-2 (rhBMP-2) and discuss clinical and histologic implications of their findings. Sinus augmentation was performed using a graft material comprising 1 g of hydroxyapatite/β-tricalcium phosphate, which contained 1 mg of rhBMP-2. Radiographic evaluation was conducted with panoramic radiographs and computed tomography images of the augmented maxillary sinus, which were analyzed using a three-dimensional image-reconstruction program. Histologic evaluation was also performed on a biopsy specimen obtained 6 months after the sinus augmentation. The total augmented volume increased from 1,582.2 mm(3) immediately after the sinus augmentation to 3,344.9 mm3 at 6 months after the augmentation because of the formation of a bone void. Twenty-six months after the sinus augmentation, the bone void remained but had reduced in volume, with the total augmented volume reduced to 2,551.7 mm(3). Histologically, new bone was observed to be in contact with the grafted particles, and a fatty marrow-like tissue was present in the area of the bone void. This case report shows that the bone void that had formed after sinus augmentation resolved over time and seemed to be partially replaced with new bone. Furthermore, none of the implants failed, and clinical adverse events were not observed during the follow-up period.

Carprofen neither reduces postoperative facial expression scores in rabbits treated with buprenorphine nor alters long term bone formation after maxillary sinus grafting.

PubMed

Hedenqvist, Patricia; Trbakovic, Amela; Thor, Andreas; Ley, Cecilia; Ekman, Stina; Jensen-Waern, Marianne

2016-08-01

In connection with bilateral maxillary sinus augmentation, the acute effects of the nonsteroidal anti-inflammatory drug carprofen on facial expressions and long-term effects on bone formation were evaluated in 18 male New Zealand White rabbits. A 10×10mm bone window was drilled in the maxilla, the sinus membrane elevated and a titanium mini-implant inserted. One of two test materials was randomly inserted unilaterally and bovine bone chips (control) on the contralateral side in the created space. Rabbits were randomly allocated to receive buprenorphine plus carprofen (n=9) or buprenorphine plus saline (n=9) postoperatively. Buprenorphine was administered subcutaneously every 6h for 3days in a tapered dose (0.05-0.01mg/kg) and carprofen (5mg/kg) or saline administered subcutaneously 1h before, and daily for 4days postoperatively. To assess pain, clinical examination, body weight recording and scoring of facial expressions from photos taken before, and 6-13h after surgery were performed. Twelve weeks after surgery the rabbits were euthanized and sections of maxillary bones and sinuses were analysed with histomorphometry and by qualitative histology. Carprofen had no effect on mean facial expression scores, which increased from 0.0 to 3.6 (carprofen) and 4.3 (saline), of a maximum of 8.0. Neither did carprofen have an effect on bone formation or implant incorporation, whereas the test materials had. In conclusion, treatment with 5mg/kg carprofen once daily for 5days did not reduce facial expression scores after maxillary sinus augmentation in buprenorphine treated rabbits and did not affect long term bone formation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Maxillary sinus augmentation with a sonic handpiece for the osteotomy of the lateral window: a clinical report.

PubMed

Geminiani, Alessandro; Papadimitriou, Dimitrios E V; Ercoli, Carlo

2011-11-01

Several techniques have been proposed to manage patients with insufficient bone height for implant placement in the posterior maxilla. The lateral approach to sinus elevation is a successful procedure, with percentages of success close to 100%. Unfortunately, a frequent complication encountered during sinus elevation procedure is perforation of the Schneiderian membrane. In this clinical report, the authors present the application of a diamond coated sonic tip and an air-driven sonic instrument, commonly used in prosthodontics for the preparation of the lateral window osteotomy during sinus augmentation procedures. Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

Lateral approach for maxillary sinus membrane elevation without bone materials in maxillary mucous retention cyst with immediate or delayed implant rehabilitation: case reports.

PubMed

Han, Ji-Deuk; Cho, Seong-Ho; Jang, Kuk-Won; Kim, Seong-Gwang; Kim, Jung-Han; Kim, Bok-Joo; Kim, Chul-Hun

2017-08-01

This case series study demonstrates the possibility of successful implant rehabilitation without bone augmentation in the atrophic posterior maxilla with cystic lesion in the sinus. Sinus lift without bone graft using the lateral approach was performed. In one patient, the cyst was aspirated and simultaneous implantation under local anesthesia was performed, whereas the other cyst was removed under general anesthesia, and the sinus membrane was elevated in a second process, followed by implantation. In both cases, tapered 11.5-mm-long implants were utilized. With all of the implants, good stability and appropriate bone height were achieved. The mean bone level gain was 5.73 mm; adequate bone augmentation around the implants was shown, the sinus floor was moved apically, and the cyst was no longer radiologically detected. Completion of all of the treatments required an average of 12.5 months. The present study showed that sufficient bone formation and stable implantation in a maxilla of insufficient bone volume are possible through sinus lift without bone materials. The results serve to demonstrate, moreover, that surgical treatment of mucous retention cyst can facilitate rehabilitation. These techniques can reduce the risk of complications related to bone grafts, save money, and successfully treat antral cyst.

Lateral approach for maxillary sinus membrane elevation without bone materials in maxillary mucous retention cyst with immediate or delayed implant rehabilitation: case reports

PubMed Central

2017-01-01

This case series study demonstrates the possibility of successful implant rehabilitation without bone augmentation in the atrophic posterior maxilla with cystic lesion in the sinus. Sinus lift without bone graft using the lateral approach was performed. In one patient, the cyst was aspirated and simultaneous implantation under local anesthesia was performed, whereas the other cyst was removed under general anesthesia, and the sinus membrane was elevated in a second process, followed by implantation. In both cases, tapered 11.5-mm-long implants were utilized. With all of the implants, good stability and appropriate bone height were achieved. The mean bone level gain was 5.73 mm; adequate bone augmentation around the implants was shown, the sinus floor was moved apically, and the cyst was no longer radiologically detected. Completion of all of the treatments required an average of 12.5 months. The present study showed that sufficient bone formation and stable implantation in a maxilla of insufficient bone volume are possible through sinus lift without bone materials. The results serve to demonstrate, moreover, that surgical treatment of mucous retention cyst can facilitate rehabilitation. These techniques can reduce the risk of complications related to bone grafts, save money, and successfully treat antral cyst. PMID:28875144

Chronic sinusitis associated with the use of unrecognized bone substitute: a case report.

PubMed

Beklen, Arzu; Pihakari, Antti; Rautemaa, Riina; Hietanen, Jarkko; Ali, Ahmed; Konttinen, Yrjö T

2008-05-01

Bone grafts are used for bone augmentation to ensure optimal implant placement. However, this procedure may sometimes cause sinusitis. The case of a 44-year-old woman with the diagnosis of recurrent and chronic sinusitis of her right maxillary sinus with a history of dental implant surgery is presented. After several attempts with normal standard sinusitis therapy, unrecognized bone substitute was removed from the sinus cavity, which finally led to resolution of the sinusitis. This case reiterates the importance of a careful examination, consultation, and second opinion for the selection of optimal treatment.

Comparison of Bovine Bone-Autogenic Bone Mixture Versus Platelet-Rich Fibrin for Maxillary Sinus Grafting: Histologic and Histomorphologic Study.

PubMed

Ocak, Hakan; Kutuk, Nukhet; Demetoglu, Umut; Balcıoglu, Esra; Ozdamar, Saim; Alkan, Alper

2017-06-01

Numerous grafting materials have been used to augment the maxillary sinus floor for long-term stability and success for implant-supported prosthesis. To enhance bone formation, adjunctive blood-born growth factor sources have gained popularity during the recent years. The present study compared the use of platelet-rich fibrin (PRF) and bovine-autogenous bone mixture for maxillary sinus floor elevation. A split-face model was used to apply 2 different filling materials for maxillary sinus floor elevation in 22 healthy adult sheep. In group 1, bovine and autogenous bone mixture; and in group 2, PRF was used. The animals were killed at 3, 6, and 9 months. Histologic and histomorphologic examinations revealed new bone formation in group 1 at the third and sixth months. In group 2, new bone formation was observed only at the sixth month, and residual PRF remnants were identified. At the ninth month, host bone and new bone could not be distinguished from each other in group 1, and bone formation was found to be proceeding in group 2. PRF remnants still existed at the ninth month. In conclusion, bovine bone and autogenous bone mixture is superior to PRF as a grafting material in sinus-lifting procedures.

Multiple Perforations of the Sinus Floor During Maxillary Sinus Floor Augmentation to Provide Access to the Bone Marrow Space: A Technical Report.

PubMed

Ulm, Christian; Bertl, Kristina; Strbac, Georg D; Esfandeyari, Azadeh; Stavropoulos, Andreas; Zechner, Werner

2017-12-01

Sinus floor augmentation is a routinely used surgical technique for increasing the bone height/volume of the atrophic posterior maxilla. Optimal integration of the implanted augmentation material within the newly formed bone will-at least partly-depend on adequate vascularization to ensure sufficient recruitment of osteoblast and osteoclast precursor cells. The present technical note describes a modification intended to facilitate increased blood inflow into the augmented space. After preparation of the lateral window and elevation of the Schneiderian membrane, the cortical bone of the sinus floor is perforated several times either by using a piezoelectric device or a microsurgical handpiece with the corresponding tip or bur; these perforations should extend into the trabecular bone. The experiences with this modified technique after 12 patients are presented and discussed. It is expected that by means of this relatively simple technique, increased blood and cell inflow into the augmented space is achieved. This may, in turn, enhance new bone formation and improve the integration of the augmentation material.

Allograft for maxillary sinus floor augmentation: a retrospective study of 90 cases.

PubMed

Guerrero, Jaime S; Al-Jandan, Badr A

2012-04-01

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.

Bone formation in sinus augmentation procedures using autologous bone, porcine bone, and a 50 : 50 mixture: a human clinical and histological evaluation at 2 months.

PubMed

Cassetta, Michele; Perrotti, Vittoria; Calasso, Sabrina; Piattelli, Adriano; Sinjari, Bruna; Iezzi, Giovanna

2015-10-01

The aim of this study was to perform a 2 months clinical and histological comparison of autologous bone, porcine bone, and a 50 : 50 mixture in maxillary sinus augmentation procedures. A total of 10 consecutive patients, undergoing two-stage sinus augmentation procedures using 100% autologous bone (Group A), 100% porcine bone (Group B), and a 50 : 50 mixture of autologous and porcine bone (Group C) were included in this study. After a 2-month healing period, at the time of implant insertion, clinical evaluation was performed and bone core biopsies were harvested and processed for histological analysis. The postoperative healing was uneventful regardless of the materials used for the sinus augmentation procedures. The histomorphometrical analysis revealed comparable percentages of newly formed bone, marrow spaces, and residual grafted material in the three groups. The clinical and histological results of this study indicated that porcine bone alone or in combination with autologous bone are biocompatible and osteoconductive materials and can be successfully used in sinus augmentation procedures. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Radiographic study of maxillary sinus associated with molars in adult].

PubMed

Hu, Zhi; Sun, Daming; Zhou, Quansheng; Wang, Yuli; Gu, Jingcheng; Han, Yaohua

2014-12-01

to explore the relationship between the maxillary sinus volume and the amount of alveolar bone, and the effect of molar loss upon the maxillary sinus was further analyzed,by measuring adult maxillary sinus volume, sinus ridge distance, and calculating the gasification coefficient of maxillary sinus. One hundred and ninety cases (361 maxillary sinus) with CT examinations were collected, they were divided into group A and group B, 121 cases (242 maxillary sinus) of normal subjects served as group A, 42 cases (65 maxillary sinus) with molar part off were B group, in which 31 maxillary sinus with a molar loss were group B1,22 maxillary sinus with two molar loss were B2 group,12 maxillary sinus with three molar loss (one molar remains) were B3 group, 27 cases (54 maxillary sinus) with upper teeth off were C group. Bymeasureing the maxillary sinus volume, sinus ridge distance and the size of the maxillary sinus, calculating the gasification coefficient, we analyzed the relationship between maxillary volume and sinus ridge distance, and comparatively analyzed the differences among the three groups in the size, gasification coefficient, volume of maxillary sinus and sinus ridge distance. In the normal group,the volume of maxillary sinus and sinus ridge distance had a correlation coefficient of -0. 63,(P< 0.05); Sinus ridge distance in group A was larger than the other two groups (P<0.05), and larger in B group than in C group (P<0. 05), anteroposterior maxillary sinus diameter and reft-right diameter in C group was greater than in A group and B group(P<0.05), group C gasification coeffiecent was less than A group and B group (P<0. 05). The volume of maxillary sinus is negatively correlated with the amont of alveolar bone; Upper teeth's shedding promotes maxillary sinus deformation; Maxiuary sinus volume has a tendency to decrease.

A comparative study of the effect of Bio-Oss® in combination with concentrated growth factors or bone marrow-derived mesenchymal stem cells in canine sinus grafting.

PubMed

Wang, Fang; Li, Qiong; Wang, Zuolin

2017-08-01

To compare the effects of Bio-Oss ® in combination with concentrated growth factors (CGFs) and bone marrow-derived mesenchymal stem cells (BMSCs) on bone regeneration for maxillary sinus floor augmentation in beagle dogs. Six beagle dogs received bilateral maxillary sinus floor augmentation. Venous blood drawn from dogs was collected and centrifuged to obtain CGFs. BMSCs derived from canine bone marrow were cultured using density gradient centrifugation. The suspension of BMSCs was added onto Bio-Oss ® granules at a density of 2 × 10 6 cells/ml, and the BMSCs/Bio-Oss ® constructs were incubated for an additional 4 h before use. Twelve sinuses were grafted with a mixture of CGFs/Bio-Oss ® , BMSCs/Bio-Oss ® construct, or Bio-Oss ® alone. Six months later, the bone formation of bilateral sinuses was evaluated by Micro-CT, microhardness test, histological examination, and histomorphometry. No adverse effect was found in these dogs. The dome-shaped augmentation protruded into the sinus cavity. Micro-CT revealed that there was significant difference in BV/TV but not in Tb. N, between groups A, B, and C. The extent of microhardness in groups A and B was significantly higher than in group C. The proportion of newly formed bone in groups A and B showed significant difference when compared to group C (P ≤ 0.01). The amount of residual grafts in groups A and B was significantly lower than in group C. Grafting with Bio-Oss ® in combination with CGFs can increase new bone formation more efficiently than using Bio-Oss ® alone in a canine model. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A comparative study of the incidence of Schneiderian membrane perforations during maxillary sinus augmentation with a sonic oscillating handpiece versus a conventional turbine handpiece.

PubMed

Geminiani, Alessandro; Weitz, Daniel S; Ercoli, Carlo; Feng, Changyong; Caton, Jack G; Papadimitriou, Dimitrios E V

2015-04-01

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.

Intra- and Postoperative Complications of Lateral Maxillary Sinus Augmentation in Smokers vs Nonsmokers: A Systematic Review and Meta-Analysis.

PubMed

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.

Osteotome-Mediated Sinus Lift without Grafting Material: A Review of Literature and a Technique Proposal

PubMed Central

Taschieri, Silvio; Corbella, Stefano; Saita, Massimo; Tsesis, Igor; Del Fabbro, Massimo

2012-01-01

Implant rehabilitation of the edentulous posterior maxilla may be a challenging procedure in the presence of insufficient bone volume for implant placement. Maxillary sinus augmentation with or without using grafting materials aims to provide adequate bone volume. The aim of the present study was to systematically review the existing literature on transalveolar maxillary sinus augmentation without grafting materials and to propose and describe an osteotome-mediated approach in postextraction sites in combination with platelet derivative. The systematic review showed that high implant survival rate (more than 96% after 5 years) can be achieved even without grafting the site, with a low rate of complications. Available alveolar bone height before surgery was not correlated to survival rate. In the described case report, three implants were placed in posterior maxilla after extraction of two teeth. An osteotome-mediated sinus lifting technique was performed with the use of platelet derivative (PRGF); a synthetic bone substitute was used to fill the gaps between implant and socket walls. No complications occurred, and implants were successfully in site after 1 year from prosthetic loading. The presented technique might represent a viable alternative for the treatment of edentulous posterior maxilla with atrophy of the alveolar bone though it needs to be validated by studies with a large sample size. PMID:22792108

Maxillary sinus floor augmentation using a nano-crystalline hydroxyapatite silica gel: case series and 3-month preliminary histological results.

PubMed

Canullo, Luigi; Dellavia, Claudia; Heinemann, Friedhelm

2012-03-20

The aim of this case series is to histologically examine a new hydroxyapatite in sinus lift procedure after 3 months. Ten 2-stage sinus lifts were performed in 10 healthy patients having initial bone height of 1-2mm and bone width of 5mm, asking for a fixed implant-supported rehabilitation. After graft material augmentation, a rough-surfaced mini-implant was inserted to maintain stability of the sinus widow. A bioptical core containing a mini-implant was retrieved 3 months after maxillary sinus augmentation with NanoBone(®) and processed for undecalcified histology. From the histomorphometric analysis, NanoBone(®) residuals accounted for the 38.26% ± 8.07% of the bioptical volume, marrow spaces for the 29.23% ± 5.18% and bone for the 32.51% ± 4.96% (new bone: 20.64% ± 2.96%, native bone: 11.87% ± 3.27%). Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systems surrounded the residual NanoBone(®) particles. The measured bone-to-implant contact amounted to 26.02% ± 5.46%. No connective tissue was observed at the implant boundary surface. In conclusion, the tested material showed good histological outcomes also 3 months after surgery. In such critical conditions, the use of a rough-surfaced mini-implant showed BIC values supposed to be effective also in case of functional loading. Although longer follow-up and a wider patient size are needed, these preliminary results encourage further research on this biomaterial for implant load also under early stage and critical conditions. Copyright © 2011 Elsevier GmbH. All rights reserved.

A 3-year clinical and radiographic study of implants placed simultaneously with maxillary sinus floor augmentations using a new nanocrystalline hydroxyapatite.

PubMed

Heinemann, F; Mundt, T; Biffar, R; Gedrange, T; Goetz, W

2009-12-01

The aims of this case series was to evaluate the success rate of implants and their restorations, the sinus bone graft resorption, and the marginal bone loss around the implants when nanocristalline HA embedded in a silica matrix was exclusively used as grafting material. In 13 partially edentulous patients of a private practice having missing teeth in the posterior maxilla and a subantral bone height between 3 and 7 mm, 19 sinus augmentations (100% Nanobone, Artoss, Rostock, Germany) by the lateral lift technique were performed. The implants (Tiolox/Tiologic Implants, Dentaurum, Ispringen, Germany) were simultaneously placed. After 6 to 9 months 37 implants were restored with fixed dental prostheses. The clinical evaluation included peri-implant parameters, periotest measurements and the restorations. The radiographic bone heights over time were estimated with linear mixed models. The implant success rate was 100% after three years. The periotest values (between -7 and -6) after implant abutment connection indicated a solid osseointegration. The mean rates of the marginal bone loss over the first year were higher (mesial: -0.55, distal: -0.51 mm) than the annual rates thereafter (mesial: -0.09 mm, distal: -0.08 mm). The mean rates of changes in the total bone height were neglectable (<0.2 mm) and not significant. The prosthodontic and esthetic evaluation revealed a successful outcome. Within the limits of this clinical report it may be concluded that maxillary sinus augmentation using 100% nanocristalline HA embedded in a silica matrix to support implants is a reliable procedure.

Marginal Bone Loss in Implants Placed in the Maxillary Sinus Grafted With Anorganic Bovine Bone: A Prospective Clinical and Radiographic Study.

PubMed

Dinato, Thiago R; Grossi, Márcio L; Teixeira, Eduardo R; Dinato, José C; Sczepanik, Fábio S C; Gehrke, Sergio A

2016-08-01

Sinus elevation is a reliable and often-used technique. Success of implants placed in such situations, even with bone substitutes alone, prompted the authors of this study to strive for bone loss close to zero and research variables that cause higher or lower rates of resorption. The objective of this study is to evaluate survival rates and marginal bone loss (MBL) around implants placed in sites treated with maxillary sinus augmentation using anorganic bovine bone (ABB), and identify surgical and prosthetic prognostic variables. Fifty-five implants were placed in 30 grafted maxillary sinuses in 24 patients. Periapical radiographs were evaluated immediately after implant placement (baseline), 6 months, and at the most recent follow-up. MBL was calculated from the difference between initial and final measurements, taking into account a distortion rate for each radiograph compared with original implant measurements. Survival rate was 98.2%, with only one implant lost (100% survival rate after loading) over a mean follow-up time of 2.0 ± 0.9 years. MBL ranged from 0 to 2.85 mm: 75.9% of mesial sites and 83.4% of distal sites showed <1 mm of MBL, whereas 35.2% of mesial sites and 37% of distal sites exhibited no bone loss. MBL was significantly (P <0.05) greater in open-flap compared with flapless surgery. Within the limitations of the present study, it was concluded that maxillary sinus elevation with 100% ABB gives predictable results, and that flapless surgery results in less MBL compared with traditional open-flap surgery.

Recombinant human bone morphogenetic protein 2 outcomes for maxillary sinus floor augmentation: a systematic review and meta-analysis.

PubMed

Lin, Guo-Hao; Lim, Glendale; Chan, Hsun-Liang; Giannobile, William V; Wang, Hom-Lay

2016-11-01

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 in rhBMP-2 approaches as compared to bone autograft procedures (both intraoral and extraoral bone harvesting because no donor site is required). Long-term studies are required to determine the cost-benefit of sinus floor augmentation procedures for patients requiring implant reconstruction. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Rehabilitation of postrior atrophic edentulous jaws: prostheses supported by 5 mm short implants or by longer implants in augmented bone? One-year results from a pilot randomised clinical trial.

PubMed

Esposito, Marco; Pellegrino, Gerardo; Pistilli, Roberto; Felice, Pietro

2011-01-01

To evaluate whether 5 mm short dental implants could be an alternative to augmentation with anorganic bovine bone and placement of at least 10 mm long implants in posterior atrophic jaws. Fifteen patients with bilateral atrophic mandibles (5-7 mm bone height above the mandibular canal), and 15 patients with bilateral atrophic maxillae (4-6 mm bone height below the maxillary sinus) and bone thickness of at least 8 mm, were randomised according to a splitmouth design to receive one to three 5 mm short implants or at least 10 mm long implants in augmented bone. Mandibles were vertically augmented with interpositional bone blocks and maxillary sinuses with particulated bone via a lateral window. Implants were placed after 4 months, submerged and loaded, after 4 months, with provisional prostheses. Four months later, definitive provisionally cemented prostheses were delivered. Outcome measures were: prosthesis and implant failures, any complication and peri-implant marginal bone level changes. In 5 augmented mandibles, the planned 10 mm long implants could not be placed and shorter implants (7 and 8.5 mm) had to be used instead. One year after loading no patient dropped out. Two long (8.5 mm in the mandible and 13 mm in the maxilla) implants and one 5 mm short maxillary implant failed. There were no statistically significant differences in failures or complications. Patients with short implants lost on average 1 mm of peri-implant bone and patients with longer implants lost 1.2 mm. This difference was statistically significant. This pilot study suggests that 1 year after loading, 5 mm short implants achieve similar if not better results than longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation since the treatment is faster, cheaper and associated with less morbidity, however their long-term prognosis is unknown.

The morphological interaction between the nasal cavity and maxillary sinuses in living humans.

PubMed

Holton, Nathan; Yokley, Todd; Butaric, Lauren

2013-03-01

To understand how variation in nasal architecture accommodates the need for effective conditioning of respired air, it is necessary to assess the morphological interaction between the nasal cavity and other aspects of the nasofacial skeleton. Previous studies indicate that the maxillary sinuses may play a key role in accommodating climatically induced nasal variation such that a decrease in nasal cavity volume is associated with a concomitant increase in maxillary sinus volume. However, due to conflicting results in previous studies, the precise interaction of the nasal cavity and maxillary sinuses, in humans, is unclear. This is likely due to the prior emphasis on nasal cavity size, whereas arguably, nasal cavity shape is more important with regard to the interaction with the maxillary sinuses. Using computed tomography scans of living human subjects (N=40), the goal of this study is to assess the interaction between nasal cavity form and maxillary sinus volume in European- and African-derived individuals with differences in nasal cavity morphology. First, we assessed whether there is an inverse relationship between nasal cavity and maxillary sinus volumes. Next, we examined the relationship between maxillary sinus volume and nasal cavity shape using multivariate regression. Our results show that there is a positive relationship between nasal cavity and maxillary sinus volume, indicating that the maxillary sinuses do not accommodate variation in nasal cavity size. However, maxillary sinus volume is significantly correlated with variation in relative internal nasal breadth. Thus, the maxillary sinuses appear to be important for accommodating nasal cavity shape rather than size. Copyright © 2013 Wiley Periodicals, Inc.

A new biphasic osteoinductive calcium composite material with a negative Zeta potential for bone augmentation

PubMed Central

Smeets, Ralf; Kolk, Andreas; Gerressen, Marcus; Driemel, Oliver; Maciejewski, Oliver; Hermanns-Sachweh, Benita; Riediger, Dieter; Stein, Jamal M

2009-01-01

The aim of the present study was to analyze the osteogenic potential of a biphasic calcium composite material (BCC) with a negative surface charge for maxillary sinus floor augmentation. In a 61 year old patient, the BCC material was used in a bilateral sinus floor augmentation procedure. Six months postoperative, a bone sample was taken from the augmented regions before two titanium implants were inserted at each side. We analyzed bone neoformation by histology, bone density by computed tomography, and measured the activity of voltage-activated calcium currents of osteoblasts and surface charge effects. Control orthopantomograms were carried out five months after implant insertion. The BCC was biocompatible and replaced by new mineralized bone after being resorbed completely. The material demonstrated a negative surface charge (negative Zeta potential) which was found to be favorable for bone regeneration and osseointegration of dental implants. PMID:19523239

Simultaneous sinus lift and implantation using platelet-rich fibrin as sole grafting material.

PubMed

Jeong, Seung-Mi; Lee, Chun-Ui; Son, Jeong-Seog; Oh, Ji-Hyeon; Fang, Yiqin; Choi, Byung-Ho

2014-09-01

Recently, several authors have shown that simultaneous sinus lift and implantation using autologous platelet-rich fibrin as the sole filling material is a reliable procedure promoting bone augmentation in the maxillary sinus. The aim of this study was to examine the effect of simultaneous sinus lift and implantation using platelet-rich fibrin as the sole grafting material on bone formation in a canine sinus model. An implant was placed after sinus membrane elevation in the maxillary sinus of six adult female mongrel dogs. The resulting space between the membrane and sinus floor was filled with autologous platelet-rich fibrin retrieved from each dog. The implants were left in place for six months. Bone tissue was seen at the lower part of the implants introduced into the sinus cavity. The height of the newly formed bone around the implants ranged from 0 mm to 4.9 mm (mean; 2.6 ± 2.0 mm) on the buccal side and from 0 mm to 4.2 mm (mean; 1.3 ± 1.8 mm) on the palatal side. The findings from this study suggest that simultaneous sinus lift and implantation using platelet-rich fibrin as sole grafting material is not a predictable and reproducible procedure, especially with respect to the bone formation around the implants in the sinus cavity. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. All rights reserved.

Computed tomography-based volumetric tool for standardized measurement of the maxillary sinus

PubMed Central

Giacomini, Guilherme; Pavan, Ana Luiza Menegatti; Altemani, João Mauricio Carrasco; Duarte, Sergio Barbosa; Fortaleza, Carlos Magno Castelo Branco; Miranda, José Ricardo de Arruda

2018-01-01

Volume measurements of maxillary sinus may be useful to identify diseases affecting paranasal sinuses. However, literature shows a lack of consensus in studies measuring the volume. This may be attributable to different computed tomography data acquisition techniques, segmentation methods, focuses of investigation, among other reasons. Furthermore, methods for volumetrically quantifying the maxillary sinus are commonly manual or semiautomated, which require substantial user expertise and are time-consuming. The purpose of the present study was to develop an automated tool for quantifying the total and air-free volume of the maxillary sinus based on computed tomography images. The quantification tool seeks to standardize maxillary sinus volume measurements, thus allowing better comparisons and determinations of factors that influence maxillary sinus size. The automated tool utilized image processing techniques (watershed, threshold, and morphological operators). The maxillary sinus volume was quantified in 30 patients. To evaluate the accuracy of the automated tool, the results were compared with manual segmentation that was performed by an experienced radiologist using a standard procedure. The mean percent differences between the automated and manual methods were 7.19% ± 5.83% and 6.93% ± 4.29% for total and air-free maxillary sinus volume, respectively. Linear regression and Bland-Altman statistics showed good agreement and low dispersion between both methods. The present automated tool for maxillary sinus volume assessment was rapid, reliable, robust, accurate, and reproducible and may be applied in clinical practice. The tool may be used to standardize measurements of maxillary volume. Such standardization is extremely important for allowing comparisons between studies, providing a better understanding of the role of the maxillary sinus, and determining the factors that influence maxillary sinus size under normal and pathological conditions. PMID:29304130

A method of sealing perforated sinus membrane and histologic finding of bone substitutes: a case report.

PubMed

Shin, Hong-In; Sohn, Dong-Seok

2005-12-01

To augment the atrophic posterior maxilla, a sinus bone graft has been widely used for sinus floor augmentation. Various bone substitutes have been developed and grafted in the maxillary sinus with and without membranes perforation, although autogenous bone is recommended as a gold standard of grafting materials. Membrane perforation is the most common complication associated with sinus bone graft. To repair a perforation, various methods have been developed. This case report is focused on histologic findings of 1 bovine hydroxyapatite (Bio-Oss; Geistlich Pharma AG, Wolhusen, Switzerland) and 2 kinds of human mineral allograft- Tutoplast cancellous microchips (TutoGen Medical GmbH, Neunkirchen am. Brand Germany), and irradiated allogeniccancellous bone and marrow (ICB; Rocky Mountain Tissue Bank, Aurora, CO) used for sinus graft in the same patient with membrane perforation after various healing periods. Mineral allograft showed favorable new bone regeneration with the repair of membrane perforation. This case report also describes a technique regarding how to repair completely perforated sinus membrane after the removal of a mucocele using human collagen membrane (Tutoplast pericardium; TutoGen Medical GmbH) and fibrin adhesive (Greenplast; Green Cross Co., Youngin, Korea) to stabilize collagen membrane.

Volume changes of autogenous bone after sinus lifting and grafting procedures: a 6-year computerized tomographic follow-up.

PubMed

Sbordone, Carolina; Toti, Paolo; Guidetti, Franco; Califano, Luigi; Bufo, Pantaleo; Sbordone, Ludovico

2013-04-01

To evaluate long-term bone remodelling of autografts over time (annually, for 6 years), comparing the block and particulate bone procedures for sinus floor elevation, as well as to evaluate the survival of positioned dental implants. Twenty-three sinus lift procedures with autogenous bone were performed: seven sinus lift procedures using particulate graft and 10 with block autogenous bone were performed in 17 patients. Employing a software program, pre- and post-surgical computerized tomography (CT) scans were used to compare the volume (V) and density (D) of inlay grafts over time (up to 6 years), and to determine the percentage of remaining bone (%R). All variable (V, D and %R) measurements were then compared statistically. At the 6-year survey for block form, a resorption of 21.5% was seen, whereas for particulate grafts there was a resorption of 39.2%. Both groups exhibited bone remodelling between the first and second follow-up which was significant regarding volume for the block form and regarding density for the particulate group. During the initial period of healing, the cortico-cancellous block bone grafted into the maxillary sinus underwent a negative remodelling of the volume, which is most probably due to graft cortex resorption, coupled with, primarily, an increase in density in the spongious area; for the particulate grafts, significant augmentations in density were obtained. The lack of significant differences among volumes was due to the wide degree of dispersion of the data. The rough data presented in this paper seem to support the use of a bone-block grafting procedure in maxillary sinus augmentation. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

A hybrid technique for sinus floor elevation in the severely resorbed posterior maxilla

PubMed Central

Jung, Ui-Won; Hong, Ji-Youn; Lee, Jung-Seok; Kim, Chang-Sung; Cho, Kyoo-Sung

2010-01-01

Purpose This study aimed to evaluate the effectiveness of the modified sinus floor elevation technique described hereafter as a "hybrid technique," in 11 patients with severely resorbed posterior maxillae. Methods Eleven patients who received 22 implants in the maxillary premolar and molar areas by the hybrid technique were enrolled in this study. A slot-shaped osteotomy for access was prepared on the lateral wall along the lower border of the sinus floor. The Schneiderian membrane was fully reflected through the lateral slot. Following drilling with the membrane protected by a periosteal elevator, the bone was grafted. All implants were placed simultaneously with sinus augmentation. The cumulative success rate was calculated and clinical parameters were recorded. Radiographic measurements were performed. Results All implants were well maintained at last follow up (cumulative success rate=100%). The mean residual bone height, augmented bone height, crown-to-implant ratio, and marginal bone loss were 4.1±1.64 mm, 8.76±1.77 mm, 1.21±0.33 mm, and 0.34±0.72 mm, respectively. Conclusions Simultaneous implant placement with sinus augmentation by hybrid technique showed successful clinical results over a 2-year observation period and may be a reliable modality for reconstruction of a severely resorbed posterior maxilla. PMID:20498764

Is the Maxillary Sinus Really Suitable in Sex Determination? A Three-Dimensional Analysis of Maxillary Sinus Volume and Surface Depending on Sex and Dentition.

PubMed

Möhlhenrich, Stephan Christian; Heussen, Nicole; Peters, Florian; Steiner, Timm; Hölzle, Frank; Modabber, Ali

2015-11-01

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.

Maxillary sinus volume in patients with impacted canines.

PubMed

Oz, Aslihan Zeynep; Oz, Abdullah Alper; El, Hakan; Palomo, Juan Martin

2017-01-01

To evaluate the maxillary sinus volumes in unilaterally impacted canine patients and to compare the volumetric changes that occur after the eruption of canines to the dental arch using cone beam computed tomography (CBCT). Pre- (T0) and posttreatment (T1) CBCT records of 30 patients were used to calculate maxillary sinus volumes between the impacted and erupted canine sides. The InVivoDental 5.0 program was used to measure the volume of the maxillary sinuses. The distance from impacted canine cusp tip to the target point on the palatal plane was also measured. Right maxillary sinus volume was statistically significantly smaller compared to that of the left maxillary sinus when the canine was impacted on the right side at T0. According to the T1 measurements there was no significant difference between the mean volumes of the impaction side and the contralateral side. The distance from the canine tip to its target point on the palatal plane were 17.17 mm, and the distance from the tip to the target point was 15.14 mm for the left- and right-side impacted canines, respectively, and there was a significant difference between the mean amount of change of both sides of maxillary sinuses after treatment of impacted canines. Orthodontic treatment of impacted canines created a significant increase in maxillary sinus volume when the impacted canines were closer with respect to the maxillary sinus.

The microbiology of ethmoid and maxillary sinuses in patients with chronic sinusitis.

PubMed

Aral, Murat; Keles, Erol; Kaygusuz, Irfan

2003-01-01

To investigate aerob-anaerob microorganisms growth in maxillary and ethmoid sinuses by evaluating aspiration materials from patients with chronic sinusitis. The study was performed prospectively, and there were 31 patients (23 men, 8 women; mean age, 31.4+/-14.15, between 18-65 years) who had endoscopic sinus surgery because of chronic sinusitis. During the operation, when the maxillary sinus ostium and ethmoid sinus were opened, readily aspirated materials from sinuses were evaluated regarding aerob and anaerob bacteria. Nose and throat swap samples were collected preoperatively to determine the upper respiratory tract flora and also to understand the relationship between the flora and the microorganisms aspirated from sinuses. Total aerob bacteria count, which was isolated from preoperative nasal swab cultures, was 36, and aerob-anaerob bacteria count that included cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery was 42. For each 2 samples, the most common isolated aerob bacteria were coagulase (-) staphylococci. Microorganisms were isolated in 87.0% of 27 patients, in which cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery were included. It is determined that the isolated aerob bacteria rate was 90.4%, and the isolated anaerob bacteria rate was 14.2%. All of the 6 samples in which anaerob bacteria isolated were all maxillary sinus aspiration materials. Microorganisms that isolated from the nose and the sinuses were similar with the rate of 25.8%, and microorganisms that isolated from the throat cultures and sinuses were similar with the rate of 22.5%. This study reveals the aerob and anaerob microbiology of the maxillary and ethmoid sinuses so the treatment of chronic sinusitis will be easier.

Airflow and temperature distribution inside the maxillary sinus: a computational fluid dynamics simulation.

PubMed

Zang, Hongrui; Liu, Yingxi; Han, Demin; Zhang, Luo; Wang, Tong; Sun, Xiuzhen; Li, Lifeng

2012-06-01

The airflow velocity and flux in maxillary sinuses were much lower than those in the nasal cavity, and the temperature in maxillary sinuses was much higher than the temperature in the middle meatus. With the increase of maximum diameter of the ostium, the above indices changed little. The purpose of the paper was to investigate, first, the flow and temperature distribution inside normal maxillary sinus in inspiration, and second, flow and temperature alteration with the increase of maximum ostium diameter. Three-dimensional models with nasal cavities and bilateral maxillary sinuses were constructed for computational fluid dynamics analysis. Virtual surgeries were implemented for the maxillary ostium, the maximum diameters of which were 8, 10, 12, and 15 mm, respectively. The finite volume method was used for numerical simulation. The indices of velocity, pressure, vector, and temperature were processed and compared between models. The airflow velocity in maxillary sinuses (average velocity 0.062 m/s) was much lower than that in the middle meatus (average velocity 3.26 m/s). With the increase of ostium diameter, airflow characteristics distributed in the maxillary sinuses changed little. The normal temperature in the maxillary sinus remained almost constant at 34°C and changed little with the increase of ostium diameter.

A high concentration of recombinant human bone morphogenetic protein-2 induces low-efficacy bone regeneration in sinus augmentation: a histomorphometric analysis in rabbits.

PubMed

Hong, Ji-Youn; Kim, Min-Soo; Lim, Hyun-Chang; Lee, Jung-Seok; Choi, Seong-Ho; Jung, Ui-Won

2016-12-01

The aim of the study was to elucidate the efficacy of bone regeneration at the early stage of healing in rabbit sinuses grafted with a biphasic calcium phosphate (BCP) carrier soaked in a high concentration of recombinant human bone morphogenetic protein-2 (rhBMP-2). Both maxillary sinuses of eight male rabbits were used. The sinus on one side (assigned randomly) was grafted with BCP loaded with rhBMP-2 (1.5 mg/ml; test group) using a soaking method, while the other was grafted with saline-soaked BCP (control group). After a 2-week healing period, the sinuses were analyzed by micro-computed tomography and histomorphometry. The total augmented area and soft tissue space were significantly larger in the test group than in the control group, whereas the opposite was true for the area of residual material and newly formed bone. Most of the new bone in the test group was localized to the Schneiderian membrane (SM), while very little bone formation was observed in the window and center regions of the sinus. New bone was distributed evenly in the control group sinuses. Within the limitations of this study, it appeared that application of a high concentration of rhBMP-2 soaked onto a BCP carrier inhibited bone regeneration from the pristine bone and increased soft tissue swelling and inflammatory response at the early healing stage of sinus augmentation, although osteoinductive potential was found along the SM. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Nanocrystalline hydroxyapatite bone substitute leads to sufficient bone tissue formation already after 3 months: histological and histomorphometrical analysis 3 and 6 months following human sinus cavity augmentation.

PubMed

Ghanaati, Shahram; Barbeck, Mike; Willershausen, Ines; Thimm, Benjamin; Stuebinger, Stefan; Korzinskas, Tadas; Obreja, Karina; Landes, Constantin; Kirkpatrick, Charles J; Sader, Robert A

2013-12-01

In this study the de novo bone formation capacity of a nanocrystalline hydroxyapatite bone substitute was assessed 3 and 6 months after its insertion into the human sinus cavity. Sinus cavity augmentation was performed in a total of 14 patients (n = 7 implantation after 3 months; n = 7 implantation after 6 months) with severely atrophic maxillary bone. The specimens obtained after 3 and 6 months were analyzed histologically and histomorphometrically with special focus on bone metabolism within the residual bone and the augmented region. This study revealed that bone tissue formation started from the bone-biomaterial-interface and was directed into the most cranial parts of the augmented region. There was no statistically significant difference in new bone formation after 3 and 6 months (24.89 ± 10.22% vs 31.29 ± 2.29%), respectively. Within the limits of the present study and according to previously published data, implant insertion in regions augmented with this bone substitute material could be considered already after 3 months. Further clinical studies with bone substitute materials are necessary to validate these findings. © 2012 Wiley Periodicals, Inc.

Simultaneous Sinus Lifting and Alveolar Distraction of a Severely Atrophic Posterior Maxilla for Oral Rehabilitation with Dental Implants

PubMed Central

Kanno, Takahiro; Mitsugi, Masaharu; Paeng, Jun-Young; Sukegawa, Shintaro; Furuki, Yoshihiko; Ohwada, Hiroyuki; Nariai, Yoshiki; Ishibashi, Hiroaki; Katsuyama, Hideaki; Sekine, Joji

2012-01-01

We retrospectively reviewed a new preimplantation regenerative augmentation technique for a severely atrophic posterior maxilla using sinus lifting with simultaneous alveolar distraction, together with long-term oral rehabilitation with implants. We also analyzed the regenerated bone histomorphologically. This study included 25 maxillary sinus sites in 17 patients. The technique consisted of alveolar osteotomy combined with simultaneous sinus lifting. After sufficient sinus lifting, a track-type vertical alveolar distractor was placed. Following a latent period, patient self-distraction was started. After the required augmentation was achieved, the distractor was left in place to allow consolidation. The distractor was then removed, and osseointegrated implants (average of 3.2 implants per sinus site, 80 implants) were placed. Bone for histomorphometric analysis was sampled from six patients and compared with samples collected after sinus lifting alone as controls (n = 4). A sufficient alveolus was regenerated, and all patients achieved stable oral rehabilitation. The implant survival rate was 96.3% (77/80) after an average postloading followup of 47.5 months. Good bone regeneration was observed in a morphological study, with no significant difference in the rate of bone formation compared with control samples. This new regenerative technique could be a useful option for a severely atrophic maxilla requiring implant rehabilitation. PMID:22792105

[Radiologic picture of maxillary sinus aspergilloma].

PubMed

Kaczmarek, I; Bilska, J; Osmola, K; Nowaczyk, M T

2010-06-01

Mycotic infection of paranasal sinus could be the etiological factor of chronic sinusitis. The increase in number of fungal sinusitis cases have been reported recently among nonimmunocompromised patient after endodontic treatment of maxillary teeth. Nonspecific clinical signs and incorrect radiologic pictures interpretation as well as loss of therapeutic standards seems to be the cause of false negative diagnosis and difficulties in treatment of fungal sinusitis. Clinical and radiological picture of maxillary sinus aspergillosis was described in this paper. In the period of 2006-2009 in the Department of Maxillo-Facial Surgery 19 patient with fungal maxillary sinusitis was treated. The endodontic treatment of maxillary teeth of the related side was performed previously in 80% examined cases. In 2 cases there were immunocompromised patients with immunosuppressive treatment. In 16 cases patients were referred to our Department due to metallic foreign body of the maxillary sinus. Routine diagnostic radiological imaging was performed in each case: paranasal sinus view--Water's view and panoramic radiograph (orthopantomograph). In 4 cases imaging was extended with computer tomography (CT) visualization. The surgical treatment was performed in each case. The final diagnosis was puted on histopathological examination and fungal culture. In 16 cases of analysed group histopathological examination and fungal culture revealed aspergilosis. In 2 cases fungal culture was negative, but histopathology slices confirm presence of hyphae of Aspergillus. In 1 case the root canal sealer was found in the maxillary sinus. In none case invasive form of aspergillosis was confirmed. In all cases Water's view of paranasal sinuses and ortopantomograph showed partially or totally clouded sinus with well-defined, single or multifocal radiopaque object similar to metallic foreign body. Characteristic finding in CT imaging was well-defined radiodence concretions that have been attributed to calcium deposits in inflammatory changed mucosa, that might suggest "foreign body" picture. In 1 to 3 years follow-up control there was a recurrence of symptoms in one case. Foreign body of maxillary sinus have to be differentiated with aspergilosis. Metallic "foreign body" view in maxillary sinus seems to be characteristic sign of aspergillosis. The most often form of maxillary sinus aspergilosis is aspergilloma.

Root Cause Analysis: An Examination of Odontogenic Origins of Acute Maxillary Sinusitis in Both Immunocompetent & Immunocompromised Patients.

PubMed

McCarty, Jennifer L; David, Ryan M; Lensing, Shelly Y; Samant, Rohan S; Kumar, Manoj; Van Hemert, Rudy L; Angtuaco, Edgardo J C; Fitzgerald, Ryan T

Dental and periodontal diseases represent important but often overlooked causes of acute sinusitis. Our goal was to examine the prevalence of potential odontogenic sources of acute maxillary sinusitis according to immune status and their associations with sinusitis. A retrospective review of maxillofacial computed tomography studies from 2013 to 2014 was performed. Each maxillary sinus and its ipsilateral dentition were evaluated for findings of acute sinusitis and dental/periodontal disease. Eighty-four patients (24 immunocompetent, 60 immunocompromised) had 171 maxillary sinuses that met inclusion criteria for acute maxillary sinusitis. Inspection of dentition revealed oroantral fistula in 1%, periapical lucencies in 16%, and projecting tooth root(s) in 71% of cases. Immunocompromised patients were more likely to have bilateral sinusitis than immunocompetent patients (67% vs 33%, P = 0.005). A paired case-control analysis in a subset of patients with unilateral maxillary sinusitis (n = 39) showed a higher prevalence of periapical lucency in association with sinuses that had an air fluid level-29% of sinuses with a fluid level had periapical lucency compared with 12% without sinus fluid (P = 0.033). Potential odontogenic sources of acute maxillary sinusitis are highly prevalent in both immunocompetent and immunocompromised patients, although the 2 patient populations demonstrate no difference in the prevalence of these potential odontogenic sources. Periapical lucencies were found to be associated with an ipsilateral sinus fluid level. Increased awareness of the importance of dental and periodontal diseases as key components of maxillofacial computed tomography interpretation would facilitate a more appropriate and timely treatment.

Graft shrinkage and survival rate of implants after sinus floor elevation using a nanocrystalline hydroxyapatite embedded in silica gel matrix: a 1-year prospective study.

PubMed

El Hage, Marc; Abi Najm, Semaan; Bischof, Mvark; Nedir, Rabah; Carrel, Jean-Pierre; Bernard, Jean-Pierre

2012-06-01

The aims of this study were (1) to evaluate the vertical shrinkage percentage of nanocrystalline hydroxyapatite embedded in silica gel used for maxillary sinus floor elevation (SFE) and (2) to determine the survival rate of the implants 1 year after placement in the healed grafted sinuses. Eleven maxillary sinuses were augmented in eight patients with NanoBone. After a healing period averaging 14.42 months, 19 implants were placed and followed up with clinical and radiographic evaluation. Panoramic radiographs were taken immediately after SFE and at 12 months after grafting. Measurements of changes in height were made by a computerized measuring technique using an image editing software. The mean graft height shrinkage percentage at 12 months after surgery was 8.84% (±5.32). One implant was lost before loading. All the 18 remaining osseointegrated implants received the prosthetic rehabilitation and were controlled after 3 months of functional loading. The implant survival rate at the 1-year interval was 94.74%. A 100% NanoBone alloplastic graft used in lateral SFE procedures presented limited height shrinkage. Implants placed in these grafted sinuses showed survival rates similar to those found in published data. These results should be interpreted cautiously considering the study's reduced sample size.

Maxillary Sinus Dimensions Decrease as Age and Tooth Loss Increase.

PubMed

Velasco-Torres, Miguel; Padial-Molina, Miguel; Avila-Ortiz, Gustavo; García-Delgado, Raúl; OʼValle, Francisco; Catena, Andrés; Galindo-Moreno, Pablo

2017-04-01

To investigate the correlation between patient-dependent variables and dimensional variations of the maxillary sinus. In this cross-sectional study, a total of 394 individual cone-beam computed tomography scans were evaluated by one calibrated examiner to measure the total volume of the maxillary sinus, the distance between the medial and the lateral walls at 5, 10, and 15 mm vertically from the sinus floor, the height of septa (if present), and the height of the maxillary sinus cavity from both the alveolar crest and the sinus floor to the meatus. Recorded patient-dependent variables were age, gender, and edentulism status. Total maxillary sinus volume was significantly smaller in completely and partially edentulous patients than in dentate subjects. This finding was influenced by age, as older patients exhibited less volume, regardless of gender and edentulism status. Age showed an indirect correlation with the distance to the meatus, the sinus volume, and the mediolateral dimensions. Additionally, the prevalence of accessory meatus in this population was 29.19%. The dimensions of the maxillary sinus are influenced by age and edentulism status being reduced by aging and tooth loss.

Palatal versus vestibular piezoelectric window osteotomy for maxillary sinus elevation: a comparative clinical study of two surgical techniques.

PubMed

Stübinger, Stefan; Saldamli, Belma; Seitz, Oliver; Sader, Robert; Landes, Constantin A

2009-05-01

The goal of this study was to compare the surgical advantages and disadvantages of a new palatal access osteotomy for sinus elevation with a conventional lateral approach. In 32 patients, either a palatal (n = 16) or a lateral (n = 16) osteotomy to the maxillary sinus was performed under local anesthesia. The palatal access included a circular paramarginal incision and elevation of a palatal mucosal flap based on a median pedicle. The lateral access was performed by vestibular standard incision and development of a mucoperiosteal flap with a vestibular and superior basis. For all osteotomies a piezoelectric device was used. The sinus cavity was augmented with synthetic nanostructured hydroxyapatite graft material. Intraoperative complications during both procedures were minimal and wound healing was uneventful. Membrane perforation occurred in 19% of the palatal group and in 19% of the lateral group. Soft tissue management of the palatal technique was superior to that of the lateral approach, because the vestibular anatomy was not altered and consequently no disharmonious soft tissue scarring and no postoperative swelling occurred. The palatal approach permitted higher postoperative comfort, especially for edentulous patients, because full dentures could be incorporated directly after surgery with almost perfect fit.

An easy access to retrieve dental implants displaced into the maxillary sinus: the bony window technique.

PubMed

Biglioli, Federico; Chiapasco, Matteo

2014-12-01

To present the authors' experience concerning the removal of dental implants displaced in the maxillary sinus via an intraoral approach consisting of the creation of a bony window pedicled to the maxillary sinus membrane. Thirty-six systemically healthy patients, presenting with oral implants displaced into the maxillary sinus, but with no signs of acute or chronic sinusitis, were consecutively treated between 2002 and 2012 via an intraoral approach with the bony window technique. Removal of oral implants from the maxillary sinus was achieved in all patients, and postoperative recovery was uneventful in all of them. Computed tomographies performed after surgery showed no signs of residual sinus infection in all patients and a complete ossification of the bony window margins. Twelve of the 36 treated patients were treated with a sinus grafting procedure 12-18 months after in the same areas previously treated with the bone lid technique. Seventeen implants were placed in the grafted areas 6-9 months later and, after a further waiting period needed for osseointegration, the treated patients were rehabilitated with implant-supported prostheses. The survival rate of implants was 100%, and no complications related to the sinuses and implants were recorded. Results from this study seem to demonstrate that the bony window technique is a safe and easy way to remove oral implants from the maxillary sinus under local anesthesia. The surgical access is hardly visible 6-12 months after surgery, and maxillary sinuses appeared free from residual pathology in all treated patients. Finally, this procedure allows a second-stage sinus grafting procedure via a lateral approach as in a previously untreated maxillary sinus, thus allowing an implant-supported prosthetic restoration. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Aspergillus in endodontic infection near the maxillary sinus.

PubMed

Gomes, Cinthya Cristina; Pinto, Larissa Christina Costa; Victor, Fernanda Loretti; Silva, Erlange Andrade Borges da; Ribeiro, Apoena de Aguiar; Sarquis, Maria Inês de Moura; Camões, Isabel Coelho Gomes

2015-01-01

Diseases of the maxillary sinus have been associated with dental roots near the maxillary sinus that have undergone endodontic treatment. To investigate the presence of filamentous fungi in patients with dental roots near the maxillary sinus who had apical periodontitis treated endodontically, and to alert practitioners that this could be a possible avenue of contamination of the sinus in patients who develop maxillary sinus infection. Cross-sectional study in 60 palatal roots of the first maxillary molars near the maxillary sinus, that underwent endodontic treatment for apical periodontitis. After removal of the filling material, dentin shavings were collected and placed in test tubes containing Sabouraud dextrose agar and chloramphenicol. The phenotype was determined by macroscopic and microscopic examination of the colonies. For polymerase chain reaction, the primers ITS-5 and ITS-4 were used. The sequences obtained were compared with those deposited at GenBank using the Basic Local Alignment Search Tool program. Filamentous fungi were isolated from 6 of 60 canals (10%): Aspergillus niger (6.7%), Aspergillus versicolor (1.6%), and Aspergillus fumigatus (1.6%). Root canals near the maxillary sinus with endodontic treatment and apical periodontitis may exhibit positive cultures for filamentous fungi. Interested professionals should be alert, because these microorganisms have pathogenic characteristics that can cause disease of odontogenic origin in the maxillary sinus. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Sex Determination of Adult Human Maxillary Sinuses on Panoramic Radiographs

PubMed Central

Leao de Queiroz, Cristhiane; Terada, Andrea Sayuri Silveira Dias; Dezem, Thais Uenoyama; Gomes de Araújo, Lais; Galo, Rodrigo; Oliveira-Santos, Christiano

2016-01-01

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

Drainage of the maxillary sinus: a comparative anatomy study in humans and goats.

PubMed

Ford, Rebecca L; Barsam, Alon; Velusami, Prabhu; Ellis, Harold

2011-02-01

The maxillary sinuses are the most frequently infected paranasal sinuses in humans. It has been suggested that infection occurs relatively commonly in the maxillary sinuses owing to the position of their ostia high on their superomedial walls, which may be suboptimal for natural drainage. This may represent evolutionary lag, whereby the ostia remained in a quadrupedal position as bipedal humans evolved from their primate ancestors. This study examined the hypothesis that drainage of the maxillary sinus is optimal in the quadrupedal position. The drainage of the human maxillary sinus and an analogous quadruped, the goat, was examined and compared in the upright, quadrupedal, and intermediate positions. Department of Anatomy, King's College London. Cadaveric human and goat maxillary sinuses were filled with saline in each position and the volume at which saline overflowed through the ostia was noted. Volume at which spontaneous drainage occurred through ostia. The volume of saline instilled before drainage was maximal in the upright position and reduced with each increase in anterior tilt, with drainage occurring most easily at 90° for both human and goat sinuses. Drainage was significantly better in the quadrupedal head position than upright in both species (p < .01). This study demonstrated that human maxillary sinuses exhibit better passive drainage through their ostia when tilted anteriorly to mimic a quadrupedal head position. This may be an example of an evolutionary lag phenomenon and could be one etiologic factor in the prevalence of maxillary sinusitis in humans.

Three-dimensional CAD/CAM imaging of the maxillary sinus in ageing process.

PubMed

Lovasova, Kvetuse; Kachlik, David; Rozpravkova, Mirela; Matusevska, Maria; Ferkova, Jana; Kluchova, Darina

2018-04-05

During the physiological ageing process atrophy of the alveolar bone appears in vertical direction. This bone resorption causes pushing the limits of the maxillary sinus at the expense of a degraded bone. The sinus volume increases due to the facial development in children and adolescents or during the ageing process due to the loss of teeth and bone mass. The main aim of this study is to determine the sinus shape and sinus floor morphology related to age. Human adult male and female cadaveric heads (aged 37 to 83 years) with different dental status were used. The three-dimensional CAD/CAM software was used to scan the solid impressions of the maxillary sinus to visualize the real sinus shape and sinus floor. Subsequently, other findings are shown in tables and evaluated graphically. The maxillary sinus morphology, its relationship to the nasal cavity, the sub sinus alveolar bone height, displacement of the lowest and highest points of sinus, and the sinus relationship to the roots of the upper teeth were studied and evaluated. Some septa, crests, and the prominent infraorbital canal were also found in the area of the sinus floor. This paper provides a unique view on the maxillary sinus and its changes during the ageing process with preserved topographical relations in a representative sample of the Slovak population. The visualization of the maxillary sinus anatomy is necessary in the diagnosis and treatment plans for dental implants and during current surgical procedures. Copyright © 2018 Elsevier GmbH. All rights reserved.

Bone Engineering of Maxillary Sinus Bone Deficiencies Using Enriched CD90+ Stem Cell Therapy: A Randomized Clinical Trial.

PubMed

Kaigler, Darnell; Avila-Ortiz, Gustavo; Travan, Suncica; Taut, Andrei D; Padial-Molina, Miguel; Rudek, Ivan; Wang, Feng; Lanis, Alejandro; Giannobile, William V

2015-07-01

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 tissue engineered bone quality in other craniofacial bone defects and deficiencies (Clinicaltrials.gov NCT00980278). © 2015 American Society for Bone and Mineral Research.

Silent sinus syndrome an acquired condition and the essential role of otorhinolaryngologist consultation: a retrospective study.

PubMed

Martínez-Capoccioni, Gabriel; Varela-Martínez, Ernesto; Martín-Martín, Carlos

2016-10-01

The silent sinus syndrome (SSS) is a rare clinical entity characterized by painless spontaneous enophthalmos, hypoglobus, and facial deformities secondary to chronic maxillary sinus atelectasis. The aim of this study was to present an SSS diagnostic feature and evaluate the relationship between nasal septum deviation and maxillary sinus volume. A retrospective chart review of the clinical characteristics of 20 patients diagnosed with SSS between January 2013 and July 2014 were analyzed by the Department of Otorhinolaryngology of University Hospital Complex of Santiago de Compostela. 14 patients were females and six males. The mean age was 43 years (range 28-67 years). The right maxillary sinus was involved in 12 patients and the left maxillary sinus in eight patients. There was no statistical difference between gender and the presence of SSS. Maxillary sinus sizes were significantly smaller on the same side as the deviation (p < 0.01). 14 patients were treated with functional endoscopic sinus surgery (FESS) with maxillary antrostomy. We concluded that patients with SSS usually present with facial asymmetry, and the best approach to document and show all facial asymmetries for these patients are the frontal and craneo-caudal photographs. The present study demonstrates that, in adult patients, SSS generally presents a septal deviation to the affected maxillary sinus. We recommend performing a paranasal sinus CT scan when the patient has a deviated nasal septum, retraction of the malar eminence (evidenced from the viewpoint cranio-caudal facial) and hypoglobus. FESS performing postero-anterior uncinectomy and enlargement of the maxillary ostium is recommended to restore sinus pressure and prevent progression of the enophthalmos, hypoglobus and facial deformities.

Use of piezosurgery during maxillary sinus elevation: clinical results of 40 consecutive cases.

PubMed

Cassetta, Michele; Ricci, Laura; Iezzi, Giovanna; Calasso, Sabrina; Piattelli, Adriano; Perrotti, Vittoria

2012-12-01

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.

Topographic analysis of maxillary premolars and molars and maxillary sinus using cone beam computed tomography.

PubMed

Yoshimine, Shin-Ichiro; Nishihara, Kazuhide; Nozoe, Etsuro; Yoshimine, Masako; Nakamura, Norifumi

2012-12-01

This study evaluated the anatomical characteristics of the maxillary premolars and molars and the maxillary sinus using cone beam computed tomography (CBCT) for dental implant treatment. Ten linear items and 1 angular item on 30 sites in 30 patients were measured on 3-dimensional computed tomography images using CBCT. The vertical relationship between the maxillary sinus and the maxillary molars was classified into 5 categories. The horizontal thickness of the buccal alveolar bone was thinnest on the maxillary first premolars, and the horizontal thickness of the palatal alveolar bone was thickest on the maxillary second molars. Type II was most common on the maxillary first molars. The internal angle at the maxillary premolars was significantly greater than that at the maxillary molars. The internal angle and vertical distance between the apex of the roots and the maxillary sinus floor showed a positive correlation on the maxillary first premolars (P = 0.003). For the selection of an appropriate approach on dental implant treatment, the evaluation of maxillary premolars and molars using of CBCT can be recommended.

Effect of accessory ostia on maxillary sinus ventilation: a computational fluid dynamics (CFD) study.

PubMed

Zhu, Jian Hua; Lee, Heow Pueh; Lim, Kian Meng; Gordon, Bruce R; Wang, De Yun

2012-08-15

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.

The effects of uncinectomy and natural ostial dilatation on maxillary sinus ventilation: a clinical experimental study.

PubMed

Kutluhan, Ahmet; Şalvız, Mehti; Bozdemir, Kazım; Kanbak, Orhan; Ulu, Mustafa; Yalçıner, Gökhan; Bilgen, Akif Sinan

2011-04-01

The purpose of this study was to determine the effect of uncinectomy without sinusotomy and natural ostial dilatation on maxillary sinus ventilation in chronic rhinosinusitis. Twenty patients with chronic rhinosinusitis were included in this study. The patients were randomly divided into two groups. Group 1 consisted of patients with uncinectomy (n = 10), while group 2 was made up of patients treated with natural ostial dilatation (n = 10). The CO(2) tension and pressure levels of the maxillary sinus during inspiration and expiration phases were obtained and compared before and after the procedures within and between the groups. The mean CO(2) tension levels in both groups were significantly decreased after the procedures. The mean maxillary sinus pressure during inspiration was significantly decreased to a negative value after uncinectomy; however, no significant change was observed during expiration. There were no significant changes in maxillary sinus pressures after natural ostial dilatation procedure. Both uncinectomy and natural ostial dilatation seem to be equally effective in decreasing maxillary sinus pCO(2) levels. The effects of decreased maxillary sinus pressure during inspiration after uncinectomy on mucociliary clearance and development mechanisms of chronic rhinosinusitis seem to be worth investigating.

Marker-free registration for the accurate integration of CT images and the subject's anatomy during navigation surgery of the maxillary sinus

PubMed Central

Kang, S-H; Kim, M-K; Kim, J-H; Park, H-K; Park, W

2012-01-01

Objective This study compared three marker-free registration methods that are applicable to a navigation system that can be used for maxillary sinus surgery, and evaluated the associated errors, with the aim of determining which registration method is the most applicable for operations that require accurate navigation. Methods The CT digital imaging and communications in medicine (DICOM) data of ten maxillary models in DICOM files were converted into stereolithography file format. All of the ten maxillofacial models were scanned three dimensionally using a light-based three-dimensional scanner. The methods applied for registration of the maxillofacial models utilized the tooth cusp, bony landmarks and maxillary sinus anterior wall area. The errors during registration were compared between the groups. Results There were differences between the three registration methods in the zygoma, sinus posterior wall, molar alveolar, premolar alveolar, lateral nasal aperture and the infraorbital areas. The error was smallest using the overlay method for the anterior wall of the maxillary sinus, and the difference was statistically significant. Conclusion The navigation error can be minimized by conducting registration using the anterior wall of the maxillary sinus during image-guided surgery of the maxillary sinus. PMID:22499127

Volumetric analysis of maxillary sinuses of Zulu and European crania by helical, multislice computed tomography.

PubMed

Fernandes, C L

2004-11-01

The volumes of the maxillary sinuses are of interest to surgeons operating endoscopically as variation in maxillary sinus volume may mean variation in anatomical landmarks. Other surgical disciplines, such as dentistry, maxillo-facial surgery and plastic surgery, may benefit from this information. To compare the maxillary sinus volumes of dried crania from cadavers of European and Zulu descent, with respect to ethnic group and gender. Helical, multislice computed tomography (CT) was performed using 1-mm coronal slices. The area for each slice was obtained by tracing the outline of each slice. The CT machine calculated a volume by totalling the slices for each sinus. Ethnic and gender variations were found in the different groups. It was found that European crania had significantly larger antral volumes than Zulu crania and men had larger volumes than women. Race and gender interaction was also assessed, as was maxillary sinus side. A variation in maxillary sinus volume between different ethnic groups and genders exists, and surgeons operating in this region should be aware of this.

Endoscopic Modified Medial Maxillectomy for Fungal Ball of the Hypoplastic Maxillary Sinus With Bony Hypertrophy.

PubMed

Nomura, Kazuhiro; Ikushima, Hiroyuki; Ozawa, Daiki; Shimizu, Yuichi; Arakawa, Kazuya; Suzuki, Jun; Hidaka, Hiroshi; Katori, Yukio; Ohyama, Kenji

2018-05-01

Sinus fungal ball is defined as noninvasive chronic rhino-sinusitis with a clump of mold in the paranasal sinuses, typically affecting the maxillary sinus. Fairly good outcomes of endoscopic surgery have been reported where the ball is removed through the antrostomy. However, the affected sinus tends to have a smaller cavity and thicker bony walls. As such, it is often challenging to maintain a window size that is sufficient to control possible recurrence. The endoscopic modified medial maxillectomy procedure was applied to a 61-year old and a 70-year old female patient with maxillary sinus fungal ball. Using this method, we created a much larger inferior meatal antrostomy without difficulty. The window provided us with an endoscopic view of the whole sinus and complete eradication of the lesion. Endoscopic modified medial maxillectomy is useful as a surgical procedure for maxillary sinus fungal ball and should be considered for better outcomes.

A 3-year clinical follow-up of implants placed in two different biomaterials used for sinus augmentation.

PubMed

Lindgren, Christer; Mordenfeld, Arne; Johansson, Carina B; Hallman, Mats

2012-01-01

The aims of the present study were to compare a novel biphasic calcium phosphate (BCP) with deproteinized bovine bone (DBB) for maxillary sinus floor augmentation in a split-mouth design and to perform a clinical follow-up of dental implants placed in the augmented sinuses. Partially or completely edentulous patients requiring bilateral sinus augmentation were included in the study. The patients were randomized for augmentation with BCP (test) and DBB (control) in the contralateral side. Eight months after grafting, dental implants were placed. After 3 years of graft healing, core biopsy specimens were obtained from the grafted areas for histologic and histomorphometric analyses. After 3 years of functional implant loading, implant survival/success rates and clinical indices were assessed and radiographic examination and resonance frequency analysis were performed. Nine completely edentulous patients and two partially edentulous patients (mean age, 67 years) who required bilateral sinus augmentation were included in the study, and 62 implants were placed. The mean values for the area of newly formed bone in the retrieved specimens were 29% ± 14.3% and 32% ± 18.0% for BCP and DBB, respectively; the percentage of graft particles in contact with bone was 38% ± 10.9% in the BCP group and 44% ± 12.1% in the DBB group (no statistical significant differences between groups). The mean values for the area of BCP particles and DBB particles were 20% ± 7.5% and 24% ± 13.5%, respectively (difference not significant). One dental implant was lost from each group, resulting in an overall implant survival rate of 96.8% after 3 years of loading. After 3 years, a similar amount of newly formed bone was present regardless of the biomaterial used. The choice of biomaterial did not seem to influence implant survival rates.

Development of the maxillary sinus in infants and children.

PubMed

Bhushan, Bharat; Rychlik, Karen; Schroeder, James W

2016-12-01

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.

Maxillary sinusitis and periapical abscess following periodontal therapy: a case report using three-dimensional evaluation.

PubMed

Huang, Chih-Hao; Brunsvold, Michael A

2006-01-01

Maxillary sinusitis may develop from the extension of periodontal disease. In this case, reconstructed three-dimensional images from multidetector spiral computed tomographs were helpful in evaluating periodontal bony defects and their relationship with the maxillary sinus. A 42-year-old woman in good general health presented with a chronic deep periodontal pocket on the palatal and interproximal aspects of tooth #14. Probing depths of the tooth ranged from 2 to 9 mm, and it exhibited a Class 1 mobility. Radiographs revealed a close relationship between the root apex and the maxillary sinus. The patient's periodontal diagnosis was localized severe chronic periodontitis. Treatment of the tooth consisted of cause-related therapy, surgical exploration, and bone grafting. A very deep circumferential bony defect at the palatal root of tooth #14 was noted during surgery. After the operation, the wound healed without incidence, but 10 days later, a maxillary sinusitis and periapical abscess developed. To control the infection, an evaluation of sinus and alveolus using computed tomographs was performed, systemic antibiotics were prescribed, and endodontic treatment was initiated. Two weeks after surgical treatment, the infection was relieved with the help of antibiotics and endodontic treatment. Bilateral bony communications between the maxillary sinus and periodontal bony defect of maxillary first molars were shown on three-dimensional computed tomographs. The digitally reconstructed images added valuable information for evaluating the periodontal defects. Three-dimensional images from spiral computed tomographs (CT) aided in evaluating and treating the close relationship between maxillary sinus disease and adjacent periodontal defects.

Role of Modified Endoscopic Medial Maxillectomy in Persistent Chronic Maxillary Sinusitis

PubMed Central

Thulasidas, Ponnaiah; Vaidyanathan, Venkatraman

2014-01-01

Introduction Functional endoscopic sinus surgery has a long-term high rate of success for symptomatic improvement in patients with medically refractory chronic rhinosinusitis. As the popularity of the technique continues to grow, however, so does the population of patients with postsurgical persistent sinus disease, especially in those with a large window for ventilation and drainage. In addition, chronic infections of the sinuses especially fungal sinusitis have a higher incidence of recurrence even though a wide maxillary ostium had been performed earlier. This subset of patients often represents a challenge to the otorhinolaryngologist. Objectives To identify the patients with chronic recalcitrant maxillary sinusitis and devise treatment protocols for this subset of patients. Methods A retrospective review was done of all patients with persistent maxillary sinus disease who had undergone modified endoscopic medial maxillectomy between 2009 and 2012. We studied patient demographics, previous surgical history, and follow-up details and categorized the types of endoscopic medial maxillectomies performed in different disease situations. Results We performed modified endoscopic medial maxillectomies in 37 maxillary sinuses of 24 patients. The average age was 43.83 years. Average follow-up was 14.58 months. All patients had good disease control in postoperative visits with no clinical evidence of recurrences. Conclusion Modified endoscopic medial maxillectomy appears to be an effective surgery for treatment of chronic, recalcitrant maxillary sinusitis. PMID:25992084

Mesenchymal stem cells in maxillary sinus augmentation: A systematic review with meta-analysis

PubMed Central

Mangano, Francesco G; Colombo, Marco; Veronesi, Giovanni; Caprioglio, Alberto; Mangano, Carlo

2015-01-01

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 humans) and follow-up length (8 or 12 wk) as covariates. After adding publication year, support type and follow-up length to the meta-regression model, heterogeneity was no longer significant (I2 = 33%, P = 0.25). CONCLUSION: Several studies have demonstrated the potential for cell-based approaches in MSA; further clinical trials are needed to confirm these results. PMID:26240683

Transnasal endoscopic medial maxillectomy in recurrent maxillary sinus inverted papilloma.

PubMed

Kamel, Reda H; Abdel Fattah, Ahmed F; Awad, Ayman G

2014-12-01

Maxillary sinus inverted papilloma entails medial maxillectomy and is associated with high incidence of recurrence. To study the impact of prior surgery on recurrence rate after transnasal endoscopic medial maxillectomy. Eighteen patients with primary and 33 with recurrent maxillary sinus inverted papilloma underwent transnasal endoscopic medial maxillectomy. Caldwell-Luc operation was the primary surgery in 12 patients, transnasal endoscopic resection in 20, and midfacial degloving technique in one. The follow-up period ranged between 2 to 19.5 years with an average of 8.8 years. Recurrence was detected in 8/51 maxillary sinus inverted papilloma patients (15.7 %), 1/18 of primary cases (5.5 %), 7/33 of recurrent cases (21.2 %); 3/20 of the transnasal endoscopic resection group (15%) and 4/12 of the Caldwell-Luc group (33.3%). Redo transnasal endoscopic medial maxillectomy was followed by a single recurrence in the Caldwell-Luc group (25%), and no recurrence in the other groups. Recurrence is more common in recurrent maxillary sinus inverted papilloma than primary lesions. Recurrent maxillary sinus inverted papilloma after Caldwell-Luc operation has higher incidence of recurrence than after transnasal endoscopic resection.

A comparative study of the regenerative effect of sinus bone grafting with platelet-rich fibrin-mixed Bio-Oss® and commercial fibrin-mixed Bio-Oss®: an experimental study.

PubMed

Xuan, Feng; Lee, Chun-Ui; Son, Jeong-Seog; Jeong, Seung-Mi; Choi, Byung-Ho

2014-06-01

Anorganic bovine bone (Bio-Oss®) particles are one of the most popular grafting materials. The particles are often mixed with platelet-rich fibrin (PRF) or a commercial fibrin (Tisseel®) to form a mouldable graft material. The objective of this study was to compare the potentials of PRF-mixed Bio-Oss® and Tisseel®-mixed Bio-Oss® to enhance bone regeneration in a canine sinus model. Six mongrel dogs were used in this study. After elevating the sinus membrane in both maxillary sinus cavities, an implant was placed into the sinus cavity. In one of the sinus cavities, the PRF/Bio-Oss® composite was grafted, and the Tisseel®/Bio-Oss® composite was grafted in the other sinus cavity. After a 6 month healing period, bone formation in the graft sites and bone-implant contact were evaluated. The mean osseointegration rate was 43.5 ± 12.4% and new bone formation rate 41.8 ± 5.9% in the PRF/Bio-Oss® composite sites. In the Tisseel®/Bio-Oss® composite sites they were 30.7 ± 7.9% and 31.3 ± 6.4%. There were statistically significant differences between the groups. The findings from this study suggest that when platelet-rich fibrin is used as an adjunct to Bio-Oss® particles for bone augmentation in the maxillary sinus, bone formation in the graft sites is significantly greater than when Tisseel® is used. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

The use of maxillary sinus dimensions in gender determination: a thin-slice multidetector computed tomography assisted morphometric study.

PubMed

Ekizoglu, Oguzhan; Inci, Ercan; Hocaoglu, Elif; Sayin, Ibrahim; Kayhan, Fatma Tulin; Can, Ismail Ozgur

2014-05-01

Gender determination is an important step in identification. For gender determination, anthropometric evaluation is one of the main forensic evaluations. In the present study, morphometric analysis of maxillary sinuses was performed to determine gender. For morphometric analysis, coronal and axial paranasal sinus computed tomography (CT) scan with 1-mm slice thickness was used. For this study, 140 subjects (70 women and 70 men) were enrolled (age ranged between 18 and 63). The size of each subject's maxillary sinuses was measured in anteroposterior, transverse, cephalocaudal, and volume directions. In each measurement, the size of the maxillary sinus is significantly small in female gender (P < 0.001). When discrimination analysis was performed, the accuracy rate was detected as 80% for women and 74.3% for men with an overall rate of 77.15%. With the use of 1-mm slice thickness CT, morphometric analysis of maxillary sinuses will be helpful for gender determination.

A new Strategy to Improve Drug Delivery to the Maxillary Sinuses: The Frequency Sweep Acoustic Airflow.

PubMed

El Merhie, Amira; Navarro, Laurent; Delavenne, Xavier; Leclerc, Lara; Pourchez, Jérémie

2016-05-01

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.

[Comparative analysis on data of nasal sinus between helicopter and(strike) fighter pilots under physical examination for change to new-type aircraft].

PubMed

Xu, Xianrong; Ma, Xiaoli; Zhang, Yang; Xiong, Wei

2012-01-01

To comparatively analyze the disease data of nasal sinus between helicopter and (strike) fighter pilots under flying qualification, and then to provide references for aeromedical support as a significant part of new logistics service union in army, The CT data of nasal sinus in 138 pilots who accepted physical examination for change to new-type aircraft, were collected included 46 cases of helicopter pilots and 92 cases of (strike)fighter pilots). The incidence of chronic sinusitis and cyst of nasal sinus were computed respectively in helicopter pilots and (strike)fighter pilots. (1) Fourteen cases suffered from chronic sinusitis (6 cases of maxillary sinusitis, 4 cases of ethmoiditis and 4 cases of maxillary sinusitis and ethmoiditis) in helicopter pilots whose incidence rate of chronic sinusitis was 30.4% (14/46). Of which, 3 cases of antracele were treated. Twelve cases suffered from chronic sinusitis (8 cases of maxillary sinusitis, 1 case of ethmoiditis, 3 cases of maxillary sinusitis and ethmoiditis) in (strike)fighter pilots whose incidence of chronic sinusitis was 13.0% (12/92). Of which, 1 case of antracele was treated. The incidence of chronic sinusitis was higher in helicopter pilots than (strike) fighters pilots (Chi2 = 6.07, P < 0.05). (2) Four cases suffered from unilateral mucosa cysts in maxillary sinus in helicopter pilots whose incidence of cyst of nasal sinus was 8.7% (4/46). Ten cases suffered from mucosa cysts in maxillary sinus (unilateral 8 cases and bilateral 2 cases) in (strike) fighters pilots whose incidence of cyst of nasal sinus was 10.87% (10/92). The difference of the incidence of cyst of nasal sinus was not statistically significant between the helicopter pilots and(strike)fighters pilots. The cysts of nasal sinus did not need treatment in 14 cases of this group data. The incidence of symptomless chronic sinusitis and cyst of nasal sinus are high in pilots. It is related with repeatedly changes of atmosphere pressure during flying. But most chronic sinusitis and cyst of nasal sinus do not need treatment. The incidence of chronic sinusitis is higher in helicopter pilots than(strike)fighter pilots. It may be related with the environment of helicopter which have unclosed cockpit and load other aircrew.

Piezoelectric surgery in maxillary sinus floor elevation with hydraulic pressure for xenograft and simultaneous implant placement.

PubMed

Li, Juanjuan; Lee, Kyungmo; Chen, Haohua; Ou, Guomin

2013-11-01

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. Copyright © 2013 Editorial Council for the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

Mucus retention cyst of the maxillary sinus: the endoscopic approach.

PubMed

Hadar, T; Shvero, J; Nageris, B I; Yaniv, E

2000-06-01

To present our experience of endoscopic surgery for symptomatic mucus retention cyst of the maxillary sinus. Retrospective study. Teaching hospital, Israel. 60 patients with 65 symptomatic cysts of the maxillary sinus who were operated on endoscopically. Only patients with large cysts that filled at least 50% of the sinus space were included. A rigid nasal endoscope was used in all cases; most of the cysts were removed through the natural sinus ostium. Cysts recurred in only two patients during the first postoperative year. There were no complications from the procedure. The endoscopic approach to the treatment of maxillary sinus cyst is associated with a low rate of recurrence (3% in this study) and no complications, and we recommend it as the surgical procedure of choice. Copyright 2000 The British Association of Oral and Maxillofacial Surgeons.

The microbiome of the maxillary sinus and middle nasal meatus in chronic rhinosinusitis.

PubMed

Ivanchenko, O A; Karpishchenko, S A; Kozlov, R S; Krechikova, O I; Otvagin, I V; Sopko, O N; Piskunov, G Z; Lopatin, A S

2016-03-01

This multicenter study was focused on the identification of the microorganisms inhabiting the maxillary sinus and middle nasal meatus in chronic rhinosinusitis. 112 middle meatus swabs and 112 maxillary sinus aspirates from 103 patients were available for culture. A total of 244 strains of microorganisms representing more than 50 families were identified in the maxillary sinus and middle nasal meatus (164 and 80, respectively). These included 154 (63.0%) strains of aerobic bacteria from 32 species and 90 (37.0%) strains of anaerobic bacteria from 23 species. Aerobes were more common than anaerobes in both the nasal cavity (78.7% vs. 21.3%) and in the maxillary sinus (55.2% vs. 44.8%). Species of Streptococci (28.8%) and Prevotella (17.8%) were the most common findings in the maxillary sinus aspirates. S. pneumonia, H. influenza, and S. aureus were relatively rare, and found in only 6.7%, 5.4%, and 8.9% of the samples, respectively. The results obtained suggest that common upper airway pathogens do not play a major role in the pathogenesis of chronic rhinosinusitis. The microbiome of inflamed sinonasal mucosa is extremely diverse and involves exotic species of bacteria that, to date, have not been considered as potential inhabitants of the paranasal sinuses.

Sinus lift using a nanocrystalline hydroxyapatite silica gel in severely resorbed maxillae: histological preliminary study.

PubMed

Canullo, Luigi; Dellavia, Claudia

2009-10-01

The aim of this preliminary study was to evaluate histologically a nanocrystalline hydroxyapatite silica gel in maxillary sinus floor grafting in severely resorbed maxillae. A total of 16 consecutive patients scheduled for sinus lift were recruited during this study. Patients were randomly divided in two groups, eight patients each. In both groups, preoperative residual bone level ranged between 1 and 3 mm (mean value of 2.03 mm). No membrane was used to occlude the buccal window. Second surgery was carried out after a healing period of 3 months in Group 1 and 6 months in Group 2. Using a trephine bur, one bone specimen was harvested from each augmented sinus and underwent histological and histomorphometric analysis. Histological analysis showed significant new bone formation and remodeling of the grafted material. In the cores obtained at 6 months, regenerated bone, residual NanoBone, and bone marrow occupied respectively 48 +/- 4.63%, 28 +/- 5.33%, and 24 +/- 7.23% of the grafted volume. In the specimens taken 3 months after grafting, mean new bone was 8 +/- 3.34%, mean NanoBone was 45 +/- 5.10%, and mean bone marrow was 47 +/- 6.81% of the bioptical volume. Within the limits of this preliminary prospective study, it was concluded that grafting of maxillary sinus using nanostructured hydroxyapatite silica gel as only bone filler is a reliable procedure also in critical anatomic conditions and after early healing period.

Radiographic comparison of different concentrations of recombinant human bone morphogenetic protein with allogenic bone compared with the use of 100% mineralized cancellous bone allograft in maxillary sinus grafting.

PubMed

Froum, Stuart J; Wallace, Stephen; Cho, Sang-Choon; Khouly, Ismael; Rosenberg, Edwin; Corby, Patricia; Froum, Scott; Mascarenhas, Patrick; Tarnow, Dennis P

2014-01-01

The purpose of this study was to radiographically evaluate, then analyze, bone height, volume, and density with reference to percentage of vital bone after maxillary sinuses were grafted using two different doses of recombinant human bone morphogenetic protein 2/acellular collagen sponge (rhBMP-2/ACS) combined with mineralized cancellous bone allograft (MCBA) and a control sinus grafted with MCBA only. A total of 18 patients (36 sinuses) were used for analysis of height and volume measurements, having two of three graft combinations (one in each sinus): (1) control, MCBA only; (2) test 1, MCBA + 5.6 mL of rhBMP-2/ACS (containing 8.4 mg of rhBMP-2); and (3) test 2, MCBA + 2.8 mL of rhBMP-2/ACS (containing 4.2 mg of rhBMP-2). The study was completed with 16 patients who also had bilateral cores removed 6 to 9 months following sinus augmentation. A computer software system was used to evaluate 36 computed tomography scans. Two time points where selected for measurements of height: The results indicated that height of the grafted sinus was significantly greater in the treatment groups compared with the control. However, by the second time point, there were no statistically significant differences. Three weeks post-surgery bone volume measurements showed similar statistically significant differences between test and controls. However, prior to core removal, test group 1 with the greater dose of rhBMP-2 showed a statistically significant greater increase compared with test group 2 and the control. There was no statistically significant difference between the latter two groups. All three groups had similar volume and shrinkage. Density measurements varied from the above results, with the control showing statistically significant greater density at both time points. By contrast, the density increase over time in both rhBMP groups was similar and statistically higher than in the control group. There were strong associations between height and volume in all groups and between volume and new vital bone only in the control group. There were no statistically significant relationships observed between height and bone density or between volume and bone density for any parameter measured. More cases and monitoring of the future survival of implants placed in these augmented sinuses are needed to verify these results.

Full arch rehabilitation in severe maxillary atrophy with palatal approach implant placement: a case report

PubMed Central

BASSI, M. ANDREASI; LOPEZ, M.A.; ANDRISANI, C.; ORMANIER, Z.; GARGARI, M.

2016-01-01

SUMMARY Purpose The edentulous severely atrophic maxilla, as consequence of alveolar bone resorption and pneumatisation of the maxillary sinus, represents a serious limitation to the implant rehabilitation. Implants insertion via palatal approach (PA), in combination with relatively minimally invasive techniques aimed at increasing bone volume without the use of autologous bone harvesting is a valid alternative among the options for the rehabilitation of the upper jaw. Clinical case In a 70-year-old female, with a severe maxillary atrophy, 6 spiral taper implants were placed with the PA, combined with the bilateral transcrestal elevation of both the sinus floors and nasal cavities; a further GBR, with resorbable pericardium membrane covering a termoplastic allograft associated to a xenograft, was performed. The second stage was performed after 6 months. Implant prosthetic functionalization was carried out in 4 months by placing the removable prosthesis in direct contact with the healing cup screws. After that period the case was finalized with a hybrid prosthesis. Clinical and radiographic follow-ups were carried out at 6 months and at one year after prosthetic finalization, during which no pathological signs were recorded. Conclusions The PA implant insertion described by the Authors, combined with bone augmentation procedures, performed in the same stage, may represent a valid and reliable solution to rehabilitate maxillary edentulous patients. PMID:28042439

[Evolution of maxillary sinus surgery in a university hospital].

PubMed

Waizel-Haiat, Salomón; Solano-Mendoza, María del Carmen; Vargas-Aguayo, Alejandro Martin

2012-01-01

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.

Induction of carcinomas and sarcomas by 9,10-dimethyl-1,2-benzanthracene administration into the hamster maxillary sinus.

PubMed

Yura, Y; Tsujimoto, H; Kusaka, J; Harada, K; Yoshida, H; Sato, M

1995-03-01

To determine whether the local administration of 9,10-dimethyl-1,2-benzanthracene (DMBA) into the hamster maxillary sinus induced carcinoma at the injected site, hamsters were injected with 30 microliters of 0.5% solution of DMBA in dimethyl sulfoxide (DMSO) through the infraorbital foramen into the maxillary sinus once weekly for 10 weeks (Group 2). Another group of hamsters (Group 1) received similar injections of 30 microliters of DMSO only. In a third group of animals (Group 3), a roll of oxycellulose was inserted into the maxillary sinus and 40 microliters of a 2% solution of DMBA in DMSO was injected once. Sinonasal carcinomas were demonstrated in 73% (8/11) of the hamsters in Group 2 and sarcomas were shown in 73% (8/11) of the hamsters in Group 3, as well as some carcinomas. No tumors were seen in the Group 1 hamsters. Histologic examination revealed squamous cell carcinomas arising from the surface epithelium and submucous glands of the nasal cavity and maxillary sinus. These findings indicate that the intrasinal administration of a 0.5% solution of DMBA in DMSO is a reliable method for inducing maxillary sinus cancer.

Recurrent keratocystic odontogenic tumor of right maxillary sinus involving the right infraorbital rim.

PubMed

Maruthamuthu, Karthikeyan; Vasupradha, G; Dineshshankar, Janardhanam; Balaji, Abishek Rajaram

2017-01-01

Keratocystic odontogenic tumor (KCOT) is a benign odontogenic tumor with an aggressive behavior and high recurrence rate. The most common site of predilection is the posterior mandible. In contrast, KCOTs occurring in the maxillary region are relatively rare. However, the maxillary involvement poses a greater and increased threat, due to proximity to vital structures such as maxillary sinus, orbital floor, and infratemporal fossa. This report presents such a case of KCOT involving the maxillary sinus eroding the floor of the orbit and provides an account of the factors that need to be considered during management.

Recombinant human bone morphogenetic protein 2 in augmentation procedures: case reports.

PubMed

Luiz, Jaques; Padovan, Luis Eduardo Marques; Claudino, Marcela

2014-01-01

To successfully rehabilitate edentulous patients using endosseous implants, there must be enough available bone. Several techniques have been proposed for augmentation of sites with insufficient bone volume. Although autogenous bone has long been considered the gold standard for such procedures, the limited availability of graft material and a high morbidity rate are potential disadvantages of this type of graft. An alternative is to use recombinant human bone morphogenetic protein 2 (rhBMP-2), which is able to support bone regeneration in the oral environment. These cases demonstrate the applicability of rhBMP-2 in maxillary sinus elevation and augmentation procedures in the maxilla to enable dental implant placement. The use of rhBMP-2 in alveolar augmentation procedures had several clinical benefits for these patients.

Mucosal Cysts of the Maxillary Sinus in Solid Organ Transplant Population: Computerised Tomography Follow-Up Results

PubMed Central

Aydın, Erdinç; Yerli, Hasan; Tanrıkulu, Suna; Hizal, Evren

2013-01-01

Background: The clinical significance of maxillary sinus mucosal cysts in liver and kidney transplant recipients remains unclear. Aim: To investigate the course of maxillary mucosal cysts in liver and kidney transplantation patients. Study Design: Retrospective clinical study Methods: Paranasal sinus computed tomography scans of 169 renal and 43 hepatic transplant recipients were reviewed. The incidence, size and growth characteristics of maxillary mucosal cysts in the renal and hepatic transplant population were noted. Results: Overall incidence of maxillary sinus mucosal cyst in transplantation patients was found to be 24.5%, with a male to female ratio of 2:1 (p<0.05). Follow-up views of 26 patients showed that the size of the cysts increased in 19, decreased in 4, and remained the same in 3 patients. Mean growth rate of the cysts was calculated to be 6.30 ± 7.02 mm2 per month. Most of the cysts were located on the inferior wall of the maxillary sinus. Conclusion: Incidence of the maxillary mucosal cysts in renal and hepatic transplant recipients does not differ from general population, but these cysts have a greater tendency to grow. Specific measures are not needed for isolated, asymptomatic maxillary mucosal cysts in transplant populations. PMID:25207125

Infratemporal fossa fat enlargement in chronic maxillary atelectasis.

PubMed

Kohn, Jocelyne C; Rootman, Daniel B; Xu, Dongdong; Goldberg, Robert A

2013-08-01

To describe the radiographic findings in chronic maxillary atelectasis and analyse the volume changes of the affected maxillary sinus, orbit, nasal vault and infratemporal fossa. Case series of all patients with diagnosis of chronic maxillary atelectasis presenting between January 2000 and August 2012 who underwent full oculoplastic and orbital evaluation including standardised photography and CT or MRI. Two-dimensional imaging features and volumetric changes were assessed. Affected and unaffected sides were compared. Demographic data, clinical presentation, Hertel measurements, photographic and radiological findings were analysed. 22 patients (64% men) met the inclusion criteria. Mean relative enophthalmos was 2.1 mm and mean hypoglobus was 1.8 mm. The most common radiographic findings were sinus opacification (91%), uncinate process retraction/middle meatus increase (91%), orbit enlargement (100%), ipsilateral septum deviation (64%) and infratemporal fossa fat enlargement (100%). Infratemporal fossa fat area and volume were significantly larger in the affected side (p<0.01). Additionally, ipsilateral orbit (p<0.01) and nasal vault volume (p<0.01) were similarly increased. Maxillary sinus volume correlated significantly only with infratemporal fossa fat enlargement (p<0.05). There is a significant increase in the infratemporal fossa fat, nasal and orbital volume corresponding to a decrease in maxillary sinus size in chronic maxillary atelectasis. Chronic maxillary atelectasis is associated with redistribution of volume between the maxillary sinus and the surrounding infratemporal fossa, orbit and nasal cavity.

Destructive Fibrosarcoma of the Maxillary Sinus.

PubMed

Ekinci, Adnan; Karataş, Duran; Yetiş, Abdurrahman; Erenler, Behice Hande; Ozcan, Muge

2018-05-01

Paranasal fibrosarcoma of nasal cavity and paranasal sinuses is a very rare malignant tumor. It is usually presented with nasal obstruction and epistaxis. In this clinical report, clinical symptoms, pathogenesis, and treatment principles of a paranasal fibrosarcoma originating from the right maxillary sinus and obstructing the right nasal passage are discussed.A 55-year-old male patient was admitted to the authors clinic with complaints of nasal obstruction and epistaxis lasting for 2 years. Anterior rhinoscopy revealed a mass lesion which obstructed the right nasal passage and caused frequent epistaxis. An opacity consistent with soft tissue lesion which was originated from the right maxillary sinus and filled the right nasal passage was observed in paranasal tomography. Magnetic resonance imaging revealed that the mass lesion was contrasted. Tumor was seen to erode orbital floor, and lateral and anterior walls of the maxillary sinus. Biopsy result was reported as papilloma. The patient was treated with Denker approach as anterior wall of the maxillary sinus was eroded by the tumor lesion and the mass lesion was excised. The patient received postoperative radiotherapy as pathological diagnosis was reported as paranasal fibrosarcoma.

[Clinical use of beta-tricalcium phosphate ceramics with patient's own bone in maxillary elevation with osteotome].

PubMed

Chen, Lu; Zhou, Wen-qing; Wu, Yan-ping; Lu, Jing-hua

2011-06-01

To evaluate the clinical value of using the patient's autogenous bone mixed with beta-tricalcium phosphate ceramics(β-TCP) for maxillary sinus lift with simultaneous implantation. Patients with loss of posterior teeth and bone height of maxillary sinus floor between 4-10mm underwent internal sinus floor elevation, the proportion of bone to β-TCP was 1:1 and the mixture was inserted into the sinus floor. All cases had simultaneously placed ITI implants.The final crown fabrication was taken 4-6 months after implanting. Twenty-one implants were inserted in 16 cases, the mean increase height was 4.2mm(2-6mm). There was clinical complaint of maxillary sinus inflammation in 1 case within 2 weeks, but the symptoms disappeared after antibiotic therapy. The remaining of 20 implants had no obvious complications. All implants had loaded for 32 months and were stable and well osseointegration on X-ray film. Maxillary sinus elevation with simultaneous implantation is an easy procedure. Implants can be stable for a long time.

Biomechanical Stability of Dental Implants in Augmented Maxillary Sites: Results of a Randomized Clinical Study with Four Different Biomaterials and PRF and a Biological View on Guided Bone Regeneration

PubMed Central

Angelo, Troedhan; Marcel, Wainwright; Andreas, Kurrek; Izabela, Schlichting

2015-01-01

Introduction. Bone regenerates mainly by periosteal and endosteal humoral and cellular activity, which is given only little concern in surgical techniques and choice of bone grafts for guided bone regeneration. This study investigates on a clinical level the biomechanical stability of augmented sites in maxillary bone when a new class of moldable, self-hardening calcium-phosphate biomaterials (SHB) is used with and without the addition of Platelet Rich Fibrin (aPRF) in the Piezotome-enhanced subperiosteal tunnel-technique (PeSPTT). Material and Methods. 82 patients with horizontal atrophy of anterior maxillary crest were treated with PeSPTT and randomly assigned biphasic (60% HA/40% bTCP) or monophasic (100% bTCP) SHB without or with addition of aPRF. 109 implants were inserted into the augmented sites after 8.3 months and the insertion-torque-value (ITV) measured as clinical expression of the (bio)mechanical stability of the augmented bone and compared to ITVs of a prior study in sinus lifting. Results. Significant better results of (bio)mechanical stability almost by two-fold, expressed by higher ITVs compared to native bone, were achieved with the used biomaterials and more constant results with the addition of aPRF. Conclusion. The use of SHB alone or combined with aPRF seems to be favourable to achieve a superior (bio)mechanical stable restored alveolar bone. PMID:25954758

Bone chip-induced rhinosinusitis.

PubMed

Reilly, Brian K; Conley, David B

2009-12-01

This case report describes both the pathophysiology and management of chronic rhinosinusitis (CRS). Specifically, we report a case of chronic maxillary rhinosinusitis with a free-floating maxillary sinus calcification (bone chip). After obtaining the computed tomography scan, the patient underwent endoscopic sinus surgery, with removal of the uncinate, enlargement of the diseased natural ostium of the maxillary sinus, and removal of the diseased bone chip. This eliminated the nidus for infection, ultimately restoring mucociliary flow.

Frequency, location, and association with dental pathology of mucous retention cysts in the maxillary sinus. A radiographic study using cone beam computed tomography (CBCT).

PubMed

Yeung, Andy Wai Kan; Tanaka, Ray; Khong, Pek-Lan; von Arx, Thomas; Bornstein, Michael M

2018-04-01

The purpose of the present study was to evaluate the frequency, locations, and dimensions of mucous retention cysts of the maxillary sinus and analyze potential associated dental pathology. A total of 156 cone beam computed tomography (CBCT) scans were included in the analysis, resulting in an evaluation of 310 maxillary sinuses. The presence of mucous retention cysts (MRC) manifesting as dome-shaped radiopacities in the sinus was diagnosed. Their locations were recorded, and dimensions (mm) were measured in coronal and sagittal/axial slices. The patients were grouped into (a) patients/sinuses with MRCs (test), and (b) patients/sinuses with healthy or any other changes (control) for further comparison and evaluation. There were 40 sinuses (12.9%) with a presence of a total of 56 MRCs. The mean age of involved patients was 29.0 years. The analysis showed that gender, age, sinus side, status of dentition, endodontic status, and periodontal status did not have a significant influence on the presence of MRCs when compared between test and control groups. Age and endodontic status exhibited a significant association with cyst location. Most of the sinuses analyzed (79.5%) did not present any MRC, and only 28.6% of the cysts diagnosed were found on the floor of the maxillary sinus. The mean dimension of the MRCs measured 6.28 ± 2.93 mm. No influencing factors on the presence or absence of MRCs were found in the present study. Most MRCs were not located on the floor of maxillary sinus. Future studies should assess their impact on surgical interventions in the sinus.

Radiological and clinical difficulties in the management of chronic maxillary sinusitis in β Thalassemic paediatric patients.

PubMed

Di Mauro, R; Greco, L; Melis, M; Manenti, G; Floris, R; Giacomini, P G; Di Girolamo, M; Di Girolamo, S

2016-05-01

Beta thalassemia is a blood dyscrasia that caused a marked expansion of active marrow spaces and extramedullary haematopoiesis results. In these patients various alterations and abnormalities affects different body areas, including increased risk of sinusitis. The marrow expansion in the facial bones results in delay in pneumatisation of the sinuses, overgrowth of the maxillae, and forward displacement of the upper incisors with skeletal deformities. In current literature, maxillary sinuses are not deeply evaluated by CT scan studies in these kind of patients. The aim of our study was to investigate the presence of maxillary sinuses abnormalities by the use of CT in patients with beta-thalassemia major and to compare these findings with a control group free from this disease. A retrospective analysis of 22 paediatric patients with beta-thalassemia major and 22 control subjects without sinonasal diseases was performed. CT was done using a 64-multidetector-row CT scanner without contrast injection, obtained in axial plane using thin-slice technique. Evaluated parameters were: bone thickness of the lateral and anterior wall, density and volume of the maxillary sinuses. Significant difference was found between the study group and control group in the evaluation of all the parameters examined. The maxillary sinus of β thalassemic patients was smaller respect of controls, the bone was more dense and thick in the side and anterior wall. Beta-thalassemic patients have a relative risk of 2.87 to develop a maxillary sinusitis. In these patients there is an increased incidence of sinonasal infections due to the abnormal development of cranio facial skeleton. These bone alterations might confuse the physicians and lead to an increased rate of sinusitis diagnoses. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Is there a correlation between the clinical findings and the radiological findings in chronic maxillary sinus atelectasis?

PubMed

Eyigör, Hülya; Çekiç, Bülent; Turgut Çoban, Deniz; Selçuk, Ömer Tarık; Renda, Levent; Şimşek, Emine Handan; Yılmaz, Mustafa Deniz

2016-07-01

Silent sinus syndrome (SSS) is a clinical syndrome that occurs as a result of chronic maxillary sinus atelectasis (CMA) and is seen with progressive enophthalmos and hypoglobus. The aim of this study was to investigate the correlation between radiological findings and clinical findings in patients with radiologically asymmetrical reduced maxillary sinus volume. A comparison was made of patients with CMA through evaluation of paranasal sinus computed tomography, magnetic resonance imaging examination of maxillary sinus volume of the CMA side and the contralateral side, thickness of the retroantral fat tissue, infraorbital bone curve, uncinate process lateralisation measurement, middle concha diameter, and calculation of the change in location of the inferior rectus muscle. The study included 16 patients. Although a statistically significant difference was determined between the healthy and the pathological sides in respect to maxillary sinus volume, thickness of the retroantral fat tissue, infraorbital bone curve, uncinate process lateralisation measurement, and middle concha diameter (p = 0.00, p = 0.002, p = 0.020, p = 0.020, p = 0.007), no significant difference was determined in respect to the change in location of the inferior rectus muscle (p = 0.154). A positive correlation was determined between the increase in sulcus depth and maxillary sinus volume and inferior orbital bone curve (p < 0.05). In CMA patients suspected of having SSS, radiological maxillary sinus volume analysis, determination of retroantral fat thickness, measurement of the infraorbital bone curve, and measurement of the uncinate process lateralisation can be used as objective tests. However, it should be kept in mind that radiological findings may not always be compatible with the ophthalmological examination findings. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Endoscopic partial medial maxillectomy with mucosal flap for maxillary sinus mucoceles.

PubMed

Durr, Megan L; Goldberg, Andrew N

2014-01-01

To describe a technique of endoscopic medial maxillectomy with mucosal flap for postoperative maxillary sinus mucoceles and to present a case series of subjects who underwent this procedure. This case series includes four subjects with postoperative maxillary sinus mucoceles who underwent resection via endoscopic partial medial maxillectomy with a mucosal flap. We will discuss the clinical presentation, imaging characteristics, operative details, and outcomes. Four subjects are included in this study. The average age at the time of medial maxillectomy was 52 years (range 35-65 years). Three subjects (75%) were female. One subject (25%) had bilateral postoperative maxillary sinus mucoceles. Two subjects (50%) had unilateral right sided mucoceles, and the remaining subject had a unilateral left sided mucocele. All subjects had a history of multiple sinus procedures for chronic sinusitis including Caldwell-Luc procedures ipsilateral to the postoperative mucocele. All subjects underwent endoscopic medial maxillectomy without complication and were symptom free at the last follow up appointment, average 24 months (range 3-71 months) after medial maxillectomy. For postoperative maxillary sinus mucoceles in locations that are difficult to access via the middle meatus antrostomy, we recommend endoscopic medial maxillectomy with mucosal flap. Our preliminary experience with four subjects demonstrates complete resolution of symptoms after this procedure. Copyright © 2014 Elsevier Inc. All rights reserved.

Volumetric analysis of chronic maxillary atelectasis.

PubMed

Lin, Giant C; Sedaghat, Ahmad R; Bleier, Benjamin S; Holbrook, Eric H; Busaba, Nicolas Y; Yoon, Michael K; Gray, Stacey T

2015-01-01

The relationship between orbit and maxillary sinus volumes in patients with chronic maxillary atelectasis (CMA), commonly known as silent sinus syndrome if enophthalmos is present, is poorly understood. A retrospective review of 22 patients who underwent endoscopic sinus surgery (ESS) for CMA from 2005 to 2013 was performed. Computed tomography (CT) images were analyzed using OsiriX 5.8.2 software for volumetric analysis of the orbit and maxillary sinus at presentation and after surgical treatment with ESS. Pretreatment mean orbit volumes on the diseased side (DS) and the contralateral side (CS) were 29.22 and 26.50 mL, respectively (p < 0.001); mean sinus volumes on the DS and CS were 8.51 and 17.20 mL, respectively (p < 0.001); and pretreatment mean midorbit heights (MOHs) on the DS and CS were 3.39 cm and 3.07 cm, respectively (p < 0.001). The percent decrease in sinus volume on the DS compared to that on the CS did not correlate significantly with the percent orbit-volume increase. Enophthalmos was present in nine (41%) patients, and diplopia was present in three (14%) patients. The measured degree of increased orbit volume and decreased sinus volume secondary to CMA did not significantly predict the presence of enophthalmos at presentation. Seven patients underwent sinus CT more than 6 months after ESS. In these patients, orbit volume on the DS decreased from 29.67 to 27.52 mL (p = 0.005), and sinus volume on the DS increased from 9.78 to 11.84 mL (p = 0.08). Volumetric analysis is a powerful and novel method for objectively demonstrating the degree of orbit expansion and maxillary sinus contraction seen with CMA. Spontaneous maxillary sinus expansion and a decrease in orbit volume can occur after ESS, but post-ESS volumes do not return to the normal volume of the CS.

[Subantral augmentation with porous titanium in experiment and clinic].

PubMed

Sirak, S V; Shchetinin, E V; Sletov, A A

2016-01-01

The article discusses the use of porous titanium for subantral augmentation. Experimental study was conducted on 12 yearling rams. Subantral augmentation using porous titanium was performed in 33 patients. In the control group consisting of 14 patients calcium phosphates and bone collagen based agents ("Bio-Оss" and "Collost") were used. In the main and control groups 46 and 32 implant were placed, respectively. Pilot histological and clinical studies proved that the granules of porous titanium are biocompatible with bone tissue, provide the optimal surface microrelief, thus creating good conditions for adhesion, expansion and migration of osteoforming cells, have negligible kinetics of resorption, are porous to ensure effective neovascularization of de novo formed bone tissue. Porous titanium is an effective alternative material for subantral bone augmentation for dental implantation and reconstructive operations on the maxillary sinus.

A prospective randomized controlled trial of two-window versus solo-window technique by lateral sinus floor elevation in atrophic posterior maxilla: Results from a 1-year observational phase.

PubMed

Yu, Huajie; Qiu, Lixin

2017-10-01

Implant failures are more common when multiple missing posterior teeth need lateral sinus floor elevation owing to inadequate tissue maturation after grafting. Effects of lateral window dimensions on vital bone formation have rarely been compared. To compare endo-sinus bone formation between two- and solo-window techniques to rehabilitate multiple missing posterior teeth that need substantial augmentation. Patients with severely atrophic posterior maxilla were randomized to receive lateral sinus floor elevation via solo or two bony windows. Bone core specimens harvested from lateral aspect of the augmentation sites were histomorphometrically analyzed. Proportions of mineralized bone (MB), bone substitute materials (BS), and nonmineralized tissue (NMT) were quantified. Twenty-one patients underwent 23 maxillary sinus augmentations. One patient in each group dropped out during the follow-up period. Lateral window dimensions were 81.65 ± 4.59 and 118.04 ± 19.53 mm 2 in the test and control groups, respectively. Histomorphometric analysis revealed mean MB of 42.32% ± 13.07% and 26.00% ± 15.23%, BS of 40.34% ± 9.52% and 60.03% ± 10.13%, and NMT of 18.14% ± 14.24% and 14.75% ± 10.38% in test and control groups, respectively, with significant differences. The two-window technique could facilitate faster maturation and consolidation of the grafted volume and is an effective alternative for rehabilitation of severely atrophic posterior maxilla with multiple missing posterior teeth. © 2017 Wiley Periodicals, Inc.

Toward smart Nebulization: Engineering acoustic airflow to penetrate maxillary sinuses in chronic rhinosinusitis.

PubMed

Moghadam, Shima Jowhari; Navarro, Laurent; Leclerc, Lara; Hodin, Sophie; Pourchez, Jérémie

2018-07-30

Treating chronic rhinosinusitis (CRS) by nebulization requires an airflow capable to deliver medication to deep target sites beyond the nasal valve. Fixed frequency acoustic airflow technology is currently available, mainly as post-surgical therapy, but still have not been able to realize the full potential of direct nose to paranasal sinuses delivery. Reported herein are the application of frequency sweep acoustic airflow and the optimization of its frequency range, sweep cycle duration and intensity. The resonant frequencies of the model's maxillary sinuses can be estimated using the Helmholtz resonator theory. Results indicated a resonant frequency of 479 Hz for the right maxillary sinus and one of 849 Hz for the left maxillary sinus. The highest intrasinus deposition within the experiments are from sweep cycle duration of 1 s, intensity of 80 dB, and frequency range of 100-850 Hz. The optimal range of frequency determined from experiments is in good agreement with the corresponding frequency range obtained from the Helmholtz resonator theory. Results reveal a significantly enhanced maxillary sinus drug deposition. This technique affords the potential of treating CRS. Copyright © 2018 Elsevier B.V. All rights reserved.

Classification of the maxillary sinus according to area of the medial antral wall: a comparison of two ethnic groups.

PubMed

Lee, Fernandes Carmen; Fernandes, C M C; Murrell, H C

2009-06-01

This study is an anatomical study designed to benefit surgeons working in the region of the maxillary sinus. This paper investigates ethnic and gender variations in the shape of the maxillary sinus in dried crania from the Raymond Dart collection of human skeletons. The paper claims that an estimate of the area of the medial antral wall of the maxillary sinus is one of the best ethnic/gender group predictors. Helical, multislice computed tomography was performed using 1mm coronal slices length, depth, width and volume measurements for each sinus were taken. Classification by shape and estimated area of medial wall was attempted. Shape classification was found to be unsuccessful whilst medial wall classification into ethnic/gender groupings gave encouraging results. The area of the medial wall is related to ethnic/gender groups.

Schizophyllum Commune a Causative Agent of Fungal Sinusitis: A Case Report

PubMed Central

Premamalini, T.; Ambujavalli, B. T.; Anitha, S.; Somu, L.; Kindo, Anupma J.

2011-01-01

We present a case of maxillary sinusitis caused by Schizophyllum commune, in a 50-year-old female. The patient presented with nasal obstruction, purulent nasal discharge from right side of the nose, cough, headache, and sneezing. Computed tomography revealed extensive opacity of the right maxillary sinus as well as erosion of the nasal wall and maxillary bone. Functional endoscopic sinus surgery was done, and fungal debris present on right side of the maxillary sinus was removed and sent to laboratory. Potassium hydroxide (KOH) examination of the nasal discharge showed hyaline, septate hyphae. Primary isolation on Sabouraud's dextrose agar (SDA) yielded a white woolly mould. Banana peel culture after 8 weeks showed macroscopically visible fan-shaped fruiting bodies. Lactophenol cotton blue (LPCB) mount of the same revealed hyaline septate hyphae, often with clamp connections. Identification was confirmed by the presence of clamp connections formed on the hyphae and by vegetative compatibility with known isolates. PMID:22567479

Schizophyllum commune a causative agent of fungal sinusitis: a case report.

PubMed

Premamalini, T; Ambujavalli, B T; Anitha, S; Somu, L; Kindo, Anupma J

2011-01-01

We present a case of maxillary sinusitis caused by Schizophyllum commune, in a 50-year-old female. The patient presented with nasal obstruction, purulent nasal discharge from right side of the nose, cough, headache, and sneezing. Computed tomography revealed extensive opacity of the right maxillary sinus as well as erosion of the nasal wall and maxillary bone. Functional endoscopic sinus surgery was done, and fungal debris present on right side of the maxillary sinus was removed and sent to laboratory. Potassium hydroxide (KOH) examination of the nasal discharge showed hyaline, septate hyphae. Primary isolation on Sabouraud's dextrose agar (SDA) yielded a white woolly mould. Banana peel culture after 8 weeks showed macroscopically visible fan-shaped fruiting bodies. Lactophenol cotton blue (LPCB) mount of the same revealed hyaline septate hyphae, often with clamp connections. Identification was confirmed by the presence of clamp connections formed on the hyphae and by vegetative compatibility with known isolates.

Serial sinus aspirate samples during high-dose, short-course levofloxacin treatment of acute maxillary sinusitis.

PubMed

Anon, Jack B; Paglia, Margaret; Xiang, Jim; Ambrose, Paul G; Jones, Ronald N; Kahn, James B

2007-01-01

This study assessed daily aspirate samples from an indwelling sinus catheter during high-dose, short-course levofloxacin (750 mg daily x 5 days) treatment of acute maxillary sinusitis. Pathogens were isolated from 4 of 18 recruited patients. Bacteriologic eradication occurred within 24 h for 3 patients and 72 h for the 4th.

Experimental Evaluation of the Effectiveness of Demineralized Bone Matrix and Collagenated Heterologous Bone Grafts Used Alone or in Combination with Platelet-Rich Fibrin on Bone Healing in Sinus Floor Augmentation.

PubMed

Peker, Elif; Karaca, Inci Rana; Yildirim, Benay

2016-01-01

The aim of this study was an experimental evaluation of the effectiveness of demineralized bone matrix (DBM) and collagenated heterologous bone graft (CHBG) used alone or in combination with platelet-rich fibrin on bone healing in sinus floor augmentation procedures. In this study, 36 New Zealand rabbits were used. The bilateral sinus elevation was performed, and 72 defects were obtained. The rabbit maxillary sinuses were divided into four groups according to the augmentation biomaterials obtained: demineralized bone matrix (Grafton DBM Putty, Osteotech; DBM group), DBM combined with platelet-rich fibrin (PRF; DBM + PRF group), collagenated heterologous bone graft (CHBG; Apatos Mix, OsteoBiol, Tecnoss; CHBG group), CHBG combined with PRF (CHBG + PRF group). All groups were sacrificed at 2, 4, and 8 weeks after surgery for histologic, histomorphometric, and immunohistochemical analyses. The inflammatory reaction was moderate to intense at the second week in all groups and declined from 2 to 8 weeks. New bone formation was started at the second week and increased from 2 to 8 weeks in all groups. There was no significant difference in bone formation between the experimental groups that used PRF mixed graft material and control groups that used only graft material. The percentage of new bone formation showed a significant difference in DBM groups and DBM + PRF groups compared with other groups. There were osteoclasts around all the bone graft materials used, but the percentage of residual graft particles was significantly higher in CHBG groups and CHBG + PRF groups at the eighth week. There is no beneficial effect of the application of PRF in combination with demineralized bone matrix or collagenated heterologous bone graft on bone formation in sinus floor augmentation. The results of this study showed that both collagenated heterologous bone graft and demineralized bone matrix have osteoconductive properties, but demineralized bone matrix showed more bone formation than collagenated heterologous bone graft.

Maxillary Sinusitis Caused by Actinomucor elegans

PubMed Central

Davel, Graciela; Featherston, Patricia; Fernández, Anibal; Abrantes, Ruben; Canteros, Cristina; Rodero, Laura; Sztern, Carlos; Perrotta, Diego

2001-01-01

We report the first case of maxillary sinusitis caused by Actinomucor elegans in an 11-year-old patient. Histopathological and mycological examinations of surgical maxillary sinuses samples showed coenocytic hyphae characteristic of mucoraceous fungi. The fungi recovered had stolons and rhizoids, nonapophyseal and globose sporangia, and whorled branched sporangiophores and was identified as A. elegans. After surgical cleaning and chemotherapy with amphotericin B administered intravenously and by irrigation, the patient became asymptomatic and the mycological study results were negative. PMID:11158140

The sinonasal communication in the horse: examinations using computerized three-dimensional reformatted renderings of computed-tomography datasets

PubMed Central

2014-01-01

Background Sinusitis is a common disease in the horse. In human medicine it is described, that obstruction of the sinonasal communication plays a major role in the development of sinusitis. To get spatial sense of the equine specific communication ways between the nasal cavity and the paranasal sinuses, heads of 19 horses, aged 2 to 26 years, were analyzed using three-dimensional (3D) reformatted renderings of CT-datasets. Three-dimensional models were generated following manual and semi-automated segmentation. Before segmentation, the two-dimensional (2D) CT-images were verified against corresponding frozen sections of cadaveric heads. Results Three-dimensional analysis of the paranasal sinuses showed the bilateral existence of seven sinus compartments: rostral maxillary sinus, ventral conchal sinus, caudal maxillary sinus, dorsal conchal sinus, frontal sinus, sphenopalatine sinus and middle conchal sinus. The maxillary septum divides these seven compartments into two sinus systems: a rostral paranasal sinus system composed of the rostral maxillary sinus and the ventral conchal sinus and a caudal paranasal sinus system which comprises all other sinuses. The generated 3D models revealed a typically configuration of the sinonasal communication ways. The sinonasal communication started within the middle nasal meatus at the nasomaxillary aperture (Apertura nasomaxillaris), which opens in a common sinonasal channel (Canalis sinunasalis communis). This common sinonasal channel ramifies into a rostral sinonasal channel (Canalis sinunasalis rostralis) and a caudo-lateral sinonasal channel (Canalis sinunasalis caudalis). The rostral sinonasal channel ventilated the rostral paranasal sinus system, the caudo-lateral sinonasal channel opened into the caudal paranasal sinus system. The rostral sinonasal channel was connected to the rostral paranasal sinuses in various ways. Whereas, the caudal channel showed less anatomical variations and was in all cases connected to the caudal maxillary sinus. Volumetric measurements of the sinonasal channels showed no statistically significant differences (P <0.05) between the right and left side of the head. Conclusions Under physiologic conditions both paranasal sinus systems are connected to the nasal cavity by equine specific sinonasal channels. To resolve sinus disease it is aimed to maintain or even reconstruct the normal anatomy of the sinonasal communication by surgical intervention. Therefore, the presented 3D analyses may provide a useful basis. PMID:24646003

Maxillary sinus floor extension and posterior tooth inclination in adolescent patients with Class II Division 1 malocclusion treated with maxillary first molar extractions.

PubMed

Livas, Christos; Halazonetis, Demetrios J; Booij, Johan Willem; Pandis, Nikolaos; Tu, Yu-Kang; Katsaros, Christos

2013-04-01

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 uprighting. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

The implications of different lateral wall thicknesses on surgical access to the maxillary sinus.

PubMed

Lim, Ee Lian; Ngeow, Wei Cheong; Lim, Daniel

2017-11-27

The objective of this study was to measure the topographic thickness of the lateral wall of the maxillary sinus in selected Asian populations. Measurements were made on the lateral walls of maxillary sinuses recorded using CBCT in a convenient sample of patients attending an Asian teaching hospital. The points of measurement were the intersections between the axes along the apices of the canine, first premolar, and second premolar and along the mesiobuccal and distobuccal apices of the first and second molars and horizontal planes 10 mm, 20 mm, 30 mm and 40 mm beneath the orbital floor. The CBCT images of 109 patients were reviewed. The mean age of the patients was 33.0 (SD 14.8) years. Almost three quarters (71.8%) of the patients were male. The mean bone thickness decreased beginning at the 10-mm level and continuing to 40 mm below the orbital floor. Few canine regions showed encroachment of the maxillary sinus. The thickness of the buccal wall gradually increased from the canine region (where sinus encroachment of the canine region was present) to the first molar region, after which it decreased to the thickness observed at the canine region. The buccal wall of the maxillary sinus became thicker anteroposteriorly, except in the region of the second molar, and thinner superoinferiorly. These changes will affect the approach used to osteotomize the lateral sinus wall for oral surgery and for the sinus lift procedure.

Implant-supported maxillary overdentures retained with milled bars: maxillary anterior versus maxillary posterior concept--a retrospective study.

PubMed

Krennmair, Gerald; Krainhöfner, Martin; Piehslinger, Eva

2008-01-01

The aim of the present retrospective investigation was to evaluate implant-supported maxillary overdentures using either anterior (group 1) or posterior (group 2) maxillary implant placement. Maxillary overdentures were planned with support by either 4 implants placed in the maxillary anterior region (group 1) or 6 to 8 implants placed in augmented maxillary posterior regions (group 2, bilateral sinus augmentation) and anchored either on an anterior or on 2 bilaterally placed milled bars. Cumulative implant survival rate, peri-implant conditions (marginal bone loss, pocket depth, Plaque Index, Gingival Index, Bleeding Index, and Calculus Index) and the incidence and type of prosthodontic maintenance were assessed and compared for the 2 groups. In addition, the cumulative survival rate for implants placed in grafted regions was compared with that of implants placed in nongrafted regions. Thirty-four patients (16 for group 1 and 18 for group 2) with 179 implants were available for follow-up examination after a mean period of 42.1 +/- 20.1 months. Four initially placed implants failed to osseointegrate and were replaced, but no further losses were seen during the loading period, for a 5-year cumulative implant survival rate of 978%. No differences in implant survival rates were seen between either the group-1 (98.4%) and group-2 (97.4%) concepts or nongrafted (98.0%) and grafted (97.5%) implants. The peri-implant parameters showed a healthy soft tissue, good oral hygiene, and an acceptable degree of peri-implant marginal bone loss. The rigid fixation of all overdentures was associated with a low incidence of prosthodontic maintenance, without any significant differences between the 2 groups. In well-planned overdenture treatment programs, a high survival rate and excellent peri-implant conditions can be achieved for implants placed in the anterior or posterior maxilla. Rigid anchorage of maxillary overdentures either on an extended anterior milled bar or on 2 bilateral posterior milled bars provides for a low incidence of prosthodontic maintenance.

Extended Endoscopic and Open Sinus Surgery for Refractory Chronic Rhinosinusitis.

PubMed

Eloy, Jean Anderson; Marchiano, Emily; Vázquez, Alejandro

2017-02-01

This review discusses extended endoscopic and open sinus surgery for refractory chronic rhinosinusitis. Extended maxillary sinus surgery including endoscopic maxillary mega-antrostomy, endoscopic modified medial maxillectomy, and inferior meatal antrostomy are described. Total/complete ethmoidectomy with mucosal stripping (nasalization) is discussed. Extended endoscopic sphenoid sinus procedures as well as their indications and potential risks are reviewed. Extended endoscopic frontal sinus procedures, such the modified Lothrop procedure, are described. Extended open sinus surgical procedures, such as the Caldwell-Luc approach, frontal sinus trephine procedure, external frontoethmoidectomy, frontal sinus osteoplastic flap with or without obliteration, and cranialization, are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

[Trauma induced left maxillary sinus dislocation of eyeball--a case report].

PubMed

Chen, Yu; Liu, Cuiping; Cui, Liping

2013-01-01

Patient male, 27 year old. Left facial and head trauma for 6 hours, due to motor vehicle accident. Patient state of mind was clear at arrival to hospital. Body temperature: 36C; Pulse: 80 Time/Minute; Breath: 20 Time/Minute; Blood pressure: 120/80 mm Hg. An irregular, horizontal laceration at arch of left eyebrow, approximately 8-10 cm. A laceration on left wing of nose skin, approximately 1 cm. A laceration also under lower eyelid skin of right eye, approximately 2 cm. Left blepharedema and enophthalmos. Orbital and nasal sinuses CT indications:contusion and laceration of the left frontal lobe of brain; fracture of the left orbital frontal, ethmoid, sphenoid bone, left nasal, maxillary sinus and zygoma with soft tissue contusion and laceration; the left eyeball and optic nerve sunk into the maxillary sinus (See figure 1). (1) Multiple orbital fractures; (2) Left maxillary sinus dislocation of eyeball; (3) The left frontal lobe contusion and laceration of brain.

DYSTROPHIC CALCIFICATION OF MAXILLARY SINUS IN PEDIATRIC PATIENTS WITH LIVER TRANSPLANTATION AND PIGMENTATION OF DENTAL ORGAN

PubMed Central

de Macedo, Adriana Furtado; Costa, Claudio; Mattar, Regina Helena Guedes da Motta; de Azevedo, Ramiro Anthero

2017-01-01

ABSTRACT Objective: To report a case of severe dystrophic calcification in maxillary sinus of a child with liver transplantation and dental organs pigmented by hyperbilirubinemia. Case description: female patient, 12 years old, with liver transplantation performed at the age of 7 due to extrahepatic biliary atresia (EHBA). The patient was receiving the immunosuppressant tacrolimus (2 mg daily). Intraoral clinical exam showed tooth green pigmentation by bilirubin. Cone-beam volumetric computed tomography (CT) was performed to verify radiographic density of pigmented dental elements. Hounsfield scale measurement did not show changes in radiographic density of dental structures. However, CT scan showed intense dystrophic calcification in the maxillary sinus region. Comments: CT scan indicated relevant radiographic findings, with radiopacity of the maxillary sinus due to fungal or non-fungal sinusitis. This case report highlights the presence of radiographic image associated with acute infectious processes that could compromise the systemic state of immunosuppressed patients. PMID:29166493

Sinus floor elevation from a maxillary molar tooth extraction socket in a patient with chronic inflammation.

PubMed

Tözüm, Tolga F; Dursun, Erhan; Tulunoglu, Ibrahim

2009-03-01

The compromised nature of the residual interradicular bone after extraction of periodontally hopeless maxillary molars often requires a sinus elevation procedure to ideally place the implants to accept future prosthesis. Maxillary sinus elevation surgery is a procedure used to increase the volume of bone mass so that dental implants can be placed. This article documents a sinus floor elevation technique through an extraction socket in a 65-year-old white male with chronic inflammation to increase the bone mass after the extraction of a periodontally involved maxillary molar tooth. Computerized tomography revealed an increased thickness of the sinus membrane, which was attributed to possible chronic sinus inflammation and periodontal inflammation. After consultation with the Department of Otolaryngology, it was diagnosed as chronic inflammation without any contraindication for sinus elevation surgery or implant placement. One month after the extraction, the sinus floor elevation surgery was performed through the extraction socket, and implants were placed 4 months later. An uneventful healing was noted after 6 months of osseointegration; two porcelain-fused-to-metal crowns were fabricated. Clinical follow-up took place every 3 months for 3 years, and successful healing was achieved. The patient was satisfied with the esthetic and functional results of the oral rehabilitation. Sinus floor elevation through an extraction socket without any residual bone, followed by dental implant placement, provided successful functional results and acceptable stability.

A prospective, randomized pilot study on the safety and efficacy of recombinant human growth and differentiation factor-5 coated onto β-tricalcium phosphate for sinus lift augmentation.

PubMed

Koch, Felix P; Becker, Jürgen; Terheyden, Hendrik; Capsius, Björn; Wagner, Wilfried

2010-11-01

The aim of this prospective, randomized clinical trial was to investigate the potential of recombinant human growth and differentiation factor-5 (rhGDF-5) coated onto β-tricalcium phosphate (β-TCP) (rhGDF-5/β-TCP) to support bone formation after sinus lift augmentation. In total, 31 patients participated in this multicenter clinical trial. They required a two-stage unilateral maxillary sinus floor augmentation (residual bone height <5 mm). According to a parallel-group design, the patients were randomized to three treatment groups: (a) augmentation with rhGDF-5/β-TCP and a 3-month healing period, (b) augmentation with rhGDF-5/β-TCP and a 4-month healing period and (c) medical device β-TCP mixed with autologous bone and a 4-month healing period. The primary study objective was the area of newly formed bone within the augmented area as assessed by histomorphometric evaluation of trephine bur biopsies. The osseous regeneration was similar in each treatment group; the amount of newly formed bone ranged between 28% (± 15.5%) and 31.8% (± 17.9%). Detailed analysis of histological data will be published elsewhere. As secondary efficacy variables, the augmentation height at the surgery site was measured by radiography. The largest augmentation was radiologically achieved in the rhGDF-5/β-TCP - 3-month and the rhGDF-5/β-TCP - 4-month treatment groups. As safety parameters, adverse events were recorded and anti-drug antibody levels were evaluated. Most of the adverse events were judged as unrelated to the study medication. Four out of 47 (8.5%) implants failed in patients treated with rhGDF-5/β-TCP, a result that is in agreement with the general implant failure rate of 5-15%. Transiently very low amounts of anti-rhGDF-5 antibodies were detected in some patients who received rhGDF-5, which was not related to the bone formation outcome. rhGDF-5/β-TCP was found to be effective and safe as the control treatment with autologous bone mixed β-TCP in sinus floor augmentation. Thus, further investigation regarding efficacy and safety will be carried out in larger patient populations. © 2010 John Wiley & Sons A/S.

Mucous retention cyst of the maxillary sinus.

PubMed

Ruprecht, A; Batniji, S; el-Neweihi, E

1986-12-01

The mucous retention cyst is not a rare phenomenon. The incidence of dental patients was determined. Of 1685 patient radiographs reviewed, 44 (2.6%) had one or more mucous retention cysts in the maxillary sinuses.

Miniplate With a Bendable C-Tube Head Allows the Clinician to Alter Biomechanical Advantage in Extremely Complicated Anatomic Structure.

PubMed

Seo, Kyung Won; Iskenderoglu, Nur Serife; Hwang, Eui Hwan; Chung, Kyu-Rhim; Kim, Seong-Hun

2017-05-01

This article reports C-tube miniplates as a practical temporary anchorage device choice to treat open bite patients with maxillary sinus pneumatization. The C-tube components are titanium anchor plates and monocortical screws that are basically similar to any other miniplate systems, but it has the unique characteristic of the tube head to be malleable. The manipulation of the head part is easy due to the composition of pure titanium. The I-shaped C-tube with 3 holes and T-shaped C-tube miniplates were placed above the apices of maxillary molars as an absolute anchorage system to intrude the posterior maxilla. The bending of the tube heads assisted in reduction of severe open bite patient with maxillary sinus pneumatization. Sinus perforation during placement of skeletal anchorage system weakens stability of the anchorage and further cause complications. Placement of titanium C-tube miniplates allowed reliable skeletal anchorage and avoided maxillary sinus perforation in patients with extreme pneumatizations. Simple bending of C-tube miniplates ensured increased orthodontic intrusion force without having to replace them, and eliminated consequences such as perforation of maxillary sinus, sinusitis, soft tissue irritation, or infection. Anatomic difficulties in the placement of temporary anchorage device can be easily managed by using the bendable C-tube miniplate. It can serve as a great alternative over miniscrews or regular miniplates with reduced risk of sinus perforation and ability to bend the head portion to control orthodontic vectors and forces.

The effect of the presence of the accessory maxillary ostium on the maxillary sinus.

PubMed

Yenigun, Alper; Fazliogullari, Zeliha; Gun, Cihat; Uysal, Ismihan Ilknur; Nayman, Alaaddin; Karabulut, Ahmet Kagan

2016-12-01

This study was conducted to investigate the presence of the accessory maxillary ostium and its effects on the maxillary sinus, and the concurrent occurrence of morphological variations of neighboring anatomical structures. This study was performed in a tertiary referral center. This is a cross-sectional retrospective study that evaluated coronal CTs of patients to determine the frequency of the accessory maxillary ostium and investigated any simultaneous morphological variations in neighboring anatomical structures. The presence of the accessory maxillary ostium (AMO) plus any concurrent morphological variations of neighboring structures were investigated in 377 patients, with 754 sides. AMO was found to be present in 19.1 % (72/377) of the patients. A concurrent mucus retention cyst was found to be statistically significant on both sides (right side: p = 0.00, left side: p = 0.00), as well as mucosal thickening (right side: p = 0.00, left side: p = 0.00), and maxillary sinusitis (right side: p = 0.04, left side: p = 0.03). No other concurrent variations of statistical significance were detected in the neighboring structures. Our study demonstrated that with the presence of AMO, the likelihood of encountering a mucus retention cyst (48.6 %) had an approximately threefold increase, and that of encountering mucosal thickening (43.0 %) and maxillary sinusitis (29.1 %) had a twofold increase.

Medial maxillectomy in recalcitrant sinusitis: when, why and how?

PubMed

Konstantinidis, Iordanis; Constantinidis, Jannis

2014-02-01

We reviewed all journal articles relevant to endoscopic medial maxillectomy in patients with recalcitrant chronic maxillary sinusitis in order to present all indications, the underlying pathophysiology and the developed surgical techniques. Despite the high success rate of middle meatal antrostomy, cases with persistent maxillary sinus disease exist and often need a more extended endoscopic procedure for the better control of the disease. Such surgical option uses gravity for better sinus drainage and offers better saline irrigation, local application of medications and follow-up inspection. An endoscopic medial maxillectomy and its modified forms offer a wider surgical field and access to all 'difficult' areas of the maxillary sinus. Patients with previous limited endoscopic sinus surgery or extended open surgery, cystic fibrosis, extensive mucoceles, allergic fungal sinusitis, odontogenic infections, foreign bodies and so on may suffer from recurrent disease requiring an endoscopic medial maxillectomy. Depending on the disease, various modifications of the procedure can be performed preserving the anterior buttress, nasolacrimal duct and inferior turbinate if possible.

Sinusitis in people living in the medieval ages.

PubMed

Teul, Iwona; Lorkowski, Jacek; Lorkiewicz, Wieslaw; Nowakowski, Dariusz

2013-01-01

Breathing vitally serves body homeostasis. The prevalence of upper airway infections is often taken as an indicator of overall health status of a population living at a given time. In the present study we examined the unearthed remains of skulls from the XIII-XV century inhabitants searching for signs of maxillary sinusitis. Maxillary sinuses of the skulls of 92 individuals were inspected macroscopically and, if necessary, endoscopically. Osseous changes, including the pitting and abnormal spicule formation were present in 69 cases (75.0 %). It was found that, overall, dental infection was a major cause of maxillary sinusitis (18.8 %). Severe bone changes were observed in the adults' skulls, but were also present in the sinus walls of children's skulls. Post-inflammatory changes were manifest as remodeling and damage to the sinus walls. The results indicate that both children and adults of the Middle Ages suffered from chronic sinusitis. These observations confirm that the climate, environment, and lifestyle of the medieval populations contributed to the morbidity of the upper respiratory tract.

Cadaveric validation study of computational fluid dynamics model of sinus irrigations before and after sinus surgery

PubMed Central

Craig, John R; Zhao, Kai; Doan, Ngoc; Khalili, Sammy; Lee, John YK; Adappa, Nithin D; Palmer, James N

2016-01-01

Background Investigations into the distribution of sinus irrigations have been limited by labor-intensive methodologies that do not capture the full dynamics of irrigation flow. The purpose of this study was to validate the accuracy of a computational fluid dynamics (CFD) model for sinonasal irrigations through a cadaveric experiment. Methods Endoscopic sinus surgery was performed on two fresh cadavers to open all eight sinuses, including a Draf III procedure for cadaver 1, and Draf IIb frontal sinusotomies for cadaver 2. Computed tomography maxillofacial scans were obtained preoperatively and postoperatively, from which CFD models were created. Blue-dyed saline in a 240 mL squeeze bottle was used to irrigate cadaver sinuses at 60 mL/s (120 mL per side, over 2 seconds). These parameters were replicated in CFD simulations. Endoscopes were placed through trephinations drilled through the anterior walls of the maxillary and frontal sinuses, and sphenoid roofs. Irrigation flow into the maxillary, frontal, and sphenoid sinuses was graded both ipsilateral and contralateral to the side of nasal irrigation, and then compared with the CFD simulations. Results In both cadavers, preoperative and postoperative irrigation flow into maxillary, frontal, and sphenoid sinuses matched extremely well when comparing the CFD models and cadaver endoscopic videos. For cadaver 1, there was 100% concordance between the CFD model and cadaver videos, and 83% concordance for cadaver 2. Conclusions This cadaveric experiment provided potential validation of the CFD model for simulating saline irrigation flow into the maxillary, frontal, and sphenoid sinuses before and after sinus surgery. PMID:26880742

An unusual exostotic lesion of the maxillary sinus from Roman Lincoln.

PubMed

Kendall, Ross; Kendall, Ellen J; Macleod, Iain; Gowland, Rebecca; Beaumont, Julia

2015-12-01

This report provides a differential diagnosis of an exostotic bony lesion within the left maxillary sinus of a Romano-British (3rd to 4th century AD) adult male from Newport, Lincoln. Macroscopic, radiographic, and cone beam computed tomography (CBCT) analyses suggest that the lesion is likely of odontogenic origin. The overall size of the lesion and areas of sclerosis and radiolucency, together with its hypothesised odontogenic origin, suggest that the lesion represents a chronic exostotic osteomyelitic reaction to the presence of odontogenic bacteria. While modern case studies of odontogenic maxillary sinus osteomyelitis are noteworthy, published cases of this condition are extremely rare in an archaeological context and may be underreported due to the enclosed nature of the sinuses. Such infections may have serious implications for individual and population health, and non-destructive investigation should be considered in cases where significant maxillary caries are present. Copyright © 2015 Elsevier Inc. All rights reserved.

Cone-Beam Computed Tomography Analysis of Mucosal Thickening in Unilateral Cleft Lip and Palate Maxillary Sinuses.

PubMed

Kula, Katherine; Hale, Lindsay N; Ghoneima, Ahmed; Tholpady, Sunil; Starbuck, John M

2016-11-01

  To compare maxillary mucosal thickening and sinus volumes of unilateral cleft lip and palate subjects (UCLP) with noncleft (nonCLP) controls.   Randomized, retrospective study of cone-beam computed tomographs (CBCT).   University.   Fifteen UCLP subjects and 15 sex- and age-matched non-CLP controls, aged 8 to 14 years.   Following institutional review board approval and reliability tests, Dolphin three-dimensional imaging software was used to segment and slice maxillary sinuses on randomly selected CBCTs. The surface area (SA) of bony sinus and airspace on all sinus slices was determined using Dolphin and multiplied by slice thickness (0.4 mm) to calculate volume. Mucosal thickening was the difference between bony sinus and airspace volumes. The number of slices with bony sinus and airspace outlines was totaled. Right and left sinus values for each group were pooled (t tests, P > .05; n = 30 each group). All measures were compared (principal components analysis, multivariate analysis of variance, analysis of variance) by group and age (P ≤ .016 was considered significant).   Principal components analysis axis 1 and 2 explained 89.6% of sample variance. Principal components analysis showed complete separation based on the sample on axis 1 only. Age groups showed some separation on axis 2. Unilateral cleft lip and palate subjects had significantly smaller bony sinus and airspace volumes, fewer bony and airspace slices, and greater mucosal thickening and percentage mucosal thickening when compared with controls. Older subjects had significantly greater bony sinus and airspace volumes than younger subjects.   Children with UCLP have significantly more maxillary sinus mucosal thickening and smaller sinuses than controls.

Modification of endoscopic medial maxillectomy: a novel approach for inverted papilloma of the maxillary sinus.

PubMed

Ghosh, A; Pal, S; Srivastava, A; Saha, S

2015-02-01

To describe modification to endoscopic medial maxillectomy for treating extensive Krouse stage II or III inverted papilloma of the nasal and maxillary sinus. Ten patients with inverted papilloma arising from the nasoantral area underwent diagnostic nasal endoscopy, contrast-enhanced computed tomography scanning of the paranasal sinus and pre-operative biopsy of the nasal mass. They were all managed using endoscopic medial maxillectomy and followed up for seven months to three years without recurrence. Most patients were aged 41-60 years at presentation, and most were male. Presenting symptoms were nasal obstruction, mass in the nasal cavity and epistaxis. In each case, computed tomography imaging showed a mass involving the nasal cavity and maxillary sinus, with bony remodelling. The endoscopic medial maxillectomy approach was modified by making an incision in the pyriform aperture and removing part of the anterolateral wall of the maxilla bone en bloc. Modified endoscopic medial maxillectomy providing full access to the maxillary and ethmoid sinuses is described in detail. This effective, reproducible technique is associated with reduced operative time and morbidity.

Embryonal rhabdomyosarcoma in the maxillary sinus with orbital involvement in a pediatric patient: Case report

PubMed Central

de Melo, Ana Carolina Rodrigues; Lyra, Tácio Candeia; Ribeiro, Isabella Lima Arrais; da Paz, Alexandre Rolim; Bonan, Paulo Rogério Ferreti; de Castro, Ricardo Dias; Valença, Ana Maria Gondim

2017-01-01

This report presents a case of embryonal rhabdomyosarcoma (eRMS) located in the left maxillary sinus and invading the orbital cavity in a ten-year-old male patient who was treated at a referral hospital. The images provided from the computed tomography showed a heterogeneous mass with soft-tissue density, occupying part of the left half of the face inside the maxillary sinus, and infiltrating and destroying the bone structure of the maxillary sinus, left orbit, ethmoidal cells, nasal cavity, and sphenoid sinus. An analysis of the histological sections revealed an undifferentiated malignant neoplasm infiltrating the skeletal muscle tissue. The immunohistochemical analysis was positive for the antigens: MyoD1, myogenin, desmin, and Ki67 (100% positivity in neoplastic cells), allowing the identification of the tumour as an eRMS. The treatment protocol included initial chemotherapy followed by radiotherapy and finally surgery. The total time of the treatment was nine months, and in 18-mo of follow-up period did not show no local recurrences and a lack of visual impairment. PMID:29291204

Three-dimensional alterations in pharyngeal airway and maxillary sinus volumes in Class III maxillary deficiency subjects undergoing orthopedic facemask treatment.

PubMed

Pamporakis, Paschalis; Nevzatoğlu, Şirin; Küçükkeleş, Nazan

2014-07-01

To assess short-term alterations in the volume of pharyngeal airway space and maxillary sinuses associated with rapid maxillary expansion (RME) and facemask (FM) use in growing Class III maxillary-deficient patients. Twenty-two patients (14 girls, eight boys) treated with the RME/FM and having pretreatment and posttreatment cone beam-computed tomographic scans were identified from the archives of the Marmara University, Department of Orthodontics. According to the protraction force that was used, they were divided into two groups: a group with 400 g protraction force (12 subjects) and a group with 800 g protraction force (10 subjects). Mean age for the study group was 10 years. All patients were diagnosed with normal/low vertical growth pattern, maxillary deficiency, and normal mandible. No control group was available for this study. For each patient, a hyrax expansion screw with acrylic cap splint was constructed and RME was performed for 10 days. On the seventh day, protraction with a FM started. The results showed a statistically significant increase in the volume of maxillary sinuses after treatment, which was related to the growth. On the other hand, the increase in the volume of pharyngeal airway was not statistically significant. RME/FM treatment did not affect at all the volume of maxillary sinuses and actually inhibited the normal expected increase of the volume of the pharynx when compared with a control group comprising normal individuals.

Quantitative Kinetics Evaluation of Blocks Versus Granules of Biphasic Calcium Phosphate Scaffolds (HA/β-TCP 30/70) by Synchrotron Radiation X-ray Microtomography: A Human Study.

PubMed

Giuliani, Alessandra; Manescu, Adrian; Mohammadi, Sara; Mazzoni, Serena; Piattelli, Adriano; Mangano, Francesco; Iezzi, Giovanna; Mangano, Carlo

2016-02-01

Successful bone regeneration using both granules and blocks of biphasic calcium phosphate materials has been reported in the recent literature, in some clinical applications for maxillary sinus elevation, but the long-term kinetics of bone regeneration has still not been fully investigated. Twenty-four bilateral sinus augmentation procedures were performed and grafted with hydroxyapatite/β-tricalcium phosphate 30/70, 12 with granules and 12 with blocks. The samples were retrieved at different time points and were evaluated for bone regeneration, graft resorption, neovascularization, and morphometric parameters by computed microtomography and histology. A large amount of newly formed bone was detected in the retrieved specimens, together with a good rate of biomaterial resorption and the formation of a homogeneous and rich net of new vessels. The morphometric values were comparable at 5/6 months from grafting but, 9 months after grafting, revealed that the block-based specimens mimicked slightly better than granule-based samples the healthy native bone of the maxillary site. The scaffold morphology was confirmed to influence the long-term kinetics of bone regeneration.

"TuNa-saving" endoscopic medial maxillectomy: a surgical technique for maxillary inverted papilloma.

PubMed

Pagella, Fabio; Pusateri, Alessandro; Matti, Elina; Avato, Irene; Zaccari, Dario; Emanuelli, Enzo; Volo, Tiziana; Cazzador, Diego; Citraro, Leonardo; Ricci, Giampiero; Tomacelli, Giovanni Leo

2017-07-01

The maxillary sinus is the most common site of sinonasal inverted papilloma. Endoscopic sinus surgery, in particular endoscopic medial maxillectomy, is currently the gold standard for treatment of maxillary sinus papilloma. Although a common technique, complications such as stenosis of the lacrimal pathway and consequent development of epiphora are still possible. To avoid these problems, we propose a modification of this surgical technique that preserves the head of the inferior turbinate and the nasolacrimal duct. A retrospective analysis was performed on patients treated for maxillary inverted papilloma in three tertiary medical centres between 2006 and 2014. Pedicle-oriented endoscopic surgery principles were applied and, in select cases where the tumour pedicle was located on the anterior wall, a modified endoscopic medial maxillectomy was carried out as described in this paper. From 2006 to 2014 a total of 84 patients were treated. A standard endoscopic medial maxillectomy was performed in 55 patients (65.4%), while the remaining 29 (34.6%) had a modified technique performed. Three recurrences (3/84; 3.6%) were observed after a minimum follow-up of 24 months. A new surgical approach for select cases of maxillary sinus inverted papilloma is proposed in this paper. In this technique, the endoscopic medial maxillectomy was performed while preserving the head of the inferior turbinate and the nasolacrimal duct ("TuNa-saving"). This technique allowed for good visualization of the maxillary sinus, good oncological control and a reduction in the rate of complications.

Orbital abscess during endodontic treatment: a case report.

PubMed

de Medeiros, Eduardo Henrique Pantosso; Pepato, André Oliveira; Sverzut, Cássio Edvard; Trivellato, Alexandre Elias

2012-11-01

Orbital infections may result in permanent morbidity because of the severity of infection. Furthermore, delayed diagnosis or treatment of orbital infections can lead to intracranial complications and even death. The majority of orbital infections develop from paranasal sinus infections, cutaneous infections, and periorbital trauma. Dacryocystitis and odontogenic infection are also accounted as potential etiologies but are scarcely reported in scientific literature. The patient revealed a history of having endodontic treatment on left maxillary second molar performed 2 weeks previously. Moreover, she exhibited signs of facial pain accompanied by sinusitis symptoms, fever, and nasal obstruction the week after this endodontic procedure. The patient presented proptosis, impairment of ocular motility to the right side, facial tenderness, palpebral erythema, and referred decreased visual acuity. Intraoral exam revealed root fragments of left maxillary first molar and an extensive carious lesion on left maxillary second molar. Computed tomography enabled the observation of frontal sinus, left-sided maxillary, opacity of sphenoidal and ethmoidal sinuses, and apical lesion of left maxillary first and second molars, all suggesting the presence of their apex in the maxillary sinus. In addition, images revealed ocular proptosis and presence of high-density areas suggestive of pus in the medial orbital wall region. The patient was submitted to surgical drainage under general anesthesia approximately 8 hours after the clinical evaluation. Early detection of orbital infection, proper diagnostic tests, and treatment may provide successful outcomes of this rarely occurring disease. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Histologic and histomorphometric evaluation of two grafting materials Cenobone and ITB-MBA in open sinus lift surgery

PubMed Central

Amoian, Babak; Seyedmajidi, Maryam; Safipor, Hamidreza; Ebrahimipour, Sediqe

2016-01-01

Aims and Objectives: Alveolar ridge reduction caused after tooth extraction can be minimized through ridge preservation and application of graft materials. The aim of this study was to compare the histologic and histomorphometric aspects of bone particulated allografts, Cenobone and ITB-MBA, in the reconstruction of vertical alveolar ridge after maxillary sinus augmentation. Materials and Methods: This clinical trial was performed among 20 patients. The participants were randomly divided into two groups of 10 participants. The first group received Cenobone and the second group received ITB-MBA. Tissue samples were prepared 6 months later at the time of implant installation and after successful maxillary sinus floor augmentation. Tissue sections were examined under a light microscope. The data were analyzed by Chi-square and t-test. Results: The mean trabecular thickness of the samples in the Cenobone group was 13.61 ± 7.47 μm compared to 13.73 ± 7.37 μm in the ITB-MBA group (P = 0.93). A mild inflammation process (Grade 1) was detected in both the groups. The amount of remaining biomaterial in the Cenobone group was estimated to be 8 ± 19% vs. 7 ± 12% in the ITB-MBA group (P = 0.30). Bone formation was reported 49.71% in the Cenobone group vs. 40.76% in the ITB-MBA group (P = 0.68). The mean newly formed vessel in the Cenobone group was 0.64 ± 0.7 vs. 1.5 ± 2.3 in the ITB-MBA group (P = 0.14). Conclusions: There was no significant difference between the two groups of patients regarding trabecular thickness, remaining biomaterial allograft, and the density of blood vessels after sinus floor elevation; hence, there was no difference between the two groups regarding implant outcome. More designed studies as randomized controlled trials and controlled clinical trials, which evaluate the long-term implant outcome; comparing the different bone graft materials is also required to improve evidence on survival and success rate. PMID:27891316

Water-filled balloon in the postoperative resection cavity improves dose distribution to target volumes in radiotherapy of maxillary sinus carcinoma.

PubMed

Zhang, Qun; Lin, Shi-Rong; He, Fang; Kang, De-Hua; Chen, Guo-Zhang; Luo, Wei

2011-11-01

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.

The incidence of maxillary sinus membrane perforation during endoscopically assessed crestal sinus floor elevation: a pilot study.

PubMed

Garbacea, Antoanela; Lozada, Jaime L; Church, Christopher A; Al-Ardah, Aladdin J; Seiberling, Kristin A; Naylor, W Patrick; Chen, Jung-Wei

2012-08-01

Transcrestal sinus membrane elevation is a surgical procedure performed to increase the bone volume in the maxillary sinus cavity. Because of visual limitations, the potential for maxillary sinus membrane perforations may be greater than with the lateral approach technique. The aim of this study was to macroscopically investigate ex vivo the occurrence of sinus membrane perforation during surgery using 3 transcrestal sinus floor elevation methods. Twenty fresh human cadaver heads, with 40 intact sinuses, were used for simultaneous sinus membrane elevation, placement of graft material, and dental implants. Real-time sinus endoscopy, periapical digital radiographs, and cone-beam computerized tomography (CBCT) images were subsequently used to evaluate the outcome of each surgical procedure. Perforation rates for each of the 3 techniques were then compared using a significance level of P < .05. No statistically significant differences in the perforation rate (P = .79) were found among the 3 surgical techniques. Although the sinus endoscope noted a higher frequency of perforations at the time of implant placement as compared with instrumentation or graft insertion, the difference was not statistically significant (P = .04). The CBCT readings were judged to be more accurate for identifying evidence of sinus perforations than the periapical radiographs when compared with the direct visualization with the endoscope. This pilot study demonstrated that a sinus membrane perforation can occur at any time during the sinus lift procedure, independent of the surgical method used.

Influence of Healing Period Upon Bone Turn Over on Maxillary Sinus Floor Augmentation Grafted Solely with Deproteinized Bovine Bone Mineral: A Prospective Human Histological and Clinical Trial.

PubMed

Wang, Feng; Zhou, Wenjie; Monje, Alberto; Huang, Wei; Wang, Yueping; Wu, Yiqun

2017-04-01

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.

Removal of an Upper Third Molar from the Maxillary Sinus

PubMed Central

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

2015-01-01

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

Displacement of a dental implant into the maxillary sinus after internal sinus floor elevation: report of a case and review of literature.

PubMed

Ding, Xiaojun; Wang, Qing; Guo, Xuehua; Yu, Youcheng

2015-01-01

Dental implant placement in the posterior maxilla may be complicated by implant migration into the maxillary sinus. 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. 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. 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. 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.

Apical and marginal bone alterations around implants in maxillary sinus augmentation grafted with autogenous bone or bovine bone material and simultaneous or delayed dental implant positioning.

PubMed

Sbordone, Ludovico; Levin, Liran; Guidetti, Franco; Sbordone, Carolina; Glikman, Ari; Schwartz-Arad, Devorah

2011-05-01

A re-pneumatization phenomenon was recorded in sinuses grafted with different materials. The specific aims of this paper were to assess the dental implant survival rate and the behavior of marginal and apical bone remodeling around dental implants placed following sinus augmentation. A retrospective study was conducted on consecutive patients treated in two surgical centers. Different surgical techniques were adopted for sinus augmentation: simultaneous or delayed dental implant insertion with bovine bone-material augmentation or autologous bone grafting (chin and iliac crest). Survival rates were recorded for the overall number of implants (patients of group A). Apical and marginal bone levels (ABL and MBL, respectively) were radiographically measured, and statistical analysis was performed in implants of a subgroup of patients (group B). A total of 282 dental implants were positioned. Recorded cumulative survival rates (CSRs) were 95.6% and 100% for autogenous and bovine bone material, respectively, while CSRs at 2-year follow-up for immediate and delayed procedures were 99.3% and 96.5%. For the subgroup B, 57 sinus augmentation procedures were performed in 39 patients, with the positioning of 154 implants. Generally, the apical- and marginal-bone resorption of the bovine bone-material group was less than that of the autogenous group. The differences between the ABL values of the bovine bone-material and iliac-crest groups were statistically significant at 1 year, whereas this significance disappeared at the 2-year follow-up; tests showed that a statistical difference was recorded in the bovine bone-material group between the 1- and 2-year follow-ups. With regard to MBL comparisons between simultaneous and delayed implantation, the differences maintained their significance at the 2-year follow-up also. Differences regarding apical bone alteration between autogenous bone from the iliac crest and bovine bone material at the 1- and 2-year follow-ups, as well as in the bovine bone-material group between the 1- and 2-year follow-ups, attested to slower but more prolonged physiologic bone remodeling in the bovine-graft-material group than in the autogenous-bone group. The MBL analysis showed that remodeling in the delayed implant group demonstrated a greater resorption in the cervical portion than was seen in the simultaneous implant group. © 2010 John Wiley & Sons A/S.

Aberrant Anatomical Variation of Maxillary Sinus Mimicking Periapical Cyst: A Report of Two Cases and Role of CBCT in Diagnosis

PubMed Central

Sekerci, Ahmet Ercan; Sisman, Yildiray; Etoz, Meryem; Bulut, Duygu Goller

2013-01-01

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

Impact of airborne particle size, acoustic airflow and breathing pattern on delivery of nebulized antibiotic into the maxillary sinuses using a realistic human nasal replica.

PubMed

Leclerc, Lara; Pourchez, Jérémie; Aubert, Gérald; Leguellec, Sandrine; Vecellio, Laurent; Cottier, Michèle; Durand, Marc

2014-09-01

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.

Rapidly Progressive Maxillary Atelectasis.

PubMed

Elkhatib, Ahmad; McMullen, Kyle; Hachem, Ralph Abi; Carrau, Ricardo L; Mastros, Nicholas

2017-07-01

Report of a patient with rapidly progressive maxillary atelectasis documented by sequential imaging. A 51-year-old man, presented with left periorbital and retro-orbital pain associated with left nasal obstruction. An initial computed tomographic (CT) scan of the paranasal sinuses failed to reveal any significant abnormality. A subsequent CT scan, indicated for recurrence of symptoms 11 months later, showed significant maxillary atelectasis. An uncinectomy, maxillary antrostomy, and anterior ethmoidectomy resulted in a complete resolution of the symptoms. Chronic maxillary atelectasis is most commonly a consequence of chronic rhinosinusitis. All previous reports have indicated a chronic process but lacked documentation of the course of the disease. This report documents a patient of rapidly progressive chronic maxillary atelectasis with CT scans that demonstrate changes in the maxillary sinus (from normal to atelectatic) within 11 months.

The incidence of late neck recurrence in N0 maxillary sinus squamous cell carcinomas after superselective intra-arterial chemoradiotherapy without prophylactic neck irradiation.

PubMed

Sakashita, Tomohiro; Homma, Akihiro; Hatakeyama, Hiromitsu; Kano, Satoshi; Mizumachi, Takatsugu; Furusawa, Jun; Yoshida, Daisuke; Fujima, Noriyuki; Onimaru, Rikiya; Tsuchiya, Kazuhiko; Yasuda, Koichi; Shirato, Hiroki; Fukuda, Satoshi

2014-10-01

The efficacy of elective neck irradiation (ENI) for patients with N0 carcinoma of the maxillary sinus has been controversial. The purpose of our study was to investigate the incidence of late neck recurrence and the mortality rate from regional disease in patients with N0 maxillary sinus cancer after superselective cisplatin infusion and concomitant radiotherapy (RADPLAT) without ENI. We retrospectively analyzed 48 patients with N0 maxillary sinus cancer who underwent RADPLAT. Chemotherapy consisted of 100-120 mg/m(2) superselective intra-arterial cisplatin administered at a median rate of four times weekly. Concurrent radiation therapy was administered at a median dose of 65 Gy without ENI. Late neck recurrence was observed in 8.3% (4/48). Three patients underwent salvage neck dissection and survived without any evidence of disease. The remaining patient did not undergo neck dissection due to coexistence with distant metastasis, and he died of regional disease. The mortality rate from regional disease was calculated to be 2% (1/48). The incidence of late neck recurrence was not frequent, and the mortality rate from regional disease was low. Salvage neck dissection was considered to be feasible for patients with late neck recurrence. When definitive radiotherapy and concomitant chemotherapy are applied, it is considered that ENI is not required for cases of N0 maxillary sinus cancer.

Maxillary sinusitis from Microascus cinereus and Aspergillus repens.

PubMed

Aznar, C; de Bievre, C; Guiguen, C

1989-02-01

Microascus was associated with Aspergillus repens in a left maxillary sinus. Tissue contained septale filaments of two types, conidia, ostiolate perithecia containing ascospores corresponding to Microascus cinereus which was identified by culture. The abundance of sexual fructifications in the tissue indicates that pathogenicity is due to Microascus cinereus.

Stage II Chronic Maxillary Atelectasis Associated with Subclinical Visual Field Defect.

PubMed

Mangussi-Gomes, João; Nakanishi, Márcio; Chalita, Maria Regina; Damasco, Fabiana; De Oliveira, Carlos Augusto Costa Pires

2013-10-01

Introduction Chronic maxillary atelectasis (CMA) is characterized by a persistent decrease in the maxillary sinus volume due to inward bowing of its walls. According to its severity, it may be classified into three clinical-radiological stages. Objective To report a case of stage II CMA associated with subclinical visual field defect. Case Report A 34-year-old woman presented with a 15-year history of recurrent episodes of sinusitis and intermittent right facial discomfort for the past 5 years. She denied visual complaints, and no facial deformities were observed on physical examination. Paranasal sinus computed tomography (CT) demonstrated a completely opacified right maxillary sinus with inward bowing of its walls, suggesting the diagnosis of stage II CMA. A computerized campimetry (CC) disclosed a scotoma adjacent to the blind spot of the right eye, indicating a possible damage to the optic nerve. The patient was submitted to functional endoscopic sinus surgery, with drainage of a thick mucous fluid from the sinus. She did well after surgery and has been asymptomatic since then. Postoperative CT was satisfactory and CC was normal. Discussion CMA occurs because of a persistent ostiomeatal obstruction, which creates negative pressure inside the sinus. It is associated with nasosinusal symptoms but had never been described in association with any visual field defect. It can be divided into stage I (membranous deformity), stage II (bony deformity), and stage III (clinical deformity). The silent sinus syndrome is a special form of CMA. This term should only be used to describe those cases with spontaneous enophthalmos, hypoglobus, and/or midfacial deformity in the absence of nasosinusal symptoms.

Knowledge of orthodontic tooth movement through the maxillary sinus: a systematic review.

PubMed

Sun, Wentian; Xia, Kai; Huang, Xinqi; Cen, Xiao; Liu, Qing; Liu, Jun

2018-05-23

To investigate the feasibility, safety and stability of current interventions for moving teeth through the maxillary sinus (MTTMS) by performing a systematic review of the literature. The electronic databases PubMed, Embase, CENTRAL, Web of Science, CBM, CNKI and SIGLE were searched without a language restriction. The primary outcomes were parameters related to orthodontic treatment, including orthodontic protocols, magnitude of forces, type of tooth movement, duration and rate of tooth movement, and remolding of alveolar bone and the maxillary sinus floor. The secondary outcomes were safety and stability, including root resorption, perforation of the sinus floor, loss of pulp vitality and periodontal health and relapse. Nine case reports with 25 teeth were included and systematically analyzed. Fifty to two hundred g of force was applied to move teeth through the maxillary sinus. Bodily movement was accomplished, but initial tipping was observed in 7 cases. The rate was 0.6-0.7 mm/month for molar intrusion and 0.16-1.17 and 0.05-0.16 mm/month for mesial-distal movement of premolars and molars, respectively. Bone formation and remolding of the sinus floor occurred in 7 cases. Root resorption within 6 to 30 months was observed in 3 cases, while no cases of perforation of the sinus floor, loss of pulp vitality, periodontal health impairment or relapse were reported. At the present stage, no evidence-based protocol could be recommended to guide MTTMS. The empirical application of constant and light to moderate forces (by TAD, segment and multibrackets) to slowly move teeth through or into the maxillary sinus in adults appears to be practical and secure. Bodily movement was accomplished, but teeth appear to be easily tipped initially, potentially resulting in root resorption. However, this conclusion should be interpreted with caution as the currently available evidence is based on only a few case reports or case series and longitudinal or controlled studies are lacking in this area.

Equine nasal and paranasal sinus tumours. Part 1: review of the literature and tumour classification.

PubMed

Head, K W; Dixon, P M

1999-05-01

The normal gross and histological anatomy of the equine nasal and paranasal sinuses are reviewed and the relationships between the local anatomy, the occurrence of different tumour types, and of tumour spread are examined. The histological classification of the more common equine sinonasal tumours and tumour-like lesions are discussed. Clinical and pathological descriptions of 50 more recently recorded such tumours are separately tabulated. The literature shows that equine sinonasal tumours, both endemic and sporadic, are relatively uncommon in horses, with non-neoplastic growths such as maxillary (sinus) cysts, progressive ethmoid haematoma and inflammatory nasal polyps more commonly recorded. The equine paranasal sinuses, especially the caudal maxillary sinus, are the most common sites for sinonasal tumours and, in contrast to other species, primary nasal tumours are uncommon. The more common tumour types include squamous cell carcinoma that, in some cases, arise in the oral cavity and spread to the maxillary sinuses; adenocarcinomas; bone and dental tumours; fibrosarcomas and haemangiosarcomas. Except for some benign bone tumours, there are few records of successful treatment of equine sinonasal tumours.

Analysis of manual segmentation in paranasal CT images.

PubMed

Tingelhoff, Kathrin; Eichhorn, Klaus W G; Wagner, Ingo; Kunkel, Maria E; Moral, Analia I; Rilk, Markus E; Wahl, Friedrich M; Bootz, Friedrich

2008-09-01

Manual segmentation is often used for evaluation of automatic or semi-automatic segmentation. The purpose of this paper is to describe the inter and intraindividual variability, the dubiety of manual segmentation as a gold standard and to find reasons for the discrepancy. We realized two experiments. In the first one ten ENT surgeons, ten medical students and one engineer outlined the right maxillary sinus and ethmoid sinuses manually on a standard CT dataset of a human head. In the second experiment two participants outlined maxillary sinus and ethmoid sinuses five times consecutively. Manual segmentation was accomplished with custom software using a line segmentation tool. The first experiment shows the interindividual variability of manual segmentation which is higher for ethmoidal sinuses than for maxillary sinuses. The variability can be caused by the level of experience, different interpretation of the CT data or different levels of accuracy. The second experiment shows intraindividual variability which is lower than interindividual variability. Most variances in both experiments appear during segmentation of ethmoidal sinuses and outlining hiatus semilunaris. Concerning the inter and intraindividual variances the segmentation result of one manual segmenter could not directly be used as gold standard for the evaluation of automatic segmentation algorithms.

Long-term Evaluation of Peri-implant Bone Level after Reconstruction of Severely Atrophic Edentulous Maxilla via Vertical and Horizontal Guided Bone Regeneration in Combination with Sinus Augmentation: A Case Series with 1 to 15 Years of Loading.

PubMed

Urban, Istvan A; Monje, Alberto; Lozada, Jaime L; Wang, Hom-Lay

2017-02-01

To the best of the authors' knowledge, there is very limited clinical data on the outcomes of simultaneous guided bone regeneration (GBR) for horizontal and/or vertical bone gain for the reconstruction of severely atrophic edentulous maxilla. Therefore, the purpose of the clinical series presented herein was to clinically evaluate long-term horizontal and vertical bone gain, as well as implant survival rate after reconstruction of severely atrophic edentulous maxillary ridges. Sixteen patients (mean age: 64.6 ± 14.6 years of age) were consecutively treated for vertical and/or horizontal bone augmentation via GBR in combination with bilateral sinus augmentation utilizing a mixture of autologous and anorganic bovine bone. Implant survival, bone gain, intraoperative/postoperative complications and peri-implant bone loss were calculated up to the last follow-up exam. Overall, 122 dental implants were placed into augmented sites and have been followed from 12 to 180 months (mean: 76.5 months). Implant survival was 100% (satisfactory survival rate of 97.5%). Mean bone gain was 5.6 mm (max: 9 mm; min: 3 mm) While vertical bone gain was 5.1 ± 1.8 mm; horizontal bone gain was 7.0 ± 1.5 mm. No intraoperative/postoperative complications were noted. Mean peri-implant bone loss values were consistent within the standards for implant success (1.4 ± 1.0 mm). At patient-level, only one patient who had three implants presented with severe peri-implant bone loss. Complete reconstruction of an atrophied maxilla can be successfully achieved by means of guided bone regeneration for horizontal and/or vertical bone gain including bilateral sinus augmentation using a mixture of anorganic bovine bone and autologous bone. © 2016 Wiley Periodicals, Inc.

Chronic sinusitis and woodworking as risk factors for cancer of the maxillary sinus in northeast Japan.

PubMed

Shimizu, H; Hozawa, J; Saito, H; Murai, K; Hirata, H; Takasaka, T; Togawa, K; Konno, A; Kimura, Y; Kikuchi, A

1989-01-01

In the period 1983 to 1985, 66 patients presented to six Japanese university hospitals with squamous cell carcinoma of the maxillary sinus. Using self-administered questionnaires, a case-control study was conducted to examine history of nasal diseases, occupational exposures, and other possible risk factors for this disease. For each patient, two controls were selected from the general population, matched to the patient by sex, age (+/- 5 years), and district of residence. A history of chronic sinusitis was associated with a 2.3-fold increase in risk (p = 0.05). A high relative risk was also observed in males with an occupational history of woodworking or joinery, particularly when these jobs involved sanding or lathing practices (RR = 7.5, p = 0.02). No association between cigarette smoking and maxillary sinus cancer was observed in this study and no evidence was found that indoor air pollution in the home is involved in cancer development.

Impact of acoustic airflow on intrasinus drug deposition: New insights into the vibrating mode and the optimal acoustic frequency to enhance the delivery of nebulized antibiotic.

PubMed

Leclerc, Lara; Merhie, Amira El; Navarro, Laurent; Prévôt, Nathalie; Durand, Marc; Pourchez, Jérémie

2015-10-15

We investigated the impact of vibrating acoustic airflow, the high frequency (f≥100 Hz) and the low frequency (f≤45 Hz) sound waves, on the enhancement of intrasinus drug deposition. (81m)Kr-gas ventilation study was performed in a plastinated human cast with and without the addition of vibrating acoustic airflow. Similarly, intrasinus drug deposition in a nasal replica using gentamicin as a marker was studied with and without the superposition of different modes of acoustic airflow. Ventilation experiments demonstrate that no sinus ventilation was observed without acoustic airflow although sinus ventilation occurred whatever the modes of acoustic airflow applied. Intrasinus drug deposition experiments showed that the high frequency acoustic airflow led to 4-fold increase in gentamicin deposition into the left maxillary sinus and to 2-fold deposition increase into the right maxillary sinus. Besides, the low frequency acoustic airflow demonstrated a significant increase of 4-fold and 2-fold in the right and left maxillary sinuses, respectively. We demonstrated the benefit of different modes of vibrating acoustic airflow for maxillary sinus ventilation and intrasinus drug deposition. The degree of gentamicin deposition varies as a function of frequency of the vibrating acoustic airflow and the geometry of the ostia. Copyright © 2015 Elsevier B.V. All rights reserved.

Endoscopic medial maxillectomy with preservation of inferior turbinate and nasolacrimal duct.

PubMed

Nakayama, Tsuguhisa; Asaka, Daiya; Okushi, Tetsushi; Yoshikawa, Mamoru; Moriyama, Hiroshi; Otori, Nobuyoshi

2012-01-01

Endoscopic medial maxillectomy (EMM) is a safe and effective procedure for treatment of inverted papilloma (IP) originating from the maxillary sinus. However, EMM usually removes the inferior turbinate and nasolacrimal duct. The inferior turbinate has a critical function in conditioning of the nasal airflow, and resection of the nasolacrimal ducts has a risk of epiphora. We developed a newly derived surgical technique, endoscopic modified medial maxillectomy (EMMM), which enables preservation of the inferior turbinate and nasolacrimal duct. A retrospective case series of six patients with IP and nine patients with mucoceles of the maxillary sinus after a Caldwell-Luc operation, who underwent surgery using the EMMM technique, were reviewed. In patients with IP, there were no recurrences for a mean follow-up of 16.7 months. Eight of nine patients with mucoceles of the maxillary sinus showed patency. All patients showed preservation of the inferior turbinate. One patient with mucocele was referred for dacryocystorhinostomy because of epiphora. EMMM produces access to the maxillary sinus identically to conventional EMM, despite preservation of the inferior turbinate and nasolacrimal duct.

[The staphylococcal enterotoxin burden determines the ultrastructure of ciliated epithelia and inflammatory changes in maxillary sinus mucosa of rabbits].

PubMed

Wei, Hongqi; Zhu, Zhengwen; Cao, Zhongsheng; Liu, Zhiyong; Wu, Xiaofan; Yuan, Hui

2014-12-01

To investigate the ultrastructure of ciliated epithelia and inflammatory changes upon repeated exposure to staphylococcal enterotoxin A (SEA) of different concentrations in the maxillary sinus mucosa of rabbits. The rabbits were randomly divided into 2 groups (24 rabbits per group): low-dose SEA group and high-dose SEA group. The low-dose SEA group and high-dose SEA group received daily injections of 0.6 ng of SEA (2 ml) and 60 ng of SEA (2 ml) into the left maxillary sinus of rabbits for 28 days, respectively. Concurrent treatment of the right maxillary sinus with normal saline was used as control. Six rabbits chosen randomly in two groups were examined by computed tomography (CT) scans and then sacrificed to obtain the sinus mucosa from the two-side of maxillary sinuses for histological assessment on days 3, 7, 14 and 28. To characterize the inflammatory changes of the sinus mucosa examined using light microscope, hematoxylin and eosin (HE) and toluidine blue staining was performed. Scanning and transmission electron microscopy were performed to observe ultrastructure of ciliated epithelia in the maxillary sinus mucosa. SPSS 13.0 software was used to analyze the data. On days 14 and 28, CT images showed opacification of the left maxillary sinus in the high-dose SEA group. The percentage of epithelial disruption was (22.73 ± 5.72) % and (30.79 ± 4.30)% in the high-dose SEA group respectively, and were significantly greater than those in the low-dose SEA group (5.12% ± 1.98% and 5.38% ± 1.64%, q value was 10.079 and 19.132) and control group (4.08% ± 1.29% and 4.81% ± 1.62%, q value was 11.016 and 19.592, respectively, all P < 0.01). The subepithelial thickness in the high-dose SEA group was (113.34 ± 14.81)µm and (120.86 ± 12.35) µm respectively, and were significantly different from those of the low-dose SEA group [(71.08 ± 10.39)µm and (81.63 ± 9.32)µm, q value was 8.090 and 8.782] and control group [(37.45 ± 7.67)µm and (38.79 ± 7.68)µm, q value was 15.759 and 19.541, all P < 0.01]. Viewed under the electron microscope, loss of cilia was observed, a few compound cilia and cytoplasmic protrusion were found, an obvious stretching of the endoplasmic reticulum and an obvious turgescence of the mitochondria was also observed. However, in the low-dose SEA group on days 14 and 28, CT scan of the left maxillary sinus showed transparency; light microscopy observations of the maxillary sinus mucosa showed the number of eosinophils was markedly increased as compared with the high-dose SEA and control groups, the differences were significant (q value was 5.871 and 6.766 on day 14, and q value was 7.572 and 8.970 on day 28, respectively, all P < 0.05). But no significant differences were observed in epithelial disruption between the low-dose SEA and the control groups on days 14 and 28 (q value was 1.512 and 0.859 respectively, all P > 0.05); inordinate array and adhesion of cilia was observed, but cilia loss, compound cilia, cytoplasmic protrusions, mitochondrial swelling and endoplasmic reticulum stretching were not found. SEA may induce allergic inflammation of the sinus mucosa without damaging the structure of ciliated epithelia at low concentration. Whereas SEA impairs the structure of mitochondria and endoplasmic reticulum in ciliated epithelial cells at high concentration, and results in cilia loss and epithelial disruption, which may be one of the main reasons to induce acute sinusitis.

Metronomic palliative chemotherapy in maxillary sinus tumor

PubMed Central

Patil, Vijay M.; Noronh, Vanita; Joshi, Amit; Karpe, Ashay; Talreja, Vikas; Chandrasekharan, Arun; Dhumal, Sachin; Prabhash, Kumar

2016-01-01

Background: Metronomic chemotherapy consisting of methotrexate and celecoxib recently has shown promising results in multiple studies in head and neck cancers. However, these studies have not included patients with maxillary sinus primaries. Hence, the role of palliative metronomic chemotherapy in patients with maxillary sinus carcinoma that is not amenable to radical therapy is unknown. Methods: This was a retrospective analysis of carcinoma maxillary sinus patients who received palliative metronomic chemotherapy between August 2011 and August 2014. The demographic details, symptomatology, previous treatment details, indication for palliative chemotherapy, response to therapy, and overall survival (OS) details were extracted. SPSS version 16 was used for analysis. Descriptive statistics have been performed. Survival analysis was done by Kaplan–Meier method. Results: Five patients had received metronomic chemotherapy. The median age was 60 years (range 37–64 years). The proportion of patients surviving at 6 months, 12 months, and 18 months were 40%, 40%, and 20%, respectively. The estimated median OS was 126 days (95% confidence interval 0–299.9 days). The estimated median survival in patients with an event-free period after the last therapy of <6 months was 45 days, whereas it was 409 days in patients with an event-free period postlast therapy above 6 months (P = 0.063). Conclusion: Metronomic chemotherapy in carcinoma maxillary sinus holds promise. It has activity similar to that seen in head and neck cancers and needs to be evaluated further in a larger cohort of patients. PMID:27275447

Maxillary sinus floor elevation using BMP-2 and Nell-1 gene-modified bone marrow stromal cells and TCP in rabbits.

PubMed

Xia, Lunguo; Xu, Yuanjin; Chang, Qing; Sun, Xiaojuan; Zeng, Deliang; Zhang, Wenjie; Zhang, Xiuli; Zhang, Zhiyuan; Jiang, Xinquan

2011-07-01

This study evaluated the synergistic osteogenic effect of bone morphogenetic protein-2 (BMP-2) and Nel-like molecule-1 (Nell-1) genes in a rabbit maxillary sinus floor elevation model. Bone marrow stromal cells (bMSCs) were cultured and transduced with AdEGFP, AdNell-1, AdBMP-2, or AdNell-1 + AdBMP-2 overexpression virus. These gene-modified autologous bMSCs were then combined with a β-tricalcium phosphate (β-TCP) granule scaffold and used to elevate the maxillary sinus floor in rabbits. bMSCs cotransduced with AdNell-1 + AdBMP-2 demonstrated a synergistic effect on osteogenic differentiation as detected by real-time PCR analysis on markers of runt-related transcription factor-2, osteocalcin, collagen type 1, alkaline phosphatase activity, and calcium deposits in vitro. As for maxillary sinus floor elevation in a rabbit model in vivo, AdNell-1 + AdBMP-2 gene-transduced autologeous bMSCs/β-TCP complex had the largest bone area and most mature bone structure among the groups, as detected by HE staining and immunohistochemistry at weeks 2 and 8 after implantation. Our data suggested that the BMP-2 and Nell-1 genes possessed a synergistic effect on osteogenic differentiation of bMSCs, while bMSCs modified with the BMP-2 and Nell-1 genes could promote new bone formation and maturation in the rabbit maxillary sinus model.

Non-intrusive optical study of gas and its exchange in human maxillary sinuses

NASA Astrophysics Data System (ADS)

Persson, L.; Andersson, M.; Svensson, T.; Cassel-Engquist, M.; Svanberg, K.; Svanberg, S.

2007-07-01

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.

[Use of porous permeable titanium nickelide implants in surgery of the frontal and maxillary sinuses (a clinical-experimental study)].

PubMed

Starokha, A V; Itin, V I; Kovrizhnykh, V V; Ryzhov, A I; Monasevich, L A

1990-01-01

The purpose of the investigation was to study the efficacy of closing the bone defect in facial walls of the frontal and maxillary sinuses, formed as a result of their purulent inflammation, by porous permeable titanium nickelide. Analysis of the experimental data (18 dogs) and clinical observations (20 patients in whom the anatomic structure and function of frontal and maxillary sinuses with osteomyelitis were restored by an antibiotic pooling implantation material) gives evidence that the material can be well used to reconstruct an organ with an infected wound. The porous structure of the bioinert graft facilitates the ingrowth of osteogenic tissues, which becomes packed in the bone matrix without any intermediate connective tissue layer.

[Comparative experiments of stripping sheep maxillary sinus mucosal with new-type stripper and umbrella detacher].

PubMed

Jiadong, Fan; Yanfeng, Li; Le, Liu; Yishi, Han; Pin, Hu; Yue, Zhang; Wenya, Bao

2016-10-01

To compare the stripping length obtained through the model of 0.012 and 0.014 of the nickel-titanium dual-stage maxillary sinus mucosa stripper, and the umbrella detacher. Twenty-four goats (1.5-2 years old) were chosen, randomly divided into A, B, C groups, each group of eight. Group A was 0.012 model group, group B was 0.014 model group, group C was umbrella detacher group. Animal model was established, and maxillary sinus mucosa was stripped to the left and right sides of the bottom of the sinus in three groups. The data was measured when stripping to the limit or being perforated. The average length of group A was 12.41 mm±4.35 mm, two cases perforated. The average length of group B was 23.38 mm±4.84 mm, one case perforated. The average length of group C was 2.61 mm±0.30 mm. The population mean of stripping length in three groups was not all the same calculated by analysis of variance (P<0.01). There were significant differences in the stripping length of the three groups by the SNK test (P<0.05). The nickel-titanium dual-stage maxillary sinus mucosa stripper can achieve a larger mucosal stripping range. The stripper with a model of 0.014 has a moderate flexibility and safety, and it can strip a large area of sinus mucosa.
.

Combined transoral and endoscopic approach for total maxillectomy: a pioneering report.

PubMed

Liu, Zhuofu; Yu, Huapeng; Wang, Dehui; Wang, Jingjing; Sun, Xicai; Liu, Juan

2013-06-01

Total maxillectomy is sometimes necessary especially for malignant tumors originating from the maxillary sinus. Here we describe a combined transoral and endoscopic approach for total maxillectomy for the treatment of malignant maxillary sinus tumors and evaluate its short-term outcome. This approach was evaluated in terms of the physiological function, aesthetic outcome, and complications. Six patients underwent the above-mentioned approach for resection of malignant maxillary sinus tumors from May 2010 to June 2011. This combined transoral and endoscopic approach includes five basic steps: total sphenoethmoidectomy, sublabial incision, incision of the frontal process of the maxilla, incision of the zygomaticomaxillary fissure, and hard palate osteotomy. All patients with malignant maxillary sinus tumors successfully underwent the planned total endoscopic maxillectomy without the need for facial incision or transfixion of the nasal septum; there were no significant complications. Five patients received preoperative radiation therapy. All patients were well and had no recurrence at follow-up from 13 to 27 months. The combined approach is feasible and can be performed in carefully selected patients. The benefit of the absence of facial incisions or transfixion of the nasal septum, potential improvement in hemostasis, and visual magnification may help to decrease the morbidity of traditional open approaches.

Combined Transoral and Endoscopic Approach for Total Maxillectomy: A Pioneering Report

PubMed Central

Liu, Zhuofu; Yu, Huapeng; Wang, Dehui; Wang, Jingjing; Sun, Xicai; Liu, Juan

2013-01-01

Total maxillectomy is sometimes necessary especially for malignant tumors originating from the maxillary sinus. Here we describe a combined transoral and endoscopic approach for total maxillectomy for the treatment of malignant maxillary sinus tumors and evaluate its short-term outcome. This approach was evaluated in terms of the physiological function, aesthetic outcome, and complications. Six patients underwent the above-mentioned approach for resection of malignant maxillary sinus tumors from May 2010 to June 2011. This combined transoral and endoscopic approach includes five basic steps: total sphenoethmoidectomy, sublabial incision, incision of the frontal process of the maxilla, incision of the zygomaticomaxillary fissure, and hard palate osteotomy. All patients with malignant maxillary sinus tumors successfully underwent the planned total endoscopic maxillectomy without the need for facial incision or transfixion of the nasal septum; there were no significant complications. Five patients received preoperative radiation therapy. All patients were well and had no recurrence at follow-up from 13 to 27 months. The combined approach is feasible and can be performed in carefully selected patients. The benefit of the absence of facial incisions or transfixion of the nasal septum, potential improvement in hemostasis, and visual magnification may help to decrease the morbidity of traditional open approaches. PMID:24436907

[Maxillary sinus infection by Bacillus licheniformis: a case report from Djibouti].

PubMed

Garcia Hejl, C; Sanmartin, N; Samson, T; Soler, C; Koeck, J-L

2015-01-01

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.

Endoscopic contralateral transmaxillary approach for pterygoid process osteotomy in total maxillectomy: A technical case report.

PubMed

Hanazawa, Toyoyuki; Yamasaki, Kazuki; Chazono, Hideaki; Okamoto, Yoshitaka

2018-06-01

An approach for total maxillectomy with endoscopic transection of the pterygoid process via the contralateral maxillary sinus is described. In total maxillectomy, the resection of the pterygoid process of the sphenoid is a key step for successful resection. However, a conventional craniofacial approach requires extensive incision in the face, elevation of the lateral cheek flap. Even after elevation of the lateral cheek flap, visualization of this region is not good. An endoscopic approach through the contralateral maxillary sinus improved visualization of the pterygoid process, and osteotomy using a diamond-drilling bar was successfully performed. This technique has the potential to widen the indication for total maxillectomy in malignant neoplasms of the maxillary sinus. Copyright © 2017 Elsevier B.V. All rights reserved.

Do altitude and climate affect paranasal sinus volume?

PubMed

Selcuk, Omer Tarık; Erol, Bekir; Renda, Levent; Osma, Ustun; Eyigor, Hulya; Gunsoy, Behcet; Yagci, Buket; Yılmaz, Deniz

2015-09-01

The aim of this study was to evaluate the effect of climate and altitude differences on the volume of paranasal sinuses and on the frequency of anatomic variations by comparing the paranasal sinus tomograms (PNSCT) of patients who were born and living in a cold, dry climate at high altitude with those of patients who were born and living on the coast at sea level in a temperate climate. We also aimed to determine differences relating to gender. A total of 55 PNSCTs of 55 patients from the city center of Antalya and 60 PNSCTs of 60 patients from the city center of Agrı were evaluated and compared prospectively. The study included a total of 115 patients with a mean age of 44.75 ± 9.64 years (range, 27-63 years). Group 1 (Antalya) comprised 26 females (47.3%) and 29 males (52.7%) with a mean age of 36.7 ± 12.4 years. Group 2 (Agrı) comprised 25 females (41.7%) and 35 males (58.3%) with a mean age of 35.1 ± 13.4 years. Maxillary sinus volumes were 18.27 cm(3) (range, 5.04-37.62) and 15.06 cm(3) (4.11-41.40); sphenoid sinus volumes were 7.81 cm(3) (1.80-20.63) and 6.35 cm(3) (0.54-16.50); frontal sinus volumes were 5.51 cm(3) (0.50-29.25) and 3.76 cm(3) (0.68-22.81) respectively. There was no statistically significant difference between the groups in term of volumes (p > 0.025). Both maxillary and frontal sinus volumes were greater in males compared to females (p < 0.025). The mean value of the maxillary sinus volume was 15.7 ± 5.3 cm(3) and was 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. There was no statistically significant difference between the groups in terms of septum deviation and concha bullosa rates (p = 0.469 and p = 0.388). There have been many studies of nasal cavity changes due to climatic conditions but this is the first study to measure the difference of paranasal sinus volumes. No difference was determined in the anatomic variations and volumes of the maxillary, frontal, sphenoid sinuses on PNSCT of patients from different climates and altitudes. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Management of maxillary sinus inverted papilloma via endoscopic partial medial maxillectomy with an inferior turbinate reversing approach.

PubMed

Wang, Feng; Yang, Yang; Wang, Shenqing; Chen, Haihong; Wang, Dehui; Wang, Qinying

2017-12-01

The aim of this study is to evaluate the efficacy of endoscopic treatment for maxillary inverted papilloma (IP) through partial medial maxillectomy with an inferior turbinate reversing approach. A retrospective analysis of patients treated in our institution for maxillary sinus IP between July 2011 and August 2015 was performed. Demographics, operative technique, characteristics of tumors, complications, postoperative follow-up, and recurrence were evaluated. Twenty-two patients were enrolled in the study. All tumor attachments were identified intraoperatively. Adequate visualization was obtained following our approach. All inferior turbinate and nasolacrimal ducts were preserved. The median follow-up time was 41 months. One recurrence occurred at the follow-up time of 27 months. Postoperative hemorrhage and numbness at the ipsilateral frontal teeth were reported in two and one patients, respectively. Endoscopic surgery through partial medial maxillectomy using an inferior turbinate reversing approach provides full access to the maxillary sinus and preserves the inferior turbinate and nasolacrimal duct.

Mandibular fracture patterns consistent with posterior maxillary fractures involving the posterior maxillary sinus, pterygoid plate or both: CT characteristics.

PubMed

Imai, T; Sukegawa, S; Kanno, T; Fujita, G; Yamamoto, N; Furuki, Y; Michizawa, M

2014-01-01

The aim of this study was to determine the incidence of posterior maxillary fractures involving the posterior maxillary sinus wall, pterygoid plate or both, unrelated to major midface fractures in patients with mandibular fractures, and to characterize associated fractures. A CT study was performed in patients with mandibular fractures to identify posterior maxillary fractures. Patients aged under 16 years, those with mandibular fractures involving only dentoalveolar components and those with concurrent major midfacial fractures were excluded. 13 (6.7%) of 194 patients with mandibular fractures also had posterior maxillary fractures (case group). The injury pattern correlated with the external force directed to the lateral side of the mandible (p < 0.001), alcohol consumption (p = 0.049), the presence of multifocal fractures (p = 0.002) and the fracture regions in the symphysis/parasymphysis (p = 0.001) and the angle/ramus (p = 0.001). No significant difference between the case and non-case groups was seen for age, sex or cause of trauma. Non-displaced fractures in the ipsilateral posterior mandible occurred with significant frequency (p = 0.001) when the posterior maxillary fractures involved only the sinus. Mandibular fractures accompanied by posterior maxillary fractures are not rare. The finding of a unilateral posterior maxillary fracture on CT may aid the efficient radiological examination of the mandible based on possible patterns of associated fractures, as follows: in the ipsilateral posterior region as a direct fracture when the impact is a medially directed force, and in the symphysis/parasymphysis or contralateral condylar neck as an indirect fracture.

Late temporal lobe necrosis after conventional radiotherapy for carcinoma of maxillary sinus.

PubMed

Kanakamedala, Madhava R; Mahta, Ali; Liu, Jianlin; Kesari, Santosh

2012-12-01

Cerebral radiation necrosis is a serious late complication after conventional radiotherapy that can present with focal neurologic deficits or with more generalized signs and symptoms of increased intracranial pressure, depending on the location. The incidence and severity of radionecrosis are dose-volume dependent. We report a case of cerebral radiation necrosis 5 years after radiotherapy for a maxillary sinus carcinoma.

A 5-year clinical and computerized tomographic implant follow-up in sinus-lifted maxillae and native bone.

PubMed

Sbordone, Carolina; Toti, Paolo; Ramaglia, Luca; Guidetti, Franco; Sbordone, Ludovico; Martuscelli, Ranieri

2014-09-01

The present study analysed apical and marginal bone remodelling around dental implants placed in both maxillary (sinus elevated with particulated autogenous osseous graft) and corresponding native bone areas, with a follow-up of 5 years. The clinical survival of implants was also observed. In this retrospective chart review, 27 patients were enrolled, with 55 dental implants inserted from 2000 to 2006, 26 of which were followed (one implant per patient); if required, patients were treated via sinus lift with autogenous bone and particulate technique. The internal controls were implants positioned in native areas beneath the sinus. Radiologic survey was assessed via computerized tomographic analysis measuring apical bone level (ABL) and marginal bone level (MBL), at 1- (T1 ), 3- (T2 ) and 5 years (T3 ), around implants (buccal, b; palatal, p; mesial, m; and distal sides, d). Clinical probing depth (CPD) and clinical attachment level (CAL) for all the four peri-implant aspects were measured. Cumulative survival rate (CSR) and survival rate (SR) of implants were calculated. Significances for paired and unpaired comparisons were searched for. A significant degree of apical resorption was recorded between T1 and T3 for the mesial particulate group; again, a significant difference was discovered between the native and particulate procedures for mABL. A further feature was discovered for the particulate procedure, for which ABLs resulted negative at least for three of the aspects. Regarding MBL measurements, similar behaviours were revealed using time-comparison analysis for the two procedures at the buccal aspect. Comparisons among diameters, irrespective of the procedure, showed that resorption times for the bMBL were shorter as the diameter of the implant became wider. The implant CSR was 92% in native areas (two failures/25 implants) and 93.3% in sinuses lifted with particulate bone (two failures/30 implants). The results suggest that a protrusion of the implant apices into augmented sinus lift occurred, whereas the bone remodelling of the coronal areas was not influenced by the events in the maxillary sinus. A diameter ranging from 4 to 5 mm might better guarantee a conservation of marginal peri-implant bone level compared with implants with smaller diameters. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Prevalence of chronic maxillary sinusitis in children from rural and urban skeletal populations in Poland.

PubMed

Krenz-Niedbała, Marta; Łukasik, Sylwia

2016-12-01

Maxillary sinuses of 100 subadults from Cedynia, an early-urban site (stronghold), dated to the 10th-14th centuries AD, and of 28 subadults from Słaboszewo, a rural site, dated to the 14th-17th centuries AD, were examined for bone formation indicative of chronic sinusitis in order to explore the effect of urban and rural environments on the occurrence of upper respiratory tract infections in the past. We expected a higher prevalence of sinusitis in subadults from a stronghold than from a village, because of such factors as crowding, rapid spread of infections, and pollution from workshops located in the streets. We found a statistically non-significant tendency toward a higher prevalence of the condition in Cedynia compared to Słaboszewo (18.0% and 7.1%, respectively). The majority of maxillary lesions were classified as spicules. Changes to bone morphology suggestive of sinusitis of dental origin were not found. The development of observed osseous lesions may be attributed to culturally determined risk factors such as low quality of housing, air pollution caused by smoke from the household hearth and street workshops, poor levels of hygiene, and water contamination. Copyright © 2016 Elsevier Inc. All rights reserved.

Ophthalmic manifestations of maxillary sinus mucoceles.

PubMed

Ormerod, L D; Weber, A L; Rauch, S D; Feldon, S E

1987-08-01

Mucoceles involving any of the paranasal sinuses may present with ophthalmic disturbances. Maxillary antral mucoceles can encroach on the inferior orbit with ocular displacement and compression, proptosis or enophthalmos, lower lid distortion, tethering of extraocular muscles, and ptosis. Periocular pain, erosion of the inferior orbital rim, infraorbital nerve compression, epiphora, and inner canthal swellings are other important presentations. Postoperative mucoceles may involve only a portion of the antrum. Five illustrative cases are presented.

[Reconstruction of maxillary sinus superior wall fractures with calcium phosphate cement/recombinant human bonemorphogenetic protein 7 compound implanted material in rabbit].

PubMed

Zhang, Qunhui; Yu, Feng; Zhang, Haoliang; Gong, Huicheng; Lin, Ying

2015-11-01

To evaluate the osteogenetic character and repairing maxillary sinus superior wall fractures capability of calcium phosphate cement (CPC) before and after combined with recombinant human bone morphogenetie protein-7(rhBMP-7). A 10 mmX5 mm bone defect in the maxillary sinus superior wall was induced by surgery in all 24 New Zealand white rabbits. These 24 rabbits were randomly divided into two groups. The defects were repaired with CPC group (n = 12) and CPC/rhBMP-7 group (n = 12). The osteogenesis of bone defect was monitored by gro'ss observation, histological examination, observation under scanning electron microscope and measurement of ALP activity at 6 and 12 weeks after the implantation. In group CPC,new bone was found to form slowly and little by little. In group CPC/rhBMP-7, however, new bone was observed to form early and massively. The ALP activity in group CPC showed significant statistical difference with that of group CPC/rhBMP-7 (P < 0.05). The CPC/rhBMP-7 composite has osteoconductibility and osteoinductibility, comparing the use of CPC/rhBMP-7 with CPC for the repair of orbital fracture, the former show obvious advantage repairing ability in maxillary sinus superior wall defect.

Management of enophthalmos and superior sulcus deformity induced by the silent sinus syndrome.

PubMed

Ando, Andre; Cruz, Antonio Augusto Velasco

2005-01-01

Silent sinus syndrome is a dysfunction of the maxillary sinus that induces a progressive and asymptomatic enophthalmos with prominent deep superior sulcus deformity. Two cases of silent sinus syndrome are reported, and the simultaneous management of both enophthalmos and superior sulcus deformity caused by this syndrome is discussed. The patients underwent surgical endoscopic maxillary meatotomy and transconjunctival subperiosteal implantation of porous polyethylene sheets. The treatment successfully corrected both the enophthalmos and the upper eyelid sulcus deformity. However, small degrees of vertical eye dystopia were observed. Silent sinus syndrome is a rare cause of enophthalmos and superior sulcus deformity. Orbital floor implants can be used to increase the volume of the orbital contents, but vertical eye dystopia is likely to be induced if this method of treatment is the only option chosen.

Topical Drug Delivery in Chronic Rhinosinusitis Patients before and after Sinus Surgery Using Pulsating Aerosols

PubMed Central

Möller, Winfried; Schuschnig, Uwe; Celik, Gülnaz; Münzing, Wolfgang; Bartenstein, Peter; Häussinger, Karl; Kreyling, Wolfgang G.; Knoch, Martin

2013-01-01

Objectives Chronic rhinosinusitis (CRS) is a common chronic disease of the upper airways and has considerable impact on quality of life. Topical delivery of drugs to the paranasal sinuses is challenging, therefore the rate of surgery is high. This study investigates the delivery efficiency of a pulsating aerosol in comparison to a nasal pump spray to the sinuses and the nose in healthy volunteers and in CRS patients before and after sinus surgery. Methods 99mTc-DTPA pulsating aerosols were applied in eleven CRSsNP patients without nasal polyps before and after sinus surgery. In addition, pulsating aerosols were studied in comparison to nasal pump sprays in eleven healthy volunteers. Total nasal and frontal, maxillary and sphenoidal sinus aerosol deposition and lung penetration were assessed by anterior and lateral planar gamma camera imaging. Results In healthy volunteers nasal pump sprays resulted in 100% nasal, non-significant sinus and lung deposition, while pulsating aerosols resulted 61.3+/-8.6% nasal deposition and 38.7% exit the other nostril. 9.7+/-2.0 % of the nasal dose penetrated into maxillary and sphenoidal sinuses. In CRS patients, total nasal deposition was 56.7+/-13.3% and 46.7+/-12.7% before and after sinus surgery, respectively (p<0.01). Accordingly, maxillary and sphenoidal sinus deposition was 4.8+/-2.2% and 8.2+/-3.8% of the nasal dose (p<0.01). Neither in healthy volunteers nor in CRS patients there was significant dose in the frontal sinuses. Conclusion In contrast to nasal pump sprays, pulsating aerosols can deliver significant doses into posterior nasal spaces and paranasal sinuses, providing alternative therapy options before and after sinus surgery. Patients with chronic lung diseases based on clearance dysfunction may also benefit from pulsating aerosols, since these diseases also manifest in the upper airways. PMID:24040372

Piezosurgery in Bone Augmentation Procedures Previous to Dental Implant Surgery: A Review of the Literature

PubMed Central

Magrin, Gabriel Leonardo; Sigua-Rodriguez, Eder Alberto; Goulart, Douglas Rangel; Asprino, Luciana

2015-01-01

The piezosurgery has been used with increasing frequency and applicability by health professionals, especially those who deal with dental implants. The concept of piezoelectricity has emerged in the nineteenth century, but it was applied in oral surgery from 1988 by Tomaso Vercellotti. It consists of an ultrasonic device able to cut mineralized bone tissue, without injuring the adjacent soft tissue. It also has several advantages when compared to conventional techniques with drills and saws, such as the production of a precise, clean and low bleed bone cut that shows positive biological results. In dental implants surgery, it has been used for maxillary sinus lifting, removal of bone blocks, distraction osteogenesis, lateralization of the inferior alveolar nerve, split crest of alveolar ridge and even for dental implants placement. The purpose of this paper is to discuss the use of piezosurgery in bone augmentation procedures used previously to dental implants placement. PMID:26966469

Risk factors associated with oroantral perforation during surgical removal of maxillary third molar teeth.

PubMed

Hasegawa, Takumi; Tachibana, Akira; Takeda, Daisuke; Iwata, Eiji; Arimoto, Satomi; Sakakibara, Akiko; Akashi, Masaya; Komori, Takahide

2016-12-01

The relationship between radiographic findings and the occurrence of oroantral perforation is controversial. Few studies have quantitatively analyzed the risk factors contributing to oroantral perforation, and no study has reported multivariate analysis of the relationship(s) between these various factors. This retrospective study aims to fill this void. Various risk factors for oroantral perforation during maxillary third molar extraction were investigated by univariate and multivariate analysis. The proximity of the roots to the maxillary sinus floor (root-sinus [RS] classification) was assessed using panoramic radiography and classified as types 1-5. The relationship between the maxillary second and third molars was classified according to a modified version of the Archer classification. The relative depth of the maxillary third molar in the bone was classified as class A-C, and its angulation relative to the long axis of the second molar was also recorded. Performance of an incision (OR 5.16), mesioangular tooth angulation (OR 6.05), and type 3 RS classification (i.e., significant superimposition of the roots of all posterior maxillary teeth with the sinus floor; OR 10.18) were all identified as risk factors with significant association to an outcome of oroantral perforation. To our knowledge, this is the first multivariate analysis of the risk factors for oroantral perforation during surgical extraction of the maxillary third molar. This RS classification may offer a new predictive parameter for estimating the risk of oroantral perforation.

Mandibular fracture patterns consistent with posterior maxillary fractures involving the posterior maxillary sinus, pterygoid plate or both: CT characteristics

PubMed Central

Sukegawa, S; Kanno, T; Fujita, G; Yamamoto, N; Furuki, Y; Michizawa, M

2014-01-01

Objectives: The aim of this study was to determine the incidence of posterior maxillary fractures involving the posterior maxillary sinus wall, pterygoid plate or both, unrelated to major midface fractures in patients with mandibular fractures, and to characterize associated fractures. Methods: A CT study was performed in patients with mandibular fractures to identify posterior maxillary fractures. Patients aged under 16 years, those with mandibular fractures involving only dentoalveolar components and those with concurrent major midfacial fractures were excluded. Results: 13 (6.7%) of 194 patients with mandibular fractures also had posterior maxillary fractures (case group). The injury pattern correlated with the external force directed to the lateral side of the mandible (p < 0.001), alcohol consumption (p = 0.049), the presence of multifocal fractures (p = 0.002) and the fracture regions in the symphysis/parasymphysis (p = 0.001) and the angle/ramus (p = 0.001). No significant difference between the case and non-case groups was seen for age, sex or cause of trauma. Non-displaced fractures in the ipsilateral posterior mandible occurred with significant frequency (p = 0.001) when the posterior maxillary fractures involved only the sinus. Conclusions: Mandibular fractures accompanied by posterior maxillary fractures are not rare. The finding of a unilateral posterior maxillary fracture on CT may aid the efficient radiological examination of the mandible based on possible patterns of associated fractures, as follows: in the ipsilateral posterior region as a direct fracture when the impact is a medially directed force, and in the symphysis/parasymphysis or contralateral condylar neck as an indirect fracture. PMID:24336313

Delayed retrieval of a displaced maxillary third molar from infratemporal space via trans-sinusoidal approach: a case report and the review of the literature.

PubMed

Sencimen, Metin; Gülses, Aydin; Secer, Sencer; Zerener, Tamer; Özarslantürk, Savaş

2017-03-01

The aim of this case report is to present the trans-sinusoidal pathway used to remove a displaced maxillary third molar from the infratemporal fossa and review the English literature regarding the techniques used. A 21-year-old male patient was referred with the findings of an oroantral fistula on the left maxillary vestibular first molar region and slight restriction of mouth opening. The patient underwent a maxillary sinus surgery in order to remove a sinus retention cyst via Caldwell-Luc access in a dental clinic 4 years ago. A computerized tomography scan showed the inverted third molar to be located in the infratemporal fossa, just between zygomatic arch and lateral pterygoid plate. The tooth was accessed through the remaining lateral bone defect from the Caldwell-Luc approach of the lateral sinus wall. The bone defect was extended. The posterior bony wall of the maxillary sinus was removed via a surgical burr. After that, the displaced tooth was exposed. The tooth was mobilized via Warwick James elevator downwards and removed with a forceps. Access for surgical removal of the tooth from the infratemporal fossa is not only difficult but also has potential for morbidity due to the structures running through it. Wide incision in the maxillary sulcus and blunt dissection are reported with lower success rates and usually necessitate a second intervention via extraoral route. Trans-sinusoidal approach might be an old fashioned but relatively successfully attempt in the removal of the upper third molars from the infratemporal fossa. Considering the time of removal, if no symptoms were present, it is beneficial to wait for a couple of weeks thus facilitating development of fibrous surrounding around the tooth.

Climatic effects on the nasal complex: a CT imaging, comparative anatomical, and morphometric investigation of Macaca mulatta and Macaca fascicularis.

PubMed

Márquez, Samuel; Laitman, Jeffrey T

2008-11-01

Previous studies exploring the effects of climate on the nasal region have largely focused on external craniofacial linear parameters, using dry crania of modern human populations. This investigation augments traditional craniofacial morphometrics with internal linear and volumetric measures of the anatomic units comprising the nasal complex (i.e., internal nasal cavity depth, maxillary sinus volumes). The study focuses on macaques (i.e., Macaca mulatta and Macaca fascicularis) living at high and low altitudes, rather than on humans, since the short residency of migratory human populations may preclude using them as reliable models to test the long-term relationship of climate to nasal morphology. It is hypothesized that there will be significant differences in nasal complex morphology among macaques inhabiting different climates. This study integrated three different approaches: CT imaging, comparative anatomy, and morphometrics-in an effort to better understand the morphological structure and adaptive nature of the nasal complex. Results showed statistically significant differences when subsets of splanchnocranial and neurocranial variables were regressed against total maxillary sinus volume for particular taxa. For example, basion-hormion was significant for M. fascicularis, whereas choanal dimensions were significant only for M. mulatta. Both taxa revealed strong correlation between sinus volume and prosthion to staphylion distance, which essentially represents the length of the nasal cavity floor-and is by extension an indicator of the air conditioning capacity of the nasal region. These results clearly show that climatic effects play a major role in shaping the anatomy of the nasal complex in closely related species. The major influence upon these differing structures appears to be related to respiratory-related adaptations subserving differing climatic factors. In addition, the interdependence of the paranasal sinuses with other parts of the complex strongly indicates a functional role for them in nasal complex/upper respiratory functions. Copyright 2008 Wiley-Liss, Inc.

Synthetic Bone Substitute Engineered with Amniotic Epithelial Cells Enhances Bone Regeneration after Maxillary Sinus Augmentation

PubMed Central

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

2013-01-01

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-on the expression of a specific bone-related protein (osteocalcin, OCN) when transplanted into host tissues. PMID:23696804

Unusually large complex odontoma in maxillary sinus associated with unerupted tooth. Report of case and review of literature.

PubMed

Singer, Steven R; Mupparapu, Muralidhar; Milles, Maano; Rinaggio, Joseph; Pisano, Dominic; Quaranta, Patrick

2007-01-01

An unusual case of a large complex odontoma with an associated impacted tooth is presented. Odontomas are hamartomatous growths of enamel, dentin, cementum and pulp tissue. Although they are usually tooth-sized or smaller, occasionally, the complex variant can exhibit considerable growth, as was seen in the case presented here. It occupied most of the maxillary sinus and displaced the floor of the orbit and the medial and posterior walls of the left maxillary sinus. Panoramic radiographs, as well as axial and coronal CT studies, showed the extent of the lesion in various dimensions. A differential diagnosis of various calcifying tumors was formulated on the basis of these findings. The lesion was surgically excised, and histologic analysis confirmed the radiographic impression. Although odontomas of this magnitude are rare, this case demonstrates the value of imaging, radiographic histopathologic diagnosis and surgical treatment planning prior to any definitive treatment.

[CONE BEAM COMPUTED TOMOGRAPHY IN DIAGNOSTICS OF ODONTOGENIC MAXILLARY SINUSITIS (CASE REPORTS)].

PubMed

Demidova, E; Khurdzidze, G

2017-06-01

Diagnostic studies performed by cone beam computed tomography Morita 3D made possible to obtain high resolution images of hard tissues of upper jawbone and maxillary sinus, to detect bony tissue defects, such as odontogenic cysts, cystogranulomas and granulomas. High-resolution and three dimensional tomographic image reconstructions allowed for optimal and prompt determination of the scope of surgical treatment and planning of effective conservative treatment regimen. Interactive diagnostics helped to estimate cosmetic and functional results of surgical treatment, to prevent the occurrence of surgical complications, and to evaluate the efficacy of conservative treatment. The obtained data contributed to determination of particular applications of cone beam computed tomography in the diagnosis of odontogenic maxillary sinusitis, detection of specific defects with cone beam tomography as the most informative method of diagnosis; as well as to determination of weak and strong sides, and helped to offer mechanisms of x-ray diagnostics to dental surgeons and ENT specialists.

Computerized tomography-assisted calculation of sinus augmentation volume.

PubMed

Krennmair, Gerald; Krainhöfner, Martin; Maier, Harald; Weinländer, Michael; Piehslinger, Eva

2006-01-01

This study was intended to calculate the augmentation volume for a sinus lift procedure based on cross-sectional computerized tomography (CT) scans for 2 different augmentation heights. Based on area calculations of cross-sectional CT scans, the volume of additional bone needed was calculated for 44 sinus lift procedures. The amount of bone volume needed to raise the sinus floor to heights of both 12 and 17 mm was calculated. To achieve a sinus floor height of 12 mm, it was necessary to increase the height by a mean of 7.2+/-2.1 mm (range, 3.0 to 10.5 mm), depending on the residual ridge height; to achieve a height of 17 mm, a mean of 12.4+/-2.0 mm (range, 8.5 to 15.5 mm) was required (P < .01). The calculated augmentation volume for an augmentation height of 12 mm was 1.7+/-.9 cm3; for an augmentation height of 17 mm, the volume required was 3.6+/-1.5 cm3. Increasing the height of the sinus lift by 5 mm, ie, from 12 mm to 17 mm augmentation height, increased the augmentation volume by 100%. A significant correlation was found between augmentation height and the calculated sinus lift augmentation volume (r = 0. 78, P < .01). Detailed preoperative knowledge of sinus lift augmentation volume is helpful as a predictive value in deciding on a donor site for harvesting autogenous bone and on the ratio of bone to bone substitute to use. Calculation of the augmentation size can help determine the surgical approach and thus perioperative treatment and the costs of the surgery for both patients and clinicians.

Use of piezosurgery device in management of oral surgery complications: clincal case and clinical experience report.

PubMed

Sammartino, G; Riccitiello, F; Trosino, O; Marenzi, G; Cioffi, A; Mortellaro, C

2012-05-01

The root displacement into the maxillary sinus could be a complication of oral surgery in the upper jaw. In these cases, the root removal is needed in order to avoid the occurrence of sinus pathologies. Piezosurgery techniques could assure a safer management of such complications, because of the clear surgical visibility and the selective ability of cut. The aim of this article is to present a case of oral surgery complication (root displacement in the right maxillary sinus), in which piezosurgery technique helped for a correct and safe clinical management, allowing to reduce the soft tissue damage.

Use of negative air pressure by nasal suction during maxillary sinus floor lift: audit of 13 consecutive sinus grafts.

PubMed

Ucer, T C

2009-03-01

A common and serious intraoperative complication of sinus floor lift is perforation of the sinus lining. Several strategies to prevent or treat it have had varying results. We report the results of an audit of 13 consecutive sinus grafts in 11 patients in which nasal suction was used to facilitate raising the sinus lining, and to reduce the risk of perforation.

Association between demographic and radiographic characteristics of the schneiderian membrane and periapical and periodontal diseases using cone-beam computed tomography scanning: A retrospective study.

PubMed

Khorramdel, Azin; Shirmohammadi, Adileh; Sadighi, Alireza; Faramarzi, Masoumeh; Babaloo, Amir Reza; Sadighi Shamami, Mehrnoosh; Mousavi, Amin; Ebrahim Adhami, Zia

2017-01-01

Background. This study was undertaken to assess the pathological and spatial associations between periapical and periodontal diseases of the maxillary first molars and thickening of maxillary sinus mucosa with cone-beam computed tomography. Methods. A total of 132 CBCT images of subjects 20‒60 years of age were evaluated retrospectively. The patients' sex and age and demographic and pathologic findings of the maxillary sinus in the first molar area were recorded, graded and analyzed. Results. Approximately 59% of patients were male and 41% were female, with no significant difference in the thickness of schneiderian membrane between males and females. Based on the periapical index scoring, the highest frequency was detected in group 1. Based on the results of ANOVA, there were no significant differences in the frequencies of endodontic‒periodontal lesions and an increase in schneiderian membrane thickness. There were significant relationships between periapical and periodontal infections (P<0.001) and schneiderian membrane thickness. Furthermore, a significant relationship was detected between the thickness of the schneiderian membrane and the distance between the sinus floor and the root apices (P=0.38). Conclusion. A retrospective inspection of CBCT imaging revealed that periapical lesions and periodontal infections in the posterior area of the maxilla were associated with thickening of the schneiderian membrane. In addition, there was a significant relationship between the location of maxillary posterior teeth, i.e. the thickness of bone from the root apex to the maxillary sinus floor, and schneiderian membrane thickness.

Maxillary sinus by-pass with tilted implants via tapered-screw bone expanders in low density bone: one year follow -up of a case series.

PubMed

Andreasi Bassi, M; Andrisani, C; Lopez, M A; Gaudio, R M; Lombardo, L; Lauritano, D

2016-01-01

In the present paper the use of tapered-screw bone expanders (TSBEs) is proposed, in combination with the placement of tilted implants in close proximity to the anterior sinus wall, solving the problem of the reduced height of the alveolar bone in the sub-antral area. The Authors named the procedure: Tilted Implant Expansion Osteotomy (TIEO). Fifteen patients (10 females and 5 males, mean age 47.8±8.15 years) with distal edentulous maxillae were enrolled in this study. For each edentulous site 2 implants were placed, the anterior implant in the area of the most anterior missing tooth while, the posterior implant, immediately in front of the maxillary sinus, with an inclined position. Adopting the aforesaid procedure, 34 cylindrical two-piece implants were placed, 17 of which were placed in tilted position, in order to by-pass the maxillary sinus. After a healing period of 4-6 months, the second stage surgery was performed. The cases were finalized by metal-ceramic cementable restorations with a variable number of elements, from 2 to 4, without any cantilever element. The post finalization follow-up was at 12 months. Survival rate was 100% since no fixtures were lost. At the one-year follow-up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. TIEO is a promising surgical procedure for oral rehabilitation of maxillary edentulous sites and represents a therapeutic alternative to sinus lift techniques.

Augmentation of the posterior maxilla: a proposed hierarchy of treatment selection.

PubMed

Fugazzotto, Paul A

2003-11-01

Literature is reviewed that discusses treatment results following Cauldwel Luc approach sinus augmentation therapy or osteotome sinus augmentation therapy, with and without simultaneous implant placement. A hierarchy of treatment selection for the augmentation of the posterior maxilla, based upon quantity and position of residual alveolar bone crestal to the floor of the sinus, is proposed.

Complications Associated With the Use of Recombinant Human Bone Morphogenic Protein-2 in Ridge Augmentation: A Case Report.

PubMed

Dragonas, Panagiotis; Palin, Charles; Khan, Saba; Gajendrareddy, Praveen K; Weiner, Whitney D

2017-10-01

This case report aims to describe in detail a complication associated with resorption of regenerated bone following implant placement and ridge augmentation using recombinant human bone morphogenic protein-2 (rhBMP-2) in combination with allograft and xenograft. Bilateral maxillary sinus and ridge augmentation procedures were completed using rhBMP-2 combined with allograft and xenograft. Five months later, significant bone augmentation was achieved, which allowed for the placement of 4 implants. Upon stage 2 surgery, significant dehiscence was noted in all implants. Treatment steps to address this complication included implant removal, guided bone regeneration with xenograft only, and placement of new implants followed by soft-tissue grafting. At the time of publication, this patient is status 1½ years post case completion with maintenance of therapy outcomes. Off-label use of rhBMP-2 has gained significant acceptance in implant dentistry. However, there is limited evidence regarding the bone maturation process when rhBMP-2 is combined with other biomaterials. More research may be needed regarding the timing and process of bone healing in the presence of rhBMP-2, in an effort to avoid surgical complications.

Effects of a collagen membrane positioned between augmentation material and the sinus mucosa in the elevation of the maxillary sinus floor. An experimental study in sheep.

PubMed

Scala, Alessandro; Lang, Niklaus P; Velez, Joaquin Urbizo; Favero, Riccardo; Bengazi, Franco; Botticelli, Daniele

2016-11-01

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.

Gas monitoring in human sinuses using tunable diode laser spectroscopy.

PubMed

Persson, Linda; Andersson, Mats; Cassel-Engquist, Märta; Svanberg, Katarina; Svanberg, Sune

2007-01-01

We demonstrate a novel nonintrusive technique based on tunable diode laser absorption spectroscopy to investigate human sinuses in vivo. The technique relies on the fact that free gases have spectral imprints that are about 10.000 times sharper than spectral structures of the surrounding tissue. Two gases are detected; molecular oxygen at 760 nm and water vapor at 935 nm. Light is launched fiber optically into the tissue in close proximity to the particular maxillary sinus under study. When investigating the frontal sinuses, the fiber is positioned onto the caudal part of the frontal bone. Multiply scattered light in both cases is detected externally by a handheld probe. Molecular oxygen is detected in the maxillary sinuses on 11 volunteers, of which one had constantly recurring sinus problems. Significant oxygen absorption imprint differences can be observed between different volunteers and also left-right asymmetries. Water vapor can also be detected, and by normalizing the oxygen signal on the water vapor signal, the sinus oxygen concentration can be assessed. Gas exchange between the sinuses and the nasal cavity is also successfully demonstrated by flushing nitrogen through the nostril. Advantages over current ventilation assessment methods using ionizing radiation are pointed out.

Near-infrared transillumination of the maxillary sinuses: overview of methods and preliminary clinical results

NASA Astrophysics Data System (ADS)

Mahmood, Usama; Dehdari, Reza; Cerussi, Albert; Nguyen, Quoc; Kelley, Timothy; Tromberg, Bruce J.; Wong, Brian J.

2005-04-01

Though sinusitis is a significant health problem, it remains a challenging diagnosis for many physicians mainly because of its vague, non-specific symptomology. As such, physicians must often rely on x-rays and CT, which are not only costly but also expose the patient to ionizing radiation. As an alternative to these methods of diagnosis, our laboratory constructed a near infrared (NIR) transillumination system to image the paranasal maxillary sinuses. In contrast to the more conventional form of transillumination, which uses visible light, NIR transillumination uses light with a longer wavelength which is less attenuated by soft tissues, allowing increased signal intensity and tissue penetration. Our NIR transillumination system is low-cost, consisting of a light source containing two series of light emitting diodes, which give off light at wavelengths of 810 nm and 850 nm, and a charge coupled device (CCD) camera sensitive to NIR light. The light source is simply placed in the patient"s mouth and the resultant image created by the transmittance of NIR light is captured with the CCD camera via notebook PC. Using this NIR transillumination system, we imaged the paranasal maxillary sinuses of both healthy patients (n=5) and patients with sinus disease (n=12) and compared the resultant findings with conventional CT scans. We found that air and fluid/tissue-filled spaces can be reasonably distinguished by their differing NIR opacities. Based on these findings, we believe NIR transillumination of the paranasal sinuses may provide a simple, safe, and cost effective modality in the diagnosis and management of sinus disease.

Unusual Synchronous Presentation of Maxillary Sinus Fibrosarcoma and Gemistocytic Astrocytoma with a Complication Called Leukocytoclastic Vasculitis: A Case Report

PubMed Central

Cadir, Bilge; Karahan, Nermin; Nasir, Serdar; Aydin, M. Asim; Turkaslan, S. Suha

2009-01-01

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

Composite three-layer closure of oral antral communication with 10 months follow-up-a case study.

PubMed

Weinstock, Robert J; Nikoyan, Levon; Dym, Harry

2014-02-01

We propose a 3-layer composite closure technique for an oral antral communication (OAC) while avoiding secondary donor site morbidity. A patient had developed a 1-cm OAC after extraction of right maxillary first molar. The patient subsequently developed acute maxillary sinusitis. The patient was taken to the operating room, and a Caldwell-Luc procedure was performed. The bony window from the Caldwell-Luc was "press fit" over the bony OAC defect. Soft tissue closure was then achieved with a buccal fat pad flap and a buccal mucosal advancement flap. The patient was examined on postoperative day 5 and 1, 2, 3, 6, and 10 months postoperatively. The acute sinusitis had resolved. The soft tissue closure was successful. The bone graft remained intact, prevented sinus pneumatization, and restored continuity to the floor of the maxillary sinus. The presented technique for 3-layer closure of OACs allows for the stability of a double-layer closure of OAC with the added benefit of bone grafting from single operative site, achieving stable oral antral closure, bone grafting, and the avoidance of secondary donor site morbidity. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Impact of beta thalassemia on maxillary sinuses and sino-nasal passages: A case control study.

PubMed

Ragab, Ahmed; Ragab, Seham Mohammed; Shawki, Mohammed

2015-12-01

Skeletal changes among beta (β) thalassemia children are well documented, but without available data regarding sino-nasal passages alterations. The authors investigated the maxillary sinuses and sino-nasal passages changes in β-thalassemia children and correlated such changes with the amount of transfused red cells and the erythroid marrow activity. Clinical analyses including otorhinolaryngical examination (ORL) were obtained in twenty β-thalassemia children and 20 matched healthy controls. Hemoglobin (Hb), serum ferritin, soluble transferrin receptor (sTfR) levels and bone mineral density of the lumbar spine (BMD ls) were assayed. The two groups were analyzed for the CT image parameters: bone thickness, anterior and posterior choanae diameters, extramedullary hematopoiesis and chronic rhinosinusitis (CRS) RESULTS: Nasal congestion/obstruction was identified in 14 (70%) children. Eight patients (40%) had criteria of chronic rhinosinusitis. In comparison with the normal controls, the increase in the roof, floor, medial, anterior, lateral and posterior maxillary bony walls thickness was significantly higher (1.26, 2.46, 2.6, 2.9, 3.23 and 5.34-folds, respectively). The mean posterior choanae horizontal, vertical diameters and their surface area were significantly reduced in the patients compared to the controls. The mean anterior maxillary wall bone thickness directly correlated with sTfR (P=0.047) while that of the posterior wall correlated inversely with Hb level (P=0.013). The mean vertical posterior choanae diameter had positive correlation with the amount of transfused red cells (P=0.001) and negative correlation with sTfR (P=0.001). The Hounsfield unit of maxillary sinus wall had direct relation with BMDls (P=0.003) CONCLUSIONS: Thalassemia children are at risk of different folds increase of maxillary sinuses walls thicknesses utmost at posterior and lateral walls. Other sino-nasal morbidities include diminished posterior choanal diameter, nasal obstruction and CRS. Certain morbidities had relations to the erythroid marrow activity and the transfusion adequacy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Assessment of the effect of deviated nasal septum on the structure of nasal cavity.

PubMed

Wang, Junguo; Dou, Xin; Liu, Dingding; Song, Panpan; Qian, Xiaoyun; Wang, Shoulin; Gao, Xia

2016-06-01

The present study was aimed to investigate the effects of DNS on the structure of nasal cavity. The paranasal sinus coronal view CT of 108 patients with DNS and 129 hospitalized patients without DNS was retrospectively analyzed. The transverse diameter of nasal cavity (a), transverse diameter of nasal cavity and paranasal sinus (b), angle between maxillary and palatal bone, interalveolar distance, and maxillary rotation distance were measured. The ratio of a/b in experimental group was 0.367 ± 0.006 which was significantly (P = 0.0023) less than that in control group (0.391 ± 0.005). For the angle between maxillary and palatal bone, there was no significant difference found between DNS and control group for both right and left sides. The interalveolar distance was 40.75 mm in experimental group, and 38.8 mm in control (P = 0.0002). For the maxillary rotation distance, findings were considered as significant (P < 0.0001) in experimental group (11.25 mm) compared with control (10.1 mm). The present study demonstrates that long-term DNS affects the development of nasal cavity and paranasal sinus, as well as increases the interalveolar distance and maxillary rotation distance. These influences may be caused by the alteration of airflow inside the nasal cavities.

Upper and lower full arch dental reconstruction with implant supported overdentures: a case study.

PubMed

Sullivan, Jerome P

2013-04-01

In clinical situations where implant placement in the maxilla is prohibited due to the lack of available bone, more invasive techniques such as autogenous bone grafting and sinus augmentation are often off-putting to patients due to the added expense, risk and morbidity. Purpose of treatment: The intention of this treatment was to dentally restore a patient with a severely resorbed edentulous maxilla, without the use of any grafting techniques. Under local anaesthetic, five implants were placed in the patient's maxilla using the combined techniques of alveolar ridge-splitting and a Summer's lift. The crest of the alveolus was dissected bilaterally with a fine rotary disc. A combination of osteotomes and bone spreaders were then used to create the individual osteotomies. In the most distal site on the right side, the floor of the maxillary sinus was tapped up to facilitate implant placement. All implants were submerged under the gum for six months to allow them to ossteointegrate. Restorative stages were then completed. At six months, all five maxillary implants had successfully integrated. The maxilla also showed marked expansion where the alveolus had been dissected and bone had healed between the separated buccal and palatal plates. The final restoration was a metal-framed overdenture attached to a milled titanium bar supported on five implants. In this single case study, a patient's atrophic, edentulous maxilla was successfully restored without grafting techniques. The overdenture has been in trouble-free function for two years.

Minimum Abutment Height to Eliminate Bone Loss: Influence of Implant Neck Design and Platform Switching.

PubMed

Spinato, Sergio; Galindo-Moreno, Pablo; Bernardello, Fabio; Zaffe, Davide

This retrospective study quantitatively analyzed the minimum prosthetic abutment height to eliminate bone loss after 4.7-mm-diameter implant placement in maxillary bone and how grafting techniques can affect the marginal bone loss in implants placed in maxillary areas. Two different implant types with a similar neck design were singularly placed in two groups of patients: the test group, with platform-switched implants, and the control group, with conventional (non-platform-switched) implants. Patients requiring bone augmentation underwent unilateral sinus augmentation using a transcrestal technique with mineralized xenograft. Radiographs were taken immediately after implant placement, after delivery of the prosthetic restoration, and after 12 months of loading. The average mesial and distal marginal bone loss of the control group (25 patients) was significantly more than twice that of the test group (26 patients), while their average abutment height was similar. Linear regression analysis highlighted a statistically significant inverse relationship between marginal bone loss and abutment height in both groups; however, the intercept of the regression line, both mesially and distally, was 50% lower for the test group than for the control group. The marginal bone loss was annulled with an abutment height of 2.5 mm for the test group and 3.0 mm for the control group. No statistically significant differences were found regarding marginal bone loss of implants placed in native maxillary bone compared with those placed in the grafted areas. The results suggest that the shorter the abutment height, the greater the marginal bone loss in cement-retained prostheses. Abutment height showed a greater influence in platform-switched than in non-platform-switched implants on the limitation of marginal bone loss.

Quality of life in advanced maxillary sinus cancer after radical versus conservative maxillectomy.

PubMed

Liu, Liting; Liu, Dan; Guo, Qiyun; Shen, Bin

2013-07-01

A study of patients with advanced maxillary sinus cancer who underwent radical or conservative maxillectomy was performed to show the differences between the 2 groups in patients' survival rate and quality of life (QOL). A total of 61 advanced maxillary sinus cancer patients from Weifang People's Hospital in China were traced: 27 radical maxillectomy and 34 conservative maxillectomy. Survival rate was compared between the 2 groups. Quality of life assessments were performed at the time of preoperation as well as 6, 12, and 18 months after the operation. Measures included the University of Washington-QOL scale (UW-QOL) and the Hospital Anxiety and Depression Scale. The UW-QOL scale scores of the composite score, appearance, activity, recreation, swallowing, speech, and chewing in the conservative surgical group were much higher than those in the radical surgical group. However, there is no big difference in total survival rate between these 2 groups. Also, no significant difference can be seen in the scores of pain, employment, and shoulder between the 2 groups. At the 6-month follow-up, the radical maxillectomy had more effects on anxiety than the conservative maxillectomy, while they are almost equally effective on depression. The 12-month and 18-month follow-ups showed that the radical maxillectomy made a greater impact on both anxiety and depression than the conservative maxillectomy. Conservative maxillectomy is more effective than radical maxillectomy to preserve the QOL of patients with advanced maxillary sinus cancer.

Mucormycosis (Mucor fungus ball) of the maxillary sinus.

PubMed

Cho, Hang Sun; Yang, Hoon Shik; Kim, Kyung Soo

2014-01-01

A fungus ball is an extramucosal fungal proliferation that completely fills one or more paranasal sinuses and usually occurs as a unilateral infection. It is mainly caused by Aspergillus spp in an immunocompetent host, but some cases of paranasal fungal balls reportedly have been caused by Mucor spp. A Mucor fungus ball is usually found in the maxillary sinus and/or the sphenoid sinus and may be black in color. Patients with mucormycosis, or a Mucor fungal ball infection, usually present with facial pain or headache. On computed tomography, there are no pathognomonic findings that are conclusive for a diagnosis of mucormycosis. In this article we report a case of mucormycosis in a 56-year-old woman and provide a comprehensive review of the literature on the "Mucor fungus ball." To the best of our knowledge, 5 case reports (8 patients) have been published in which the fungus ball was thought to be caused by Mucor spp.

[Juvenile angiofibroma originating from the sphenoid sinus: a case report].

PubMed

Keskin, Ibrahim Gürkan; Ila, Kadri

2013-01-01

Angiofibromas are histologically benign, but unencapsulated and highly vascular tumors with a potential of local destructive effect. Angiofibromas predominantly originate from the posterolateral wall of the nasopharynx. Extranasopharyngeal angiofibromas are extremely rare and mostly seen in maxillary sinus and ethmoid sinus. In this article, we report a 21-year-old male case who was admitted with headache and diagnosed with an angiofibroma originating from the sphenoid sinus.

Evolution of the paranasal sinuses' anatomy through the ages

PubMed Central

Mavrodi, Alexandra

2013-01-01

Previously, anatomists considered paranasal sinuses as a mysterious region of the human skull. Historically, paranasal sinuses were first identified by ancient Egyptians and later, by Greek physicians. After a long period of no remarkable improvement in the understanding of anatomy during the Middle Ages, anatomists of the Renaissance period-Leonardo da Vinci and Vesalius-made their own contribution. Nathaniel Highmore's name is also associated with the anatomy of paranasal sinuses as he was first to describe the maxillary sinus. PMID:24386595

Trans-sinusal maxillary distraction for correction of midfacial hypoplasia: long-term clinical results.

PubMed

Nadjmi, N; Schutyser, F; Van Erum, R

2006-10-01

Maxillary distraction osteogenesis is indicated in severe angle class III malocclusions, and severe maxillary hypoplasia among some cleft patients and other craniofacial deformities. Twenty patients, aged 8-48 years (mean 17.8+/-10.5 SD) with maxillary and midfacial hypoplasia were treated. The follow-up period was 13-65 months (mean 35+/-16.3 SD). A trans-sinusal maxillary distractor was placed intraorally at each side of the maxilla. The distraction vector was predicted using specialist software, and was transferred to the patients using stereolithographic models and individual templates. A (high) Le Fort I type osteotomy was performed. The amount of activation varied from 8 to 17.5 mm (mean 13.1+/-2.9 SD). Soft and hard tissue formation resulted in complete healing across the distraction gaps. The distractors are almost completely submerged, and can be left in place as long as necessary to avoid relapse. Wit's appraisal was used to measure the stability of the long-term distraction results. Results up to 5 years after distraction showed considerable maxillary advancement with long-term stability. Ongoing growth of the facial skeleton must be considered when distraction osteogenesis is chosen in growing patients.

Infraorbital nerve transposition to expand the endoscopic transnasal maxillectomy.

PubMed

Salzano, Giovanni; Turri-Zanoni, Mario; Karligkiotis, Apostolos; Zocchi, Jacopo; Dell'Aversana Orabona, Giovanni; Califano, Luigi; Battaglia, Paolo; Castelnuovo, Paolo

2017-02-01

The infraorbital nerve (ION) is a terminal branch of the maxillary nerve (V2) providing sensory innervation to the malar skin. It is sometimes necessary to sacrifice the ION and its branches to obtain adequate maxillary sinus exposure for radical resection of sinonasal tumors. Consequently, patients suffer temporary or permanent paresthesia, hypoestesthia, and neuralgia of the face. We describe an innovative technique used for preservation of the ION while removing the anterior, superior, and lateral walls of the maxillary sinus through a medial endoscopic transnasal maxillectomy. All patients who underwent transnasal endoscopic maxillectomy with ION transposition in our institute were retrospectively reviewed. Two patients were identified who had been treated for sinonasal cancers using this approach. No major complications were observed. Transient loss of ION function was observed with complete recovery of skin sensory perception within 6 months of surgery. One patient referred to a mild permanent anesthesia of the upper incisors. No diplopia or enophthalmos were encountered in any of the patients. The ION transposition is useful for selected cases of benign and malignant sinonasal tumors that do not infiltrate the ION itself but involve the surrounding portion of the maxillary sinus. Anatomic preservation of the ION seems to be beneficial to the postoperative quality of life of such patients. © 2016 ARS-AAOA, LLC.

The use of injectable sonication-induced silk hydrogel for VEGF165 and BMP-2 delivery for elevation of the maxillary sinus floor

PubMed Central

Zhang, Wenjie; Wang, Xiuli; Wang, Shaoyi; Zhao, Jun; Xu, Lianyi; Zhu, Chao; Zeng, Deliang; Chen, Jake; Zhang, Zhiyuan; Kaplan, David L.; Jiang, Xinquan

2011-01-01

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 regenerate irregular bony cavities. PMID:21889205

Orbital abscess caused by Fusobacterium necrophorum.

PubMed

Pitkäranta, Anne; Lindahl, Päivi; Raade, Merja; Puohiniemi, Ritvaleena

2004-05-01

We report the case of previously healthy boy with orbital abscess secondary to sinusitis. Fusobacterium necrophorum and Streptococcus anginosus was cultured both from the maxillary sinus and the orbital abscess. After surgical drainage and intravenous antibiotic treatment the boy recovered without complications.

Is Le Fort I Osteotomy Associated With Maxillary Sinusitis?

PubMed

Nocini, Pier Francesco; D'Agostino, Antonio; Trevisiol, Lorenzo; Favero, Vittorio; Pessina, Mattia; Procacci, Pasquale

2016-02-01

The purpose of the present study was to investigate the association between Le Fort I osteotomy and the anatomic, radiologic, and symptomatic modifications of the maxillary sinus. Subjects who had undergone Le Fort I osteotomy from January 2008 to December 2013 were enrolled in a retrospective cohort study. The eligibility criteria were the availability of a cone beam computed tomography (CBCT) scan taken before and 12 to 24 months after the procedure. The exclusion criteria were the unavailability of CBCT scans, the use of tobacco, and previous orthognathic procedures. The primary predictor variable was time (pre-vs postoperative). The primary outcome variables were the sinus volume, mucosal thickening, iatrogenic alterations in the sinus anatomy, and rhinosinusitis symptoms, evaluated using the Sino-Nasal Outcome 20-item Test (SNOT-20). Descriptive statistics were computed for each variable, and paired analyses were used to compare the pre- and postoperative values. The data from 64 subjects (mean age 27; 59.4% were female; median follow-up 32.4 months, range 13 to 66 months) were studied. Postoperatively, 1.6% of the sample (0% preoperatively) had moderate-to-severe and 15.6% (3.1% preoperatively) had mild-to-moderate sinusitis symptoms. The rest of the sample presented with mild to no symptoms. The increase in the SNOT scores after surgery was statistically significant (P = .016). Radiologic evidence of postoperative inflammatory processes affecting the paranasal sinuses was found in 27.3% of the sinuses (9.4% preoperatively). The postoperative Lund-Mackay scores were significantly greater (P = .0005). A 19% decrease was found in the mean postoperative sinus volume, with a 37% incidence of iatrogenic injury. The study results indicate that Le Fort I osteotomies can have an important impact on sinus health. The postoperative radiologic evidence of maxillary sinus inflammatory processes and the incidence of rhinosinusitis symptoms and iatrogenic damage in these patients have led us to conclude that CBCT scans and the SNOT-20 questionnaire should be used routinely during postoperative monitoring. Larger long-term studies are warranted to clarify the postoperative outcomes and complications. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Decreasing incidence of malignant tumors of the paranasal sinuses in Sweden. An analysis of 141 consecutive cases at Karolinska Hospital from 1960 to 1980.

PubMed

Norlander, Tomas; Frödin, Jan-Erik; Silfverswärd, Claes; Anggård, Anders

2003-03-01

We reviewed 141 cases of paranasal sinus tumors treated at Karolinska Hospital from 1960 to 1980. Of these tumors, 100 were located in the maxillary sinus, 32 in the ethmoidal sinuses, 8 in both the ethmoidal and maxillary regions, and 1 in the sphenoidal sinus. The male-to-female ratio was 2.1 to 1. Squamous cell carcinoma and adenocarcinoma were the most frequent types of tumors (55% and 13%, respectively). Treatment included surgery, irradiation, or both. The 5-year survival rate was 34% for squamous cell carcinomas and 64% for adenocarcinomas. When compared to a previous material of patients treated at the same hospital from 1940 to 1950, the proportion of poorly differentiated squamous cell carcinomas had increased significantly. The age-adjusted incidence rate decreased from 1.2 to 0.4 for male patients and from 0.7 to 0.3 for female patients between 1960 and 1980. We conclude that the incidence of malignant paranasal sinus tumors has decreased, and that squamous cell tumors now seem to be generally less differentiated than they were 50 years ago.

Frequency of Maxillary Sinus Mucous Retention Cysts in a Central Brazilian Population.

PubMed

Marçal Vieira, Evanice Menezes; de Morais, Sylvania; de Musis, Carlo Ralph; Borges, Álvaro Henrique; Palma, Vinícius Canavarros; da Silva Basilio, Laiane; Guedes, Orlando Aguirre

2015-09-01

Mucous retention cysts (MRCs) of the maxillary sinus are lesions with undefined pathogenesis. In recent researches, geographical and climatic aspects have been related as risk factors. The purpose of this study was to determine the frequency of MRCs of the maxillary sinus using panoramic radiographs. A total of 631 panoramic radiographs were selected from a secondary database from a private radiology clinic and analyzed by two specialists in dental radiology according to gender, age, month, relative air humidity, and mean temperature. A total of 87 (6.89%) radiographic images were suggestive of MRCs. Thirty-five MRCs (40.22%) were detected on the right side, 10 (11.49%) on the left side and 42 (48.29%) on both sides. A high frequency was detected in female participants (n=45; 51, 72%), those aged 18-35 years (n=31; 35, 63%) and those from August (n=24; 27.59%) and July (n=22; 25.29%). The frequency of MRCs was low, and no statistically significant correlation was found between the prevalence of MRCs and the studied variables with the exception of the mean temperature.

Large Reactional Osteogenesis in Maxillary Sinus Associated with Secondary Root Canal Infection Detected Using Cone-beam Computed Tomography.

PubMed

Estrela, Carlos; Porto, Olavo César Lyra; Costa, Nádia Lago; Garrote, Marcel da Silva; Decurcio, Daniel Almeida; Bueno, Mike R; Silva, Brunno Santos de Freitas

2015-12-01

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. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

[The use of Foley catheter in reconstructive procedures involving the middle third of the facial skeleton].

PubMed

Medvedev, Yu A; Petruk, P S; Shamanaeva, L S; Volkova, V A; Davidov, A R

2016-01-01

The aim of this study was to improve the efficiency of surgical treatment of patients with fractures involving zygomatico-orbital complex and maxillary sinus through the use of Foley catheter. 352 patients with fractures of the middle third of the facial skeleton were treated at the Departments of Oral & Maxillofacial Surgery in Novokuznetsk Institute and I.M. Sechenov First MSMU. All patients underwent open reduction and osteosynthesis using extramedullary titanium mini-plates and NiTi mini-clamps. In the cases with large bone defects additional reconstructive techniques were used such as replantation of bone fragments and endoprosthesis with NiTi implants. For the purpose of drainage and retention Foley catheter was placed in the cavity of the maxillary sinus after the surgical procedure. We obtained good and satisfactory results in the majority of clinical cases. The use of Foley catheter was found to be very effective for the post-operative drainage and hemostasis of the maxillary sinus and in cases involving the use of fixation implant in the reconstructive surgeries in the middle third of the face.

[The effect of mandibular distraction on the maxilla growth in children with hemifacial microsomia].

PubMed

Yang, Renkai; Tang, Xiaojun; Shi, Lei; Yin, Lin; Yang, Bin; Yin, Hongyu; Liu, Wei; Zhang, Zhiyong

2014-11-01

To analyze the effect of mandibular distraction on the maxilla growth in children with hemifacial microsomia through measurement with the posterior-anterior cephalometric X-ray films and Three-dimensional CT reconstruction images. The deviation angular of maxilla occlusion plane and nasal base plane from the infra-orbital plane were measured on the posterior-anterior cephalometric X-ray films in 22 patients before and half a year after operation. The vertical distance from the midpoint of 5th teeth alveolar and the lowest point of maxillary sinus to reference plane were measured on 3D reconstruction images in 15 patients. The data were statistically analyzed. On posterior-anterior cephalometric X-ray films, the cant of occlusion plane were significantly reduced (P < 0.05), While the angular of nasal base plane and the infra-orbital plane had no significant change. On 3D reconstruction images, all the detection points had significantly declined except the lowest point of maxillary sinus on normal side. Distraction osteogenesis of mandible can promote the growth of the maxilla in children with HFM, the accelerated growth parts include alveolar bone and maxillary sinus.

Functional evaluation of a CAD/CAM prosthesis for immediate defect repair after total maxillectomy: a case series of 18 patients with maxillary sinus cancer.

PubMed

Jiang, Fei-Fei; Hou, Yan; Lu, Li; Ding, Xiao-Xu; Li, Wei; Yan, Ai-Hui

2015-01-01

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 functions, and improve the quality of life of patients. Tumor recurrence can be detected by direct observation of the postoperative maxillary cavity. This technique avoids the need for dental implants because the bottom part of the prosthesis contains a palatal plate with dentures. © 2014 Wiley Periodicals, Inc.

Outcomes of flapless crestal maxillary sinus elevation under hydraulic pressure.

PubMed

Bensaha, Tarik

2012-01-01

Sinus elevation through the crestal approach has become a routine procedure for implant placement in the posterior edentulous maxilla. The combination of flapless surgery and crestal sinus elevation with simultaneous placement of implants is an attractive surgical approach for implant grafting in the posterior maxilla, but its efficacy and safety have seldom been studied. The aim of this study is to evaluate retrospectively the outcomes of flapless crestal sinus floor elevation using piezosurgery and a hydraulic sinus elevation system with simultaneous implant placement. Between October 2009 and August 2010, flapless implant surgery using a crestal approach, accompanied by simultaneous hydraulic sinus elevation and grafting, was performed. Patients were followed up clinically and with intraoral and panoramic radiographs. Any postoperative complications, including swelling, discomfort, infection, fractures, and implant loss, were recorded, and sinus bone gain was measured. Thirty-one sinuses were elevated and 35 implants were placed. Patients were a mean of 41.2 ± 6.69 years old, and 45% were women. The sinus was elevated to 7 to 15 mm, and no membrane perforations were noted. The mean follow-up period was 21 weeks. The mean bone gain under the maxillary sinus was 12.03 ± 2.1 mm, and all implants displayed primary stability with a mean insertion torque ≥ 15 Ncm. No postoperative discomfort, swelling, hematoma, infection, or bone fenestration was noted. One patient experienced prolonged edema in the lower eyelid region, and another lost an implant. In this retrospective analysis, flapless crestal sinus floor elevation was safe and effective, decreasing surgical discomfort and trauma and early implant failures.

Orofacial haemangiopericytoma--a rare case.

PubMed

Shetty, S R; Chatra, L; Shenai, K P

2007-10-01

Haemangiopericytoma is an uncommon vascular tumour that originates from small pericapillary spindle-shaped cells. Clinical diagnosis of such a lesion is an extremely challenging task because there are very few detailed reports of such lesions and one would hardly think of a diagnosis such as haemangiopericytoma while examining a lesion. We report here a case of haemangiopericytoma arising from the infratemporal fossa involving the orbit, the lateral wall of the nasal cavity, the maxillary sinus, the maxillary alveolar process and the ethmoidal sinus. The clinical features, radiological findings and differential diagnoses to be considered, and the available treatment options, are discussed in this case report.

Maxillary sinus marrow hyperplasia in sickle cell anemia.

PubMed

Fernandez, M; Slovis, T L; Whitten-Shurney, W

1995-11-01

Marrow hyperplasia is a sequela of sickle cell anemia (SCA) and may be seen in the skull in children after 5 years of age [1]. The facial bones, except for the mandible and orbits, are usually not involved [1-3]. We report an unusual case of a 28-month-old black boy with SCA who presented with extensive marrow hyperplasia of the maxillary sinuses in addition to severe calvarial and mandibular changes. The imaging characteristics on CT (similar to other sites of marrow hyperplasia) and MR (low signal on both T1 and T2 sequences) should aid in making the correct diagnosis.

Anatomical variations and sinusitis.

PubMed

Jorissen, M; Hermans, R; Bertrand, B; Eloy, P

1997-01-01

Paranasal sinus anatomy and variations have gained interest with the introduction of functional endoscopic sinus surgery and the concept of the ostiomeatal complex. Anatomical variations can be divided in structural abnormalities, (increased) pneumatization and supplementary openings. Most anatomical variations are equally found in control and sinusitis patients. The anatomical variations which are most commonly associated with sinus pathology are septal deviations, true conchae bullosae and supplementary maxillary ostia but the latter one only when recycling is present. The knowledge of anatomical variations is most important in the surgical management and specifically in the prevention of complications.

Anorganic bovine-derived hydroxyapatite vs β-tricalcium phosphate in sinus augmentation: a comparative histomorphometric study.

PubMed

Kurkcu, Mehmet; Benlidayi, M Emre; Cam, Burcu; Sertdemir, Yasar

2012-09-01

The choice of augmentation material is a crucial factor in sinus augmentation surgery. Bovine-derived hydroxyapatite (BHA) and beta-tricalcium phosphate (β-TCP) have been used successfully in sinus augmentation procedures. Choosing one of these materials for sinus augmentation is still controversial. The aim of this clinical study was to compare the biological performance of the new BHA graft material and the well-known synthetic β-TCP material in the sinus augmentation procedure. The study consisted of 23 patients (12 male and 11 female) who were either edentulous or partially edentulous in the posterior maxilla and required implant placement. A total of 23 two-step sinus-grafting procedures were performed. BHA was used in 13 patients, and β-TCP was used in 10 patients. After an average of 6.5 months of healing, bone biopsies were taken from the grafted areas. Undecalcified sections were prepared for histomorphometric analysis. The mean new bone formation was 30.13% ± 3.45% in the BHA group and 21.09% ± 2.86% in the β-TCP group (P = .001). The mean percentage of residual graft particle area was 31.88% ± 6.05% and 34.05% ± 3.01% for the BHA group and β-TCP group, respectively (P = .047). The mean percentage of soft-tissue area was 37.99% ± 5.92% in the BHA group and 44.86% ± 4.28% in the β-TCP group (P = .011). Both graft materials demonstrated successful biocompatibility and osteoconductivity in the sinus augmentation procedure. However, BHA appears to be more efficient in osteoconduction when compared with β-TCP.

Chronic Invasive Fungal Sinusitis Presenting as Inferior Altitudinal Visual Field Defect.

PubMed

Bansal, Reema; Takkar, Aastha; Lal, Vivek; Bal, Amanjit; Bansal, Sandeep

2017-06-01

A young male with acute blurring of vision (6/9) complained of an inferior altitudinal field defect in right eye. Clinical ophthalmological examination was normal. Magnetic resonance imaging (MRI) of the brain revealed the expansion and mucosal thickening of right posterior ethmoid and sphenoid sinuses and opacified right maxillary sinus. Surgical intervention (transethmoidal sphenoidotomy) and histopathological examination revealed chronic invasive granulomatous fungal sinusitis. Anti-fungal therapy led to resolution of visual complaints and restoration of visual field defects.

Clinical evaluation of sinus bone graft in patients with mucous retention cyst.

PubMed

Kim, Seong-Beom; Yun, Pil-Young; Kim, Young-Kyun

2016-12-01

Mucous retention cyst refers to a cyst made by expansion due to the blockage of the salivary gland near the maxillary sinus, and it is surrounded by epithelial cells. Most of them are small; therefore, they cannot be found well and are frequently with antral polyp. The aim of this study was to evaluate the clinical prognosis of sinus bone graft in patients with mucous retention cyst. This study was performed retrospectively on 23 patients who had sinus bone graft. Group 1 was 8 patients (10 sinuses) who had a mucous retention cyst, and group 2 was 15 patients (17 sinuses) who had no pathologic history about the maxillary sinus. For these patients, sinus bone graft was performed using the lateral approach technique. The total 51 implants were placed 6.22 weeks on the average after sinus bone graft. Sinus membrane perforation during operation, postoperative complications, marginal bone loss after restorative function, implant success rate, and survival rate were analyzed. There was no complication in group 1, and there were three complications in group 2. In group 2, two cases of implants failed. The types of postoperative complications consisted of two minor infections and one wound dehiscence. Two implants of total 51 implants were removed, and the survival rate of implants was 96.08 % (group 1 100 %, group 2 93.5 %). The total success rate of implants was 92.2 % (group 1 95 %, group 2 90.3 %). The clinical prognosis was not affected by the presence of mucous retention cyst.

Distribution of CGRP and TRPV2 in Human Paranasal Sinuses.

PubMed

Sato, Tadasu; Sasahara, Nobuyuki; Kanda, Noriyuki; Sasaki, Yu; Yamaguma, Yu; Kokubun, Souichi; Yajima, Takehiro; Ichikawa, Hiroyuki

2017-01-01

Immunohistochemistry for protein gene product 9.5 (PGP 9.5), calcitonin gene-related peptide (CGRP) and the transient receptor potential cation channel subfamily V member 2 (TRPV2) was performed on human paranasal sinuses. It was found that in the paranasal sinuses, mucous membranes contain PGP 9.5-immunoreactive (PGP 9.5-IR) nerve fibers. Such nerve fibers terminated around large blood vessels as fine varicosities. Isolated PGP 9.5-IR nerve fibers were scattered beneath the epithelium. Glandular tissues were also innervated by PGP 9.5-IR nerve fibers. These fibers were numerous in the maxillary and ethmoid sinuses, and relatively rare in the frontal and sphenoid sinuses. CGRP-IR nerve fibers were common in the maxillary sinus whereas TRPV2-IR nerve fibers were abundant in the ethmoid sinus. They were located around large blood vessels in the lamina propria. Many subepithelial nerve fibers contained TRPV2 immunoreactivity in the ethmoid sinus. CGRP- and TRPV2-IR nerve fibers were very infrequent in the frontal and sphenoid sinuses. In the human trigeminal ganglion (TG), sensory neurons contained CGRP or TRPV2 immunoreactivity. CGRP-IR TG neurons were more common than TRPV2-IR TG neurons. CGRP-IR TG neurons were of various cell body sizes, whereas TRPV2-IR TG neurons were mostly medium-to-large. In addition, human spinal and principal trigeminal sensory nuclei contained abundant CGRP- and TRPV2-IR varicosities. This study indicates that CGRP- and TRPV2-containing TG neurons probably innervate the paranasal sinus mucosae, and project into spinal and principal trigeminal sensory nuclei. © 2016 S. Karger AG, Basel.

Upper full arch rehabilitation with sinus by-pass with tilted implants via tapered-threaded expanders in low density bone: a clinical trial.

PubMed

Andreasi Bassi, M; Andrisani, C; Lico, S; Ormanier, Z; Arcuri, C

2016-01-01

In the present paper the use of tapered-screw bone expanders (TSBEs) is proposed, in combination with the placement of tilted implants, in close proximity to the anterior sinus wall, solving the problem of the reduced height of the alveolar bone in the sub-antral area. The Authors present a case series of full-arch rehabilitations performed with this procedure named: Tilted Implant Expansion Osteotomy (TIEO). 12 patients (5 males and 7 females, average age 58.5 ± 8.1 years) with totally or partially edentulous maxilla were enrolled in this study. For each patient 4 implants were placed, the anterior implants in the area of lateral incisors or canines while, the posterior implants, immediately in front of the maxillary sinus, with an inclined position. Adopting the aforesaid procedure, 48 cylindrical two-piece implants were placed, 24 of which were placed in tilted position, in order to by-pass the maxillary sinus. After a healing period of 6 months, the second stage surgery was performed. The cases were finalized by means of a hybrid metal-acrylic prosthesis. The post finalization follow-up was at 12 months. Survival rate was 100% since none fixtures were lost. At the one-year follow up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. TIEO is a promising surgical procedure for full-arch rehabilitation of maxillary edentulous sites and represents a therapeutic alternative to sinus lift techniques.

Upper full arch rehabilitation with sinus by-pass with tilted implants via tapered-threaded expanders in low density bone: a clinical trial

PubMed Central

BASSI, M. ANDREASI; ANDRISANI, C.; LICO, S.; ORMANIER, Z.; ARCURI, C.

2016-01-01

SUMMARY Purpose In the present paper the use of tapered-screw bone expanders (TSBEs) is proposed, in combination with the placement of tilted implants, in close proximity to the anterior sinus wall, solving the problem of the reduced height of the alveolar bone in the sub-antral area. The Authors present a case series of full-arch rehabilitations performed with this procedure named: Tilted Implant Expansion Osteotomy (TIEO). Materials and methods 12 patients (5 males and 7 females, average age 58.5 ± 8.1 years) with totally or partially edentulous maxilla were enrolled in this study. For each patient 4 implants were placed, the anterior implants in the area of lateral incisors or canines while, the posterior implants, immediately in front of the maxillary sinus, with an inclined position. Adopting the aforesaid procedure, 48 cylindrical two-piece implants were placed, 24 of which were placed in tilted position, in order to by-pass the maxillary sinus. After a healing period of 6 months, the second stage surgery was performed. The cases were finalized by means of a hybrid metal-acrylic prosthesis. The post finalization follow-up was at 12 months. Results Survival rate was 100% since none fixtures were lost. At the one-year follow up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. Conclusion TIEO is a promising surgical procedure for full-arch rehabilitation of maxillary edentulous sites and represents a therapeutic alternative to sinus lift techniques. PMID:28042432

Anorganic bovine-derived hydroxyapatite versus β-tricalcium phosphate in sinus augmentation. A comparative histomorphometric study.

PubMed

Kurkcu, Mehmet; Benlidayi, Mehmet Emre; Cam, Burcu; Sertdemir, Yasar

2012-05-22

Abstract AbstractIntroduction: The choice of augmentation material is a crucial factor in sinus augmentation surgery. Bovine-derived hydroxyapatite (BHA) and beta-tricalcium phosphate (β-TCP) have been used successfully in sinus augmentation procedures. Choosing one of these materials for sinus augmentation is still controversial. The aim of this clinical study was to compare the biological performance of the new BHA graft material and the well known synthetic β-TCP material in sinus augmentation procedure.Material and Methods: The study consisted of 23 patients (12 male and 11 female) who were either edentulous or partially edentulous in the posterior maxilla and required implant placement. A total of 23 two-step sinus grafting procedures were performed. BHA was used in 13 patients and β-TCP was used in 10 patients. After average of 6.5 months of healing bone biopsies were taken from the grafted areas. Undecalcified sections were prepared for histomorphometric analysis. Results: The mean new bone formation was 30.13±3.45% in BHA group and 21.09±2.86% in β-TCP group (p=0.001). The mean percentage of residual graft particle area was 31.88±6.05% and 34.05±3.01% for BHA group and β-TCP group, respectively (p=0.047). The mean percentage of soft tissue area was 37.99±5.92% in BHA group and 44.86±4.28% in β-TCP group (p=0.011).Conclusion: Both graft materials demonstrated successful biocompatibility and osteoconductivity in sinus augmentation procedure. However, BHA appears to be more efficient in osteoconduction when compared to β-TCP.

Histological and radiological evaluation of sintered and non-sintered deproteinized bovine bone substitute materials in sinus augmentation procedures. A prospective, randomized-controlled, clinical multicenter study.

PubMed

Fienitz, Tim; Moses, Ofer; Klemm, Christoph; Happe, Arndt; Ferrari, Daniel; Kreppel, Matthias; Ormianer, Zeev; Gal, Moti; Rothamel, Daniel

2017-04-01

The objective of this study is to histologically and radiologically compare a sintered and a non-sintered bovine bone substitute material in sinus augmentation procedures. Thirty-three patients were included in the clinically controlled randomized multicentre study resulting in a total of 44 treated sinuses. After lateral approach, sinuses were filled with either a sintered (SBM, Alpha Bio's Graft ® ) or a non-sintered (NSBM, Bio Oss ® ) deproteinized bovine bone substitute material. The augmentation sites were radiologically assessed before and immediately after the augmentation procedure as well as prior to implant placement. Bone trephine biopsies for histological analysis were harvested 6 months after augmentation whilst preparing the osteotomies for implant placement. Healing was uneventful in all patients. After 6 months, radiological evaluation of 43 sinuses revealed a residual augmentation height of 94.65 % (±2.74) for SBM and 95.76 % (±2.15) for NSBM. One patient left the study for personal reasons. Histological analysis revealed a percentage of new bone of 29.71 % (±13.67) for SBM and 30.57 % (±16.07) for NSBM. Residual bone substitute material averaged at 40.68 % (±16.32) for SBM compared to 43.43 % (±19.07) for NSBM. All differences between the groups were not statistically significant (p > 0.05, Student's t test). Both xenogeneic bone substitute materials showed comparable results regarding new bone formation and radiological height changes in external sinus grafting procedures. Both bone substitute materials allow for a predictable new bone formation following sinus augmentation procedures.

Influence of the site of origin on the outcome of squamous cell carcinoma of the maxilla-oral versus sinus.

PubMed

Bobinskas, A M; Wiesenfeld, D; Chandu, A

2014-02-01

The maxilla may be affected by squamous cell carcinoma (SCC) from both oral and sinus sites. We sought to determine whether the site of origin of the maxillary tumour, oral as compared to sinus, influences survival. Univariate Kaplan-Meier and multivariate Cox proportional hazard models analysis of 58 patients with SCC involving the maxilla, treated with curative intent, was conducted. The overall 5-year disease-free survival for the group was 41.7%. Five-year disease-free survival for oral subsite SCC was 56.8%, while for sinus subsite was only 21.6%. Univariate analysis found SCC of sinus origin to be associated with a poorer prognosis, however this was not confirmed on multivariate analysis. T-stage and positive margins were found to be the only independent risk factors. For SCC of the maxilla, sinus origin of the tumour per se does not confer a poorer prognosis; however, as a result of the complex anatomy of the midface, these tumours can present at an advanced stage, while surgical control of the disease can be more difficult, especially posteriorly. Tumour size and positive margins were the determinants of a poor prognosis in this group of patients with maxillary SCC. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Implant Stability of Biological Hydroxyapatites Used in Dentistry

PubMed Central

Ramírez Fernández, Maria Piedad; Gehrke, Sergio A.; Mazón, Patricia; Calvo-Guirado, Jose L.; De Aza, Piedad N.

2017-01-01

The aim of the present study was to monitor implant stability after sinus floor elevation with two biomaterials during the first six months of healing by resonance frequency analysis (RFA), and how physico-chemical properties affect the implant stability quotient (ISQ) at the placement and healing sites. Bilateral maxillary sinus augmentation was performed in 10 patients in a split-mouth design using a bobine HA (BBM) as a control and porcine HA (PBM). Six months after sinus lifting, 60 implants were placed in the posterior maxilla. The ISQ was recorded on the day of surgery from RFA at T1 (baseline), T2 (three months), and T3 (six months). Statistically significant differences were found in the ISQ values during the evaluation period. The ISQ (baseline) was 63.8 ± 2.97 for BBM and 62.6 ± 2.11 for PBM. The ISQ (T2) was ~73.5 ± 4.21 and 67 ± 4.99, respectively. The ISQ (T3) was ~74.65 ± 2.93 and 72.9 ± 2.63, respectively. All of the used HAs provide osseointegration and statistical increases in the ISQ at baseline, T2 and T3 (follow-up), respectively. The BBM, sintered at high temperature with high crystallinity and low porosity, presented higher stability, which demonstrates that variations in the physico-chemical properties of a bone substitute material clearly influence implant stability. PMID:28773005

Comparison of Two Xenograft Materials Used in Sinus Lift Procedures: Material Characterization and In Vivo Behavior

PubMed Central

Ramírez Fernández, María Piedad; Mazón, Patricia; Gehrke, Sergio A.; Calvo-Guirado, Jose Luis; De Aza, Piedad N.

2017-01-01

Detailed information about graft material characteristic is crucial to evaluate their clinical outcomes. The present study evaluates the physico-chemical characteristics of two xenografts manufactured on an industrial scale deproteinized at different temperatures (non-sintered and sintered) in accordance with a protocol previously used in sinus lift procedures. It compares how the physico-chemical properties influence the material’s performance in vivo by a histomorphometric study in retrieved bone biopsies following maxillary sinus augmentation in 10 clinical cases. An X-ray diffraction analysis revealed the typical structure of hydroxyapatite (HA) for both materials. Both xenografts were porous and exhibited intraparticle pores. Strong differences were observed in terms of porosity, crystallinity, and calcium/phosphate. Histomorphometric measurements on the bone biopsies showed statistically significant differences. The physic-chemical assessment of both xenografts, made in accordance with the protocol developed on an industrial scale, confirmed that these products present excellent biocompatibilitity, with similar characteristics to natural bone. The sintered HA xenografts exhibited greater osteoconductivity, but were not completely resorbable (30.80 ± 0.88% residual material). The non-sintered HA xenografts induced about 25.92 ± 1.61% of new bone and a high level of degradation after six months of implantation. Differences in the physico-chemical characteristics found between the two HA xenografts determined a different behavior for this material. PMID:28772984

Sinus Floor Augmentation Using Straumann® BoneCeramic™ and Bio-Oss® in a Split Mouth Design and Later Placement of Implants: A 5-Year Report from a Longitudinal Study.

PubMed

Mordenfeld, Arne; Lindgren, Christer; Hallman, Mats

2016-10-01

Straumann® BoneCeramic™ is a synthetic biphasic calcium phosphate (BCP) aimed for sinus floor augmentation. Long-term follow-up of implants placed in BCP after sinus augmentation is still missing. The primary aim of the study was to compare survival rates and marginal bone loss of Straumann SLActive implants placed in either BCP (test) or Bio-Oss® (DBB) (control) after sinus floor augmentation. The secondary aim was to calculate graft sinus height at different time points. Bilateral sinus floor augmentation was performed in a split mouth model. Eleven patients (mean age 67 years) received 100% BCP on one side and 100% DBB on the contralateral side. After 8 months of graft healing, 62 Straumann SLActive implants were placed. After 5 years of functional loading (6 years after augmentation) of implants, marginal bone levels and grafted sinus height were measured, and implant survival and success rates were calculated. After 5 years of loading, all prosthetic constructions were in function although two implants were lost in each grafting material. The overall implant survival rate was 93.5% (91.7% for BCP, 91.3% for DBB, and 100% for residual bone). The success rates were 83.3% and 91.3% for BCP and DBB, respectively. There was no statistically significant difference in mean marginal bone level after 5 years between BCP (1.4 ± 1.2 mm) and DBB (1.0 ± 0.7 mm). Graft height reduction (GHR) after 6 years was limited to 6.6% for BCP and 5.8% for DBB. In this limited RCT study, the choice of biomaterial used for sinus floor augmentation did not seem to have any impact on survival rates and marginal bone level of the placed implants after 5 years of functional loading and GHR was minimal. © 2015 Wiley Periodicals, Inc.

Frequency of Maxillary Sinus Mucous Retention Cysts in a Central Brazilian Population

PubMed Central

Marçal Vieira, Evanice Menezes; de Morais, Sylvania; de Musis, Carlo Ralph; Borges, Álvaro Henrique; Palma, Vinícius Canavarros; da Silva Basilio, Laiane; Guedes, Orlando Aguirre

2015-01-01

Statement of the Problem Mucous retention cysts (MRCs) of the maxillary sinus are lesions with undefined pathogenesis. In recent researches, geographical and climatic aspects have been related as risk factors. Purpose The purpose of this study was to determine the frequency of MRCs of the maxillary sinus using panoramic radiographs. Materials and Method A total of 631 panoramic radiographs were selected from a secondary database from a private radiology clinic and analyzed by two specialists in dental radiology according to gender, age, month, relative air humidity, and mean temperature. Results A total of 87 (6.89%) radiographic images were suggestive of MRCs. Thirty-five MRCs (40.22%) were detected on the right side, 10 (11.49%) on the left side and 42 (48.29%) on both sides. A high frequency was detected in female participants (n=45; 51, 72%), those aged 18-35 years (n=31; 35, 63%) and those from August (n=24; 27.59%) and July (n=22; 25.29%). Conclusion The frequency of MRCs was low, and no statistically significant correlation was found between the prevalence of MRCs and the studied variables with the exception of the mean temperature. PMID:26331145

Endoscopic modified medial maxillectomy for treatment of inverted papilloma originating from the maxillary sinus.

PubMed

Erbek, Selim S; Koycu, Alper; Buyuklu, Fuat

2015-05-01

Endoscopic approaches have become an alternative to external approaches in the treatment of sinonasal inverted papillomas (IPs) in recent years. The aim of this study was to analyze the outcomes of endoscopic modified medial maxillectomy preserving the nasolacrimal duct and the inferior turbinate in selected IP cases. Medical charts of patients diagnosed with IP originating from the maxillary sinus between July 2008 and August 2013 were reviewed. Eight patients who had undergone endoscopic modified medial maxillectomy were included in the study. Attachment of IP was located on the medial wall of the maxillary sinus in all cases. The nasolacrimal duct was preserved in all of the patients. The inferior turbinate was completely preserved in 5 patients, and the anterior part of the inferior turbinate was preserved in 3 patients. The mean follow-up period of the patients was 30.8 months (12-60  mo). None of the patients had recurrence or major complications. The postoperative complaints were minor hemorrhagic discharge and crusting for the first few weeks. Endoscopic modified medial maxillectomy preserving the nasolacrimal duct and the inferior turbinate provides good surgical and functional outcomes in selected IP cases.

Ectopic canine associated with a dentigerous cyst in the maxilla.

PubMed

Thakur, Jagdeep S; Mohindroo, Narinder K; Sharma, Dev R; Minhas, Ravinder S; Thakur, Anamika

2011-06-01

Ectopic eruption of a tooth is common in the dental arch, palate, and nose, but it is rare in the maxillary antrum. We present the case of a 35-year-old man with an ectopic canine and an associated dentigerous cyst in the maxillary sinus that masqueraded as an antrochoanal polyp.

An Anatomical Study of Maxillary-Zygomatic Complex Using Three-Dimensional Computerized Tomography-Based Zygomatic Implantation

PubMed Central

Zhao, Shijie; Liu, Hui; Sun, Zhipeng; Wang, Jianwei

2017-01-01

Objective To obtain anatomical data of maxillary-zygomatic complex based on simulating the zygomatic implantation using cadaver heads and three-dimensional computerized tomography (3D-CT). Methods Simulating zygomatic implantation was performed using seven cadaver heads and 3D-CT images from forty-eight adults. After measuring the maxillary-zygomatic complex, we analyzed the position between the implantation path and the maxillary sinus cavity as well as the distance between the implantation path and the zygomatic nerve. Results The distance from the starting point to the endpoint of the implant was 56.85 ± 5.35 mm in cadaver heads and 58.15 ± 7.37 mm in 3D-CT images. For the most common implantation path (80.20%), the implant went through the maxillary sinus cavity completely. The projecting points of the implant axis (IA) on the surface of zygoma were mainly located in the region of frontal process of zygomatic bone close to the lateral orbital wall. The distances between IA and zygomatic nerve in 53 sides were shorter than 2 mm. Conclusion The simulating zygomatic implantation on cadaver skulls and 3D-CT imaging provided useful anatomical data of the maxillary-zygomatic complex. It is necessary to take care to avoid the zygomatic nerve injury during implantation, because it frequently appears on the route of implantation. PMID:29376077

Evaluation of surgically assisted rapid maxillary expansion with piezosurgery versus oscillating saw and chisel osteotomy - a randomized prospective trial.

PubMed

Rana, Majeed; Gellrich, Nils-Claudius; Rana, Madiha; Piffkó, Jozsef; Kater, Wolfgang

2013-02-17

Ultrasonic bone-cutting surgery has been introduced as a feasible alternative to the conventional sharp instruments used in craniomaxillofacial surgery because of its precision and safety. The piezosurgery medical device allows the efficient cutting of mineralized tissues with minimal trauma to soft tissues. Piezoelectric osteotome has found its role in surgically assisted rapid maxillary expansion (SARME), a procedure well established to correct transverse maxillary discrepancies. The advantages include minimal risk to critical anatomic structures. The purpose of this clinical comparative study (CIS 2007-237-M) was to present the advantages of the piezoelectric cut as a minimally invasive device in surgically assisted, rapid maxillary expansion by protecting the maxillary sinus mucosal lining. Thirty patients (18 females and 12 males) at the age of 18 to 54 underwent a surgically assisted palatal expansion of the maxilla with a combined orthodontic and surgical approach. The patients were randomly divided into two separate treatment groups. While Group 1 received conventional surgery using an oscillating saw, Group 2 was treated with piezosurgery. The following parameters were examined: blood pressure, blood values, required medication, bleeding level in the maxillary sinus, duration of inpatient stay, duration of surgery and height of body temperature. The results displayed no statistically significant differences between the two groups regarding laboratory blood values and inpatient stay. The duration of surgery revealed a significant discrepancy. Deploying piezosurgery took the surgeon an average of 10 minutes longer than working with a conventional-saw technique. However, the observation of the bleeding level in the paranasal sinus presented a major and statistically significant advantage of piezosurgery: on average the bleeding level was one category above the one of the remaining patients. This method of piezoelectric surgery with all its advantages is going to replace many conventional operating procedures in oral and maxillofacial surgery. CIS 2007-237-M.

Evaluation of surgically assisted rapid maxillary expansion with piezosurgery versus oscillating saw and chisel osteotomy - a randomized prospective trial

PubMed Central

2013-01-01

Background Ultrasonic bone-cutting surgery has been introduced as a feasible alternative to the conventional sharp instruments used in craniomaxillofacial surgery because of its precision and safety. The piezosurgery medical device allows the efficient cutting of mineralized tissues with minimal trauma to soft tissues. Piezoelectric osteotome has found its role in surgically assisted rapid maxillary expansion (SARME), a procedure well established to correct transverse maxillary discrepancies. The advantages include minimal risk to critical anatomic structures. The purpose of this clinical comparative study (CIS 2007-237-M) was to present the advantages of the piezoelectric cut as a minimally invasive device in surgically assisted, rapid maxillary expansion by protecting the maxillary sinus mucosal lining. Methods Thirty patients (18 females and 12 males) at the age of 18 to 54 underwent a surgically assisted palatal expansion of the maxilla with a combined orthodontic and surgical approach. The patients were randomly divided into two separate treatment groups. While Group 1 received conventional surgery using an oscillating saw, Group 2 was treated with piezosurgery. The following parameters were examined: blood pressure, blood values, required medication, bleeding level in the maxillary sinus, duration of inpatient stay, duration of surgery and height of body temperature. Results The results displayed no statistically significant differences between the two groups regarding laboratory blood values and inpatient stay. The duration of surgery revealed a significant discrepancy. Deploying piezosurgery took the surgeon an average of 10 minutes longer than working with a conventional-saw technique. However, the observation of the bleeding level in the paranasal sinus presented a major and statistically significant advantage of piezosurgery: on average the bleeding level was one category above the one of the remaining patients. Conclusion This method of piezoelectric surgery with all its advantages is going to replace many conventional operating procedures in oral and maxillofacial surgery. Trial registration CIS 2007-237-M PMID:23414112

Perforating internal root resorption repaired with mineral trioxide aggregate caused complete resolution of odontogenic sinus mucositis: a case report.

PubMed

Bendyk-Szeffer, Maja; Łagocka, Ryta; Trusewicz, Matylda; Lipski, Mariusz; Buczkowska-Radlińska, Jadwiga

2015-02-01

An extensive perforating internal root resorption accompanied by apical periodontitis and odontogenic sinus mucositis was detected on preoperative cone-beam computed tomographic scans in a first maxillary molar. After the chemomechanical debridement of the root canals, calcium hydroxide was placed as a temporary dressing for 7 days. Mineral trioxide aggregate was used to fill the perforation site with the aid of a surgical microscope. At the next visit, the root with the resorption defect was filled with warm vertical compaction of gutta-percha. A control cone-beam computed tomographic scan acquired 6 months after the endodontic treatment revealed complete resolution of the sinus retention cyst. Moreover, the patient's frequent otolaryngologic disturbances ceased. The tooth was functional with satisfactory clinical and radiographic results after 12 months. Based on the results of this case, successful repair of an extensive, perforating internal resorption with mineral trioxide aggregate may lead to complete resolution of apical periodontitis and maxillary sinus retention cyst. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Cavernous sinus thrombosis caused by contralateral sphenoid sinusitis: a case report

PubMed Central

2013-01-01

Objective To report a rare case of unilateral cavernous sinus thrombosis caused by contralateral sphenoid sinusitis. Case report A 33-year-old female visited our hospital for severe, right-sided, temporal headache, chemosis, periorbital edema, and proptosis. These signs were associated with congested erythematous nasal mucosa with purulent discharge from the right superior nasal meatus. Contrast enhanced CT showed dilated left superior ophthalmic vein, suggestive of thrombosis, contrast enhancement of the left cavernous sinuses, and dilation of cavernous sinus, indicating cavernous sinus inflammation. The right maxillary, ethmoid and sphenoid sinuses showed mucosal thickening and retention of purulent material. She was diagnosed with cavernous sinus thrombosis caused by contralateral sphenoid sinusitis. All clinical symptoms and signs improved after endoscopic sphenoidotomy and appropriate medical treatment. Conclusions Sphenoiditis can cause contralateral cavernous sinus thrombosis. Early surgical sphenoidotomy and aggressive medical treatment are the cornerstones of successful management of this life-threatening complication. PMID:23497466

Neuro-ophthalmological presentation of non-invasive Aspergillus sinus disease in the non-immunocompromised host.

PubMed Central

Brown, P; Demaerel, P; McNaught, A; Revesz, T; Graham, E; Kendall, B E; Plant, G

1994-01-01

Two cases of non-invasive aspergillosis of the nose and paranasal sinuses are described. The first presented with left proptosis and ophthalmoplegia. Imaging and histology showed a maxillary sinus aspergilloma. The second case presented as a compressive optic neuropathy and histology showed allergic aspergillus sinusitis. The pathological distinction between invasive and non-invasive forms of aspergillus sinusitis is important as in invasive aspergillosis surgical treatment is most effectively combined with systemic antifungal treatment, whereas in aspergilloma of the paranasal sinuses surgical drainage of the sinuses alone is usually sufficient, and in allergic aspergillus sinusitis surgery is best combined with systemic or topical steroids. The distinction between invasive and non-invasive forms is particularly important as both may present with cranial neuropathies. Images PMID:8126516

The use of cancellous block allograft for sinus floor augmentation with simultaneous implant placement in the posterior atrophic maxilla.

PubMed

Chaushu, Gavriel; Mardinger, Ofer; Calderon, Shlomo; Moses, Ofer; Nissan, Joseph

2009-03-01

The simultaneous placement of dental implants during sinus augmentation is advocated in cases in which >or=4 to 5 mm of alveolar bone exists coronally to the sinus floor. The aim of the present study was to assess the survival rate of dental implants placed during sinus augmentation and stabilized by the use of cancellous freeze-dried block allograft. Residual alveolar ridge height

Endoscopic and computed tomographic evaluation of influence of nasal septal deviation on lateral wall of nose and its relation to sinus diseases.

PubMed

Poorey, V K; Gupta, Neha

2014-09-01

To correlate symptoms of deviated nasal septum (DNS) and chronic rhinosinusitis with the findings of nasal endoscopy and computed tomographic (CT) imaging. To evaluate the influence of degree of septal angle deviation on the severity of lateral nasal wall abnormalities. A prospective study was conducted on 67 patients with clinical evidence of DNS and chronic sinusitis attending ENT OPD between January 2012 and September 2013. All these patients underwent nasal endoscopy and CT scan PNS coronal sections. Direction and degree of DNS was recorded. Range of sinus mucosal thickening on CT scan films was also recorded. Chronic sinusitis is common in the age group between 21 and 40 years (50.74 %) with male preponderance (55.22 %), chief symptoms being nasal obstruction (86.56 %), headache (73.13 %) and nasal discharge (52.23 %). Left sided DNS is more common (64.17 %). Most of the patients have moderate DNS, i.e. 6°-10° (56.7 %), followed by severe (22.4 %) and then mild (20.9 %). DNS results in compensatory structural changes in the turbinates and/or lateral nasal wall which causes ostiomeatal complex (OMC) obstruction resulting in sinusitis. Contralateral concha bullosa and ethmoid bulla prominence was noted. Maxillary sinus is most commonly affected sinus (73.13 %). Patients with increasing septal angles were associated with a higher incidence of maxillary sinus mucosal changes (p < 0.05). Present study reemphasized the concept that septal deviation causes obstruction at OMC which results in an increased incidence and severity of bilateral chronic sinus disease.

Non-invasive diagnostics of the maxillary and frontal sinuses based on diode laser gas spectroscopy.

PubMed

Lewander, Märta; Lindberg, Sven; Svensson, Tomas; Siemund, Roger; Svanberg, Katarina; Svanberg, Sune

2012-03-01

Suspected, but objectively absent, rhinosinusitis constitutes a major cause of visits to the doctor, high health care costs, and the over-prescription of antibiotics, contributing to the serious problem of resistant bacteria. This situation is largely due to a lack of reliable and widely applicable diagnostic methods. A novel method for the diagnosis of rhinosinusitis based on non-intrusive diode laser gas spectroscopy is presented. The technique is based on light absorption by free gas (oxygen and water vapour) inside the sinuses, and has the potential to be a complementary diagnostic tool in primary health care. The method was evaluated on 40 patients with suspected sinus problems, referred to the diagnostic radiology clinic for low-dose computed tomography (CT), which was used as the reference technique. The data obtained with the new laser-based method correlated well with the grading of opacification and ventilation using CT. The sensitivity and specificity were estimated to be 93% and 61%, respectively, for the maxillary sinuses, and 94% and 86%, respectively, for the frontal sinuses. Good reproducibility was shown. The laser-based technique presents real-time clinical data that correlate well to CT findings, while being non-intrusive and avoiding the use of ionizing radiation.

Minimally invasive medial maxillectomy and the position of nasolacrimal duct: the CT study.

PubMed

Sieskiewicz, Andrzej; Buczko, Krzysztof; Janica, Jacek; Lukasiewicz, Adam; Lebkowska, Urszula; Piszczatowski, Bartosz; Olszewska, Ewa

2017-03-01

Several minimally invasive modifications of endoscopic medial maxillectomy have been proposed recently, with the least traumatic techniques utilizing the lacrimal recess as a route to enter the sinus. The aim of the study was to analyze the anatomy of medial maxillary wall in the region of nasolacrimal canal and, thus, to determine the capability of performing minimally invasive approach to the maxillary sinus leading through the lacrimal recess. The course of nasolacrimal canal and the distance between the anterior maxillary wall and the nasolacrimal canal (the width of lacrimal recess) were evaluated in 125 randomly selected computed tomography (CT) head examinations. The proportion of cases with unfavorable anatomical conditions (lacrimal recess too narrow to accept a 4 mm optic) to perform minimally invasive middle maxillectomy was assessed. The width of lacrimal recess, measured at the level of the inferior turbinate attachment, varied between 0 and 15.2 mm and was related to slanted course of nasolacrimal canal. The more perpendicular the axis of the canal to the nasal flor, the narrower the lacrimal recess. In about 16% of cases, lacrimal recess width was less than 4 mm and in 14.4% it was missing. The endoscopic approach to maxillary sinus leading through lacrimal recess is possible in about 70% of patients. In the remaining group of patients when the lacrimal recess is too narrow, this type of approach may be difficult to perform without damaging the piriform aperture rim or bony framework of nasolacrimal duct, or it may be impracticable when lacrimal recess is missing.

Trigeminofacial reflex: a means of detecting proximity to ophthalmic and maxillary divisions of the trigeminal nerve during surgery.

PubMed

AlMasri, Omar A; Brown, Emma E; Forster, Alan; Kamel, Mahmoud H

2014-11-01

The aim in this paper was to localize and detect incipient damage to the ophthalmic and maxillary branches of the trigeminal nerve during tumor surgery. This was an observational study of patients with skull base, retroorbital, or cavernous sinus tumors warranting dissection toward the cavernous sinus at a university hospital. Stimuli were applied as normal during approach to the cavernous sinus to localize cranial nerves (CNs) III, IV, and VI. Recordings were also obtained from the facial muscles to localize CN VII. The trigeminofacial reflex was sought simply by observing a longer time base routinely. Clear facial electromyography responses were reproduced when stimuli were applied to the region of V1, V2, and V3. Response latency was increased compared with direct CN VII stimuli seen in some cases. Responses gave early warning of approach to these sensory trigeminal branches. The authors submit this as a new technique, which may improve the chances of preserving trigeminal sensory branches during surgery in this region.

[Structure of maxillary sinus mucous membrane under normal conditions and in odontogenic perforative sinusitis].

PubMed

Baĭdik, O D; Logvinov, S V; Zubarev, S G; Sysoliatin, P G; Gurin, A A

2011-01-01

Methods of light, electron microscopy and immunohistochemistry were used to study the samples of maxillary sinus (MS) mucous membrane (MM) under normal conditions and in odontogenic sinusitis. To study the normal structure, the samples were obtained at autopsy from 26 human corpses 12-24 hours after death. Electron microscopic and immunohistochemical study was performed on biopsies of grossly morphologically unchanged MS MM, obtained during the operations for retention cysts in 6 patients. MS MM in perforative sinusitis was studied using the biopsies obtained from 43 patients. The material is broken into 4 groups depending on perforative sinusitis duration. Under normal conditions, MS MM is lined with a pseudostratified columnar ciliated epithelium. Degenerative changes of ciliated epithelial cells were already detected at short time intervals after MS perforations and become apparent due to reduction of specific volume of mitochondria and, rough endoplasmic reticulum, and increase of nuclear-cytoplasmic ratio. In the globlet cells, the reduction of nuclear-cytoplasmic ratio was associated with the disturbance of the secretory product release. At time intervals exceeding 3 months, epithelium underwent metaplasia into simple cuboidal and stratified squamous keratinized, while in MS MM lamina propria, cellular infiltration was increased. CD4+ cell content in sinus MM gradually increased, while at late periods after perforation occurrence it decreased. Low CD4+ cell count within the epithelium and the absence of muromidase on the surface of MS MM was detected. With the increase of the time interval since MS perforation, the number of CD8+ and CD20+ cells in MS MM was found to increase.

Multimodality Treatment in Ewing's Sarcoma Family Tumors of the Maxilla and Maxillary Sinus: Review of the Literature

PubMed Central

Mamot, Christoph; Krasniqi, Fatime; Metternich, Frank

2016-01-01

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

An unusual case of schwannomatosis with bilateral maxillary sinus schwannomas and a novel SMARCB1 gene mutation.

PubMed

Toms, Jamie; Harrison, Jason; Richard, Hope; Childers, Adrienne; Reiter, Evan R; Graham, Robert S

2016-01-01

Schwannomas are benign tumors that arise from Schwann cells in the peripheral nervous system. Patients with multiple schwannomas without signs and symptoms of neurofibromatosis Type 1 or 2 have the rare disease schwannomatosis. Tumors in these patients occur along peripheral nerves throughout the body. Mutations of the SMARCB1 gene have been described as one of the predisposing genetic factors in the development of this disease. This report describes a patient who was observed for 6 years after having undergone removal of 7 schwannomas, including bilateral maxillary sinus schwannomas, a tumor that has not been previously reported. Genetic analysis revealed a novel mutation of c.93G>A in exon 1 of the SMARCB1 gene.

A bioarcheological study of maxillary sinusitis.

PubMed

Roberts, Charlotte A

2007-06-01

Maxillary sinusitis was studied as an indicator of poor air quality. Seven skeletal samples were examined from North America, England, and Nubia, and selected to represent different geographic locations, environments, and subsistence economies. Frequency rates varied from 17.2 to 51.5% of individuals affected with one or both sinuses preserved. Hardin Village had the highest frequency (51.5%), followed by the Aleuts (42.9%), "Illinois" (38.6%), Indian Knoll (38.5%), Kulubnarti (21.8%), Christchurch, Spitalfields (18.0%), and "South Dakota" (17.2%). Male frequencies ranged from 16.7 to 36.7%, but the female frequency ranged more widely from 18.0 to 76.5%. At most sites female rates exceeded male. The effect of urban and rural environment on sinusitis occurrence, and also subsistence economy, biological sex, and social status were explored, and comparative sites also considered; urban agricultural sites had a mean frequency of 48.5%, rural agricultural sites had a mean frequency of 45.0%, and hunter-gatherer sites had a mean frequency of 40.0%. In the urban sites male and female frequencies were near equal, but in the rural agricultural and hunter-gatherer sites female frequencies exceeded male frequencies. Dental disease was not found to have much impact on sinusitis frequency. The importance of the link between poor air quality and respiratory health is highlighted in clinical studies in both developed and developing countries, but also in bioarcheological studies.

Three-dimensional images contribute to the diagnosis of mucous retention cyst in maxillary sinus

PubMed Central

Donizeth-Rodrigues, Cleomar; Fonseca-Da Silveira, Márcia; Gonçalves-De Alencar, Ana H.; Garcia-Santos-Silva, Maria A.; Francisco-De-Mendonça, Elismauro

2013-01-01

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

Shunts to divert aqueous humor to distant epithelialized cavities after keratoprosthesis surgery.

PubMed

Dohlman, Claes H; Grosskreutz, Cynthia L; Chen, Teresa C; Pasquale, Louis R; Rubin, Peter A D; Kim, Eva C; Durand, Marlene

2010-02-01

Glaucoma is a frequent and often severe problem in patients needing keratoprosthesis (KPro) surgery. Standard glaucoma shunts in these cases often develop a very dense capsule that obstructs flow and causes intraocular pressure elevation. Therefore, we developed shunts that deliver aqueous to distant epithelialized cavities where an obstructing capsule is less likely to form. In this retroactive study of such shunts, the risk of postoperative infection (especially endophthalmitis) has been assessed. Ahmed shunts were connected with a tube to the lacrimal sac or ethmoid sinuses. In subsequent designs the polypropylene plate was eliminated, the valve was enclosed and a distal tube added (New World Medical Inc, Rancho Cucamonga, CA). The latter shunts were connected to the maxillary sinus or lower lid fornix. Between 2001 and 2005 the devices were implanted in 34 patients with very severe ocular disease. (31 had KPro implanted). Thus, the distal tube was led to the lacrimal sac (2 cases), to the ethmoid sinuses (6), to the maxillary sinus (16 cases), and to the lower lid fornix (10 cases). The patients were followed for cumulatively 145 shunt years, with a mean follow-up of 4 years and 3 months. They were instructed to administer low-dose topical antibiotics indefinitely. Only 1 case of acute bacterial endophthalmitis occurred, thus an incidence of 0.7% per shunt year. A slow-growing Mycobacterium was cultured in a disintegrating eye and 1 bacterial maxillary sinusitis occurred, both in autoimmune diseases. Three valves became exposed and had to be removed (1 replaced). Four eyes developed hypotony, probably from valve failure. The shunt arrangement, which connects the anterior chamber to potentially microbe-populated cavities or to the lower lid fornix and its flora, might be suspected to allow rapid retrograde invasion of infective agents, resulting in endophthalmitis. In this series of KPro patients, however, the incidence of severe infection was very low, in fact comparable to that after standard trabeculectomy.

[Predictability of maxillary distraction with the trans-sinusoidal distractor].

PubMed

Nadjmi, N

2004-02-01

This work was conducted to evaluate a new maxillary distractor with an activating system introduced into the maxilary sinus. Fourteen patients age 8 to 55 Years with severe maxillary and midfacial hypoplasia were treated in our center. A trans-sinusoidal maxillary distractor (TS-MD, developed by Dr. N. Nadjmi in cooperation with Martin, Tuttlingen, Germany) was placed intra-orally at each side of the maxilla. The distraction vector was predicted with devoted software (Medicim N.V Belgium), and was transferred to the patients using stereolithographic models and individual templates. A high Lefort I type osteotomy was performed. Forward maxillary movement at distractor level varied from 7 to 22 mm. Soft and hard tIssue formation resulted in complete healing across the distraction gaps. The maxillary movements and new bone formation in the sagittal, horizontal, and vertical planes could be predicted and achieved. Distractors were designed to allow clockwise rotation of the maxilla during the distraction phase allowing the correction of the anterior open-bite in all patients with this skeletal deformity. The distractors were almost completely submerged, and could be left in place as long as necessary to avoid relapse. The TS-MD distractor has the advantage of good tolerance since the most voluminous part is placed within the maxilary sinus. Implantation via an exclusively oral approach is a further advantage. The devise does not interfere with the patient's social life and does not require alveolodental fixation. The TS-MD distractor can also aleviate the need for bone grafting in cases with major advancement. Correct position of the vector is crucial but one-sided catch-up distraction is possible.

Platelet Rich Fibrin (P.R.F.) in Reconstructive Surgery of Atrophied Maxillary Bones: Clinical and Histological Evaluations

PubMed Central

Tatullo, Marco; Marrelli, Massimo; Cassetta, Michele; Pacifici, Andrea; Stefanelli, Luigi Vito; Scacco, Salvatore; Dipalma, Gianna; Pacifici, Luciano; Inchingolo, Francesco

2012-01-01

Introduction. Maxillary bone losses often require additional regenerative procedures: as a supplement to the procedures of tissue regeneration, a platelet concentrate called PRF (Platelet Rich Fibrin) was tested for the first time in France by Dr. Choukroun. Aim of the present study is to investigate, clinically and histologically, the potential use of PRF, associated with deproteinized bovine bone (Bio-Oss), as grafting materials in pre-implantology sinus grafting of severe maxillary atrophy, in comparison with a control group, in which only deproteinized bovine bone (Bio-Oss) was used as reconstructive material. Materials and Methods. 60 patients were recruited using the cluster-sampling method; inclusion criteria were maxillary atrophy with residual ridge < 5mm. The major atrophies in selected patients involved sinus-lift, with a second-look reopening for the implant insertion phase. The used grafting materials were: a) Bio-Oss and b) amorphous and membranous PRF together with Bio-Oss. We performed all operations by means of piezosurgery in order to reduce trauma and to optimize the design of the operculum on the cortical bone. The reopening of the surgical area was scheduled at 3 different times. Results. 72 sinus lifts were performed with subsequent implants insertions. We want to underline how the histological results proved that the samples collected after 106 days (Early protocol) with the adding of PRF were constituted by lamellar bone tissue with an interposed stroma that appeared relaxed and richly vascularized. Conclusions. The use of PRF and piezosurgery reduced the healing time, compared to the 150 days described in literature, favoring optimal bone regeneration. At 106 days, it is already possible to achieve good primary stability of endosseous implants, though lacking of functional loading. PMID:23155361

Development of the ethmoid sinus and extramural migration: the anatomical basis of this paranasal sinus.

PubMed

Márquez, Samuel; Tessema, Belachew; Clement, Peter Ar; Schaefer, Steven D

2008-11-01

Frontal and/or maxillary sinusitis frequently originates with pathologic processes of the ethmoid sinuses. This clinical association is explained by the close anatomical relationship between the frontal and maxillary sinuses and the ethmoid sinus, since developmental trajectories place the ethmoid in a strategic central position within the nasal complex. The advent of optical endoscopes has permitted improved visualization of these spaces, leading to a renaissance in intranasal sinus surgery. Advancing patient care has consequently driven the need for the proper and accurate anatomical description of the paranasal sinuses, regrettably the continuing subject of persistent confusion and ambiguity in nomenclature and terminology. Developmental tracking of the pneumatization of the ethmoid and adjacent bones, and particularly of the extramural cells of the ethmoid, helps to explain the highly variable adult morphology of the ethmoid air sinus system. To fully understand the nature and underlying biology of this sinus system, multiple approaches were employed here. These include CT imaging of living humans (n = 100), examination of dry cranial material (n = 220), fresh tissue and cadaveric anatomical dissections (n = 168), and three-dimensional volume rendering methods that allow digitizing of the spaces of the ethmoid sinus for graphical examination. Results show the ethmoid sinus to be highly variable in form and structure as well as in the quantity of air cells. The endochondral bony origin of the ethmoid sinuses leads to remarkably thin bony contours of their irregular and morphologically unique borders, making them substantially different from the other paranasal sinuses. These investigations allow development of a detailed anatomical template of this region based on observed patterns of morphological diversity, which can initially mask the underlying anatomy. For example, the frontal recess, ethmoid infundibulum, and hiatus semilunaris are key anatomical components of the ethmoid structural complex that are fully documented and explained here on the basis of the template we have developed, as well as being comprehensively illustrated. In addition, an exhaustive 2000-year literature search identified original sources of nomenclature, in order to help clarify the persistent confusions found in the literature. Modified anatomical terms are suggested to permit proper description of the ethmoid region. This clarification of nomenclature will permit better communication in addition to eliminating redundant terminology. The combination of anatomical, evolutionary, and clinical perspectives provides an important strategy for gaining insight into the complexity of these sinuses. Copyright 2008 Wiley-Liss, Inc.

Comprehensive review on endonasal endoscopic sinus surgery

PubMed Central

Weber, Rainer K.; Hosemann, Werner

2015-01-01

Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment. PMID:26770282

Granulocytic sarcoma in non-leukaemic child involving maxillary sinus with long term follow up: A rare case report.

PubMed

Sharma, Aman; Singh, Harkanwal Preet; Gupta, Anish Ashok; Garg, Parveen; Moon, Ninad Joshirao; Chavan, Rahul

2014-01-01

Granulocytic sarcoma (GS) is a rare extramedullary malignant tumor composed of immature myeloid cells. It is strongly associated with acute myeloid leukaemia, chronic myeloproliferative diseases. Occurrence of GS in the oral cavity is extremely uncommon. Present case reported an unusual occurrence of GS without leukemia involving maxillary sinus of a child. The patient underwent chemotherapy followed by radiotherapy with complete remission. A long-term follow-up of the patient was carried without any evidence of recurrence with special focus on diagnostic difficulties. The present case highlights the perplexity in diagnosing such lesions with emphasis on the need of careful interpretation of all clinical, radiographic, histopathological and immunohistochemical details as it is one of the most frequently misdiagnosed disorder.

Extrasinonasal infiltrative process associated with a sinonasal fungus ball: does it mean invasive fungal sinusitis?

PubMed Central

Kim, Yi-Kyung; Kim, Hyung-Jin; Kim, Hyo Yeol; Cha, Jihoon; Lee, Ji Young; Chung, Seung-Kyu; Dhong, Hun-Jong; Song, Mina; Kim, Sung Tae

2016-01-01

PURPOSE Invasive fungal sinusitis (IFS) has rarely been reported to develop from non-IFS. The purpose of this study was to disclose the nature of the extrasinonasal infiltrative process in the presence of a sinonasal fungus ball (FB). METHODS We retrospectively reviewed the medical records, computed tomography, magnetic resonance images of 13 patients with sinonasal FB and the extrasinonasal infiltrative process. Based on histology and clinical course, we divided the extrasinonasal infiltrative process into IFS and the nonfungal inflammatory/infectious process (NFIP). The images were analyzed with particular attention to the presence of cervicofacial tissue infarction (CFTI). RESULTS Of the 13 patients, IFS was confirmed in only one, while the remaining 12 were diagnosed to have presumed NFIP. One patient with IFS died shortly after diagnosis. In contrast, all 12 patients with presumed NFIP, except one, survived during a mean follow-up of 17 months. FB was located in the maxillary sinus (n=4), sphenoid sinus (n=8), and both sinuses (n=1). Bone defect was found in five patients, of whom four had a defect in the sphenoid sinus. Various sites were involved in the extrasinonasal infiltrative process, including the orbit (n=10), intracranial cavity (n=9), and soft tissues of the face and neck (n=7). CFTI was recognized only in one patient with IFS. CONCLUSION In most cases, the extrasinonasal infiltrative process in the presence of sinonasal FB did not seem to be caused by IFS but probably by NFIP. In our study, there were more cases of invasive changes with the sphenoid than with the maxillary FB. PMID:27283592

Extrasinonasal infiltrative process associated with a sinonasal fungus ball: does it mean invasive fungal sinusitis?

PubMed

Kim, Yi Kyung; Kim, Hyung Jin; Kim, Hyo Yeol; Cha, Jihoon; Lee, Ji Young; Chung, Seung Kyu; Dhong, Hun Jong; Song, Mina; Kim, Sung Tae

2016-01-01

Invasive fungal sinusitis (IFS) has rarely been reported to develop from non-IFS. The purpose of this study was to disclose the nature of the extrasinonasal infiltrative process in the presence of a sinonasal fungus ball (FB). We retrospectively reviewed the medical records, computed tomography, magnetic resonance images of 13 patients with sinonasal FB and the extrasinonasal infiltrative process. Based on histology and clinical course, we divided the extrasinonasal infiltrative process into IFS and the nonfungal inflammatory/infectious process (NFIP). The images were analyzed with particular attention to the presence of cervicofacial tissue infarction (CFTI). Of the 13 patients, IFS was confirmed in only one, while the remaining 12 were diagnosed to have presumed NFIP. One patient with IFS died shortly after diagnosis. In contrast, all 12 patients with presumed NFIP, except one, survived during a mean follow-up of 17 months. FB was located in the maxillary sinus (n=4), sphenoid sinus (n=8), and both sinuses (n=1). Bone defect was found in five patients, of whom four had a defect in the sphenoid sinus. Various sites were involved in the extrasinonasal infiltrative process, including the orbit (n=10), intracranial cavity (n=9), and soft tissues of the face and neck (n=7). CFTI was recognized only in one patient with IFS. In most cases, the extrasinonasal infiltrative process in the presence of sinonasal FB did not seem to be caused by IFS but probably by NFIP. In our study, there were more cases of invasive changes with the sphenoid than with the maxillary FB.

Comparative microcomputed tomography and histological study of maxillary pneumatization in four species of new world monkeys: the perinatal period.

PubMed

Smith, Timothy D; Rossie, James B; Cooper, Gregory M; Schmieg, Robin M; Bonar, Christopher J; Mooney, Mark P; Siegel, Michael I

2011-03-01

In anthropoid primates, it has been hypothesized that the magnitude of maxillary sinus growth is influenced by adjacent dental and soft tissue matrices. Relatively, little comparative evidence exists for the perinatal period when secondary pneumatization is at its earliest stages in some primates. Here, dental and midfacial variables were studied in a perinatal sample of four anthropoid primates, including three callitrichines (Leontopithecus, Saguinus, and Callithrix) and Saimiri boliviensis. In the latter species, the maxillary recess (the ontogenetic precursor to a "true" maxillary sinus) does not undergo secondary pneumatization. Using histological methods and micro-computed tomography, midfacial and dental dimensions and radiographic hydroxyapatite density of tooth cusps were measured. The distribution of osteoclasts and osteoblasts was also documented. Kruskal-Wallis's one-way analysis of variance tests indicates significant (P < 0.05) differences among groups for dental and midfacial measurements. In particular, the posterior maxillary dentition is relatively larger and more mineralized in Saimiri compared to the callitrichines. At posterior dental levels, Saimiri has the lowest palatonasal index [interdental (palatal) width/width of the nasal cavity] and highest bizygomatic-interorbital index. Distribution of osteoclasts indicates that the inferomedial surfaces of the orbits are resorptive in perinatal Saimiri, whereas, in all callitrichines, these surfaces are depository. Taken together, these findings suggest that pneumatization in Saimiri is suppressed by an inward growth trajectory of the orbits, relatively large posterior dentition, and a correspondingly compressed nasal region. Copyright © 2010 Wiley-Liss, Inc.

Sinus Floor Elevation and Augmentation Using Synthetic Nanocrystalline and Nanoporous Hydroxyapatite Bone Substitute Materials: Preliminary Histologic Results.

PubMed

Belouka, Sofia-Maria; Strietzel, Frank Peter

To compare the tissue composition of augmented sites after using two different synthetic bone substitute materials, nanocrystalline and nanoporous hydroxyapatite (HA), for sinus floor elevation and augmentation. Forty-four patients received 88 titanium screw implants (Camlog Promote plus) of 4.3-mm diameter and 11- or 13-mm length, placed simultaneously during sinus floor elevation and augmentation. Nanocrystalline (Ostim) or nanoporous (NanoBone) HA were used exclusively. Bone substitute materials and implant lengths were allocated by randomization. Bone biopsy specimens were obtained from the former area of the lateral access window at implant exposure during healing abutment placement after 6 months. Biopsy specimens were prepared and examined histologically and histomorphometrically. All implants were osseointegrated at the time of exposure. Clinically and histologically, no signs of inflammation in the augmented sites were present. The histomorphometric analysis of 44 biopsy specimens revealed 31.8% ± 11.6% newly formed bone for sites augmented with nanocrystalline HA and 34.6% ± 9.2% for nanoporous HA (P = .467). The proportion of remaining bone substitute material was 28.4% ± 18.6% and 30% ± 13%, respectively (P = .453). The proportion of soft tissue within the biopsy specimens was 39.9% ± 11.1% and 35.4% ± 6.8%, respectively (P = .064). No significant differences were found between the area fractions of bone, bone substitute material, and soft tissue concerning the bone substitute material utilized. Within the present study, both synthetic bone substitute materials, nanocrystalline and nanoporous HA, were found to support bone formation in sinus floor elevation and augmentation procedures by osteoconductivity. They were not completely resorbed after 6 months. The amounts of newly formed bone, soft tissue, and bone substitute material remnants were found to be similar, indicating that both materials are likewise suitable for sinus floor elevation and augmentation procedures.

Primary soft tissue Ewing's sarcoma of the maxillary sinus in elderly patients: presentation, management and prognosis.

PubMed

Dutta, M; Ghatak, S; Biswas, G; Sen, A

2014-06-01

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.

[Orbital extension of sinus plasmacytoma secondarily transforming into multiple myeloma: a case study].

PubMed

Balayre, S; Gicquel, J-J; Mercie, M; Dighiero, P

2004-01-01

We report the case of a 39-year-old man who consulted for severe exophthalmia with diplopia associated with chronic sinusitis evolving over 6 months. A cervicofacial CT scan showed a tumoral mass invading the maxillary and ethmoidal left sinus and orbital cavity. A biopsy of the mass and general evaluation confirmed the diagnosis of extramedullary plasmocytoma. Secondarily it transformed into multiple myeloma. In light of this case of extramedullary plasmocytoma in a young subject, we discuss the clinical characteristics, ophthalmologic manifestations, and the various therapeutic modalities according to the stage of the disease and the ocular repercussions.

Cavernous sinus involvement is not a risk factor for the primary tumor site treatment outcome of Sinonasal adenoid cystic carcinoma.

PubMed

Lee, Yi-Chan; Lee, Ta-Jen; Tsang, Ngan-Ming; Huang, Yenlin; Hsu, Cheng-Lung; Hsin, Li-Jen; Lee, Yi-Hsuan; Chang, Kai-Ping

2018-02-05

Sinonasal adenoid cystic carcinoma is a rare malignancy of the head and neck. Cavernous sinus invasion from sinonasal adenoid cystic carcinoma and its related management have rarely been investigated. This study evaluated the relationship between treatment outcome and cavernous sinus involvement in addition to other parameters. A retrospective case series study was conducted at a tertiary referral center. The medical records of 47 patients diagnosed with primary sinonasal adenoid cystic carcinoma between 1984 and 2015 were retrospectively reviewed. The survival impact of the primary treatment modalities and the anatomic sites of tumor involvement were analyzed. Cavernous sinus invasion was observed in 8 patients (17%), of whom 7 had ACC tumors originating from the maxillary sinus. The results of univariate analysis revealed that tumor stage, primary surgery, and the absence of skull-base and infratemporal fossa invasion were associated with better overall survival (P = 0.033, P = 0.012, P = 0.011, and P = 0.040, respectively) and better disease-free survival (P = 0.019, P = 0.001, P = 0.017, and P = 0.029, respectively). Multivariate analysis identified primary surgery as the only independent prognostic factor for disease-free survival (P = 0.026). Cavernous sinus invasion by sinonasal adenoid cystic carcinoma was not associated with worse overall survival or disease-free survival (P = 0.200 and P = 0.198, respectively). Because maxillary adenoid cystic carcinoma is associated with a higher rate of cavernous sinus invasion, such cases warrant caution during preoperative planning. Primary surgery as the initial therapy provides better locoregional control and survival for patients with sinonasal adenoid cystic carcinoma. Cavernous sinus invasion did not significantly impact survival; thus, it should not be regarded as a contraindication for curative treatment.

Low lymphatic vessel density associates with chronic rhinosinusitis with nasal polyps.

PubMed

Luukkainen, A; Seppälä, M; Renkonen, J; Renkonen, R; Hagstrő M, J; Huhtala, H; Rautiainen, M; Myller, J; Paavonen, T; Ranta, A; Torkkeli, T; Toppila-Salmi, S

2017-06-01

Chronic rhinosinusitis with and without nasal polyps (CRSwNP and CRSsNP) and antrochoanal polyps (ACP) are different upper airway inflammation phenotypes with different pathomechanisms. In order to understand the development of tissue edema, the present study aimed to evaluate lymphatic vessel density in CRSsNP, CRSwNP and ACP. 120 retrospective nasal and maxillary sinus specimens were stained immunohistochemically with a von Willebrand factor polyclonal antibody recognizing vascular and lymphatic endothelium, and with a podoplanin monoclonal antibody recognizing lymphatic endothelium. Vessels were studied by microscopy in a blinded fashion, and the vessel density and the relative density of lymphatic vessels were calculated. Patient characteristic factors and follow-up data of in average 9 years were collected from patient records. In the nasal cavity, the low absolute and relative density of vessels and of lymphatic vessels was associated with CRSwNP and ACP tissues compared to control inferior turbinate. This was observed also in the inflammatory hotspot area. In the maxillary sinus, lower absolute and relative density of lymphatic vessels associated with the CRSwNP phenotype. High lymphatic vessel density in polyp tissue associated with the need for revision CRS-surgery. As a conclusion, low density of lymphatic vessels distinguished patients with CRSwNP not only in the hotspot area of polyp tissue, but also in maxillary sinus mucosa. Yet, higher lymphatic vessel density seems to associate with polyp recurrence. Further studies are still needed to explore if formation of nasal polyps could be diminished by intranasal therapeutics affecting lymphangiogenesis.

A new screening pathway for identifying asymptomatic patients using dental panoramic radiographs

NASA Astrophysics Data System (ADS)

Hayashi, Tatsuro; Matsumoto, Takuya; Sawagashira, Tsuyoshi; Tagami, Motoki; Katsumata, Akitoshi; Hayashi, Yoshinori; Muramatsu, Chisako; Zhou, Xiangrong; Iida, Yukihiro; Matsuoka, Masato; Katagi, Kiyoji; Fujita, Hiroshi

2012-03-01

To identify asymptomatic patients is the challenging task and the essential first step in diagnosis. Findings of dental panoramic radiographs include not only dental conditions but also radiographic signs that are suggestive of possible systemic diseases such as osteoporosis, arteriosclerosis, and maxillary sinusitis. Detection of such signs on panoramic radiographs has a potential to provide supplemental benefits for patients. However, it is not easy for general dental practitioners to pay careful attention to such signs. We addressed the development of a computer-aided detection (CAD) system that detects radiographic signs of pathology on panoramic images, and the design of the framework of new screening pathway by cooperation of dentists and our CAD system. The performance evaluation of our CAD system showed the sensitivity and specificity in the identification of osteoporotic patients were 92.6 % and 100 %, respectively, and those of the maxillary sinus abnormality were 89.6 % and 73.6 %, respectively. The detection rate of carotid artery calcifications that suggests the need for further medical evaluation was approximately 93.6 % with 4.4 false-positives per image. To validate the utility of the new screening pathway, preliminary clinical trials by using our CAD system were conducted. To date, 223 panoramic images were processed and 4 asymptomatic patients with suspected osteoporosis, 7 asymptomatic patients with suspected calcifications, and 40 asymptomatic patients with suspected maxillary sinusitis were detected in our initial trial. It was suggested that our new screening pathway could be useful to identify asymptomatic patients with systemic diseases.

Fibrosarcoma of the ethmoid.

PubMed

Smith, M C; Soames, J V

1989-07-01

Fibrosarcoma may involve the ethmoid sinus by extension from the maxillary antrum or, more rarely, arise as a primary neoplasm. A case of a well differentiated primary fibrosarcoma of the ethmoid sinuses is reported which presented in a 24-year-old male. The tumour was treated by wide local resection. From a review of similar cases in the literature together with their treatment modalities and outcome, it is concluded that wide local resection is the treatment of choice.

Acute rhinosinusitis (ARS). Diagnosis and treatment of adults in general practice.

PubMed

Hansen, Jens Georg

2014-02-01

The idea behind this thesis is to present how ARS and especially acute maxillary sinusitis in adults is diagnosed and treated in general practice. The study extends over many years, beginning with the first survey in 1991. Based on doctors' answers, we then investigated the diagnostic values ​​of the symptoms, signs and examinations which the doctors reported using. All patients over 18 years suspected of acute maxillary sinusitis were included consecutively and only once and, after a clinical examination with the GP, they were offered the opportunity to enter into the prospective study referred to acute CT scan and by changes in the CT, immediately referred to sinus puncture. Both examinations were conducted at Aalborg Hospital. The disease was found most frequently in younger and 2/3 were women. The reason for this gender difference is unknown. We have assessed the diagnostic values of the symptoms, objective findings and investigations ​​using 3 different reference standards: sinus puncture, microbiological diagnosis and CT scan described in three articles. In all examinations, it appeared that the usual signs and symptoms of acute maxillary sinusitis occur almost equally often and with a few exceptions in patients, with and without pus in the sinus cavities. Pain in the sinus cavities occurring in 95% of patients, and only elevated levels of CRP and ESR are significantly and independently associated with pus in the sinus cavities. This finding is surprising, because they are two nonspecific markers. CRP tested by near-patient testing has, within the investigations period, been introduced in general practice, and from 1999 the doctors also get reimbursed for performing the test. We have on this background originally defined a clinical criterion with pain over the sinuses accompanied by elevated values ​​of CRP and/or ESR giving a sensitivity of 0.82, specificity 0.57, ppv 0.68 and npv 0.74. But looking at the ROC curve we suggest that a more clinical relevant diagnose will be based on use of CRP alone, as the test can be made easily and fast while the patient is in the clinic compared to the use of ESR. The disease is over-diagnosed in general practice. In only 53% of patients, who the GP suspected of having acute sinusitis, was there detected pus or mucopus at the sinus puncture, furthermore the patients' statements that they had had sinusitis was significantly negatively associated with current acute maxillary sinusitis. Almost all patients are prescribed topical treatment to the nose in the form of vasoconstrictor, and 50-70% also antibiotics. The most common bacteria that can be isolated are S. pneumoniae and H. influenzae. For many years the first drug of choice has been penicillin V, and treatment with penicillin V has followed Scandinavian recommendations. However, the resistance patterns in respect of H. influenzae have changed over the years and if the dominant flora is H. influenzae, then oral penicillin is not sufficient anymore, and should be replaced by amoxicillin with or without clavulanate. It is reported that the MIC of penicillin V is too high, such that oral dosage cannot provide sufficiently high concentrations. However, in daily clinical practice the doctor does not have the possibility to decide whether the infection is caused by either S. pneumoniae or H. influenzae, unless a sinus puncture is performed and it is not considered as a standard procedure. The recommended treatment is therefore starting with penicillin V, and at treatment failure switching to amoxicillin with or without clavulanate. It is well known that URTI's can exacerbate a chronic pulmonary disease - like asthma - in allergic patients, but this influence is also demonstrated as described in article 6 where ARS in adults without any sign of chronic lung disease or allergy is accompanied by a temporary reduction lung function. Future research should focus on the use of CRP in general practice, analysing cost-effectiveness of the use of CRP patient outcome in relation to antibiotic treatment, clarification of ARS as a female disease, and a detailed exploration of the relationship between URTI's and impaired lung function in lung-healthy patients.

Concrescence of permanent maxillary second and third molars: case report of non-surgical root canal treatment.

PubMed

Foran, Denise; Komabayashi, Takashi; Lin, Louis M

2012-03-01

Concrescence is a rare developmental anomaly with an overall incidence of 0.8% in the permanent dentition. While many case reports describe the treatment of concrescence with extraction, there are few reports of non-surgical root canal treatment (NSRCT), due to the atypical root form, canal morphology, and technical difficulties involved in concrescence. This unique case report describes a technical modification of NSRCT that can retain joined posterior maxillary teeth to maintain natural posterior occlusion without surgical intervention or dental implants, thereby avoiding the risk of damage to a large portion of the alveolar bone near the maxillary sinus.

Change of prevalence and clinical aspects of fungal ball according to temporal difference.

PubMed

Lee, Jun Seok; Shin, Seung Youp; Lee, Kun Hee; Kim, Sung Wan; Cho, Joong Saeng

2013-05-01

Fungal ball in paranasal sinus was reported to be rare, but these days we have encountered numerous cases. We retrospectively analyzed the data of 4,485 patients with chronic rhinosinusitis (CRS) who underwent sinus surgery from 1999 to 2010. Patients were categorized into group A (patients from 1999 to 2004) and group B (patients from 2005 to 2010). We compared the prevalence and clinical aspects of fungal ball between the two groups by analyzing the medical records, PNS CT findings, surgical findings, and pathologic reports. One hundred and twelve patients were diagnosed with fungal ball during the study periods. The prevalence of fungal ball was 0.9 % (23/2,333) in group A and 4.1 % (89/2,152) in group B, showing that it increased 4.6 times over 6 years. The prevalence of underlying diseases was 21.7 % (5/23) for hypertension and 8.7 % (2/23) for diabetes in group A, and 23.6 % (21/89) for hypertension and 14.6 % (13/89) for diabetes in group B. On PNS CT examination, calcification was identified in 78.2 % (18/23) of cases in group A and 44.9 % (40/89) in group B. The most involved paranasal sinus in group A was the co-involved maxillary and ethmoid sinuses at 26.1 % (6/23), whereas, the most prevalent involved sinus in group B was the maxillary sinus at 33.7 % (30/89). We found that the prevalence of fungal ball has increased steadily each year since 2005, accompanied by changes in the clinical aspects. These facts should be kept in mind when diagnosing and treating patients with medically intractable CRS.

Endodontic-periodontal management of two rooted maxillary lateral incisor associated with complex radicular lingual groove by using spiral computed tomography as a diagnostic aid: a case report.

PubMed

Gandhi, A; Kathuria, A; Gandhi, T

2011-06-01

To present the successful endodontic and periodontal management of a two rooted maxillary lateral incisor tooth with a complex radicular lingual groove and severe periodontal destruction using spiral computed tomography as a diagnostic aid. A 30-year-old male patient presented with a chief complaint of mobility and discharge of pus in an upper front tooth. Clinical examination revealed a sinus tract on the labial gingival surface and a 10-mm-deep periodontal pocket associated with maxillary left lateral incisor tooth. On the lingual side, a groove emerging from cingulum, continuing mesioapically down the lingual aspect of tooth was found. Intraoral periapical radiographs demonstrated a lateral periodontal defect around the mesial aspect and a diffuse radiolucency at the apex of maxillary left lateral incisor tooth. The sinus tract was traced with gutta-percha to the maxillary left lateral incisor that showed an accessory root surrounded by a large radiolucent area. A spiral computed tomographic scan for better understanding of the complicated root canal morphology of the tooth was performed. Based on the clinical, radiographic and spiral computed tomographic findings, a diagnosis of an endo-perio lesion in tooth 22 was made. Management consisted of conventional root canal treatment, radiculoplasty, root resection of accessory root and surgical curettage of the periodontal defect. Follow-up with radiographic examination at 3 months and 1 year was performed. At 1-year recall, the patient was asymptomatic, there was no evidence of the sinus tract and a 3-mm nonbleeding pocket was present in relation to tooth 22. Progression of hard tissue healing was observed in the periapical radiograph taken 1 year postoperatively. The key to achieving favourable results in this particular type of developmental anomaly is accurate diagnosis and treatment planning. The health of the periapical osseous tissues appears to be the provital factor for tooth retention. A favourable outcome can only be achieved with a comprehensive treatment approach that effectively manages all local factors that are contributing to the disease process. © 2011 International Endodontic Journal.

EAO Supplement Working Group 4 - EAO CC 2015 Short implants versus sinus lifting with longer implants to restore the posterior maxilla: a systematic review.

PubMed

Thoma, D S; Zeltner, M; Hüsler, J; Hämmerle, C H F; Jung, R E

2015-09-01

To compare short implants in the posterior maxilla to longer implants placed after or simultaneously with sinus floor elevation procedures. The focused question was as follows: Are short implants superior to longer implants in the augmented sinus in terms of survival and complication rates of implants and reconstructions, patient-reported outcome measures (PROMs) and costs? A MEDLINE search (1990-2014) was performed for randomized controlled clinical studies comparing short implants (≤8 mm) to longer implants (>8 mm) in augmented sinus. The search was complimented by an additional hand search of the selected papers and reviews published between 2011 and 2014. Eligible studies were selected based on the inclusion criteria, and quality assessments were conducted. Descriptive statistics were applied for a number of outcome measures. Survival rates of dental implants were pooled simply in case of comparable studies. Eight randomized controlled clinical trials (RCTs) comparing short implants versus longer implants in the augmented sinus derived from an initial search count of 851 titles were selected and data extracted. In general, all studies were well conducted with a low risk of bias for the majority of the analyzed parameters. Based on the pooled analyses of longer follow-ups (5 studies, 16-18 months), the survival rate of longer implants amounted to 99.5% (95% CI: 97.6-99.98%) and for shorter implants to 99.0% (95% CI: 96.4-99.8%). For shorter follow-ups (3 studies, 8-9 months), the survival rates of longer implants are 100% (95% CI: 97.1-100%) and for shorter implants 98.2% (95% CI: 93.9-99.7%). Complications were predominantly of biological origin, mainly occurred intraoperatively as membrane perforations, and were almost three times as higher for longer implant in the augmented sinus compared to shorter implants. PROMs, morbidity, surgical time and costs were generally in favor of shorter dental implants. All studies were performed by surgeons in specialized clinical settings. The outcomes of the survey analyses demonstrated predictably high implant survival rates for short implants and longer implants placed in augmented sinus and their respective reconstructions. Given the higher number of biological complications, increased morbidity, costs and surgical time of longer dental implants in the augmented sinus, shorter dental implants may represent the preferred treatment alternative. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Endoscopic Modified Medial Maxillectomy for Resection of an Inverted Papilloma Originating from the Entire Circumference of the Maxillary Sinus

PubMed Central

Wada, Kota; Ishigaki, Takashi; Ida, Yutaro; Yamada, Yuki; Hosono, Sachiko; Edamatsu, Hideo

2015-01-01

For treatment of a sinonasal inverted papilloma (IP), it is essential to have a definite diagnosis, to identify its origin by computed tomography (CT) and magnetic resonance imaging (MRI), and to select the appropriate surgical approach based on the staging system proposed by Krouse. Recently, a new surgical approach named endoscopic modified medial maxillectomy (EMMM) was proposed. This approach can preserve the inferior turbinate and nasolacrimal duct. We successfully treated sinonasal IP with EMMM in a 71-year-old female patient. In this patient, the sinonasal IP originated from the entire circumference of the maxillary sinus. EMMM is not a difficult procedure and provides good visibility of the operative field. Lacrimation and empty nose syndrome do not occur postoperatively as the nasolacrimal duct and inferior turbinate are preserved. EMMM is considered to be a very favorable approach for treatment of sinonasal IP. PMID:26146581

Penetrating maxillary sinus injury caused by a construction nail passing through the orbital cavity.

PubMed

Simsek, Tekin; Demir, Bulent; Yosma, Engin; Keles, Musa K; Abdullayev, Asef

2014-03-01

Because of its anatomic position, the orbit is frequently subject to trauma, leading to functional and cosmetic problems. After blunt trauma, orbital fractures can cause functional problems by trapping the periocular tissues without affecting the anatomic integrity of the globe. In comparison, high-energy penetrating injuries can cause serious consequences such as disrupting the lacrimal drainage system and causing loss of vision. In rare cases, however, penetration of the orbit by a foreign body can result in a treatable injury that causes no functional or cosmetic problems.This article presents a patient in whom a nail penetrated the orbit from the inferomedial margin and reached the maxillary sinus without damaging the globe, extraocular muscles, or lacrimal duct system. Reports of similar injuries are reviewed, focusing on the anatomic structures that might be traumatized, to guide the readers in considering the diagnosis and treatment of such injuries.

[Experience of systematization on the treatment of patients with upper jaws fractures, during the period 1991-2000].

PubMed

Khinkov, D

2005-01-01

A retrospecive analysis was done of the 128 patients with fractures in a upper jaw, treated during the period 1991-2000. The treatment of the patients with partial fractures in a alveolar part of maxilla and frontal wall of maxillary sinus, consist of debridement on the open wound, primery stiched and stabilization by arch bar of perspective teeth. In the cases with fractures of tuber maxilla and opening of maxillary sinus they tray to clouse it by Rhermann technique, with or without radical antrothomy by Caldwell-Luc technique. On the patients by total upper jaw fractures they try lead by princip of duble stage fixation: from one side-of intact upper bone structures and the other side-on a mandible. On the cases of upper jaw fractures, combine with barain traums. was treated conservativly - the specialize treatment of facial injures was postpoun until stabilization of brain status.

Maxillary anterior ridge augmentation with recombinant human bone morphogenetic protein 2.

PubMed

Edmunds, Ryan K; Mealey, Brian L; Mills, Michael P; Thoma, Daniel S; Schoolfield, John; Cochran, David L; Mellonig, Jim

2014-01-01

No human studies exist on the use of recombinant human bone morphogenetic protein 2 (rhBMP-2) on an absorbable collagen sponge (ACS) as a sole graft material for lateral ridge augmentation in large ridge defect sites. This series evaluates the treatment outcome of maxillary anterior lateral ridge augmentation with rhBMP-2/ACS. Twenty patients were treated with rhBMP-2/ACS and fixation screws for space maintenance. Cone beam volumetric tomography measurements were used to determine gain in ridge width, and a bone core biopsy was obtained. The mean horizontal ridge gain was 1.2 mm across sites, and every site gained width.

Pre- and postoperative assessment of sinus grafting procedures using cone-beam computed tomography compared with panoramic radiographs.

PubMed

Baciut, Mihaela; Hedesiu, Mihaela; Bran, Simion; Jacobs, Reinhilde; Nackaerts, Olivia; Baciut, Grigore

2013-05-01

The present study evaluated the clinical validity of cone-beam computed tomography (CBCT) scans in comparison to panoramic radiographs regarding preoperative implant planning in combination with sinus grafting procedures. Preoperative assessment of the maxillary sinuses and implant planning using panoramic radiographs and CBCT scans was performed on 16 sinuses (13 patients) and comprised choice of treatment, timing of implant placement, sinus morphology, level of confidence, complication prediction and graft volume assessment. Six examiners were involved in the study. In the majority of cases there was a concordance between the treatment type based on either panoramic radiographs or CBCT. If any difference was found, this was due to an overestimation of bone quantity and quality on panoramic radiographs. The assessment of sinus morphology showed a significantly higher detection rate of sinus mucosal hypertrophy on CBCT. The most appealing result is a significant increase in surgical confidence and a significantly better prediction of complications when using CBCT. A preoperative planning based on CBCT seems to improve sinus diagnostics and surgical confidence. © 2012 John Wiley & Sons A/S.

Antimicrobial Lipids: Novel Innate Defense Molecules are Elevated in Sinus Secretions of Patients with Chronic Rhinosinusitis

PubMed Central

Lee, Jivianne T.; Jansen, Mike; Yilma, Abebayehu N.; Nguyen, Angels; Desharnais, Robert; Porter, Edith

2010-01-01

Introduction Airway secretions possess intrinsic antimicrobial properties that contribute to the innate host defense of the respiratory tract. These microbicidal capabilities have largely been attributed to the presence of antibacterial polypeptides. However, recent investigation has demonstrated that host-derived lipids including cholesteryl esters also exhibit antimicrobial properties. The purpose of this study was to determine whether sinus secretions contain such antimicrobial lipids and to compare the lipid composition in patients with and without chronic rhinosinusitis (CRS). Methods Maxillary sinus fluid was obtained via antral lavage from subjects with (7) and without (9) a history of CRS. Following specimen collection, total lipid was extracted according to Bligh & Dyer and lipid profiles were obtained by reverse phase HPLC on an amide-embedded C18 column. In addition, the neutrophil specific antimicrobial peptides HNP1-3 were quantified by immunoblotting. Results Lipids were identified in the maxillary sinus secretions of patients with and without CRS including cholesteryl esters. However, levels of lipid composition differed between the two groups with CRS patients exhibiting greater amounts of all classes of lipids; reaching over 10-fold higher concentration when compared to nonCRS patients. This increase was independent of HNP1-3 content. Conclusions Sinus secretions of patients with CRS appear to demonstrate elevated levels of antimicrobial lipids compared to controls independent from neutrophil influx. This upregulation suggests that host-derived lipids act as mediators of mucosal immunity in CRS. Further study is necessary to determine if such antimicrobial lipids function alone or synergistically with antibacterial peptides in conferring such inherent microbicidal properties. PMID:20338107

Association of magnetic resonance imaging findings and histologic diagnosis in dogs with nasal disease: 78 cases (2001-2004).

PubMed

Miles, Macon S; Dhaliwal, Ravinder S; Moore, Michael P; Reed, Ann L

2008-06-15

OBJECTIVE-To determine whether magnetic resonance imaging (MRI) features correlated with histologic diagnosis in dogs with nasal disease. DESIGN-Retrospective case series. ANIMALS-78 Dogs undergoing MRI for evaluation of nasal disease. PROCEDURES-Medical records and MRI reports of dogs were reviewed to identify MRI features associated with histologic diagnosis. Features evaluated were presence of a mass effect, frontal sinus involvement, sphenoid sinus involvement, maxillary recess involvement, nasopharyngeal infiltration by soft tissue, nasal turbinate destruction, vomer bone lysis, paranasal bone destruction, cribriform plate erosion, and lesion extent (ie, unilateral vs bilateral). RESULTS-33 Dogs had neoplastic disease, 38 had inflammatory rhinitis, and 7 had fungal rhinitis. Lesion extent was not significantly associated with histologic diagnosis. Absence of a mass effect was significantly associated with inflammatory disease. However, presence of a mass was not specific for neoplasia. In dogs with evidence of a mass on magnetic resonance (MR) images, nasal turbinate destruction, frontal sinus invasion, and maxillary recess invasion were not useful in distinguishing neoplastic from nonneoplastic disease, but cribriform plate erosion, vomer bone lysis, paranasal bone destruction, sphenoid sinus invasion, and nasopharyngeal invasion were. CONCLUSIONS AND CLINICAL RELEVANCE-Results suggested that in dogs with nasal disease, the lack of a mass effect on MR images was significantly associated with inflammatory disease. In dogs with a mass effect on MR images, vomer bone lysis, cribriform plate erosion, paranasal bone destruction, sphenoid sinus invasion by a mass, and nasopharyngeal invasion by a mass were significantly associated with a diagnosis of neoplasia.

Significance of maxillary sinus mucosal thickening in patients with periodontal disease.

PubMed

Ren, Song; Zhao, Haijiao; Liu, Jingbo; Wang, Qingxuan; Pan, Yaping

2015-12-01

To characterise and measure the Schneiderian membranes of individuals with periodontal diseases in China and to analyse the factors impacting maxillary sinus mucosal thickness using cone-beam computed tomography (CBCT). A cohort of 221 patients with periodontal disease was subjected to cross-sectional CBCT examination. Various parameters, including age, sex, alveolar bone loss, furcation lesions and vertical infrabony pockets, were analysed as correlates of mucosal thickening (MT). Sinus mucosal thickness ≥ 2 mm qualified as MT. MT was detected in 103 (48.9%) patients, increasing in frequency as the degree of alveolar bone loss advanced (mild, 14.5%; moderate, 29.5%; severe, 87.9%). The association between MT and vertical infrabony pockets was statistically significant (P < 0.001). The likelihood of MT increased with moderate [odds ratio (OR) = 1.02] and severe (OR = 4.62) periodontal bone loss (P < 0.001), as well as with furcation lesions (OR = 2.76) and vertical infrabony pockets (OR = 13.58). Relative to the case in patients with periodontitis and normal mucosa, the probability of MT increased dramatically as alveolar bone loss worsened. Periodontal pathologies (i.e. furcation lesions and vertical infrabony pockets) were also more likely to coincide with MT. © 2015 FDI World Dental Federation.

Secondary pneumatization of the maxillary sinus in callitrichid primates: insights from immunohistochemistry and bone cell distribution.

PubMed

Smith, Timothy D; Rossie, James B; Cooper, Gregory M; Mooney, Mark P; Siegel, Michael I

2005-08-01

The paranasal sinuses remain elusive both in terms of function and in the proximate mechanism of their development. The present study sought to describe the maxillary sinuses (MSs) in three species of callitrichid primates at birth, a time when secondary pneumatization occurs rapidly in humans. The MSs were examined in serially sectioned and stained slides from the heads of two Callithrix jacchus, one Leontopithecus rosalia, and two Saguinus geoffroyi. Specimens were examined microscopically regarding the distribution of osteoclasts and osteoblasts along the osseous boundaries of the MS and other parts of the maxillary bone. Selected sections were immunohistochemically evaluated for the distribution of osteopontin (OPN), which facilitates osteoclast binding. Taken together, OPN immunoreactivity and bone cell distribution suggested trends of bone resorption/deposition that were consistent among species for the superior (roof) and inferior (floor) boundaries of the MS. Expansion at the roof and floor of the MS appeared to correspond to overall vertical midfacial growth in callitrichids. Much more variability was noted for the lateral (alveolar) and medial (nasal walls) of the MS. Unlike the other species, the nasal wall of Saguinus was static and mostly composed of inferior portions of the nasal capsule that were undergoing endochondral ossification. The variation seen in the alveolar walls may relate to the presence or absence of adjacent structures, although it was noted that adjacency of deciduous molars influenced medial drift of the alveolar wall in Saguinus but not Leontopithecus. The results of this study are largely consistent with the "structural" or "architectural" hypothesis of sinus formation with respect to vertical MS enlargement, and the variable cellular/OPN distribution found along the nasal and alveolar walls was evocative of Witmer's (J Vert Paleontol 1997;17:1-73) epithelial hypothesis in revealing that most expansion occurred in regions unopposed by adjacent structures. (c) 2005 Wiley-Liss, Inc.

Highly porous hydroxyapatite with and without local harvested bone in sinus floor augmentation: a histometric study in pigs.

PubMed

Möller, Björn; Acil, Yahya; Birkenfeld, Falk; Behrens, Eleonore; Terheyden, Hendrik; Wiltfang, Jörg

2014-07-01

Sinus floor augmentation with autologous bone is an accepted treatment option in dental implantology. In this study, an entirely synthetic, nano-structured, hydroxyapatite-based bone substitute material (SBSM, NanoBone(®); Artoss, Rostock, Germany) was supplemented with a mixture of locally harvested bone to enhance osteogenesis. Bilateral sinus augmentation procedures were performed in eight domestic pigs using the lateral window technique. On the right side (control), 2.6 ml of SBSM was used, and on the left side (test), 2.6 ml of SBSM with additional 15% (390 μl) autologous bone was used. At the time of augmentation, a titanium implant (ITI(®)) was inserted from a laterocaudal direction. After 3 months, the sites of augmentation were removed and examined in non-decalcified sections by microradiography and fluorescence microscopy of sequentially labelled specimens and histometry. On both sides, a significant amount of newly formed bone was observed. However, a statistically significant difference in the bone-implant contact was observed in the control group (median, 28.9%) compared with the test side with the additional autologous bone (median, 40.6%) (P = 0.01). Different bone density was achieved from the coronal to apical surfaces (medians, 54.6%, 9.6%, and 27.5%) compared with the test side (medians, 55.2%, 40.6%, and 44.2%). The median of augmentation height was 8.6 mm on the control side and 11.5 mm on the test side (P = 0.01). Bone apposition was observed in both groups after 15 days. The SBSM shows acceptable results in sinus floor augmentation. The additional use of locally harvested autologous bone enhances bone density and osseointegration of the implants. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

Anatomy and ontogeny of a novel hemodynamic organ in zebrafish.

PubMed

Binelli, Erica A; Luna, Alejandra N; LeClair, Elizabeth E

2014-12-01

The zebrafish maxillary barbel can protract and retract in response to stimuli, and appears connected to a prominent blood sinus on the lateral aspect of the maxillary bone. However, the mechanism of barbel movement is not described. Using whole-mount phalloidin staining of the sinus region, we observed long filamentous actin cables, suggesting highly organized vascular smooth muscle cells, surrounding an endothelial chamber. Although the chamber is variably filled by erythrocytes in vivo, cardiac injection of fluorescent dextrans shows that it consistently contains plasma. Full-thickness confocal imaging of dextran-injected adults containing EGFP(+) endothelial cells revealed a vascular complex with three compartments, here named the distal bulb, central chamber, and accessory chamber. The early ontogeny of all three compartments was confirmed in a whole-mount series of Tg(fli1a:EGFP) juveniles. In wild type adults, the fine structure of each chamber was studied using paraffin- and plastic-section histochemistry and transmission electron microscopy. The distal bulb and central chamber have smooth muscle coats with luminally-elongated septa, forming semi-detached blood-filled lacunae. The central chamber walls and septa are extensively innervated by small, unmyelinated axons, as confirmed by immunohistochemical detection of acetylated tubulin, a component of axonal cytoplasm. The accessory chamber appears neither innervated nor muscularized, but is an endothelial cul-de-sac with a thickened elastic adventitia, suggesting an extensible fluid reservoir. We propose that we have identified a new organ in zebrafish, the maxillary barbel blood sinus, whose neurovascular specializations may contribute to zebrafish sensory biology and appendage control. © 2014 Wiley Periodicals, Inc.

Intensity-modulated radiotherapy (IMRT) for carcinoma of the maxillary sinus: A comparison of IMRT planning systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ahmed, Raef S.; Ove, Roger; Duan, Jun

2006-10-01

The treatment of maxillary sinus carcinoma with forward planning can be technically difficult when the neck also requires radiotherapy. This difficulty arises because of the need to spare the contralateral face while treating the bilateral neck. There is considerable potential for error in clinical setup and treatment delivery. We evaluated intensity-modulated radiotherapy (IMRT) as an improvement on forward planning, and compared several inverse planning IMRT platforms. A composite dose-volume histogram (DVH) was generated from a complex forward planned case. We compared the results with those generated by sliding window fixed field dynamic multileaf collimator (MLC) IMRT, using sets of coplanarmore » beams. All setups included an anterior posterior (AP) beam, and 3-, 5-, 7-, and 9-field configurations were evaluated. The dose prescription and objective function priorities were invariant. We also evaluated 2 commercial tomotherapy IMRT delivery platforms. DVH results from all of the IMRT approaches compared favorably with the forward plan. Results for the various inverse planning approaches varied considerably across platforms, despite an attempt to prescribe the therapy similarly. The improvement seen with the addition of beams in the fixed beam sliding window case was modest. IMRT is an effective means of delivering radiotherapy reliably in the complex setting of maxillary sinus carcinoma with neck irradiation. Differences in objective function definition and optimization algorithms can lead to unexpected differences in the final dose distribution, and our evaluation suggests that these factors are more significant than the beam arrangement or number of beams.« less

3D CBCT anatomy of the pterygopalatine fossa.

PubMed

Rusu, Mugurel Constantin; Didilescu, Andreea Cristiana; Jianu, Adelina Maria; Păduraru, Dumitru

2013-03-01

The anatomy of the pterygopalatine fossa keeps a traditional level and is viewed as constant, even though a series of structures neighboring the fossa are known to present individual variations. We aimed to evaluate on 3D volume renderizations the anatomical variables of the pterygopalatine fossa, as related to the variable pneumatization patterns of the bones surrounding the fossa. The study was performed retrospectively on cone beam computed tomography (CBCT) scans of 100 patients. The pterygopalatine fossa was divided into an upper (orbital) and a lower (pterygomaxillary) floor; the medial compartment of the orbital floor lodges the pterygopalatine ganglion. The pneumatization patterns of the pterygopalatine fossa orbital floor walls were variable: (a) the posterior wall pneumatization pattern was determined in 89.5 % by recesses of the sphenoidal sinus related to the maxillary nerve and pterygoid canals; (b) the upper continuation of the pterygopalatine fossa with the orbital apex was narrowed in 79.5 % by ethmoid air cells and/or a maxillary recess of the sphenoidal sinus; (c) according to its pneumatization pattern, the anterior wall of the pterygopalatine fossa was a maxillary (40.5 %), maxillo-ethmoidal (46.5 %), or maxillo-sphenoidal (13 %) wall. The logistic regression models showed that the maxillo-ethmoidal type of pterygopalatine fossa anterior wall was significantly associated with a sphenoidal sinus only expanded above the pterygoid canal and a spheno-ethmoidal upper wall. The pterygopalatine fossa viewed as an intersinus space is related to variable pneumatization patterns which can be accurately identified by CBCT and 3DVR studies, for anatomic and preoperatory purposes.

Sinus grafting using recombinant human tissue factor, platelet-rich plasma gel, autologous bone, and anorganic bovine bone mineral xenograft: histologic analysis and case reports.

PubMed

Philippart, Pierre; Daubie, Valéry; Pochet, Roland

2005-01-01

The purpose of this study was to analyze healthy bone formation by means of histology and immunohistochemistry after grafting with a mixture of autologous ground calvarial bone, inorganic xenograft, platelet-rich plasma (PRP), and recombinant human tissue factor (rhTF). Maxillary sinus floor augmentation was performed on 3 patients by grafting with 5 to 10 mL of a paste consisting of autologous powder from calvarial bone (diameter < 1 mm), 50% v/v anorganic bovine bone mineral xenograft (PepGen P-15, a new tissue-engineered bone replacement graft material), PRP (1.8 x 10(6) platelets/mm3 plasma), and about 1 microg rhTF. Six and 10 months after grafting, bone cores were extracted for implant fixation and analyzed. Histology demonstrated a high degree of inorganic xenograft integration and natural bone regeneration. Both the xenograft and newly synthesized bone were colonized with osteocytes and surrounded by osteoblasts. Six-month-old bone cores demonstrated a ratio of synthesized bone to xenograft particles ratio of 0.5, whereas 10-month-old cores demonstrated a ratio of 2. A low degree of inflammation could also be observed using S100A8 immunohistochemistry. Autologous grafting in edentulous patients is a complex procedure; the successful substitution of synthetic analogs for ground bone is a major challenge. In this investigation, it was shown that inorganic xenograft in the harvested bone paste could be safe for patients and had high bone regeneration capacity over time. The sinus graft showed intense bone formation 6 months after grafting and a further increase in bone growth 10 months after grafting.

[Hemangiopericytoma in nasal cavity: a case report].

PubMed

Hu, Honghai; Shi, Qifeng; Chen, Jidong

2015-05-01

We report a case of a 46 year old female patient with nasal hemangiopericytoma. She complained of left nasal congestion, pus snot for 10 years, sometimes with left nasal bleeding. Physical examination: in the left nasal tract saw red soft neoplasm, roughness surface, easy bleeding when touched. Sinus CT shows: bilateral maxillary sinus, ethmoid sinus, sphenoid sinus and the left posterior nasal cavity lesions, considering inflammation with the formation of polyps, tumor not excluded. The left nasal cavity neoplasm biopsy shows: hemangioma of left nasal cavity. After admission in general anesthesia, we do transnasal endoscopic sinus openning operation and the left nasal cavity neoplasm resection. Postoperative pathological examination shows: the left nasal cavity hemangiopericytoma. Immunohistochemical showed: Vimentin(+), Smooth muscle actin(+), Desmin(-), endothelial cells CD31(-) and CD34(-). No postoperative radiotherapy or chemotherapy, no tumor recurrence. After one year of follow-up, the contact was lost.

[One case report: removal of foreign body in ethmoidal sinus-medial orbital wall through nose assisted by endoscope].

PubMed

Yang, Zeyin; Yang, Xiaohong

2013-07-01

The patient was male, 20 years old, and complained of pain, bleeding and decreased vision after the right eye was injured by nail for an hour. right exophthalmos, conjunctival edema, skin laceration at the lower eyelid of right eye, limitation of eye movement, asymmetric eyes and weak light-reflecting. X-ray showed: metallic foreign body shadow in the right orbit, 0.5 cm x 0.4 cm approximately. Orbit and paranasal sinus CT showed: 1 hematoma of the right eye and inside. 2 high density foreign body embedded in the bone wall of the inside of right orbit and ethmoid. 3 medial wall fracture of right eye orbit. 4 bilateral maxillary sinus and right ethmoidal sinus effusion. 5 slightly left side of nasal septum. The patient was initially diagnosed as foreign body in right ethmoidal sinus, skin laceration of right lower eyelid, retrobulbar hematoma.

[Odontogenic cyst of the left maxilla and oro-antral fistula].

PubMed

Gil Tutor, E

1999-01-01

We considered these cases of odontogenic cysts of the maxillary sinus. One of them complicated with an oroantral fistula. The aim of our paper is to consider the origine, the radiology and the surgery of those items.

A rare sinonasal neoplasm: fibrosarcoma.

PubMed

Bercin, Sami; Muderris, Togay; Kırıs, Muzaffer; Kanmaz, Alper; Kandemir, Olcay

2011-05-01

Sinonasal fibrosarcoma is an infrequently occurring malignant neoplasm. It usually presents with nasal obstruction and epistaxis, as do other sarcomas in this region. The final diagnosis is based on the histopathologic and immunohistochemical examination. We report a case involving a 47-year-old woman with a 2-year history of left nasal obstruction and proptosis, as well as diplopia for the 2 months preceding her visit. Computed tomography and magnetic resonance imaging showed a neoplasm occupying the left nasal cavity, ethmoid sinuses, and bilateral frontal sinuses. The neoplasm also was eroding the medial wall of the maxillary sinus, the lamina papyracea, the cribriform plate, and the anterior wall of the frontal sinus. Complete removal of the tumor was achieved both endoscopically and through a Lynch incision. Sinonasal fibrosarcoma was found on histopathologic examination.

Maxillary sinus floor elevation using a tissue-engineered bone with calcium-magnesium phosphate cement and bone marrow stromal cells in rabbits.

PubMed

Zeng, Deliang; Xia, Lunguo; Zhang, Wenjie; Huang, Hui; Wei, Bin; Huang, Qingfeng; Wei, Jie; Liu, Changsheng; Jiang, Xinquan

2012-04-01

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 CMPC possesses moderate biodegradability and excellent osteoconductivity, which may be attributed to its Ca and Mg ion composition, and the tissue-engineered bone constructed of CMPC and bMSCs might be a potential alterative graft for maxillofacial bone regeneration.

A prospective study of implants placed in augmented sinuses with minimal and moderate residual crestal bone: results after 1 to 5 years.

PubMed

Urban, Istvan A; Lozada, Jaime L

2010-01-01

The aims of this prospective study were to: (1) determine clinical and radiographic success and survival rates of implants placed in a staged procedure after sinus augmentation; and (2) compare the success and survival rate of implants in two patient groups with different ridge height prior to treatment (those with minimal residual crestal bone [⋜ 3.5 mm] below the sinus and those with moderate residual crestal bone [> 3.5 mm]). The study used anorganic bovine bone-derived mineral and autogenous bone for the sagittal sandwich bone augmentation technique, a collagen membrane to protect the sinus window, and a staged approach for implant placement; all implants featured an anodized surface. Two hundred forty-five implants were placed in 100 sinus sites (79 patients), and 244 have survived to date. The cumulative success and survival rates of all implants overall at 5 years were 96.5% (SE 2.0%) and 99.6% (SE 0.4%), respectively. The overall success and survival rates at 5 years for implants placed into minimal residual crestal bone were 94.1% (SE 3.4%) and 99.4% (SE 0.6%), respectively. For implants placed into moderate crestal bone, overall success and survival rates were both 100.0% (SE 0.0%). Success of implants placed after sinus augmentation appears similar to implants placed in native bone when a classical submerged implant healing time of 6 months is used. The success and survival rates and crestal bone remodeling of implants placed in minimal residual crestal bone were comparable to those of implants placed in moderate residual crestal bone.

Unilateral advancement of the maxillary minor segment by distraction osteogenesis in patients with repaired unilateral cleft lip and palate: report of two cases.

PubMed

Kuroe, Kazuto; Iino, Shoichiro; Shomura, Kenji; Okubo, Akiro; Sugihara, Kazumasa; Ito, Gakuji

2003-05-01

Collapse of the maxillary minor segment with lateral crossbite is a common feature in patients with repaired unilateral cleft lip/palate because of maxillary alveolar bony defect and palatal scar tissue. Distraction osteogenesis (DOG) is an effective technique of lengthening and augmentation for bone and gingiva. This case report describes the effects of unilateral advancement of the maxillary minor segment by DOG in two patients with the repaired unilateral cleft lip/palate.

Odontogenic sinus tracts: a cohort study.

PubMed

Slutzky-Goldberg, Iris; Tsesis, Igor; Slutzky, Hagay; Heling, Ilana

2009-01-01

To determine the prevalence,location, and distribution of sinus tracts in patients referred for endodontic consultation. This cohort study included 1,119 subjects referred for endodontic consultation, 108 of whom presented with sinus tracts. Following clinical and radiographic examination, the diameter of the rarifying osteitis lesion on the radiograph was measured and the path and origin of the sinus tracts determined. Signs and symptoms, tooth site,buccal/lingual location, and diameter were recorded. Data were statistically analyzed using Pearson chi-square test. Sinus tracts originated mainly from maxillary teeth (63.1%); only 38.9% originated from mandibular teeth. Chronic periapical abscess was the most prevalent diagnosed origin (71.0%). Broken restorations were highly associated with the presence of sinus tracts (53.0%). The most frequent site of orifices was buccal(82.4%), followed by lingual or palatal (12.0%). Orifices on the lingual aspect of the gingiva were observed in mandibularmolars. There was an 86.8% correlation between the occurrence of an apically located sinus tract and apical rarifying osteitis(P<.01). Sinus tract in the lingual or palatal aspect of the gingiva is relatively common. Practitioners should look for signs of sinus tract during routine examination

Trigeminal pathways deliver a low molecular weight drug from the nose to the brain and orofacial structures.

PubMed

Johnson, Neil J; Hanson, Leah R; Frey, William H

2010-06-07

Intranasal delivery has been shown to noninvasively deliver drugs from the nose to the brain in minutes along the olfactory and trigeminal nerve pathways, bypassing the blood-brain barrier. However, no one has investigated whether nasally applied drugs target orofacial structures, despite high concentrations observed in the trigeminal nerve innervating these tissues. Following intranasal administration of lidocaine to rats, trigeminally innervated structures (teeth, temporomandibular joint (TMJ), and masseter muscle) were found to have up to 20-fold higher tissue concentrations of lidocaine than the brain and blood as measured by ELISA. This concentration difference could allow intranasally administered therapeutics to treat disorders of orofacial structures (i.e., teeth, TMJ, and masseter muscle) without causing unwanted side effects in the brain and the rest of the body. In this study, an intranasally administered infrared dye reached the brain within 10 minutes. Distribution of dye is consistent with dye entering the trigeminal nerve after intranasal administration through three regions with high drug concentrations in the nasal cavity: the middle concha, the maxillary sinus, and the choana. In humans the trigeminal nerve passes through the maxillary sinus to innervate the maxillary teeth. Delivering lidocaine intranasally may provide an effective anesthetic technique for a noninvasive maxillary nerve block. Intranasal delivery could be used to target vaccinations and treat disorders with fewer side effects such as tooth pain, TMJ disorder, trigeminal neuralgia, headache, and brain diseases.

Oral Rehabilitation of a Severely Resorbed Edentulous Maxilla with Screwed-retained Hybrid Denture Using Cresco System: A Case Report

PubMed Central

Turkyilmaz, Ilser; Patel, Neal S.; McGlumphy, Edwin A.

2008-01-01

Due to the angulation of maxillary bone as the maxillary bone resorption occurs from a buccal to palatal direction, bucco-lingually tilted implant placement is more likely especially in the posterior maxilla. The aim of this paper was to present a case restored by using a maxillary hybrid denture using Cresco method. A 59-year-old woman with an edentulous maxilla and five missing mandibular teeth was referred for implant treatment. Six months after sinus lift operation, four mandibular implants and six maxillary implants were placed. Due to the bucco-lingual tilt of two implants, the Cresco method was chosen to fabricate the metal framework for the maxillary hybrid denture that was delivered four months after implant placement. The main advantages of the Cresco method are a perfectly passive framework fit and corrected screw access holes. All ten implants placed were considered successful at 1-year recall, and no screw access holes were seen in the buccal part of the maxillary acrylic teeth. It was concluded that such screw-retained maxillary hybrid denture using the Cresco method met the esthetic expectations of a highly demanding patient. PMID:19212552

Craniotomy with endoscopic assistance in the treatment of nasopharygeal fibroangioma.

PubMed

Fu, Ji-di; Liu, Hao-cheng; Zhao, Shang-feng; Zhang, Jia-liang; Li, Yong; Ni, Xin; Yu, Chun-jiang

2010-05-20

Nasopharygeal fibroangioma (NPF) can be approached through lateral rhinotomy, the middle skull fossa approach and the transcranial-facial combined approach. It is complicated and thus results in more insults, and when adopted, the total resection rate of tumor is still low. The nasal endoscope is minimally invasive, the dead angles of a craniotomy, such as sphenoid sinus, maxillary sinus, and nasopharynx are easily approached by an endoscope. Lateral rhinotomy have to make facial incision and affects maxillary bone development. We combined the craniotomy and endoscopic approach intending to take advantages of the two approaches. Twelve NPF patients who underwent craniotomy with endoscopic assistance from March 2002 to July 2008 at the Beijing Tongren Hospital were selected. All patients were male. Their ages ranged from 11 to 33 years. The main symptoms were visual deterioration, exophthalmos, nasal obstruction, epistaxis and pharynx nasalis neoplasm. The diagnosis was based on CT, MRI and digital subtraction angiography (DSA). All patients had intracranial encroachment and all underwent DSA and embolism treatment were taken before surgery. Seven patients had a pterional craniotomy, five had a frontal-temporal-orbital-zygomatic craniotomy. Most of the tumor was resected piecemeal, then removed through the sphenoidal sinus. Finally, using an endoscope in the nasal cavity, tumor in nasal cavity was resected and removed through the sphenoidal sinus, observing the dead angle of the craniotomy and confirming that sinus drainage was unobstructed. The tumor was removed completely in 11 patients and partially resected in one patient because of hemorrhage. One patient had an infection after the operation and one patient had cerebrospinal rhinorrhea 3 years after surgery that was remediated by endoscopic repair. Craniotomy with endoscopic assistance in the treatment of NPF was minimally invasive, safe and efficient, and avoided facial incision.

Antimicrobial lipids: novel innate defense molecules are elevated in sinus secretions of patients with chronic rhinosinusitis.

PubMed

Lee, Jivianne T; Jansen, Mike; Yilma, Abebayehu N; Nguyen, Angels; Desharnais, Robert; Porter, Edith

2010-01-01

Airway secretions possess intrinsic antimicrobial properties that contribute to the innate host defense of the respiratory tract. These microbicidal capabilities have largely been attributed to the presence of antibacterial polypeptides. However, recent investigation has indicated that host-derived lipids including cholesteryl esters also exhibit antimicrobial properties. The purpose of this study was to determine whether sinus secretions contain such antimicrobial lipids and to compare the lipid composition in patients with and without chronic rhinosinusitis (CRS). Maxillary sinus fluid was obtained via antral lavage from subjects with (seven patients) and without (nine patients) a history of CRS. After specimen collection, total lipid was extracted according to Bligh and Dyer (Bligh EG and Dyer WJ, A rapid method of total lipid extraction and purification, Can J Biochem Physiol 37:911-918, 1959) and lipid profiles were obtained by reverse phase high-performance liquid chromatography on an amide-embedded C18 column. In addition, the neutrophil-specific antimicrobial peptides human neutrophil peptides 1-3 (HNP1-3) were quantified by Western immunoblotting. Lipids, including cholesteryl esters, were identified in the maxillary sinus secretions of patients with and without CRS. However, levels of lipid composition differed between the two groups with CRS patients exhibiting greater amounts of all classes of lipids, reaching over 10-fold higher concentration when compared with non-CRS patients. This increase was independent of HNP1-3 content. Sinus secretions of patients with CRS appear to show elevated levels of antimicrobial lipids compared with controls independent from neutrophil influx. This up-regulation suggests that host-derived lipids act as mediators of mucosal immunity in CRS. Further study is necessary to determine if such antimicrobial lipids function alone or synergistically with antibacterial peptides in conferring such inherent microbicidal properties.

Evolving trends in sinus surgery: What is the impact of balloon sinus dilation?

PubMed

Svider, Peter F; Darlin, Spencer; Bobian, Michael; Sekhsaria, Vibhav; Harvey, Richard J; Gray, Stacey T; Baredes, Soly; Folbe, Adam J; Eloy, Jean Anderson

2018-06-01

Balloon dilation (BD) represents a minimally invasive alternative to endoscopic sinus surgery (ESS). Although BD was introduced in 2006, distinct Current Procedural Terminology (CPT) codes were not available until 2011, making prior analysis of population-based trends difficult. Our objectives were to evaluate these trends and compare any changes to the use of traditional ESS techniques. Geographic trends also were evaluated. Medicare Part B national datasets encompassing procedures from 2011 to 2015 were obtained. ESS CPT codes (frontal sinusotomy, maxillary antrostomy with/without tissue removal, sphenoidotomy) and BD codes were searched to determine temporal trends in their use. Additionally, state carriers were individually evaluated for geographic trends. National use of BD increased greater than five-fold (39,193 from 7,496 among Medicare patients), whereas the use of ESS increased by only 5.9%. This increase in BD was observed across all sites, including the sphenoid (7.0x), maxillary (5.1x), and frontal (4.7x) sinuses. In the most recent year for which data was available (2015), a significantly greater portion of sinus procedures in these sites utilized BD in the South (42.1%) compared to the Northeast (30.6%), West (29.5%), and Midwest (25.3%) regions (P < 0.0001). The performance of BD has increased markedly in recent years. Because the use of ESS codes remain stable, observed BD trends are unlikely to be due simply to greater familiarity with newer CPT coding. The reasons for the striking increase in BD popularity are speculative and beyond the scope of this analysis, but further study may be needed. NA. Laryngoscope, 128:1299-1303, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

``Magical'' fluid pathways: inspired airflow corridors for optimal drug delivery to human sinuses

NASA Astrophysics Data System (ADS)

Basu, Saikat; Farzal, Zainab; Kimbell, Julia S.

2017-11-01

Topical delivery methods like nasal sprays are an important therapeutic component for sinusitis (inflammation and clogging of the paranasal sinuses). The sinuses are air-filled sacs, identified as: maxillaries (under the eyes and deep to cheeks bilaterally; largest in volume), frontals (above and medial to the eyes, behind forehead area), ethmoids (between the eyes, inferior to the frontal sinuses), and sphenoids (superior and posterior to ethmoids). We develop anatomic CT-based 3D reconstructions of the human nasal cavity for multiple subjects. Through CFD simulations on Fluent for measured breathing rates, we track inspiratory airflow in all the models and the corresponding sprayed drug transport (for a commercially available sprayer, with experimentally tested particle size distributions). The protocol is implemented for a wide array of spray release points. We make the striking observation that the same release points in each subject provide better particle deposition in all the sinuses, despite the sinuses being located at different portions of the nasal cavity. This leads to the conjecture that the complicated anatomy-based flow physics artifacts in the nasal canal generate certain ``magical'' streamlines, providing passage for improved drug transport to all sinus targets. Supported by NIH Grant R01 HL122154.

Dens invaginatus with necrotic pulp in a right maxillary lateral incisor with preserved vitality.

PubMed

Alessandro, Lanza; Fabrizio, Di Francesco; Gennaro, De Marco; Dario, Di Stasio; Eugenio, Guidetti; Letizia, Perillo; Luigi, Femiano; Felice, Femiano

2018-01-01

Dens invaginatus (DI) is a dental malformation occurring in several morphologic types. Consequently, treatment of teeth affected by DI can get complicated because of the complex root canal anatomy. The aim is to describe how to manage a rare report of a DI with necrotic pulp held within the vital pulp of a maxillary lateral incisor. Oral fistula was found on the buccal mucosa of the apex of the vital maxillary lateral incisor with a DI having necrotic pulp. Endodontic treatment of the maxillary lateral incisor and of the tract canal of DI was realized. Clinical disappearance of oral sinus tract was observed after 10 days. On the contrary, the disappearance of radiolucent area occurred after 6 months. A proper and prompt diagnosis is necessary to carry out effective prevention protocols or prevent consequences generating nonrecoverable endo-perio diseases.

Endodontic treatment of a maxillary second molar with developmental anomaly: a case report.

PubMed

Asgary, Saeed

2007-01-01

Fusion is a rare occurrence in molar teeth. The purpose of this rare case presentation is to describe the nonsurgical endodontic treatment of maxillary molar. A 28-year-old patient was referred for endodontic treatment of her chronic apical abscess of right maxillary second molar. In the clinical examination, a sinus tract adjacent to involved tooth and a small crown of supernumerary tooth fused to the buccal surface of the molar at gingival margin was observed. Endodontic treatment was decided for the involved molar for functional reason. Recall examination, a year after completion of endodontic and restorative treatments, showed the tooth was clinically asymptomatic and there was no radiographic lucency around the apical region.

IMRT vs. 3D Noncoplanar Treatment Plans for Maxillary Sinus Tumors: A New Tool for Quantitative Evaluation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Levin, Daphne; Menhel, Janna; Alezra, Dror

2008-01-01

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 amore » 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.« less

Use of autogenous bone and beta-tricalcium phosphate in maxillary sinus lifting: histomorphometric study and immunohistochemical assessment of RUNX2 and VEGF.

PubMed

Pereira, R S; Gorla, L F; Boos, F B J D; Okamoto, R; Garcia Júnior, I R; Hochuli-Vieira, E

2017-04-01

The aim of this study was to compare the use of beta-tricalcium phosphate (β-TCP) (chronOS) with autogenous bone grafts alone in maxillary sinus elevation surgery. The test samples were β-TCP alone, β-TCP mixed with autogenous bone grafts (1:1), and autogenous bone grafts alone. Twelve maxillary sinuses were grafted with β-TCP (group 1), nine with β-TCP+autogenous bone graft (group 2), and 12 with autogenous bone graft (group 3). After 6 months, biopsies were obtained concurrent to the placement of dental implants; these were subjected to histomorphometric analysis and immunohistochemical analysis for runt-related transcription factor 2 (RUNX2) and vascular endothelial growth factor (VEGF). The average bone formation in group 1 was 46.3±11.6% in the pristine bone region, 47.6±9.9% in the intermediate region, and 44.8±22.1% in the apical region; in group 2, values were 35.0±15.8%, 32.5±13.7%, and 32.8±16.0%, respectively; in group 3, values were 43.1±16.0%, 31.0±13.0%, and 46.1±16.3%, respectively. Immunostaining of samples in group 2 showed high cellular activity and immature bone; this differed from groups 1 and 3, in which mature bone was demonstrated. Thus, this study showed that β-TCP presents the same behaviour as autogenous bone graft, which makes it a good bone substitute. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Impact of the use of plasma rich in growth factors (PRGF) on the quality of life of patients treated with endodontic surgery when a perforation of sinus membrane occurred. A comparative study.

PubMed

Taschieri, S; Corbella, S; Tsesis, I; Del Fabbro, M

2014-03-01

The aim of this retrospective investigation was to evaluate the postoperative quality of life after endodontic surgery in maxillary molars when a sinus membrane perforation occurred and platelet concentrates were used. Included patients were treated by microsurgical endodontic treatment in molar and premolar maxillary regions between 2007 and 2010. Patients who fulfilled the inclusion criteria were screened. Data from the quality of life questionnaire were analyzed. The use of plasma rich in growth factors (PRGF) (test group) was compared with a control group when a Schneiderian membrane perforation occurred during endodontic surgery performed with a modern technique in maxillary molars and premolars. A total of 20 patients (12 in the control group and eight in the test group) fulfilled the inclusion criteria. No differences were evaluated at baseline for clinical parameters. Significantly improved patients' quality of life was observed in the test group considering symptoms as swelling, bad breath or taste, and pain. Functional activities were less impaired in the test group and swelling was significantly higher in the control group. In the test group, pain was significantly lower than the control group during the first 6 days after surgery and also, the consumption of painkillers was lower for patients belonging to the test group even if it was not statistically significant. In general, a small sinus membrane perforation (less than 6 mm) during endodontic surgery did not cause severe complications. The use of platelet concentrates could be effective in reducing the impact on patients' quality of life, decreasing pain and surgery side effects as well as swelling.

Rigid fixation of facial fractures in children.

PubMed

Koltai, P J; Rabkin, D; Hoehn, J

1995-01-01

This article presents a retrospective analysis of a selective use of rigid fixation among 62 children with facial fractures, treated at a Level I trauma center over a 5-year period (1986-1991). There were 21 mandible fractures, 11 orbital fractures, 11 zygomaticomalar complex fractures, 7 nasal fractures, 5 maxillary fractures, 3 pan-facial fractures, 2 nasal-orbital-ethmoidal complex fractures, and 2 frontal sinus fractures. Only 18 children had rigid fixation of their injuries. Complications of Le Fort upper facial fractures repaired with rigid fixation involved perioperative sinusitis; one case required oral antibiotics, the other ethmoidectomy and maxillary antrostomy. One child with a Le Fort fracture had delayed exposure of a zygomaticomalar buttress plate, which required surgical removal. Permanent enophthalmos occurred in two children with Le Fort fractures. The authors conclude that traditional conservative management is appropriate in most cases. However, in children aged 13 and older with mandible fractures and children with complex mid- and upper facial fractures, a judicious use of rigid fixation has advantages over the traditional techniques.

Sex Estimation from Human Cranium: Forensic and Anthropological Interest of Maxillary Sinus Volumes.

PubMed

Radulesco, Thomas; Michel, Justin; Mancini, Julien; Dessi, Patrick; Adalian, Pascal

2018-05-01

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.

Paranasal sinus mucoceles: our clinical experiments

PubMed Central

Topdag, Murat; Iseri, Mete; Sari, Fatih; Erdogan, Selvet; Keskin, I Gurkan

2015-01-01

Objectives: We present the clinical and radiological features, treatment protocols, and medium-long-term results of our patients following surgery for paranasal sinus mucocele, along with a review of the relevant literature. Materials and methods: A total of 18 patients (11 women and 7 men) who underwent surgery for paranasal sinus mucocele at Kocaeli University Faculty of Medicine, Department of Otolaryngology, between 2006 and 2013 were examined retrospectively. The mean patient age was 41 (range 4-73). Demographic and radiological features, symptoms, treatment protocols, and postoperative outcomes were recorded. Results: The most frequently affected sinus was the maxillary sinus (n=9, 50%) followed by the frontal sinus (n=6, 33%) and sphenoidal sinus (n=3, 16%). The main symptom was headache. Endoscopic marsupialization of the mucocele was applied in all 18 patients, while frontal sinus exploration with the osteoplastic flap procedure was performed in one patient and the Caldwell-Luc operation was performed in another patient. The Caldwell-Luc procedure was subsequently required in one patient (6%) and endoscopic revision surgery was required in another patient (6%). Conclusion: Sinus mucocele that enlarges, eroding the surrounding bone tissue, and induces various clinical symptoms due to the impression of the expansile mass, is treated surgically, and must be planned carefully to prevent serious complications. PMID:26770462

Radiographic analysis of the transcrestal sinus floor elevation: short-term observations.

PubMed

Diserens, Valérie; Mericske, Ernoe; Mericske-Stern, Regina

2005-01-01

There are some limitations for implant placement in the posterior maxilla when there is an extended sinus. Various techniques for sinus floor elevation allow an increase in implant length. The aim of the present radiographic study was to assess the augmented site in the sinus around implants that were installed by means of an osteotome-mediated transcrestal sinus floor elevation. Thirty-three patients with 44 implants were available. In 39% of the implants the sinus floor elevation was performed exclusively with bone chips. Bone fill material (Bio-Oss, Geistlich Söhne AG, Wolhusen, Switzerland) was additionally used to increase the volume and stability of the lifted area at 61% of the implants. The visibility and morphology of the augmentation were assessed and compared by means of intraoral radiography (long-cone technique). All implants were stable and were considered to be successful when they were reexamined in the context of the present study. The mean residual bone height was 5.78 +/- 1.4 mm. The increase of the implant length as compared to the original bone height resulted in a mean value of 3.87 +/- 2.0 mm. The volume and density of the lifted area were more visible if Bio-Oss was added. A shrinkage and/or condensation of the grafted material was visible at 37% of the implants after a minimum loaded period of 200 days. Equally, a decreased visibility of the original sinus floor was noted at 61% of implants. The formation of a cortical bone layer at the apex of the implants was detected at 35% of implants. The surgical procedure appears to be a safe method with rare complications. Radiographic assessment of the augmentation procedure proved to be difficult, and measurements are not fully reliable.

Long palatal connective tissue rolled pedicle graft with demineralized freeze-dried bone allograft plus platelet-rich fibrin combination: A novel technique for ridge augmentation - Three case reports

PubMed Central

Reddy, Pathakota Krishnajaneya; Bolla, Vijayalakshmi; Koppolu, Pradeep; Srujan, Peruka

2015-01-01

Replacement of missing maxillary anterior tooth with localized residual alveolar ridge defect is challenging, considering the high esthetic demand. Various soft and hard tissue procedures were proposed to correct alveolar ridge deformities. Novel techniques have evolved in treating these ridge defects to improve function and esthetics. In the present case reports, a novel technique using long palatal connective tissue rolled pedicle graft with demineralized freeze-dried bone allografts (DFDBAs) plus Platelet-rich fibrin (PRF) combination was proposed to correct the Class III localized anterior maxillary anterior alveolar ridge defect. The present technique resulted in predictable ridge augmentation, which can be attributed to the soft and hard tissue augmentation with a connective tissue pedicle and DFDBA plus PRF combination. This technique suggests a variation in roll technique with DFDBA plus PRF and appears to promise in gaining predictable volume in the residual ridge defect and can be considered for the treatment of moderate to severe maxillary anterior ridge defects. PMID:26015679

Tissue engineering for lateral ridge augmentation with recombinant human bone morphogenetic protein 2 combination therapy: a case report.

PubMed

Mandelaris, George A; Spagnoli, Daniel B; Rosenfeld, Alan L; McKee, James; Lu, Mei

2015-01-01

This case report describes a tissue-engineered reconstruction with recombinant human bone morphogenetic protein 2/acellular collagen sponge (rhBMP-2/ ACS) + cancellous allograft and space maintenance via Medpor Contain mesh in the treatment of a patient requiring maxillary and mandibular horizontal ridge augmentation to enable implant placement. The patient underwent a previously unsuccessful corticocancellous bone graft at these sites. Multiple and contiguous sites in the maxilla and in the mandibular anterior, demonstrating advanced lateral ridge deficiencies, were managed using a tissue engineering approach as an alternative to autogenous bone harvesting. Four maxillary and three mandibular implants were placed 9 and 10 months, respectively, after tissue engineering reconstruction, and all were functioning successfully after 24 months of follow-up. Histomorphometric analysis of a bone core obtained at the time of the maxillary implant placement demonstrated a mean of 76.1% new vital bone formation, 22.2% marrow/cells, and 1.7% residual graft tissue. Tissue engineering for lateral ridge augmentation with combination therapy requires further research to determine predictability and limitations.

[Cholesterol granuloma in paranasal sinus. An unfrequent pseudotumor in maxillary sinuses].

PubMed

García de Hombre, Alina María; Pérez Peñate, Armando

2005-01-01

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.

[Sinus floor elevation and augmentation. Evidence-based analysis of prognosis and risk factors].

PubMed

Strietzel, F P

2004-03-01

It was the aim of this investigation to analyze evidence of prognosis, predictors, and risk factors concerning sinus floor elevation and augmentation (SFEA). A MEDLINE search was performed to analyze the literature published between 1990 and 2002, limited to keywords ("sinus floor elevation and dental implants", "complications", "success"), study type (randomized as well as clinical prospective studies, retrospective studies, reviews), and language (German or English). Of 229 publications identified, 72 met the inclusion criteria (22 prospective and 47 retrospective studies, 3 reviews). Considering the augmentation material [autogenous bone (AB), bone substitution materials (BSM), and combinations of AB and BSM], the frequency of implant loss was not significantly different (AB 8%, BSM 9%, AB + BSM 5%, p>0.09) after an observation period of 2-4 years. The average duration of the healing period was 6 months (AB) and 8 months (BSM) with simultaneous SFEA and implantation and 6-7 months (AB and BSM) for the staged approach after an average healing period of 6 months for the augmentation materials. Frequency of implant loss was not different between simultaneous and staged approaches (7-8%). Postoperative sinusitis occurred in 3-8% of the cases. Smoking, positive sinusitis history, obstructive pathoses of the nose and ostium, allergic rhino-pathoses, use of short implants (<13 mm), treatment of edentulous maxilla compared to partially edentulous maxilla, bruxism, and uncontrolled early loading of implants were identified as predictors for complications. Presupposing proper consideration of indications, SFEA should be considered as an evidence-based and clinically established method for implant prosthetic rehabilitation of the atrophic posterior maxilla with an overall cumulative survival rate of 90% within an average observation period of 4 years.

Is radical surgery of an inverted papilloma of the maxillary sinus obsolete? a case report.

PubMed

Yildirim, Vedat; Pausch, Niels Christian; Halama, Dirk; Lübbers, Heinz-Theo; Yildirim, Ayhan

2016-12-01

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 restrictions. He has remained disease-free for 25 months following the surgery and surveillance was continued in our tumor clinic. Endoscopic resection of an inverted papilloma continues to be the gold standard. However, some cases require a radical approach. This does not necessarily increase patient morbidity.

Paranasal sinus bony structures and sinus functioning during viral colds in subjects with and without a history of recurrent sinusitis.

PubMed

Alho, Olli-Pekka

2003-12-01

The objective was to assess the impact of ostial obstruction and anatomical variations on paranasal sinus functioning during viral colds with computed tomography (CT) in subjects with and without a history of sinusitis. Cross-sectional study. Twenty-three volunteers with a history of recurrent sinusitis and 25 subjects without such history who had an early (symptoms for 2-4 d) natural cold were examined by taking viral specimens and CT scans and recording symptoms. The pathological sinus changes in the CT scans were scored, and several paranasal bony anatomical variations recorded. Viral origin of the cold was identified in 32 (67%) subjects, similarly in the two groups. Ostiomeatal obstruction and anatomical variations were equally frequent in the subjects with and without a sinusitis history (17 of 23 vs. 17 of 25 for ostial obstruction and 17 of 23 vs. 20 of 25 for at least one variation, respectively). However, in the case of ostiomeatal obstruction the combined CT score of ethmoidal and maxillary sinuses was significantly higher in the subjects with a sinusitis history than in those without (mean +/- SD, 3.0 +/- 0.9 vs. 2.3 +/- 1.2 [P =.05, t test]). In the sinusitis-prone subjects, several variations were associated significantly with various pathological sinus CT changes (septal deviation, horizontally situated processus uncinatus, large concha bullosa, and laterally concave concha media), whereas in the control subjects, only the presence of Haller cells was related to sphenoidal sinus disease. Ostiomeatal complex obstruction and bony anatomical variations seem to have a greater impact on the functioning of paranasal sinuses during viral colds in sinusitis-prone subjects than in subjects without a sinusitis history. These differences may be associated with the increased risk of bacterial sinusitis.

Sinus floor elevation with a crestal approach using a press-fit bone block: a case series.

PubMed

Isidori, M; Genty, C; David-Tchouda, S; Fortin, T

2015-09-01

This prospective study aimed to provide detailed clinical information on a sinus augmentation procedure, i.e., transcrestal sinus floor elevation with a bone block using the press-fit technique. A bone block is harvested with a trephine burr to obtain a cylinder. This block is inserted into the antrum via a crestal approach after creation of a circular crestal window. Thirty-three patients were treated with a fixed prosthesis supported by implants placed on 70 cylindrical bone blocks. The mean bone augmentation was 6.08±2.87 mm, ranging from 0 to 12.7 mm. Only one graft failed before implant placement. During surgery and the subsequent observation period, no complications were recorded, one implant was lost, and no infection or inflammation was observed. This proof-of-concept study suggests that the use of a bone block inserted into the sinus cavity via a crestal approach can be an alternative to the sinus lift procedure with the creation of a lateral window. It reduces the duration of surgery, cost of treatment, and overall discomfort. Copyright © 2015. Published by Elsevier Ltd.

Correlation between presumed sinusitis-induced pain and paranasal sinus computed tomographic findings.

PubMed

Mudgil, Shikha P; Wise, Scott W; Hopper, Kenneth D; Kasales, Claudia J; Mauger, David; Fornadley, John A

2002-02-01

The correlation between facial and/or head pain in patients clinically suspected of having sinusitis and actual localized findings on sinus computed tomographic (CT) imaging are poorly understood. To prospectively evaluate the relationship of paranasal sinus pain symptoms with CT imaging. Two hundred consecutive patients referred by otolaryngologists and internists for CT of the paranasal sinuses participated by completing a questionnaire immediately before undergoing CT. Three radiologists blinded to the patients' responses scored the degree of air/fluid level, mucosal thickening, bony reaction, and mucus retention cysts using a graded scale of severity (0 to 3 points). The osteomeatal complexes and nasolacrimal ducts were also evaluated for patency. Bivariate analysis was performed to evaluate the relationship between patients' localized symptoms and CT findings in the respective sinus. One hundred sixty-three patients (82%) reported having some form of facial pain or headache. The right temple/forehead was the most frequently reported region of maximal pain. On CT imaging the maxillary sinus was the most frequently involved sinus. Bivariate analysis failed to show any relationship between patient symptoms and findings on CT. Patients with a normal CT reported a mean 5.88 sites of facial or head pain versus 5.45 sites for patients with an abnormal CT. Patient-based responses of sinonasal pain symptoms fail to correlate with findings in the respective sinuses. CT should therefore be reserved for delineating the anatomy and degree of sinus disease before surgical intervention.

Sphenoid sinus types, dimensions and relationship with surrounding structures.

PubMed

Štoković, Nikola; Trkulja, Vladimir; Dumić-Čule, Ivo; Čuković-Bagić, Ivana; Lauc, Tomislav; Vukičević, Slobodan; Grgurević, Lovorka

2016-01-01

The human sphenoid sinus is an extremely variable cavity and an important landmark in hypophyseal surgery. The aim of this study was to investigate the relationship between the sphenoid sinus type, size, extent of pneumatization and occurrence of protrusions of the adjacent neurovascular structures. A total of 51 randomly selected skulls (≥20 years of age, 33 male; 102 sinuses) were analyzed using cone beam computed tomography to estimate pneumatization extension beyond the body of the sphenoid (planum sphenoidale, pterygoid process, greater wings, clivus, dorsum sellae) and protrusions of the maxillary, mandibular, optic or pterygoid nerve or the internal carotid artery. Difference in pneumatization type between the left and the right-sided sinus was observed in 45% of the skulls. Conchal pneumatization was registered in 2%, presellar in 24%, sellar in 41% and postsellar in 33% of total sinuses. Presellar sinuses frequently pneumatized planum sphenoidale and sporadically other structures, and were characterized by sporadic optic nerve protrusions. Sellar and particularly postsellar sinuses were characterized by simultaneous pneumatization extensions and neurovascular protrusions. In the case of postsellar-type sinuses, the probability of these multiple interactions was not affected by their actual size, while it increased with the increasing sinus dimensions in the case of sellar-type sinuses. A more detailed analysis indicated that increasing sinus height, length or width increased the probability of interactions and pneumatization of particular surrounding structures. Data suggest that the sphenoid sinus pneumatization type and dimensions might be used to estimate the risks of iatrogenic injury during transsphenoidal surgical procedures. Copyright © 2015 Elsevier GmbH. All rights reserved.

Volumetric analysis of bone substitute material performance within the human sinus cavity of former head and neck cancer patients: A prospective, randomized clinical trial.

PubMed

Lorenz, Jonas; Eichler, Kathrin; Barbeck, Mike; Lerner, Henriette; Stübinger, Stefan; Seipel, Catherine; Vogl, Thomas J; Kovács, Adorján F; Ghanaati, Shahram; Sader, Robert A

2016-01-01

In numerous animal and human studies, it could be detected that in bone augmentation procedures, material's physicochemical characteristics can influence the cellular inflammatory pattern and therefore the integration in the host tissue. Histological, histomorphometrical, and clinical analyses of the integration of the biomaterial in the surrounding tissue are well established methodologies; however, they do not make a statement on volume and density changes of the augmented biomaterial. The aim of the present study was to assess the volume and density of a xenogeneic (Bio-Oss ® , BO) and a synthetic (NanoBone ® , NB) bone substitute material in split-mouth sinus augmentations in former tumor patients to complete histological and histomorphometrical assessment. Immediately and 6 months after sinus augmentation computed tomography scans were recorded, bone grafts were marked, and the volume was calculated with radiologic RIS-PACS software (General Electric Healthcare, Chalfont St. Giles, Great Britain) to determine the integration and degradation behavior of both biomaterials. Radiographic analysis revealed a volume reduction of the initial augmented bone substitute material (i.e. 100%) to 77.36 (±11.68) % in the BO-group, respectively, 75.82 (±22.28) % in the NB-group six months after augmentation. In both materials, the volume reduction was not significant. Bone density significantly increased in both groups. The presented radiological investigation presents a favorable method to obtain clinically relevant information concerning the integration and degradation behavior of bone substitute materials.

[History of diaphanoscopy. Pictures from the history of otorhinolaryngology, illustrated by instruments from the collection of the Ingolstadt German Medical History Museum].

PubMed

Feldmann, H

1998-05-01

In 1854 the Spanish singing teacher Manuel Garcia succeeded in inspecting his own larynx. In 1857 the neurologist Ludwig Türck in Vienna, without knowledge of Garcia's achievement, had been experimenting on laryngoscopy with his patients using a small mirror and sunlight. When in the winter of 1857-1858 he had to suspend his experiments for lack of sunlight, he lent his mirror to physiologist Johann Czermak in Budapest. Czermak, using artificial light reflected by a perforated mirror, developed modern laryngoscopy within a few weeks and made it a clinically valuable method. He described it in March 1858 as his own invention. This was the beginning of a an embittered fight with Türck about whose development had priority. During his very first studies on laryngoscopy Czermak noticed that the interior of the larynx could be inspected very well when the neck was illuminated by a strong light from without and the mirror was held in the dark pharynx. The tissue would then appear transilluminated in a glowing deep red. When sufficiently bright electric lamps became available in 1889, Rudolph Voltolini in Breslau, Germany, took up the transillumination of the larynx and even carried out some minor intralaryngeal operations using this method. Although suitable diaphanoscopes were soon on the market this technique was not widely adopted. It was ony used once in 1954 (Pellnitz et al.) for diagnosing early stages of laryngeal cancer. Voltolini in Breslau and Cozzolino in Naples experimented independently of each other with small electric lamps with the aim of finding new techniques of rhinoscopy. Both of them placed their lamp in the nasopharynx and performed anterior rhinoscopy using an ordinary speculum. However, it was only Voltolini who noticed the transillumination of the maxillary sinuses when the lamp was placed in the oral cavity. On October 29, 1888, in Breslau he demonstrated diaphanoscopy of the maxillary sinus for the first time. Cozzolino claimed that he had introduced this technique prior to Voltolini. Voltolini had died in 1889 and could not comment on this. A careful study of the original publications, however, shows that Cozzolino had only inspected the nasal cavity with retronasal illumination, but had not demonstrated the maxillary sinus by transillumination. The diaphanoscopy of the paranal sinuses was very soon elaborated to perfection: Vohse in 1890 applied it to the frontal sinuses, Gerber in 1900 invented a double diaphanoscope for examining both frontal sinuses simultaneously. Although the shortcomings of diaphanoscopy soon became apparent, the method was widely used for about half a century, but in the end could not compete with modern techniques of radiography and ultrasound. The history is related in detail and illustrated with numerous figures.

Edentulous maxillary arch fixed implant rehabilitation using a hybrid prosthesis made of micro-ceramic-composite: case report.

PubMed

Geckili, Onur; Bilhan, Hakan; Ceylan, Gulsum; Cilingir, Altug

2013-02-01

The prosthetic treatment of patients with an edentulous maxilla opposing mandibular natural teeth is one of the most challenging endeavors that face clinicians. Occlusal forces from the opposing natural teeth may cause fractures in the maxillary prosthesis and also result in advanced bone loss of the edentulous maxilla. With the presence of extreme gagging reflex, the treatment may become more complicated. This article describes and illustrates the 2-stage surgical and prosthetic treatment of a patient with an edentulous maxilla opposing natural teeth. In the beginning, the patient was treated with 4 implants and a maxillary implant-supported overdenture. The extreme gagging reflex and the occlusal forces from the mandibular natural teeth obligated the team a second stage surgical and prosthetic treatment, which included increasing the number of implants after bilateral sinus lifting in the posterior maxilla and fabricating a maxillary fixed hybrid prosthesis made of micro-ceramic composite that yielded a satisfactory result.

Recovery of multiple impacted maxillary teeth in a hyperdivergent Class I patient using Temporary Skeletal Anchorage Devices and augmented corticotomy.

PubMed

Kim, Kyung A; Hwang, Hyeon-Shik; Chung, Kyu-Rhim; Kim, Seong-Hun; Nelson, Gerald

2018-01-01

Treatment of multiple impacted teeth is challenging. Three-dimensional treatment planning can help in delivering a better outcome. This case report presents a patient with an incomplete dental transposition between the canine and lateral incisor of the maxillary right side associated with the impaction of a dilacerated right central incisor. Using a two-stage surgical exposure and augmented corticotomy, the patient's occlusion and smile esthetics were significantly improved, and Class I occlusal relationships with optimal overjet and overbite were achieved after 50 months of orthodontic treatment. Thirty-month posttreatment records revealed a stable result.

Maxillary Swelling as the First Evidence of Multiple Myeloma

PubMed Central

Kasamatsu, Atsushi; Kimura, Yasushi; Tsujimura, Hideki; Kanazawa, Harusachi; Koide, Nao; Miyamoto, Isao; Endo-Sakamoto, Yosuke; Shiiba, Masashi; Tanzawa, Hideki; Uzawa, Katsuhiro

2015-01-01

Multiple myeloma is a malignant neoplasm of plasma cells characterized by proliferation of a single clone of abnormal immunoglobulin-secreting plasma cells. Since the amount of hemopoietic bone marrow is decreased in the maxilla, oral manifestations of multiple myeloma are less common in the maxilla than in the mandible. We report the case of 33-year-old Japanese man who presented with a mass in the right maxillary alveolar region. Computed tomography and magnetic resonance images showed a soft tissue mass in the right maxilla eroding the anterior and lateral walls of the maxillary sinus and extending into the buccal space. The biopsy results, imaging, and laboratory investigations led to the diagnosis of multiple myeloma. This case report suggests that oral surgeons and dentists should properly address oral manifestations as first indications of multiple myeloma. PMID:26640721

Autogenous bone versus deproteinised bovine bone matrix in 1-stage lateral sinus floor elevation in the severely atrophied maxilla: a randomised controlled trial.

PubMed

Merli, Mauro; Moscatelli, Marco; Mariotti, Giorgia; Rotundo, Roberto; Nieri, Michele

2013-01-01

To compare 100% deproteinised bovine bone matrix (DBBM) grafts (test group) with 100% autogenous bone (AB) grafts (control group) for lateral maxillary sinus floor elevation in a parallel group, superiority, randomised controlled trial. Patients with 1 to 3 mm of residual bone height below the maxillary sinus were randomised for sinus floor elevation with DBBM and AB grafts and simultaneous implant placement. Randomisation was computer generated with allocation concealment by sealed envelopes and the radiographic examiner was blinded to group assignment. The abutment connection was performed 8 months after surgery and insertion of the provisional prostheses was performed 9 months after surgery. Outcome variables were implant failures, prosthetic failures, complications, chair time, postoperative pain and radiographic bone level 6 months after loading. Forty patients were randomised: 20 (32 implants) to the DBBM group and 20 (27 implants) to the AB group. One patient from the AB group dropped out. Two implant failures occurred in the DBBM group and no implant failure occurred in the AB group (P = 0.4872). All of the planned prostheses could be delivered. One complication occurred in the DBBM group and 2 in the AB group (P = 0.6050). Chair time was shorter for the DBBM group, with a difference of 27.3 minutes (P = 0.0428). Pain difference measured with a visual analogue scale for 6 days post-surgery was 0.2 in favour of the DBBM group (P = 0.6838). The difference in vertical bone height was 0.0 mm (95% CI -1.1, 1.1; P = 0.9703) and the difference in marginal bone level was 0.3 in favour of AB (95% CI -0.3, 0.9; P = 0.3220). No differences apart from chair time were observed when comparing DBBM and AB grafts with simultaneous implant placement in sinus elevation.

A comparative study of two different uncinectomy techniques: swing-door and classical.

PubMed

Singhania, Ankit A; Bansal, Chetan; Chauhan, Nirali; Soni, Saurav

2012-01-01

The aim of this study was to determine which technique of uncinectomy, classical or swing door technique. Four hundred eighty Cases of sinusitis were selected and operated for Functional Endoscopic Sinus Surgery (FESS). Out of these, in 240 uncinectomies classical uncinectomy was done whereas in another 240 uncinectomies swing door technique was used. Initially patients were medically managed treated according to their symptoms and prior management. Patients who had received previous adequate medical management were evaluated with CT scan of the sinuses. If disease still persists than they were operated for FESS. The authors' experience indicates that Functional endoscopic sinus surgery can be performed under local or general anesthesia, as permitted or tolerated. In this review classical technique was used in 240 uncinectomies. Out of this, ethmoidal complex injury was noted in 4 cases, missed maxillary ostium syndrome (incomplete removal) was reported in 12 patients and orbital fat exposure was encountered in 5 patients. As compared to 240 uncinectomies done with swing door technique, incomplete removal was evident in 2 cases and lacrimal duct injury was reported in 3 cases. 'Evidence that underscores how this 'swing door technique' successfully combines 'the conservation goals of the anterior-to-posterior approach and anatomic virtues of the posterior-to-anterior approach to ethmoidectomy of the total 480 uncinectomies operated. Out of which 240 uncinectomies have been performed using the 'swing-door' technique. The 240 uncinectomies performed using classical technique were used as controls. The incidence of orbital penetration, incomplete removal, ethmoidal complex injury and ostium non-identification was significantly less with the new technique. Three lacrimal injuries occurred with the 'swing-door' technique compared to no injuries with classical technique. The authors recommend swing door technique as it is easy to learn, allows complete removal of the uncinate flush with the lateral nasal wall and allows easy identification of the natural ostium of the maxillary sinus without injuring the ethmoidal complex.

Bilateral silent sinus syndrome: A rare case and review of literature.

PubMed

Trope, Michal; Schwartz, Joseph S; Tajudeen, Bobby A; Kennedy, David W

2017-06-01

In this report, we presented a rare case of bilateral silent sinus syndrome (SSS) in an otherwise healthy 57-year-old man treated with functional endoscopic sinus surgery (FESS). A systematic review of the literature regarding bilateral SSS was performed. A 57-year-old man with well-controlled allergic rhinitis in the absence of previous surgery or trauma presented with bilateral SSS, which was successfully managed with bilateral FESS. A medical literature data base search of the terms "silent sinus syndrome" "maxillary atelectasis," "imploding antrum syndrome," and "bilateral silent sinus syndrome" was performed. The results were then narrowed to include only relevant articles. Relevant articles included three case reports and two articles that describe or mention bilateral SSS. Of the three case reports found, two patients presented with bilateral SSS, whereas the third patient presented metachronously, with the contralateral SSS manifesting 4 months after presentation of the initial ipsilateral SSS. The present literature regarding bilateral SSS is likely incomplete, and further investigation is required to provide greater insight into the prevalence of this disease. In this report, bilateral FESS was successful in resolving symptoms and preventing disease progression.

Mitomycin C and endoscopic sinus surgery: where are we?

PubMed

Tabaee, Abtin; Brown, Seth M; Anand, Vijay K

2007-02-01

Mitomycin C has been used successfully in various ophthalmologic and, more recently, otolaryngologic procedures. Its modulation of fibroblast activity allows for decreased scarring and fibrosis. Several recent trials have examined the efficacy of mitomycin C in reducing synechia and stenosis following endoscopic sinus surgery. Basic science studies using fibroblast cell lines have demonstrated a dose-dependent suppression of activity with the use of mitomycin C. This is further supported by animal studies that have shown lower rates of maxillary ostial restenosis following application of mitomycin C. No human trial, however, has demonstrated a statistically significant impact of mitomycin C on the incidence of postoperative synechia or stenosis following sinus surgery. The limitations of the literature are discussed. The antiproliferative properties of mitomycin C may theoretically decrease the incidence of synechia and stenosis following endoscopic sinus surgery. Although this is supported by basic science studies and its successful use in other fields, the clinical evidence to date has not shown the application of mitomycin C to be effective in preventing stenosis after endoscopic sinus surgery. Future prospective studies are required before definitive conclusions can be made.

Angulated Dental Implants in Posterior Maxilla FEA and Experimental Verification.

PubMed

Hamed, Hamed A; Marzook, Hamdy A; Ghoneem, Nahed E; El-Anwar, Mohamed I

2018-02-15

This study aimed to evaluate the effect of different implant angulations in posterior maxilla on stress distribution by finite element analysis and verify its results experimentally. Two simplified models were prepared for an implant placed vertically and tilted 25° piercing the maxillary sinus. Geometric models' components were prepared by Autodesk Inventor then assembled in ANSYS for finite element analysis. The results of finite element analysis were verified against experimental trials results which were statistically analysed using student t-test (level of significance p < 0.05). Implant - abutment complex absorbed the load energy in case of vertical implant better than the case of angulated one. That was reflected on cortical bone stress, while both cases showed stress levels within the physiological limits. Comparing results between FEA and experiment trials showed full agreement. It was found that the tilted implant by 25° can be utilised in the posterior region maxilla for replacing maxillary first molar avoiding sinus penetration. The implant-bone interface and peri-implant bones received the highest Von Mises stress. Implant - bone interface with angulated implant received about 66% more stresses than the straight one.

Computed tomographic anatomy of the nasal cavity, paranasal sinuses and tympanic cavity of the koala.

PubMed

Hemsley, S; Palmer, H; Canfield, R B; Stewart, M E B; Krockenberger, M B; Malik, R

2013-09-01

To use cross-sectional imaging (helical computed tomography (CT)) combined with conventional anatomical dissection to define the normal anatomy of the nasal cavity and bony cavitations of the koala skull. Helical CT scans of the heads of nine adult animals were obtained using a multislice scanner acquiring thin slices reconstructed in the transverse, sagittal and dorsal planes. Subsequent anatomical dissection permitted confirmation of correct identification and further delineation of bony and air-filled structures visible in axial and multiplanar reformatted CT images. The nasal cavity was relatively simple, with little scrolling of nasal conchae, but bony cavitations were complex and extensive. A rostral maxillary recess and ventral conchal, caudal maxillary, frontal and sphenoidal paranasal sinuses were identified and characterised. Extensive temporal bone cavitation was shown to be related to a large epitympanic recess. The detailed anatomical data provided are applicable to future functional and comparative anatomical studies, as well as providing a preliminary atlas for clinical investigation of conditions such as cryptococcal rhinosinusitis, a condition more common in the koala than in many other species. © 2013 Australian Veterinary Association.

Primary paranasal sinus hyalinizing clear cell carcinoma: a case report.

PubMed

AlAli, Batool M; Alyousef, Mohammed J; Kamel, Ahmad Salah; Al Hamad, Mohammad A; Al-Bar, Mohammad H; Algowiez, Roaa M

2017-09-25

Hyalinizing clear cell carcinoma (HCCC) is a rare low-grade tumour of salivary glands that was first described as a distinct entity in 1994 by Milchgrub et al. EWSR1-ATF1 fusion was found to be specific for this tumour. The majority of the reported cases of HCCC arise from minor salivary glands within the oral cavity. Primary HCCC of the paranasal sinus is extremely uncommon. To our knowledge, only three cases have been reported in the English literature. Herein, we present a case of HCCC of the posterior ethmoid/maxillary sinus. A 63-year-old lady who presented with a long history of epistaxis. CT scan revealed a destructive mass in the left ethmoid/posterior maxillary sinus extending to the nasal cavity. Surgical excision was done and microscopic evaluation showed a tumour composed mainly of nests of clear epithelial cells separated by fibrocellular and hyalinized septa with extensive bone destruction. The tumour cells expressed CK5/6, EMA and p63 immunohistochemically but were negative for S100 protein, PAX-8, RCC and CK7. Sinonasal renal cell-like adenocarcinomas, myoepithelial carcinoma and metastatic renal cell carcinoma were excluded by radiological and immunohistochemical studies. Fluorescence in situ hybridization analysis revealed an EWSR1 gene rearrangement. Postoperative radiation was administrated and the patient did not show recurrence or distant metastasis 4 months after the surgery. Head and neck region have many tumours that demonstrate clear cell changes on histology. Thus, the differential diagnosis for HCCC is wide. Awareness of this rare entity and the possibility of it is arising in unusual location is necessary. EWSR1-AFT1 fusion, a consistent finding in HCCC, can be used to confirm the diagnosis.

Endoscopic endonasal approach to the anteromedial temporal fossa and mobilization of the lateral wall of the cavernous sinus through the inferior orbital fissure and V1-V2 corridor: An anatomical study and clinical considerations.

PubMed

Hanakita, Shunya; Chang, Wei-Chieh; Watanabe, Kentaro; Ronconi, Daniel; Labidi, Moujahed; Park, Hun-Ho; Oyama, Kenichi; Bernat, Anne-Laure; Froelich, Sebastien

2018-04-27

The aim of this study was to identify key anatomical landmarks useful in gaining access to the anteromedial temporal region via the corridor formed by the inferior orbital fissure (IOF), the ophthalmic branch (V1), and the maxillary branch (V2) of the trigeminal nerve via the EEA. An anatomical dissection of six cadaver heads was performed to confirm the feasibility and applicability of the EEA for accessing the anteromedial temporal region. Following middle turbinectomy, the lateral recess of the sphenoid sinus was opened, the orbital apex exposed, and the posterior wall of the maxillary sinus was removed, in sequence. The IOF and the pterygopalatine fossa (PPF) were then identified. After opening the foramen rotundum (FR) and removing the bony structure between the FR, V2 was transposed downward. The orbital muscle of Müller was removed. The PPF was mobilized downward exposing the greater wing of the sphenoid bone (GWS). The GWS between V1 and V2 was drilled, thus exposing the temporal dura. With blunt dissection, the medial temporal dura was peeled away from the cavernous sinus (CS) in order to increase access to the anteromedial temporal region. In this study, the anteromedial temporal fossa was exposed by drilling the V1-V2 triangle corridor via the EEA. Endoscopic endonasal exposure of the anteromedial temporal fossa is feasible and requires limited endonasal work. This approach may be considered as an alternate surgical corridor to the temporomesial lobe that offers the advantages of a direct route with less temporal lobe retraction. Copyright © 2018. Published by Elsevier Inc.

Three-dimensional finite-element analysis of functional stresses in different bone locations produced by implants placed in the maxillary posterior region of the sinus floor.

PubMed

Koca, Omer Lutfi; Eskitascioglu, Gurcan; Usumez, Aslihan

2005-01-01

Implants placed in the posterior maxilla have lower success rates compared to implants placed in other oral regions. Inadequate bone levels have been suggested as a reason for this differential success rate. The purpose of this study was to determine the amount and localization of functional stresses in implants and adjacent bone locations when the implants were placed in the posterior maxilla in proximity to the sinus using finite element analysis (FEA). A 3-dimensional finite element model of a maxillary posterior section of bone (Type 3) was used in this study. Different bony dimensions were generated to perform nonlinear calculations. A single-piece 4.1x10-mm screw-shaped dental implant system (ITI solid implant) was modeled and inserted into atrophic maxillary models with crestal bone heights of 4, 5, 7, 10, or 13 mm. In some models the implant penetrated the sinus floor. Cobalt-Chromium (Wiron 99) was used as the crown framework material placed onto the implant, and porcelain was used for occlusal surface of the crown. A total average occlusal force (vertical load) of 300 N was applied at the palatal cusp (150 N) and mesial fossa (150 N) of the crown. The implant and superstructure were simulated in finite element software (Pro/Engineer 2000i program). For the porcelain superstructure for bone levels, maximum von Mises stress values were observed on the mesial fossae and palatal cusp. For the bone structure, the maximum von Mises stress values were observed in the palatal cortical bone adjacent to the implant neck. There was no stress within the spongy bone. High stresses occurred within the implants for all bone levels. The maximum von Mises stresses in the implants were localized in the neck of implants for 4- and 5-mm bone levels, but for 7-, 10-, and 13-mm bone levels more even stresses occurred within the implants.

Microbiome and Culture Based Analysis of Chronic Rhinosinusitis Compared to Healthy Sinus Mucosa.

PubMed

Koeller, Kerstin; Herlemann, Daniel P R; Schuldt, Tobias; Ovari, Attila; Guder, Ellen; Podbielski, Andreas; Kreikemeyer, Bernd; Olzowy, Bernhard

2018-01-01

The role of bacteria in chronic rhinosinusitis (CRS) is still not well understood. Whole microbiome analysis adds new aspects to our current understanding that is mainly based on isolated bacteria. It is still unclear how the results of microbiome analysis and the classical culture based approaches interrelate. To address this, middle meatus swabs and tissue samples were obtained during sinus surgery in 5 patients with CRS with nasal polyps (CRSwNP), 5 patients with diffuse CRS without nasal polyps (CRSsNP), 5 patients with unilateral purulent maxillary CRS (upm CRS) and 3 patients with healthy sinus mucosa. Swabs were cultured, and associated bacteria were identified. Additionally, parts of each tissue sample also underwent culture approaches, and in parallel DNA was extracted for 16S rRNA gene amplicon-based microbiome analysis. From tissue samples 4.2 ± 1.2 distinct species per patient were cultured, from swabs 5.4 ± 1.6. The most frequently cultured species from the swabs were Propionibacterium acnes, Staphylococcus epidermidis, Corynebacterium spp. and Staphylococcus aureus . The 16S-RNA gene analysis revealed no clear differentiation of the bacterial community of healthy compared to CRS samples of unilateral purulent maxillary CRS and CRSwNP. However, the bacterial community of CRSsNP differed significantly from the healthy controls. In the CRSsNP samples Flavobacterium, Pseudomonas, Pedobacter, Porphyromonas, Stenotrophomonas , and Brevundimonas were significantly enriched compared to the healthy controls. Species isolated from culture did not generally correspond with the most abundant genera in microbiome analysis. Only Fusobacteria, Parvimonas , and Prevotella found in 2 unilateral purulent maxillary CRS samples by the cultivation dependent approach were also found in the cultivation independent approach in high abundance, suggesting a classic infectious pathogenesis of odontogenic origin in these two specific cases. Alterations of the bacterial community might be a more crucial factor for the development of CRSsNP compared to CRSwNP. Further studies are needed to investigate the relation between bacterial community characteristics and the development of CRSsNP.

Microbiome and Culture Based Analysis of Chronic Rhinosinusitis Compared to Healthy Sinus Mucosa

PubMed Central

Koeller, Kerstin; Herlemann, Daniel P. R.; Schuldt, Tobias; Ovari, Attila; Guder, Ellen; Podbielski, Andreas; Kreikemeyer, Bernd; Olzowy, Bernhard

2018-01-01

The role of bacteria in chronic rhinosinusitis (CRS) is still not well understood. Whole microbiome analysis adds new aspects to our current understanding that is mainly based on isolated bacteria. It is still unclear how the results of microbiome analysis and the classical culture based approaches interrelate. To address this, middle meatus swabs and tissue samples were obtained during sinus surgery in 5 patients with CRS with nasal polyps (CRSwNP), 5 patients with diffuse CRS without nasal polyps (CRSsNP), 5 patients with unilateral purulent maxillary CRS (upm CRS) and 3 patients with healthy sinus mucosa. Swabs were cultured, and associated bacteria were identified. Additionally, parts of each tissue sample also underwent culture approaches, and in parallel DNA was extracted for 16S rRNA gene amplicon-based microbiome analysis. From tissue samples 4.2 ± 1.2 distinct species per patient were cultured, from swabs 5.4 ± 1.6. The most frequently cultured species from the swabs were Propionibacterium acnes, Staphylococcus epidermidis, Corynebacterium spp. and Staphylococcus aureus. The 16S-RNA gene analysis revealed no clear differentiation of the bacterial community of healthy compared to CRS samples of unilateral purulent maxillary CRS and CRSwNP. However, the bacterial community of CRSsNP differed significantly from the healthy controls. In the CRSsNP samples Flavobacterium, Pseudomonas, Pedobacter, Porphyromonas, Stenotrophomonas, and Brevundimonas were significantly enriched compared to the healthy controls. Species isolated from culture did not generally correspond with the most abundant genera in microbiome analysis. Only Fusobacteria, Parvimonas, and Prevotella found in 2 unilateral purulent maxillary CRS samples by the cultivation dependent approach were also found in the cultivation independent approach in high abundance, suggesting a classic infectious pathogenesis of odontogenic origin in these two specific cases. Alterations of the bacterial community might be a more crucial factor for the development of CRSsNP compared to CRSwNP. Further studies are needed to investigate the relation between bacterial community characteristics and the development of CRSsNP. PMID:29755418

Volumetric analysis of bone substitute material performance within the human sinus cavity of former head and neck cancer patients: A prospective, randomized clinical trial

PubMed Central

Lorenz, Jonas; Eichler, Kathrin; Barbeck, Mike; Lerner, Henriette; Stübinger, Stefan; Seipel, Catherine; Vogl, Thomas J.; Kovács, Adorján F.; Ghanaati, Shahram; Sader, Robert A.

2016-01-01

Background: In numerous animal and human studies, it could be detected that in bone augmentation procedures, material's physicochemical characteristics can influence the cellular inflammatory pattern and therefore the integration in the host tissue. Histological, histomorphometrical, and clinical analyses of the integration of the biomaterial in the surrounding tissue are well established methodologies; however, they do not make a statement on volume and density changes of the augmented biomaterial. Aims: The aim of the present study was to assess the volume and density of a xenogeneic (Bio-Oss®, BO) and a synthetic (NanoBone®, NB) bone substitute material in split-mouth sinus augmentations in former tumor patients to complete histological and histomorphometrical assessment. Methods: Immediately and 6 months after sinus augmentation computed tomography scans were recorded, bone grafts were marked, and the volume was calculated with radiologic RIS-PACS software (General Electric Healthcare, Chalfont St. Giles, Great Britain) to determine the integration and degradation behavior of both biomaterials. Results: Radiographic analysis revealed a volume reduction of the initial augmented bone substitute material (i.e. 100%) to 77.36 (±11.68) % in the BO-group, respectively, 75.82 (±22.28) % in the NB-group six months after augmentation. In both materials, the volume reduction was not significant. Bone density significantly increased in both groups. Conclusion: The presented radiological investigation presents a favorable method to obtain clinically relevant information concerning the integration and degradation behavior of bone substitute materials. PMID:28299254

Marginal and apical bone stability after staged sinus floor augmentation using bone condensing implants with variable-thread design: a two-dimensional analysis.

PubMed

Younes, F; Eghbali, A; De Troyer, S; De Bruyckere, T; Cleymaet, R; Cosyn, J

2016-09-01

Studies on the vertical stability of augmented bone after sinus lifting differ substantially. In addition, long healing periods are usually advocated prior to implant installation. The purpose of this case series study was to evaluate the changes in bone height after sinus lifting with a bovine-derived xenograft and to evaluate the clinical outcome of bone condensing implants installed after a short healing period. Patients treated during the years 2010-2013 were re-examined using peri-apical radiographs to evaluate the changes in augmented bone height (BH) and marginal bone loss (BL). Fifty-seven of 70 eligible subjects (28 male and 29 female, mean age 56 years) attended for reassessment. Data were available for 53 sinus lifts and 105 implants installed after a mean healing period of 4.6±1.5 months. Implant survival was 99% after a mean time in function of 19±9 months. Baseline BH, BH at implant placement, and final BH were on average 3.87±1.74mm, 13.75±2.12mm, and 13.11±2.12mm, respectively (P<0.001). Mean BL was 0.51±0.65mm. Only limited resorption is to be expected after sinus lifting in the short term. A bone condensing implant can be used in the early healing phase with successful outcomes in terms of implant survival and bone adaptation. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Comparing the influence of crestal cortical bone and sinus floor cortical bone in posterior maxilla bi-cortical dental implantation: a three-dimensional finite element analysis.

PubMed

Yan, Xu; Zhang, Xinwen; Chi, Weichao; Ai, Hongjun; Wu, Lin

2015-05-01

This study aimed to compare the influence of alveolar ridge cortical bone and sinus floor cortical bone in sinus areabi-cortical dental implantation by means of 3D finite element analysis. Three-dimensional finite element (FE) models in a posterior maxillary region with sinus membrane and the same height of alveolar ridge of 10 mm were generated according to the anatomical data of the sinus area. They were either with fixed thickness of crestal cortical bone and variable thickness of sinus floor cortical bone or vice versa. Ten models were assumed to be under immediate loading or conventional loading. The standard implant model based on the Nobel Biocare implant system was created via computer-aided design software. All materials were assumed to be isotropic and linearly elastic. An inclined force of 129 N was applied. Von Mises stress mainly concentrated on the surface of crestal cortical bone around the implant neck. For all the models, both the axial and buccolingual resonance frequencies of conventional loading were higher than those of immediate loading; however, the difference is less than 5%. The results showed that bi-cortical implant in sinus area increased the stability of the implant, especially for immediately loading implantation. The thickness of both crestal cortical bone and sinus floor cortical bone influenced implant micromotion and stress distribution; however, crestal cortical bone may be more important than sinus floor cortical bone.

Orthograde retreatment failure with extruded MTA apical plug in a large periradicular lesion followed by surgical intervention: case report.

PubMed

Brito-Junior, Manoel; Faria-e-Silva, Andre Luis; Quintino, Alex Carvalho; Moreira-Junior, Gil; Geber, Mauro; Camilo, Carla Cristina; Soares, Janir Alves

2012-01-01

Absence of periapical healing after orthograde retreatment using an apical plug with mineral trioxide aggregate (MTA) can require surgical intervention. A patient with a root-filled maxillary central incisor with chronic apical periodontitis and sinus tract was referred for endodontic retreatment. Excessive apical enlargement was verified, indicating an MTA apical plug placement; however, an unintentional extrusion of MTA occurred during this step. The root canal was filled with gutta-percha and sealer, and periodic recalls were scheduled. The sinus tract was observed after six months and the lesion remained unaltered, although the extruded MTA had resorbed; therefore, an apicoectomy and retrograde root-end filling with MTA were performed. Absence of sinus tract, normal clinical aspect, and complete repair of the lesion were observed at the two-year follow-up.

Transient swelling of the Schneiderian membrane after transversal sinus augmentation: a pilot study.

PubMed

Quirynen, Marc; Lefever, David; Hellings, Peter; Jacobs, Reinhilde

2014-01-01

The predictability and simplicity of the Summers' technique for sinus floor elevation encouraged many clinicians to consider this new approach. The impact of such intervention on the sinus mucosa has, however, not been explored extensively. This pilot study followed the response of the Schneiderian membrane, longitudinally, via cone-beam CT images. Ten consecutive patients (five women, mean age 58.7 years) referred for implant therapy in the posterior part of the maxilla, in combination with a trans-alveolar sinus floor elevation (13 sinuses involved), were enrolled. CBCT images were taken prior to and at 1 week and 1 month after surgery. The changes in thickness of the Schneiderian membrane were scored at nine standardized points per sinus using reformatted cross-sectional images. One week after sinus floor elevation, the Schneiderian membrane showed a significant swelling of 9.2 mm in the middle (SD 0.3; P < 0.005), 7.2 mm medially (SD 2.5; P < 0.005) and 3.9 mm laterally (SD 0,3; P < 0.05), respectively, resulting in an overall mean of 6.7 mm (SD 2.6), which fully disappeared 3 weeks later. This swelling involved the entire floor of the sinus and not only the augmented area. Within the limitations of this pilot study, one can conclude that the Schneiderian membrane responds with a significant "transient" swelling (5-10× its size) during the first weeks of healing. © 2012 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

Equine nasal and paranasal sinus tumours: part 2: a contribution of 28 case reports.

PubMed

Dixon, P M; Head, K W

1999-05-01

The clinical and pathological findings of 28 cases (27 horses, 1 donkey) of equid sinonasal tumours examined at the Edinburgh Veterinary School are presented and include: seven cases of squamous cell carcinoma (SCC); five adenocarcinomas; three undifferentiated carcinomas; two adenomas; five fibro-osseous and bone tumours; and single cases of ameloblastoma, fibroma, fibrosarcoma, undifferentiated sarcoma, melanoma and lymphosarcoma. The median ages of animals affected with epithelial, and fibro-osseous/bone tumours were 14 and 4 years, respectively. Unilateral purulent or mucopurulent nasal discharge (81% of cases) and gross facial swellings (82% of cases) were the most common presenting signs with sinonasal tumours, with epistaxis recorded in just 23% of cases. Radiology and endoscopy were the most useful ancillary diagnostic techniques. The maxillary area was the most common site of tumour origin, and only three cases were definitively identified as originating in the nasal cavity. Four of the maxillary SCC lesions originated within the nasal cavities or maxillary sinuses, while two originated in the oral cavity. Fourteen of 15 carcinomas, but only two of the 13 remaining tumours, spread to other sites in the head. Only three cases of sinonasal tumour had lymph node metastases, and none had distant metastases. In the long term, surgical treatment with seven malignant tumours was unsuccessful (6 months median survival post-operatively), but was successful with four out of five benign tumours (no regrowth at a median of 4 years post-operatively).

Near-infrared imaging for management of chronic maxillary sinusitis

NASA Astrophysics Data System (ADS)

You, Joon S.; Cerussi, Albert E.; Kim, James; Ison, Sean; Wong, Brian; Cui, Haotian; Bhandarkar, Naveen

2015-03-01

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.

[Computed tomographic and clinical validation of the use of endosseous titanium nickelide dental implants].

PubMed

Temerkhanov, F T; Garafutdinov, D M; Arkharov, S L

1997-01-01

The authors analyze the efficacy of repair of atrophied [correction of arthrophic] alveolar processes of the jaws in the projections of the maxillary sinus and inferior alveolar canal with endosseous implants with porous cone-dilating mesostructure made of TN-1P alloy. Prospects for using the new implant design are outlined.

Cranial nerve injury after Le Fort I osteotomy.

PubMed

Kim, J-W; Chin, B-R; Park, H-S; Lee, S-H; Kwon, T-G

2011-03-01

A Le Fort I osteotomy is widely used to correct dentofacial deformity because it is a safe and reliable surgical method. Although rare, various complications have been reported in relation to pterygomaxillary separation. Cranial nerve damage is one of the serious complications that can occur after Le Fort I osteotomy. In this report, a 19-year-old man with unilateral cleft lip and palate underwent surgery to correct maxillary hypoplasia, asymmetry and mandibular prognathism. After the Le Fort I maxillary osteotomy, the patient showed multiple cranial nerve damage; an impairment of outward movement of the eye (abducens nerve), decreased vision (optic nerve), and paraesthesia of the frontal and upper cheek area (ophthalmic and maxillary nerve). The damage to the cranial nerve was related to an unexpected sphenoid bone fracture and subsequent trauma in the cavernous sinus during the pterygomaxillary osteotomy. Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Diagnostic value of NobelGuide to minimize the need for reconstructive surgery of jaws before implant placement: a review.

PubMed

Scotti, Roberto; Pellegrino, Gerardo; Marchetti, Claudio; Corinaldesi, Guiseppe; Ciocca, Leonardo

2010-01-01

To test if using a CAD/CAM system might reduce the necessity of bone augmentation in patients with atrophic maxillary arches before implant therapy. Twenty male and female patients consecutively scheduled for bone augmentation of the jaw before implant surgery were included in this study, with a total of 29 jaws (maxillary and mandibular) to analyze for the implant-supported fixed prosthesis group and 19 maxillary arches for the implant-supported removable prosthesis group. NobelGuide System (Nobel Biocare), Autocad System (Autodesk), and routine manual CT measurements of available bone were used in this study. The total results of the mean values of the fixed prosthesis group plus the mean values of the removable prosthesis group showed a statistically significant difference between the NobelGuide intervention score and both manual (P = .004) and Autocad (P = .001) measurements. The NobelGuide System represents a viable diagnostic device to reduce the entity or avoid bone reconstructive surgery before implant placements in the atrophic maxilla and mandible.

Microcomputed tomographic and histologic analysis of anorganic bone matrix coupled with cell-binding peptide suspended in sodium hyaluronate carrier after sinus augmentation: a clinical study.

PubMed

Emam, Hany; Beheiri, Galal; Elsalanty, Mohammed; Sharawy, Mohamed

2011-01-01

Anorganic bovine hydroxyapatite matrix (ABM), when coupled with synthetic cell-binding peptide (P15), mimics the cell-binding region of type 1 collagen and is commercially available suspended in a sodium hyaluronate carrier. The aim of the present study, therefore, was to test the efficacy of ABM/P-15 Putty (DENTSPLY Friadent CeraMed) as a sole graft material for sinus augmentation in patients with severely resorbed posterior maxillae. Sinus augmentation was performed in 10 patients using ABM/P-15 Putty and two provisional dental implants (3.0 mm in diameter). The graft and implants were placed simultaneously with the aid of a surgical stent. After 8 or 16 weeks, the implants were removed using a 4.25-mm trephine bur; this was followed by immediate placement of wider-diameter (5.5-mm) implants. All 20 implants were scanned by microcomputed tomography to determine bone mineral density (BMD), percent bone volume (PBV), and percent bone contact (PBC). There was a significant increase in the BMD of bone around the implants at 8 weeks and 16 weeks compared to native residual (control) bone. There was no significant difference in PBV or PBC between 8 weeks and 16 weeks. The average increase in bone height at 16 weeks was 9.63 ± 1 mm. Microcomputed tomographic images and histologic sections showed dense graft particles surrounded by vital trabecular bone. BMD increases as early as 8 weeks and does not show an additional increase after 16 weeks. PepGen P-15 Putty was found to be a promising osteoconductive graft for sinus augmentation, supporting immediate placement of implants.

Bone Regeneration Using N-Methyl-2-pyrrolidone as an Enhancer for Recombinant Human Bone Morphogenetic Protein-2 in a Rabbit Sinus Augmentation Model

PubMed Central

Thoma, Daniel S.

2017-01-01

The aim of this study was to determine whether N-methyl-2-pyrrolidone (NMP) can decrease the dose of recombinant human bone morphogenetic protein-2 (rhBMP-2) in sinus augmentation of rabbits. In each of 15 rabbits, 2 sinuses were randomly grafted using 1 of 3 treatment modalities: (i) biphasic calcium phosphate (BCP; control), (ii) rhBMP-2-coated BCP (BMP), or (iii) rhBMP-2-coated BCP soaked in NMP solution (BMP/NMP). The rabbits were sacrificed 2 weeks postoperatively. Histologic and histomorphometric analyses were performed. Bone formation in all groups was predominantly located close to the access window and the lateral walls. Newly formed bone within the total augmented area (NBTA) was greatest in BMP/NMP (1.94 ± 0.69 mm2), followed by BMP (1.50 ± 0.72 mm2) and BCP (1.28 ± 0.52 mm2) (P > 0.05). In the center of the augmentation (NBROI_C) and the area close to the sinus membrane (NBROI_M), BMP/NMP produced the largest area of NB (NBROI_C: 0.10 ± 0.11 mm2; NBROI_M: 0.17 ± 0.08 mm2); the corresponding NB values for BCP were 0.05 ± 0.05 mm2 and 0.08 ± 0.09 mm2, respectively (P > 0.05 for all comparisons). The effect of NMP on bone regeneration was inconsistent between the specimens. Adding NMP as an adjunct to rhBMP-2-coated BCP produced inconsistent effects on bone regeneration, resulting in no significant benefit compared to controls. PMID:28680881

A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study

PubMed Central

Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei

2016-01-01

Objective To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. Materials and Methods In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. Results The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. Conclusion The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon’s skills and knowledge, not as a substitute. PMID:26757365

A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.

PubMed

Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei

2016-01-01

To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon's skills and knowledge, not as a substitute.

Bone Regeneration Using N-Methyl-2-pyrrolidone as an Enhancer for Recombinant Human Bone Morphogenetic Protein-2 in a Rabbit Sinus Augmentation Model.

PubMed

Lim, Hyun-Chang; Thoma, Daniel S; Yoon, So-Ra; Cha, Jae-Kook; Lee, Jung-Seok; Jung, Ui-Won

2017-01-01

The aim of this study was to determine whether N-methyl-2-pyrrolidone (NMP) can decrease the dose of recombinant human bone morphogenetic protein-2 (rhBMP-2) in sinus augmentation of rabbits. In each of 15 rabbits, 2 sinuses were randomly grafted using 1 of 3 treatment modalities: (i) biphasic calcium phosphate (BCP; control), (ii) rhBMP-2-coated BCP (BMP), or (iii) rhBMP-2-coated BCP soaked in NMP solution (BMP/NMP). The rabbits were sacrificed 2 weeks postoperatively. Histologic and histomorphometric analyses were performed. Bone formation in all groups was predominantly located close to the access window and the lateral walls. Newly formed bone within the total augmented area (NB TA ) was greatest in BMP/NMP (1.94 ± 0.69 mm 2 ), followed by BMP (1.50 ± 0.72 mm 2 ) and BCP (1.28 ± 0.52 mm 2 ) ( P > 0.05). In the center of the augmentation (NB ROI_C ) and the area close to the sinus membrane (NB ROI_M ), BMP/NMP produced the largest area of NB (NB ROI_C : 0.10 ± 0.11 mm 2 ; NB ROI_M : 0.17 ± 0.08 mm 2 ); the corresponding NB values for BCP were 0.05 ± 0.05 mm 2 and 0.08 ± 0.09 mm 2 , respectively ( P > 0.05 for all comparisons). The effect of NMP on bone regeneration was inconsistent between the specimens. Adding NMP as an adjunct to rhBMP-2-coated BCP produced inconsistent effects on bone regeneration, resulting in no significant benefit compared to controls.

[Paranasal sinus mucoceles: About 32 cases].

PubMed

Hssaine, K; Belhoucha, B; Rochdi, Y; Nouri, H; Aderdour, L; Raji, A

2016-02-01

Mucocele is a pseudo-cystic tumor of the paranasal sinuses. Despite its benign histological nature, it is aggressive towards neighboring structures (orbit and brain). Our aim was to study the epidemiological, clinical, therapeutic, and evolution aspects of this pathology. We conducted a retrospective study over a period of 9 years on 32 patients operated on and followed for mucocele in our department. Mean age was 43.28 years with a sex ratio to 1. Mucoceles were located in the fronto-ethmoid sinus (27 cases), the maxillary sinus (3 cases) and the sphenoid sinus (2 cases). The most common symptoms were periorbital swelling and exophthalmia. CT scan confirmed the diagnosis in the majority of cases. MRI was performed in 3 patients. Surgery consisted in a large marsupialization by endonasal approach in 30 cases, and by a combined approach in two cases. A recurrence was observed in two patients after a mean period of 18 months. Mucocele is a benign and expansive pseudo-cystic tumor, affecting mostly adults and developing in the paranasal sinuses. Clinical symptoms are not specific. It may reveal itself by ophthalmic or intracranial complications. Diagnosis is based on imaging (CT and MRI). Endonasal surgery has become the gold standard for the treatment of mucoceles and is endowed with low morbidity. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

CT-based manual segmentation and evaluation of paranasal sinuses.

PubMed

Pirner, S; Tingelhoff, K; Wagner, I; Westphal, R; Rilk, M; Wahl, F M; Bootz, F; Eichhorn, Klaus W G

2009-04-01

Manual segmentation of computed tomography (CT) datasets was performed for robot-assisted endoscope movement during functional endoscopic sinus surgery (FESS). Segmented 3D models are needed for the robots' workspace definition. A total of 50 preselected CT datasets were each segmented in 150-200 coronal slices with 24 landmarks being set. Three different colors for segmentation represent diverse risk areas. Extension and volumetric measurements were performed. Three-dimensional reconstruction was generated after segmentation. Manual segmentation took 8-10 h for each CT dataset. The mean volumes were: right maxillary sinus 17.4 cm(3), left side 17.9 cm(3), right frontal sinus 4.2 cm(3), left side 4.0 cm(3), total frontal sinuses 7.9 cm(3), sphenoid sinus right side 5.3 cm(3), left side 5.5 cm(3), total sphenoid sinus volume 11.2 cm(3). Our manually segmented 3D-models present the patient's individual anatomy with a special focus on structures in danger according to the diverse colored risk areas. For safe robot assistance, the high-accuracy models represent an average of the population for anatomical variations, extension and volumetric measurements. They can be used as a database for automatic model-based segmentation. None of the segmentation methods so far described provide risk segmentation. The robot's maximum distance to the segmented border can be adjusted according to the differently colored areas.

Do Clinical and Radiological Assessments Contribute to the Understanding of Biomaterials? Results From a Prospective Randomized Sinus Augmentation Split-Mouth Trial.

PubMed

Lorenz, Jonas; Korzinskas, Tadas; Chia, Poju; Maawi, Sarah Al; Eichler, Katrin; Sader, Robert A; Ghanaati, Shahram

2018-02-01

The present prospective randomized split-mouth trial reports on the 3-year clinical and radiological follow-up investigation of implants placed 7 months after sinus augmentation with 2 different bone substitute materials. The aim of the study was to complete the histologic observation of cellular reactions by analyses of the implants and the volumetric changes of the augmented bone substitute materials. A sinus augmentation split-mouth trial was performed in 14 patients with the synthetic bone substitute material Nanobone (NB) and the xenogeneic Bio-Oss (BO). Changes in volume and density of the augmented biomaterials were investigated by analysis of computed tomography scans, taken immediately after augmentation and after 7 months. Clinical implant parameters were assessed after 3 years of loading. Both bone substitute materials underwent nonsignificant volume reduction and significant increase in bone density over an integration period of 7 months. No significant differences concerning volume and bone density were observed between the groups. Three years after loading, 51 of 53 implants were in situ with no peri-implant infections, and only a few soft-tissue variations were present. The present prospective randomized study showed that no differences could be observed clinically and radiologically. Accordingly, it seems that both biomaterials, independent of their physicochemical composition, enable clinical success and long-time stability for dental implants. Interestingly, the histological results showed distinct differences in cellular reactions: While the xenogeneic BO induced a mild tissue reaction with only few multinucleated giant cells and comparably low vascularization, the synthetic NB induced a multinucleated giant cell-triggered tissue reaction with an increase of vascularization. Thus, the present study showed that a combination analysis-histological, clinical, and radiological-is necessary for a detailed assessment of a biomaterial's quality for clinical application.

Respiratory epithelial adenomatoid hamartoma in a dog.

PubMed

Leroith, Tanya; Binder, Ellen M; Graham, A Heather; Duncan, Robert B

2009-11-01

A 6-month-old, intact, male Weimaraner dog presented to the veterinary teaching hospital for bilateral mucopurulent ocular and nasal discharge that began at approximately 10 weeks of age. A computed tomography scan showed an expansile soft-tissue mass involving both frontal sinuses, the ethmoid regions, and nasal cavities with lysis of the maxillary turbinates and hyperostosis of the walls of the frontal sinus. The dog was euthanized after complications during a trephination and biopsy procedure. At necropsy, a large, tan, papillary, gelatinous mass filled the entire nasal cavity and frontal sinus. The mass was composed of large fronds of loose fibrovascular stroma covered by a single layer of pseudostratified, columnar, ciliated epithelium and intermixed goblet cells. The cells occasionally formed glandular structures that were continuous with the surface epithelium. The mass was diagnosed as a respiratory epithelial adenomatoid hamartoma based on the morphologic appearance.

Applications of Mesenchymal Stem Cells in Sinus Lift Augmentation as a Dental Implant Technology.

PubMed

Parnia, Feridoun; Yazdani, Javad; Maleki Dizaj, Solmaz

2018-01-01

The potential application of stem cell biology in human dentistry is a new and emerging field of research. The objective of the current review was to study the efficiency of mesenchymal stem cells (MSCs) in sinus lift augmentation (SLA). A literature review was performed in PubMed Central using MeSH keywords such as sinus lift, MSCs, dental implants, and augmentation. The searches involved full-text papers written in English, published in the past 10 years (2007-2017). The review included in vitro and in vivo studies on the use of MSCs in SLA. Electronic searching provided 45 titles, and among them, 8 papers were chosen as suitable based on the inclusion requirements of this review. The reviewed studies have revealed the potential of MSCs in SLA. According to these papers, stem cell therapy combined with different biomaterials may considerably improve bone regeneration in previous steps of dental implantation and may veritably lead to efficient clinical usages in the recent future. However, the identification of an ideal source of stem cells as well as long-term studies is vital to assess the success rate of this technology. Further clinical trials are also needed to approve the potential of MSCs in SLA.

The prevalence and clinical significance of maxillary sinus mucous retention cysts in a general clinic population.

PubMed

Rhodus, N L

1990-02-01

Previous studies have documented the occurrence and potential clinical significance of MSMR cysts. Studies also have alluded to a relationship between the MSMR cyst and certain signs or symptoms of disease. We determined the prevalence of MSMR cysts in a general clinic population and identified some important correlations with clinical signs and symptoms.

Angulated Dental Implants in Posterior Maxilla FEA and Experimental Verification

PubMed Central

Hamed, Hamed A.; Marzook, Hamdy A.; Ghoneem, Nahed E.; El–Anwar, Mohamed I.

2018-01-01

AIM: This study aimed to evaluate the effect of different implant angulations in posterior maxilla on stress distribution by finite element analysis and verify its results experimentally. METHODS: Two simplified models were prepared for an implant placed vertically and tilted 25° piercing the maxillary sinus. Geometric models’ components were prepared by Autodesk Inventor then assembled in ANSYS for finite element analysis. The results of finite element analysis were verified against experimental trials results which were statistically analysed using student t-test (level of significance p < 0.05). RESULTS: Implant - abutment complex absorbed the load energy in case of vertical implant better than the case of angulated one. That was reflected on cortical bone stress, while both cases showed stress levels within the physiological limits. Comparing results between FEA and experiment trials showed full agreement. CONCLUSION: It was found that the tilted implant by 25° can be utilised in the posterior region maxilla for replacing maxillary first molar avoiding sinus penetration. The implant-bone interface and peri-implant bones received the highest Von Mises stress. Implant - bone interface with angulated implant received about 66% more stresses than the straight one. PMID:29531612

Orthovoltage radiation therapy treatment planning using Monte Carlo simulation: treatment of neuroendocrine carcinoma of the maxillary sinus

NASA Astrophysics Data System (ADS)

Gao, Wanbao; Raeside, David E.

1997-12-01

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.

The Analysis of Patients Operated for Frontal Sinus Osteomas

PubMed Central

Turan, Şükrü; Kaya, Ercan; Pınarbaşlı, Mehmet Özgür; Çaklı, Hamdi

2015-01-01

Objective Paranasal sinus osteomas are benign tumors that are smooth-walled, slow-growing, and induced by bone tissue. Although their most common localization is the frontal sinus, some osteomas are seen in the ethmoid, maxillary, and sphenoid sinuses. Frontal sinus osteomas are often asymptomatic; however, when they become symptomatic, headache is the most common complaint. In this study, we aimed to analyze the postoperative results of patients who were diagnosed with frontal sinus osteoma and were operated with appropriate surgical techniques. Methods We retrospectively evaluated 14 patients who were diagnosed with frontal sinus osteoma and were operated in our department between March 2009 and July 2014. The following parameters were analyzed: patients’ age and gender, complaints at the time of admission to our clinic, pathological findings from physically examination, tumor features observed in preoperative paranasal sinus computed tomography (size and localization), surgical methods applied, intra- and postoperative complications, and recurrence rates. All patients preoperatively provided informed consent. Results Of the 14 patients, 7 were males and 7 were females, with a mean age of 40.57 years. A total of 11 (79%) osteomas were located within the frontal sinus and 3 (21%) within the frontal recess. External surgical approach was performed to 11 patients, endoscopic approach was performed to 2 patients and external and endoscopic approach was performed to 1 patient together. Conclusion Although the preferred surgical method in frontal sinus osteoma depends depended on size and localization of tumors, experience of surgeon is also important. Although the external surgical approach is appropriate for large and laterally localized osteomas, the endoscopic approach is appropriate for small and inferomedially localized osteomas. In both surgical approaches the site of origin should be drilled. PMID:29391998

Maxillary reconstruction to enable implant insertion: a retrospective study of 181 patients

PubMed Central

Ferri, Joël; Dujoncquoy, Jean-Pascal; Carneiro, José Mario; Raoul, Gwénael

2008-01-01

Background The purpose of the present study was to evaluate different types of maxillary pre-prosthetic surgery using autogenous bone graft and suggest a guideline for maxillary reconstruction to place implant. Methods 181 patients (125 females and 56 males), age range from 16 to 76 years old, were operated at the Maxillo-Facial Service of the Lille's 2 Universitary Hospital Center (Chairman Pr Joël Ferri). Different techniques were used, but always with autogenous bone grafting. 21 patients underwent a Lefort 1 procedure, 139 underwent sinus graft with or without vestibular onlay graft and 21 underwent onlay graft. This surgical procedure was made to allow the insertion of 685 implants. Results The patients were evaluated by clinical and radiological assessment. In the cases of Lefort 1, the rate of successful osteointegration was higher when the implants were placed in the second part of a two stages procedure: 92%, against 81% for one stage. In cases of sinus lift procedure, the rate of implant success was 98%. The infection rate was 3.5%. There was no significant resorption and the type of prosthesis used was a denture retained by a bar or fixed bridge. In cases of onlay graft, the implant insertion success was 97% and there was no infection. The amount of resorption was more significant in the pre-maxilla than in the other areas and the type of prosthesis used was fixed dentures. Conclusion These observations demonstrate that: the aetiology of the bone defect indicate the type and number of the surgical procedures to re-established good jaws relationship and give the bone conditions to implant insertion successful. Clinical Relevance A guideline for surgical decision in the maxillary reconstruction for oral rehabilitation by implants may help to prevent failures of osseous resorption disorders and to foresee the investment of the bone in quality and necessary quantity. PMID:19087352

Root canal treatment of a periradicular lesion caused by unintentional root damage after orthodontic miniscrew placement: a case report.

PubMed

Er, K; Bayram, M; Taşdemir, T

2011-12-01

To present the successful endodontic management of a maxillary lateral incisor tooth with a periradicular lesion caused by unintentional root damage after orthodontic miniscrew placement. A 22-year-old female was diagnosed with a skeletal Class II, Division 2 malocclusion with Class II molar and canine relationships on both sides. The treatment plan included distalization of the maxillary first molars bilaterally followed by full fixed appliance therapy. For the maxillary molar distalization, an appliance in conjunction with a miniscrew anchorage system was designed. Two months later, the patient came to the clinic with complaints of pain in the maxillary right lateral incisor region. On intraoral examination, intraoral sinus tracts were detected in the maxillary right buccal sulcus and palate. A large radiolucent lesion with a well-defined margin around the root of the maxillary right lateral incisor was seen. Root canal treatment was performed on the maxillary right lateral incisor tooth. The root canal was filled with gutta-percha and AH Plus sealer, using a lateral compaction technique. The final restoration of the tooth was completed using composite, and the tooth was reviewed after 10 months. The tooth was asymptomatic and radiographically showed repair of the lesion. Healing was achieved without any need for further endodontic or surgical intervention. Key learning points • This case illustrates the need to take care with miniscrews when performing orthodontic treatment, especially when the miniscrews are in close proximity to root apices. • The periradicular lesion as a result of miniscrew damage was successfully treated with root canal treatment. © 2011 International Endodontic Journal.

Sinonasal organized hematoma: Clinical features of seventeen cases and a systematic review.

PubMed

Choi, Soo Jung; Seo, Sung Tae; Rha, Ki-Sang; Kim, Yong Min

2015-09-01

Organized hematoma (OH) is a rare non-neoplastic disease. We studied the clinical characteristics of 17 patients with sinonasal OH and those of 75 cases in the English literature. Retrospective review of medical records and systematic review of the literature on OH. Comprehensive review of the English-language literature on OH was performed. We screened all eligible cases based on initial features, and 75 eligible cases found in 15 publications were analyzed. We also retrospectively analyzed and compared medical records of 17 patients diagnosed with pathologically proven sinonasal OH. Data such as demographics, clinical characteristics, pathologic features, radiologic findings, treatment modalities, and follow-up results were compared to the 75 previously mentioned cases. Fifteen cases involved the maxillary sinus, one case involved the frontal sinus, and one case involved the sphenoid sinus. There were six patients over 60 years old, and all were taking an antiplatelet agent. The paranasal sinus computed tomography (CT) of seven patients showed bony destruction of the involved sinus. A review of the available literature revealed mostly similar results with our cases, except for the proportion of patients taking aspirin (5.3%) and sex distribution (male:female = 49:25). We reported 17 cases of OH, including a case of frontal sinus and a case of sphenoid sinus lesion. A large proportion of OH patients had bony destruction of the affected sinus on CT. In these patients, a careful diagnosis should be made to distinguish them from a malignant tumor or other expansile diseases. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Mandibular Reconstruction with Lateral Tibial Bone Graft: An Excellent Option for Oral and Maxillofacial Surgery.

PubMed

Miceli, Ana Lucia Carpi; Pereira, Livia Costa; Torres, Thiago da Silva; Calasans-Maia, Mônica Diuana; Louro, Rafael Seabra

2017-12-01

Autogenous bone grafts are the gold standard for reconstruction of atrophic jaws, pseudoarthroses, alveolar clefts, orthognathic surgery, mandibular discontinuity, and augmentation of sinus maxillary. Bone graft can be harvested from iliac bone, calvarium, tibial bone, rib, and intraoral bone. Proximal tibia is a common donor site with few reported problems compared with other sites. The aim of this study was to evaluate the use of proximal tibia as a donor area for maxillofacial reconstructions, focusing on quantifying the volume of cancellous graft harvested by a lateral approach and to assess the complications of this technique. In a retrospective study, we collected data from 31 patients, 18 women and 13 men (mean age: 36 years, range: 19-64), who were referred to the Department of Oral and Maxillofacial Surgery at the Servidores do Estado Federal Hospital. Patients were treated for sequelae of orthognathic surgery, jaw fracture, nonunion, malunion, pathology, and augmentation of bone volume to oral implant. The technique of choice was lateral access of proximal tibia metaphysis for graft removal from Gerdy tubercle under general anesthesia. The mean volume of bone harvested was 13.0 ± 3.7 mL (ranged: 8-23 mL). Only five patients (16%) had minor complications, which included superficial infection, pain, suture dehiscence, and unwanted scar. However, none of these complications decreases the result and resolved completely. We conclude that proximal tibia metaphysis for harvesting cancellous bone graft provides sufficient volume for procedures in oral and maxillofacial surgery with minimal postoperative morbidity.

Impact of paranasal sinus invasion on advanced nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: the validity of advanced T stage of AJCC/UICC eighth edition staging system.

PubMed

Wang, Ying; Zhao, Jie; Zhao, Yajie; Yang, Zhen; Lei, Mingjun; Li, Zhanzhan; Wei, Rui; Chen, Dengming; He, Yuxiang; Shen, Liangfang

2018-05-01

The aim of this study was to clarify the prognostic role of paranasal sinus invasion in advanced NPC patients. Data of patients (n = 295) with advanced NPC (T3/T4N0-3 M0) treated with intensity-modulated radiation therapy were retrospectively analyzed. Staging was according to the AJCC/UICC eighth edition staging system. Overall survival (OS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) were calculated, and differences were compared between patients with and without paranasal sinus invasion. Multivariate analysis was used to identify the independent predictors of different survival parameters. Paranasal sinus invasion was present in 126 of 295 (42.7%) patients. Sphenoid, ethmoid, maxillary, and frontal sinus involvements were present in 123 of 295 (41.7%), 95 of 295 (32.2%), 45 of 295 (15.3%), and 0 of 295 (0%), respectively. All survival parameters were significantly better in patients without paranasal sinus invasion. When paranasal sinus invasion was reclassified as T4 instead of T3, all survival rates, other than LRFS (P = 0.156), were significantly better in the new T3 patients, and differences in all survival parameters remained nonsignificant between T3 with paranasal sinus invasion and T4 without paranasal sinus invasion patients (all P > 0.05). In multivariate analysis, paranasal sinus invasion was found to be an independent negative prognostic factor for OS, DFS, and DMFS (P = 0.016, P = 0.004, and P = 0.006, respectively), but not for LRFS (P = 0.068). Paranasal sinus invasion has prognostic value in advanced NPC. It may be reasonable to classify paranasal sinus invasion as T4 stage. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Volumetric study in the development of paranasal sinuses by CT imaging in Asian: a pilot study.

PubMed

Park, Il-Ho; Song, Jong Seok; Choi, Hyuk; Kim, Tae Hoon; Hoon, Seung; Lee, Sang Hag; Lee, Heung-Man

2010-12-01

The volume of the air cavities in the paranasal sinuses is not only the simplest, but also the most important index for paranasal sinus evaluation. However, few volumetric studies have been performed in all age groups. The purpose of the current study was to outline the normal development of paranasal sinuses in all age groups, and to determine normal adult volumetric values by means of computed tomographic (CT) scan of paranasal sinus using volumetric procedures. A prospective volumetric CT study was conducted with 260 patients (520 sides) <25 years of age by means of three-dimensional reconstruction. The frontal sinuses began to pneumatize at 2 years of age, exhibited a faster growth pattern between 6 and 19 years of age, and the mean volume after full growth was 3.46±0.78 cm(3). The maxillary sinuses were pneumatized at birth in all cases, exhibited a monomodal growth pattern increasing until 15 years of age, and the mean volume after full growth was 14.83±1.36 cm(3). The floor of the sinus was the same level as the floor of the nasal cavity was between 7 and 15 years of age. The ethmoid sinuses exhibited a faster initial tendency to increase until 7 years of age, were completed by 15-16 years of age, and the mean volume after full growth was 4.51±0.92 cm(3). The sphenoid sinuses exhibited a growth spurt between 6 and 10 years of age, were completed by 15 years of age, and the mean volume after full growth was 3.47±0.93 cm(3). The results of this study are presented to provide the basis for an objective normal volume of sinus development and for studies involving diseases of the sinuses. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

The occurrence of molds in patients with chronic sinusitis.

PubMed

Twarużek, Magdalena; Soszczyńska, Ewelina; Winiarski, Piotr; Zwierz, Aleksander; Grajewski, Jan

2014-05-01

Chronic rhinosinusitis (CRS) is a common inflammatory condition of nasal and paranasal sinus mucosa. Although pathogenic bacteria were postulated as main etiological factor responsible for most cases of CRS, the involvement of molds was recently proved in some cases. The aim of the study was to conduct mycological analysis of material obtained from patients operated on due to chronic sinusitis. The study included 107 patients, 45 women and 62 men. During the surgery, a fragment of mucosa from the region of the ethmoid bulla was obtained as microbiological characteristics of this material closely resemble those of sinus mucosa. In addition, maxillary sinus lavage was obtained. The control group comprised patients without chronic sinusitis. The dithiothreitol solution method was used for the lavage examination. The tissue material (mucosal fragment from the region of the ethmoid bulla) was incubated in 2% liquid Sabouraud medium for 24 h. The material was inoculated onto culture media. The presence of molds was detected in 67% of examined samples. Overall, 41 species belonging to 12 genera were isolated. The most frequently detected genera included Penicillium spp. (46%) and Aspergillus spp. (16%). In addition, Cladosporium spp. (11%), Fusarium spp. (7%), Acremonium spp. (4%), Eurotium spp. (4%), Alternaria spp. (2%), Chaetomium spp. (1%), Geotrichum spp. (1%), Verticillium spp. (1%), Rhizopus spp. (1%), and some unidentified colonies (5%) were isolated. Penicillium crustosum, Penicillium citrinum, Aspergillus niger, Cladosporium cladosporioides, and Fusarium verticillioides were the most prevalent species.

Eradication of common pathogens at days 2, 3 and 4 of moxifloxacin therapy in patients with acute bacterial sinusitis

PubMed Central

Ariza, Horacio; Rojas, Ramon; Johnson, Peter; Gower, Richard; Benson, Alice; Herrington, Janet; Perroncel, Renee; Pertel, Peter

2006-01-01

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

Single crowns in the resorbed posterior maxilla supported by either 6-mm implants or by 11-mm implants combined with sinus floor elevation surgery: a 1-year randomised controlled trial.

PubMed

Guljé, Felix L; Raghoebar, Gerry M; Vissink, Arjan; Meijer, Henny J A

2014-01-01

The aim of this randomised controlled trial was to assess the clinical performance of single crowns in the posterior maxilla supported by either 6-mm or 11-mm implants combined with maxillary sinus floor elevation. 41 consecutive patients with one missing premolar or molar in the posterior maxilla and with an estimated bone height of 6 to 8 mm in that area were included. Each patient was randomly allocated to one of the two treatment groups, namely to receive an 11-mm implant (Osseo Speed 4.0 S, Dentsply Implants, Mölndal, Sweden) in combination with maxillary sinus floor elevation surgery or to receive a 6-mm implant (Osseo Speed 4.0 S) without any grafting. After a 3-month osseointegration period, all implants were restored with custom-made titanium abutments and cemented zirconia-based porcelain crowns. Outcome measures were: implant survival; radiographic bone changes; plaque accumulation; bleeding tendency; peri-implant inflammation; presence of dental calculus; biological and technical complications; and patients' satisfaction. Clinical and radiographic examinations were performed at placement of the crown and 12 months thereafter. Patients' satisfaction was scored before treatment and after 12 months of functioning of the crown. One patient of the 11 mm implant group died during the follow-up. No implant failed and no biological or technical complications occurred. From loading to the 12 months follow-up, no difference was found in mean marginal bone changes between the groups (bone resorption in both groups 0.1 ± 0.3 mm). Clinical items revealed very healthy peri-implant soft tissues in both groups. Patients' satisfaction scores were high in both groups. 6-mm implants and 11-mm implants combined with sinus floor elevation surgery are equally successful to support a single crown in the resorbed posterior maxilla after 1-year follow-up.

Facial Soft Tissue Thickness of Midline in an Iranian Sample: MRI Study.

PubMed

Johari, Masume; Esmaeili, Farzad; Hamidi, Hadi

2017-01-01

To identify human skeletal remains, different methods can be used and using these techniques, important data can be obtained. However, facial reconstruction is the last method to indentify unknown human faces which requires knowledge about facial soft tissue thickness in the different positions of the face. The present study determined the facial soft tissue thickness in the different landmark points on the MRI images of patients referred to Radiology Department of Shahid Madani Hospital. In this descriptive cross-sectional trial, MRI images of 179 patients (61 males, 118 females) in the age range of 18-76 years old who did not show any pathologic lesions, were selected. The measurements of the facial soft tissue were done on 12 landmark points on the midline area by two radiologist observers using specific software on the images. The differences in the soft tissue thickness in these landmark points were statistically analyzed by Mann-Whitney U (in term of gender) and Kruskal-Wallis tests (in terms of Body Mass Index [BMI] and age groups). P value less than 0.05 was considered statistically significant. The data were compared with the results of other studies. The results obtained in the present study were higher than Turkish and American studies in most of the landmark points. Facial soft tissue thickness in most of the landmarks was more in males than females. In some of the landmarks, significant differences were found between emaciated, normal and overweight patients while in most cases, soft tissue thickness increased with the increased BMI. In some cases, significant differences were noted between soft tissue thickness values among the different age groups, in which the thickness increased or thinned with the increased age. There were statistically significant associations between the presence and surface area of Haller cells and the occurrence of ipsilateral maxillary sinusitis. Neither the angulation of the uncinate process nor the size of the maxillary sinus ostium significantly correlates with the formation of maxillary sinusitis. The data achieved in the present study can be used for the facial reconstruction purposes in the Iranian population; however, the slight differences existing between the studied population and other subgroup races must be considered for accurate reconstructions.

Evaluation of radiotherapy after incomplete surgery in patients with carcinoma of the maxillary sinus

DOE Office of Scientific and Technical Information (OSTI.GOV)

Korzeniowski, S.; Reinfuss, M.; Skolyszewski, J.

1985-03-01

The retrospective analysis of 57 patients with cancer of the maxillary antrum irradiated after incomplete surgery was performed is described. The majority of patients had very advanced disease (54% T4 tumors). In 18 patients partial resection of maxillary antrum was performed: 39 patients underwent total maxillectomy. In 35 patients macroscopic residual tumor (MRT) was present after surgery. All patients were irradiated postoperatively with /sup 60/Co teletherapy and received a dose of 60 Gy in 20-30 fractions over 4-6 weeks. Five year symptom-free survival in the whole group was 35%. An analysis of pattern of relapses indicates that histology should bemore » regarded as an important factor of management. In keratinizing squamous cell cancer, local control remains the main problem. In patients with nonkeratinizing squamous cell cancer, both local and regional control is important and elective irradiation of neck nodes may be of value. In patients with undifferentiated cancer, distant metastases appear to have the greatest impact on survival.« less

Transverse maxillary distraction with a bone-anchored appliance: dento-periodontal effects and clinical and radiological results.

PubMed

Ramieri, G A; Spada, M C; Austa, M; Bianchi, S D; Berrone, S

2005-06-01

In 29 adult patients presenting with maxillary deficiency, a bone-anchored palatal distractor (Surgi-Tec NV, Brugge, Belgium) was applied after osteotomy of the anterolateral walls of the maxillary sinuses, midpalatal suture, and, eventually, separation of the pterygomaxillary sutures. Expansion proceeded at a rate of 0.33-0.66 mm per day and the device was retained for 4-6 months for consolidation. Active orthodontic therapy was started after 8-10 weeks. The increment of arch width and the perimeter were evaluated using dental casts. Tooth thermal sensitivity and the periodontal side effects of treatment were monitored clinically after distraction, at device removal, and after 1 year. Bone healing was also investigated during the procedure using conventional radiological techniques. This experience confirms that transverse maxillary distraction is an effective technique in adult patients, leading to the formation of new bone. There were no noticeable intraoperative complications, but postsurgical periodontal side effects were documented. The procedure offers advantages over traditional teeth-borne appliances in terms of rapidity of treatment and the absence of mechanical forces acting on the teeth. Further evaluation is required to assess the long-term stability and periodontal consequences of this technique.

Chinook wind barosinusitis: an anatomic evaluation.

PubMed

Rudmik, Luke; Muzychuk, Adam; Oddone Paolucci, Elizabeth; Mechor, Brad

2009-01-01

Chinook, or föhn, is a weather phenomenon characterized by a rapid influx of warm, high-pressured winds into a specific location. Pressure changes associated with chinook winds induce facial pain similar to acute sinusitis. The purpose of this study was to determine the relationship between sinonasal anatomy and chinook headaches. Retrospective computed tomography (CT) sinonasal anatomy analysis of 38 patients with chinook headaches and 27 controls (no chinook headaches). The chinook headache status was blinded from the CT reviewer. Forty-one sinonasal anatomy variants, Lund-Mackay status, and sinus size (cm(3)) were recorded. There were three statistically significant sinonasal anatomy differences between patients with and without chinook headaches. The presence of a concha bullosa and sphenoethmoidal cell (Onodi cell) appeared to predispose to chinook headaches (p = 0.004). Chinook headache patients had larger maxillary sinus size (right, p = 0.015, and left, p = 0.002). The Lund-Mackay score was higher in the control patients (p = 0.003) indicating that chronic sinusitis does not play a role in chinook headaches. Chinook winds are a common source of facial pain and pressure. This is the first study to show that sinonasal anatomic variations may be a predisposing factor. Anatomic variants may induce facial pain by blocking the natural sinus ostia, thus preventing adequate pressure equilibrium.

A prospective, multicentre study of moxifloxacin concentrations in the sinus mucosa tissue of patients undergoing elective surgery of the sinus.

PubMed

Gehanno, P; Darantière, S; Dubreuil, C; Chobaut, J C; Bobin, S; Pages, J C; Renou, G; Bobin, F; Arvis, P; Stass, H

2002-05-01

A pharmacokinetic study was carried out to determine moxifloxacin concentrations in sinus tissue, after oral moxifloxacin 400 mg once daily for 5 days to patients with chronic sinusitis, undergoing elective sinus surgery. Patients were randomly allocated to one of seven treatment groups, in which tissues were sampled 2, 3, 4, 6, 12, 24 or 36 h post-dose. A control group with non-infected nasal polyps was also included. Forty-eight patients (13 female, 35 male, mean age 47.1 years) were allocated to one of each active treatment group (n = 42) or to the control group (n = 6). Tissue and plasma samples were taken simultaneously and stored frozen until assayed by HPLC. Thirty-nine patients were fully valid for pharmacokinetic analysis. The geometric mean moxifloxacin plasma concentration increased from 2.32 mg/L at 2 h to a maximum of 3.37 mg/L at 4 h post-dose, decreasing to 0.37 mg/L at 36 h post-dose. The moxifloxacin concentration in sinus mucosa was consistently greater than that in plasma being 4.56-5.73 mg/kg from 2 to 6 h and 2.81-1.25 mg/kg from 12 to 36 h post-dose. The elimination rates in plasma and sinus tissues were similar. The tissue/plasma ratio was c. 200% between 2 and 6 h, and up to 328.9% at 36 h. Results were similar whatever the site of tissue sampling (maxillary sinus, anterior ethmoid sinus or nasal polyps). Tissue levels exceeded the MIC(90) of all pathogens commonly causing acute sinusitis (e.g. 5-30 x MIC for Streptococcus pneumoniae: 0.25 mg/L). These results sup-port the use of moxifloxacin 400 mg once daily as a regimen for the treatment of sinus infections.

An isolated nasolacrimal duct osteoma.

PubMed

Kim, Joo Yeon; Kwon, Jae Hwan

2013-07-01

Osteomas of the nose and paranasal sinus are common benign tumors that can extend to surrounding structures and result in orbital or intracranial involvement. Presenting symptoms include facial pain, headache, cerebral symptoms, ocular symptoms, and so on, depending on the location and size of the tumor. They commonly occur within the frontal, ethmoid, maxillary, and sphenoid sinuses; however, there are rare cases of reported osteomas in the nasal cavity, turbinate, or orbit. Our case report describes a patient with nasolacrimal duct osteoma who presented with ipsilateral ocular pain, epiphora, and medial canthal swelling. We performed intranasal dacryocystorhinostomy using a nasal endoscope and removed the lacrimal duct osteoma. This report describes symptoms and management of an isolated nasolacrimal duct stone with a review of the literature.

Changes in Sinus Membrane Thickness After Lateral Sinus Floor Elevation: A Radiographic Study.

PubMed

Makary, Christian; Rebaudi, Alberto; Menhall, Abdallah; Naaman, Nada

2016-01-01

To radiographically monitor sinus membrane swelling after lateral sinus floor elevation surgery at short and long healing periods. For 26 patients seeking posterior maxillary implant-supported reconstruction, 32 lateral sinus floor elevations were performed using Piezosurgery. Sinus membranes were grafted using synthetic calcium phosphate bone substitutes, and graft volume was measured in cubic centimeters for each case. Cone beam computed tomography (CBCT) examination was conducted preoperatively in all patients and for each grafted sinus at 1 day (n = 8), 2 days (n = 9), 3 days (n = 8), or 7 days (n = 7) after surgery. Control CBCT was then performed for all patients at 3, 6, and 12 months after surgery. Sinus membrane thickness was measured on cross-sectional CBCT images at nine standardized points per sinus, before lateral sinus floor elevation and at all postoperative examinations. Mean sinus membrane thickness was 0.73 mm before surgery, and 5 mm, 4.1 mm, 5.9 mm, and 7 mm, respectively, at 1, 2, 3, and 7 days after surgery. First week combined postoperative CBCT measurements of membrane thickness was 5.4 mm, then 1.3, 0.68, and 0.39 mm at 3, 6, and 12 months, respectively, after surgery. Membrane thickness significantly increased the first week after surgery and gradually decreased significantly at 3, 6, and 12 months in all groups (P < .001). First-week postoperative measurements showed a significant increase in membrane thickness at 3 days compared with the 1- and 2-day results (P < .001) and at 7 days compared with all other time points (P < .001). Membrane thickness at 2 days did not change significantly compared with 1-day measurements. Larger graft volume was positively correlated with an increase in membrane thickness after surgery at all time points (n = 32; r = 0.527; P < .001). After lateral sinus floor elevation surgery, transient swelling of sinus membrane is observed. It reaches a peak value 7 days after surgery and completely resolves over months. This swelling is correlated to the extent of sinus floor elevation.

Influence of central venous pressure upon sinus node responses to arterial baroreflex stimulation in man

NASA Technical Reports Server (NTRS)

Mark, A. L.; Takeshita, A.; Eckberg, D. L.; Abboud, F. M.

1978-01-01

Measurements were made of sinus node responses to arterial baroreceptor stimulation with phenylephrine injection or neck suction, before and during changes of central venous pressure provoked by lower body negative pressure or leg and lower truck elevation. Variations of central venous pressure between 1.1 and 9.0 mm Hg did not influence arterial baroreflex mediated bradycardia. Baroreflex sinus node responses were augmented by intravenous propranolol, but the level of responses after propranolol was comparable during the control state, lower body negative pressure, and leg and trunk elevation. Sinus node responses to very brief baroreceptor stimuli applied during the transitions of central venous pressure also were comparable in the three states. The authors conclude that physiological variations of central venous pressure do not influence sinus node responses to arterial baroreceptor stimulation in man.

Three-dimensional images contribute to the diagnosis of mucous retention cyst in maxillary sinus.

PubMed

Donizeth-Rodrigues, Cleomar; Fonseca-Da Silveira, Márcia; Gonçalves-De Alencar, Ana-Helena; Garcia-Santos-Silva, Maria-Alves; Francisco-De-Mendonça, Elismauro; Estrela, Carlos

2013-01-01

To evaluate the detection of mucous retention cyst of maxillary sinus (MRCMS) using panoramic radiography and cone beam computed tomography (CBCT). 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%. 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). CBCT scanning detect MRCMS more accurately than panoramic radiography.

Leukocytoclastic Vasculitis: A Window to Systemic Churg Strauss Syndrome

PubMed Central

Medhekar, Sudhir V; Vasani, Resham J; Kamath, Ratnakar R

2012-01-01

A twenty year old male presented with purpuric lesions with chronic painful ulcers over the lower extremities and a recurrent pruritic rash on the trunk for 10 years. He was diagnosed as idiopathic leukocytoclastic vasculitis (LCV) after investigations failed to reveal a systemic association. He was treated with immunosuppressants at each visit with partial remission. In 2004, he was diagnosed with bronchial asthma and allergic rhinitis. In his recent admission, he showed necrotic ulcers on legs and extensive shiny, truncal micropapules. Examination revealed maxillary sinus tenderness and loss of sensation on the medial aspect of the left lower limb. Biopsy of ulcer and the micropapules showed the presence of extravascular eosinophils, while hematological investigations showed peripheral eosinophilia of 18%, raised serum Immunoglobulin E (IgE), Anti nuclear antibody (ANA) positivity and negative antineutrophil cytoplasmic antibody (ANCA). Radiography confirmed maxillary sinusitis, nerve conduction studies revealed mononeuritis of the anterior tibial nerve and pulmonary function tests (PFT) were normal. Clinical examination and investigations pointed towards the diagnosis of Churg-Strauss syndrome (CSS). This report highlights the development of full-blown CSS over a period of 12 years in a patient initially diagnosed as idiopathic LCV, emphasizing the need for regular follow-up of resistant and recurrent cases of LCV. PMID:22707776

Incidence and survival of sinonasal adenocarcinoma by site and histologic subtype.

PubMed

Kılıç, Suat; Samarrai, Ruwaa; Kılıç, Sarah S; Mikhael, Mina; Baredes, Soly; Eloy, Jean Anderson

2018-04-01

To determine the incidence and survival of sinonasal adenocarcinoma (SNAC) by subsite and histologic subtype. Retrospective database review. Using the SEER database, we performed a retrospective analysis, identified cases of SNAC diagnosed between 1973 and 2013 and analyzed demographic, histopathology, clinicopathology, and determinants of disease specific survival (DSS). A total of 746 patients with SNAC were identified. Median age at diagnosis was 64 years. Overall incidence was 0.44 per million, and was higher among blacks (O.R.:1.10-2.07:1) and males (O.R.:1.38-2.06:1). Nasal cavity (41.5%) was the most common site, followed by maxillary (26.5%), and ethmoid (17.4%) sinuses. Intestinal-type adenocarcinoma was less likely than Adenocarcinoma not otherwise specified (ANOS) to be found in the maxillary sinus (8.8% vs. 30.6%, p < .05). Surgery alone (48.56%) was the most common treatment modality, followed by surgery and radiotherapy (RT) (32.5%), and RT alone (11.6%). DSS at 5, 10, and 20 years were 63.8%, 57.6%, and 47.0%, respectively. DSS was higher for nasal cavity SNAC, lower grade, lower stage, and those receiving surgery only. SNAC is more common among men and blacks. Incidence has not changed significantly in the past 40 years. Survival varies with grade, stage, histology, subsite, and treatment.

Successful nonsurgical endodontic outcome of a severely affected permanent maxillary canine with dens invaginatus Oehlers type 3.

PubMed

Brooks, John K; Ribera, Michael J

2014-10-01

The morphogenic complexities of dens invaginatus (DI) Oehlers type 3 in maxillary canines offer significant endodontic challenges. A case report is provided of a 14-year-old female patient who presented with an anomalous-looking permanent maxillary canine associated with a sinus tract. Pulp testing revealed a normal response on the distal aspect of the tooth, whereas the mesial segment tested nonresponsive. A radiolucent lesion was seen on the mesiolateral radicular area adjacent to the severely distended pulp chamber. A gutta-percha point inserted into the sinus tract traced to this same region. The diagnosis was normal pulp coincident with DI Oehlers type 3 with pulp necrosis and chronic apical abscess. Despite a concerted effort to limit the root canal therapy to only the necrotic canal, its proximity to the normal canal obviated this possibility, entailing endodontic treatment of the entire root canal system. The necrotic pulp space was subjected to sustained irrigation with 5.25% sodium hypochlorite and then completed with 17% ethylenediaminetetraacetic acid. A bolus of gutta-percha was used to create an apical barrier, and then the remainder of the enlarged pulp space was obturated with injectable thermoplasticized gutta-percha. At a 4.5-year recall, there was no clinical and radiographic evidence of infection. Endodontic success was accomplished with meticulous efforts of disinfection. Thermoplasticized gutta-percha can offer utility for obturation of anatomically complicated pulp spaces. The use of the dental operating microscope is an invaluable aid for discernment of the intricacies of teeth affected with DI type 3 variant and can enhance clinical outcomes. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

[The clinical research of aviatic nasal diseases with medical evaluation prevention and control intervention].

PubMed

Wang, Binru; Xu, Xianrong; Jin, Zhangguo; Zhang, Yang

2015-03-01

Exploring the clinical features of aviatic nasal diseases to provide references for medical evaluation, prevention and control measures in aircrew. To analysis and summary 605 cases with 503 pilots of nasal diseases in aircrew during 1966 to 2013. (1) There were 605 cases of aviatic nasal diseases, including 550 cases of general diseases and 55 cases of specific diseases. The general nasal diseases included 140 cases of anatomical abnormalities in nasal cavity type, 290 cases of inflammation in nasal cavity, 73 cases of allergy type, 47 cases of cyst and tumor type, and the specific nasal diseases were 55 cases of sinus barotrauma (SB). (2) The, constituent ratio of SB, which was happened in frontal sinus and /or maxillary sinus, was 95.55%. (3) The constituent ratio of cyst and tumor type in nasal cavity was easier causing to SB than anatomical abnormalities, inflammation, allergy disease in nasal cavity (P < 0.05). (4) The grounded constituent ratio of secondary SB was higher than anatomical abnormalities, inflammation, allergy, cyst and tumor disease in nasal cavity (P < 0.05). (5) The ways of hypobaric chamber tests were different for the kinds of aircrew. The qualified adjustment function of sinuses for barometric pressure was an essential condition for aircrew to continue flying. (6) The key point for the treatment of aviatic nasal diseases was to remove pathological change in nasal cavity and sinus and restore sinus ostium patency. The key point for the medical evaluation was to restore normal sinus pressure balance function. The key point of medical evaluation about aviatic nasal diseases is to assess the sinus pressure balance function in hypobaric chamber tests. Normative treatment and medical evaluation can effectively avoid flight accidents and improve the attendance rate for aircrew.

Sinus Floor Elevation with Modified Crestal Approach and Single Loaded Short Implants: A Case Report with 4 Years of Follow-Up

PubMed Central

Perelli, Michele; Abundo, Roberto; Corrente, Giuseppe; Saccone, Carlo

2017-01-01

Tooth extraction is usually followed by bone reduction. In the maxillary posterior region, this remodelling combined with sinus pneumatisation and periodontal defects may lead to a reduced basal bone height available for implant placement. Sinus floor elevation can be performed with different surgical techniques. Crestal approach has demonstrated to be effective, less invasive, and associated with a reduced morbidity. This article reports a modified sinus floor elevation by means of rotary, noncutting instruments, addition of xenograft, and 2 short-threaded implant placements. The aim of the study was to evaluate the implant's success and intrasinus radiographical bone gain after 4 years of functional loading. The premolar implant site presented a starting basal bone height of 6 mm, while the molar site was of 2 mm. In the first surgical step, sinus floor elevation was performed mesially and the implant was inserted, and distally only sinus floor elevation was performed. After 6 months, the mesial implant was uncovered and the second implant was inserted; 4 months later, the second fixture was uncovered, and both fixtures were loaded with single provisional screw-retained crowns and later with single screw-retained porcelain fused to metal crowns. Implants integrated successfully, and crestal bone remodelling did not exceed the smooth collar. Bone gain was 3 mm for the mesial implant and more than 5 mm for the distal one. PMID:29403665

Sinus Floor Elevation with Modified Crestal Approach and Single Loaded Short Implants: A Case Report with 4 Years of Follow-Up.

PubMed

Perelli, Michele; Abundo, Roberto; Corrente, Giuseppe; Saccone, Carlo; Arduino, Paolo G

2017-01-01

Tooth extraction is usually followed by bone reduction. In the maxillary posterior region, this remodelling combined with sinus pneumatisation and periodontal defects may lead to a reduced basal bone height available for implant placement. Sinus floor elevation can be performed with different surgical techniques. Crestal approach has demonstrated to be effective, less invasive, and associated with a reduced morbidity. This article reports a modified sinus floor elevation by means of rotary, noncutting instruments, addition of xenograft, and 2 short-threaded implant placements. The aim of the study was to evaluate the implant's success and intrasinus radiographical bone gain after 4 years of functional loading. The premolar implant site presented a starting basal bone height of 6 mm, while the molar site was of 2 mm. In the first surgical step, sinus floor elevation was performed mesially and the implant was inserted, and distally only sinus floor elevation was performed. After 6 months, the mesial implant was uncovered and the second implant was inserted; 4 months later, the second fixture was uncovered, and both fixtures were loaded with single provisional screw-retained crowns and later with single screw-retained porcelain fused to metal crowns. Implants integrated successfully, and crestal bone remodelling did not exceed the smooth collar. Bone gain was 3 mm for the mesial implant and more than 5 mm for the distal one.

Synthetic bone substitute material comparable with xenogeneic material for bone tissue regeneration in oral cancer patients: First and preliminary histological, histomorphometrical and clinical results.

PubMed

Ghanaati, Shahram; Barbeck, Mike; Lorenz, Jonas; Stuebinger, Stefan; Seitz, Oliver; Landes, Constantin; Kovács, Adorján F; Kirkpatrick, Charles J; Sader, Robert A

2013-07-01

The present study was first to evaluate the material-specific cellular tissue response of patients with head and neck cancer to a nanocrystalline hydroxyapatite bone substitute NanoBone (NB) in comparison with a deproteinized bovine bone matrix Bio-Oss (BO) after implantation into the sinus cavity. Eight patients with tumor resection for oral cancer and severely resorbed maxillary bone received materials according to a split mouth design for 6 months. Bone cores were harvested prior to implantation and analyzed histologically and histomorphometrically. Implant survival was followed-up to 2 years after placement. Histologically, NB underwent a higher vascularization and induced significantly more tartrate-resistant acid phosphatase-positive (TRAP-positive) multinucleated giant cells when compared with BO, which induced mainly mononuclear cells. No significant difference was observed in the extent of new bone formation between both groups. The clinical follow-up showed undisturbed healing of all implants in the BO-group, whereas the loss of one implant was observed in the NB-group. Within its limits, the present study showed for the first time that both material classes evaluated, despite their induction of different cellular tissue reactions, may be useful as augmentation materials for dental and maxillofacial surgical applications, particularly in patients who previously had oral cancer.

Direct metal laser sintering (DMLS) of a customized titanium mesh for prosthetically guided bone regeneration of atrophic maxillary arches.

PubMed

Ciocca, L; Fantini, M; De Crescenzio, F; Corinaldesi, G; Scotti, R

2011-11-01

This study describes a protocol for the direct manufacturing of a customized titanium mesh using CAD-CAM procedures and rapid prototyping to augment maxillary bone and minimize surgery when severe atrophy or post-oncological deformities are present. Titanium mesh and particulate autogenous plus bovine demineralised bone were planned for patient rehabilitation. Bone augmentation planning was performed using the pre-op CT data set in relation to the prosthetic demands, minimizing the bone volume to augment at the minimum necessary for implants. The containment mesh design was used to prototype the 0.6 mm thickness customized titanium mesh, by direct metal laser sintering. The levels of regenerated bone were calculated using the post-op CT data set, through comparison with the pre-op CT data set. The mean vertical height difference of the crestal bone was 2.57 mm, while the mean buccal-palatal dimension of thickness difference was 3.41 mm. All planned implants were positioned after an 8 month healing period using two-step implant surgery, and finally restored with a partial fixed prosthesis. We present a viable and reproducible method to determine the correct bone augmentation prior to implant placement and CAD-CAM to produce a customized direct laser-sintered titanium mesh that can be used for bone regeneration.

Disseminated tuberculous myositis in a child with acute myelogenous leukemia.

PubMed

Chen, Yu-Chieh; Sheen, Jiunn-Ming; Huang, Li-Tung; Wu, Kuan-Sheng; Hsiao, Chih-Cheng

2009-04-01

Tuberculous myositis is extremely rare, even in immunocompromised hosts. We present a case of disseminated tuberculous myositis in a girl with secondary acute myelogenous Leukemia following successful chemotherapy for undifferentiated sarcoma of the maxillary sinus. The diagnosis was established by direct visualization of acid-fast bacilli in the biopsied nodule and by typical pathologic findings. Three weeks after initiation of antituberculosis treatment, the patient experienced both clinical and radiologic improvement.

[Nonsurgical endodontic treatment of an invaginated canine].

PubMed

Fernández Guerrero, F; Miñana Laliga, R; Bullon Fernandez, P

1989-01-01

We present a case of a maxillary canine with a dens invaginatus treated successfully. The patient had pain, swelling and a sinus tract coming from the inmature apex of the canine. The canals were enlarged and cleaned and the main canal was filled with Calcium Hydroxide to allow the root development. Seven months later, the patient was asymptomatic and the tooth was obturated with guttapercha. One year later it was confirm the success in the treatment.

Oculoplastic technique of connecting a glaucoma valve shunt to extraorbital locations in cases of severe glaucoma.

PubMed

Rubin, Peter A D; Chang, Eli; Bernardino, Carlo Roberto; Hatton, Mark P; Dohlman, Claes H

2004-09-01

To describe a technique for inserting glaucoma shunts to the sinuses or the lacrimal sac as a means of lowering intraocular pressure in patients with refractory glaucoma associated with severe ocular surface disease. Nineteen patients with severe ocular surface disease necessitating a keratoprosthesis and with intractable glaucoma underwent placement of a modified Ahmed shunt to direct aqueous in the maxillary or ethmoid sinus or lacrimal sac. Intraocular pressure is presently well controlled without glaucoma medications in two thirds of patients. None of the patients had endophthalmitis. Established oculoplastic surgery techniques may be used to redirect aqueous to extraorbital locations and effectively lower intraocular pressure in patients with severe ocular surface disease and refractory glaucoma. This procedure has not been associated with endophthalmitis.

Maxillary unicystic ameloblastoma: a case report.

PubMed

Agani, Zana; Hamiti-Krasniqi, Vjosa; Recica, Jehona; Loxha, Mergime Prekazi; Kurshumliu, Fisnik; Rexhepi, Aida

2016-10-18

Ameloblastoma is a benign epithelial odontogenic tumor. It is often aggressive and destructive, with the capacity to attain great size, erode bone and invade adjacent structures. Unicystic ameloblastoma is a rare odontogenic lesion, with clinical, radiographic and gross features of jaw cysts. The lesion histologically shows typical ameloblastomatous epithelium lining part of the cyst cavity with or without and/or mural tumor growth. Unicystic ameloblastoma usually presents in posterior mandibular ramus region, while it is rare and atypical in posterior maxillary region. . We report a case of 16 year old Kosovar male, Albanian ethnicity, who presented with a swelling located in right maxillary region. Clinical examination revealed a painless swelling extending from the maxillary right central incisor to the maxillary right first molar tooth. Panoramic radiograph disclosed a well corticated unilocular radiolucent lesion approximately 5 × 5 cm in diameter which was in contact with the roots of the teeth present inferiorly and with the maxillary sinus superiorly. Maxillary right canine impaction was noted and unerupted lateral incisor tooth was present inside the radiolucency. Preoperative diagnosis of the lesion was made as dentigerous cyst based on the age of the patient, location of the swelling, clinical and radiographic findings, but the unicystic ameloblastoma was also taken into consideration. The patient was treated by surgical enucleation of the lesion and extraction of lateral incisor tooth which was present inside the lesion. The histopathological examination of the lesion revealed confirmed finding for unicystic ameloblastoma mural form. No recurrence was observed in 1 year follow-up. Maxillary region is considered a rare and atypical location for unicystic ameloblastoma. We emphasize the importance of differential diagnosis of an odontogenic lesion with common clinical and radiological features that will impact the treatment planning and follow up. As oral health providers we should be aware that the unilocular radiolucencies may be unicystic ameloblastoma.

Simplified procedure for the immediate loading of a complete fixed prosthesis supported by four implants in the maxillary jaw: a 2-year prospective study.

PubMed

Piano, Sergio; Romeo, Eugenio; Sbricoli, Luca; Pisoni, Gianluca; Cea, Niccoló; Lops, Diego

2016-12-01

The aim of this study was to verify the reliability of a system for the fixed retention of complete maxillary prostheses supported by four implants with a follow-up of 2 years. Patients were treated between September 2009 and December 2010 with four Straumann Bone Level SLActive implants supporting a complete prosthesis (CPs). The two distal implants were positioned mesially to the maxillary sinus and with a mesio-distal inclination ≤ 30° in order to reduce the distal prosthesis cantilever. An immediate loading surgical protocol was used. The CPs were planned to be fixed to multibase abutments to test their retention for a fixed rehabilitation. Clinical and radiographic parameters as probing pocket depth (PPD), bleeding score (mBI), plaque index (PI), and marginal bone loss (MBL) were assessed at a 1- and 2-year follow-up visits. Moreover, any biological and prosthodontic maintenance events were recorded. Clinical and radiographic parameters changes were analyzed. Twenty-one patients treated with a total of 84 implants completed the 2-year examination period. Four patients were lost to follow up. No technical complication was recorded. Also, no implant, reconstruction, or abutment failures were observed. Therefore, an implant and prosthetic survival rate of 100% were achieved after 2 years. The mean periodontal parameter scores after 2 years of function were 2.6 mm for PPD (SD 0.8 mm), 0.3 for mBI (SD 0.5 mm), and 1.2 for PI (SD 0.4 mm) indexes, respectively. In addition, the mean MBL score measured at the 2-year follow-up visit was -0.34 mm (SD of -0.45 mm). Furthermore, no peri-implant soft tissue inflammation or peri-implant infection was observed. It has been shown that immediate loading of four implants positioned anteriorly to the maxillary sinus could be a reliable treatment procedure to support fixed complete restorations. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Hepatocyte Growth Factor Gene-Modified Mesenchymal Stem Cells Augment Sinonasal Wound Healing

PubMed Central

Li, Jing; Li, Yong; Yang, Chen; Lin, Hai; Duan, Hong-Gang

2015-01-01

This study was designed to investigate the effects of hepatocyte growth factor (HGF) transgenic mesenchymal stem cells (HGF-MSCs) on wound healing in the sinonasal mucosa and nasal epithelial cells (NECs). We also sought to determine whether HGF-MSCs and MSCs can migrate into the injured mucosa and differentiate into ciliated cells. Human HGF-overexpressing umbilical cord MSCs (hHGF-UCMSCs) were established, and upregulation of hHGF expression was confirmed by real-time PCR (RT-PCR) and enzyme-linked immunosorbant assay (ELISA). To investigate the paracrine effect of human MSCs (hMSCs) on nasal epithelial repair, hMSC- and HGF-MSC-conditioned media (CM) were used in NEC proliferation assays and in an in vitro scratch-wound repair model. The in vivo sinonasal wound-healing model was established, and all enrolled rabbits were randomly assigned to four groups: the GFP-MSC group, the HGF-MSC group, the Ad-HGF group, and the surgery control group. The average decreased diameter was recorded, and the medial wall of the maxillary sinus was removed for histological analysis and scanning electron microscopy. Collagen deposition in the wound tissue was detected via Masson trichrome (M&T) staining. The distribution of MSCs and HGF-MSCs was observed by immunofluorescence. MSCs improved nasal wound healing both in vivo and in vitro. HGF overexpression in MSCs augmented the curative effects. Reduced collagen deposition and transforming growth factor beta1 (TGF-β1) expression were detected in the HGF-MSC group compared with the MSC-, Ad-HGF-, and phosphate-buffered saline-treated groups based on M&T staining and ELISA. The enhanced therapeutic effects of HGF-MSCs were accompanied by decreased level of the fibrogenic cytokine TGF-β1. In addition, both HGF-MSCs and MSCs can migrate to the injured mucosa and epithelial layer. PMID:25835956

Hepatocyte Growth Factor Gene-Modified Mesenchymal Stem Cells Augment Sinonasal Wound Healing.

PubMed

Li, Jing; Zheng, Chun-Quan; Li, Yong; Yang, Chen; Lin, Hai; Duan, Hong-Gang

2015-08-01

This study was designed to investigate the effects of hepatocyte growth factor (HGF) transgenic mesenchymal stem cells (HGF-MSCs) on wound healing in the sinonasal mucosa and nasal epithelial cells (NECs). We also sought to determine whether HGF-MSCs and MSCs can migrate into the injured mucosa and differentiate into ciliated cells. Human HGF-overexpressing umbilical cord MSCs (hHGF-UCMSCs) were established, and upregulation of hHGF expression was confirmed by real-time PCR (RT-PCR) and enzyme-linked immunosorbant assay (ELISA). To investigate the paracrine effect of human MSCs (hMSCs) on nasal epithelial repair, hMSC- and HGF-MSC-conditioned media (CM) were used in NEC proliferation assays and in an in vitro scratch-wound repair model. The in vivo sinonasal wound-healing model was established, and all enrolled rabbits were randomly assigned to four groups: the GFP-MSC group, the HGF-MSC group, the Ad-HGF group, and the surgery control group. The average decreased diameter was recorded, and the medial wall of the maxillary sinus was removed for histological analysis and scanning electron microscopy. Collagen deposition in the wound tissue was detected via Masson trichrome (M&T) staining. The distribution of MSCs and HGF-MSCs was observed by immunofluorescence. MSCs improved nasal wound healing both in vivo and in vitro. HGF overexpression in MSCs augmented the curative effects. Reduced collagen deposition and transforming growth factor beta1 (TGF-β1) expression were detected in the HGF-MSC group compared with the MSC-, Ad-HGF-, and phosphate-buffered saline-treated groups based on M&T staining and ELISA. The enhanced therapeutic effects of HGF-MSCs were accompanied by decreased level of the fibrogenic cytokine TGF-β1. In addition, both HGF-MSCs and MSCs can migrate to the injured mucosa and epithelial layer.

Spectral analysis of /s/ sound with changing angulation of the maxillary central incisors.

PubMed

Runte, Christoph; Tawana, Djafar; Dirksen, Dieter; Runte, Bettina; Lamprecht-Dinnesen, Antoinette; Bollmann, Friedhelm; Seifert, Eberhard; Danesh, Gholamreza

2002-01-01

The aim of the study was to measure the influence of the maxillary central incisors free from adaptation phenomena using spectral analysis. The maxillary dentures of 18 subjects were duplicated. The central incisors were fixed in a pivoting appliance so that their position could be changed from labial to palatal direction. A mechanical push/pull cable enabled the incisor section to be handled extraorally. Connected to the control was a sound generator producing a sinus wave whose frequency was related to the central incisor angulation. This acoustic signal was recorded on one channel of a digital tape recorder. After calibration of the unit, the denture duplicate was inserted into the subject's mouth, and the signal of the /s/ sounds subsequently produced by the subject was recorded on the second channel during alteration of the inclination angle simultaneously with the generator signal. Spectral analysis was performed using a Kay Speech-Lab 4300B. Labial displacement in particular produced significant changes in spectral characteristics, with the lower boundary frequency of the /s/ sound being raised and the upper boundary frequency being reduced. Maxillary incisor position influences /s/ sound production. Displacement of the maxillary incisors must be considered a cause of immediate changes in /s/ sound distortion. Therefore, denture teeth should be placed in the original tooth position as accurately as possible. Our results also indicate that neuromuscular reactions are more important for initial speech sound distortions than are aerodynamic changes in the anterior speech sound-producing areas.

Evaluation of Malassezia and Common Fungal Pathogens in Subtypes of Chronic Rhinosinusitis.

PubMed

Gelber, Jonathan T; Cope, Emily K; Goldberg, Andrew N; Pletcher, Steven D

2016-09-01

Fungal hypersensitivity and fungal microbiome dysbiosis are possible etiologies of chronic rhinosinusitis. The sinus fungal microbiome is not well characterized; novel sinus-associated fungi, including Malassezia, have only recently been described. The goals for this study were to verify Malassezia as a dominant component of the sinus microbiome, to speciate sinus Malassezia, and to compare select fungal species in chronic rhinosinusitis (CRS) subtypes with known fungal association to chronic rhinosinusitis with polyps (CRSwNP) and healthy controls. Twenty-eight patients were enrolled and categorized as CRSwNP (n = 15), fungus ball (n = 3), allergic fungal rhinosinusitis (AFRS, n = 3), or healthy control (n = 7). Brush samples were taken from ethmoid or maxillary sinus mucosa and tested for DNA from 7 index fungi using quantitative polymerase chain reaction. Index fungal species were chosen based on existing data of the sinus fungal microbiome. Malassezia species were detected in 68% of patients, without variation among clinical phenotypes (p > 0.99). Malassezia restricta was more commonly detected than Malassezia globosa (p = 0.029). Presence of one Malassezia species predicted the presence of the other (p = 0.035). Aspergillus was identified in 2 of 3 of fungus ball patients (both A. fumigatus) and 2 of 3 AFRS patients (1 A. fumigatus and 1 A. flavus). Aspergillus was absent in control and CRSwNP patients (p < 0.001). This study confirmed and speciated Malassezia in healthy and diseased sinuses. Presence of Malassezia species in all groups suggests a commensal role for the fungus. Future work will determine whether Malassezia influences CRS pathogenesis. Aspergillus species were identified in fungal CRS subtypes despite negative surgical cultures, highlighting the importance of culture-independent technology. © 2016 ARS-AAOA, LLC.

The Prevalence of Concha Bullosa and Nasal Septal Deviation and Their Relationship to Maxillary Sinusitis by Volumetric Tomography

DTIC Science & Technology

2010-07-01

2Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA 3Lieutenant Colonel, US Army DENTAC...of the region, independently reviewed Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of...Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other

Malignant Fibrous Histiocytoma of the Maxillary Sinus in a Spray Painter from an Automobile Repair Shop

PubMed Central

2013-01-01

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

The nasal and paranasal architecture of the Middle Miocene ape Pierolapithecus catalaunicus (primates: Hominidae): phylogenetic implications.

PubMed

Pérez de Los Ríos, Miriam; Moyà-Solà, Salvador; Alba, David M

2012-09-01

The internal (nasal and paranasal) cranial anatomy of the Middle Miocene (11.9 Ma [millions of years ago]) great ape Pierolapithecus catalaunicus (Hominidae: Dryopithecini) is described on the basis of computed-tomography scans of the holotype specimen (IPS21350), with particular emphasis on its phylogenetic implications. Pierolapithecus displays the following characters: an anteriorly-restricted maxillary sinus that posteriorly spreads towards the ethmoidal area (thus resembling the pongine condition), although being situated well above the molar roots (as in kenyapithecins, other dryopithecins and pongines); lack of frontal sinus (a synapomorphy of derived pongines, independently acquired by both cercopithecoids and hylobatids); posteriorly-situated turbinals (as in Pongo); anteriorly-projecting nasolacrimal canal (as in Pongo); and probably stepped nasal floor with non-overlapping premaxillary-maxillary contact (as in dryopithecines and stem hominoids, although it cannot be conclusively shown due to bone damage). Overall, Pierolapithecus displays a mosaic of primitive hominid and derived pongine features that are inconsistent with this taxon being a hominine (as previously suggested). Two alternative phylogenetic interpretations are possible: Pierolapithecus may be a stem member of the Hominidae as previously suggested in its original description, or alternatively this taxon may be a stem member of the Ponginae s.l. (with the European dryopithecines being the sister taxon to the Asian pongines). Copyright © 2012 Elsevier Ltd. All rights reserved.

A new synthetic granular calcium phosphate compound induces new bone in a sinus lift rabbit model.

PubMed

Trbakovic, Amela; Hedenqvist, Patricia; Mellgren, Torbjörn; Ley, Cecilia; Hilborn, Jöns; Ossipov, Dmitri; Ekman, Stina; Johansson, Carina B; Jensen-Waern, Marianne; Thor, Andreas

2018-03-01

The aim of this study was to investigate if a synthetic granular calcium phosphate compound (CPC) and a composite bisphosphonate-linked hyaluronic acid-calcium phosphate hydrogel (HABP·CaP) induced similar or more amount of bone as bovine mineral in a modified sinus lift rabbit model. Eighteen adult male New Zeeland White rabbits, received randomly one of the two test materials on a random side of the face, and bovine mineral as control on the contralateral side. In a sinus lift, the sinus mucosa was elevated and a titanium mini-implant was placed in the alveolar bone. Augmentation material (CPC, HABP·CaP or bovine bone) was applied in the space around the implant. The rabbits were euthanized three months after surgery and qualitative and histomorphometric evaluation were conducted. Histomorphometric evaluation included three different regions of interest (ROIs) and the bone to implant contact on each installed implant. Qualitative assessment (p = <.05), histomorphometric evaluations (p = < .01), and implant incorporation (p = <.05) showed that CPC and bovine mineral induced similar amount of bone and more than the HABP·CaP hydrogel. CPC induced similar amount of bone as bovine mineral and both materials induced more bone than HABP·CaP hydrogel. The CPC is suggested as a synthetic alternative for augmentations in the maxillofacial area. Copyright © 2017 Elsevier Ltd. All rights reserved.

Antibiotics for acute maxillary sinusitis in adults.

PubMed

Ahovuo-Saloranta, Anneli; Rautakorpi, Ulla-Maija; Borisenko, Oleg V; Liira, Helena; Williams, John W; Mäkelä, Marjukka

2014-02-11

Sinusitis is one of the most common diagnoses among adults in ambulatory care, accounting for 15% to 21% of all adult outpatient antibiotic prescriptions. However, the role of antibiotics for sinusitis is controversial. To assess the effects of antibiotics in adults with acute maxillary sinusitis by comparing antibiotics with placebo, antibiotics from different classes and the side effects of different treatments. We searched CENTRAL 2013, Issue 2, MEDLINE (1946 to March week 3, 2013), EMBASE (1974 to March 2013), SIGLE (OpenSIGLE, later OpenGrey (accessed 15 January 2013)), reference lists of the identified trials and systematic reviews of placebo-controlled studies. We also searched for ongoing trials via ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). We imposed no language or publication restrictions. Randomised controlled trials (RCTs) comparing antibiotics with placebo or antibiotics from different classes for acute maxillary sinusitis in adults. We included trials with clinically diagnosed acute sinusitis, confirmed or not by imaging or bacterial culture. Two review authors independently screened search results, extracted data and assessed trial quality. We calculated risk ratios (RRs) for differences between intervention and control groups in whether the treatment failed or not. All measures are presented with 95% confidence intervals (CIs). We conducted the meta-analyses using either the fixed-effect or random-effects model. In meta-analyses of the placebo-controlled studies, we combined data across antibiotic classes. Primary outcomes were clinical failure rates at 7 to 15 days and 16 to 60 days follow-up. We used GRADEpro to assess the quality of the evidence. We included 63 studies in this updated review; nine placebo-controlled studies involving 1915 participants (seven of the studies clearly conducted in primary care settings) and 54 studies comparing different classes of antibiotics (10 different comparisons). Five studies at low risk of bias comparing penicillin or amoxicillin to placebo provided information on the main outcome: clinical failure rate at 7 to 15 days follow-up, defined as a lack of full recovery or improvement, for participants with symptoms lasting at least seven days. In these studies antibiotics decreased the risk of clinical failure (pooled RR of 0.66, 95% CI 0.47 to 0.94, 1084 participants randomised, 1058 evaluated, moderate quality evidence). However, the clinical benefit was small. Cure or improvement rates were high in both the placebo group (86%) and the antibiotic group (91%) in these five studies. When clinical failure was defined as a lack of full recovery (n = five studies), results were similar: antibiotics decreased the risk of failure (pooled RR of 0.73, 95% CI 0.63 to 0.85, high quality evidence) at 7 to 15 days follow-up.Adverse effects in seven of the nine placebo-controlled studies (comparing penicillin, amoxicillin, azithromycin or moxicillin to placebo) were more common in antibiotic than in placebo groups (median of difference between groups 10.5%, range 2% to 23%). However, drop-outs due to adverse effects were rare in both groups: 1.5% in antibiotic groups and 1% in control groups.In the 10 head-to-head comparisons, none of the antibiotic preparations were superior to another. However, amoxicillin-clavulanate had significantly more drop-outs due to adverse effects than cephalosporins and macrolides. There is moderate evidence that antibiotics provide a small benefit for clinical outcomes in immunocompetent primary care patients with uncomplicated acute sinusitis. However, about 80% of participants treated without antibiotics improved within two weeks. Clinicians need to weigh the small benefits of antibiotic treatment against the potential for adverse effects at both the individual and general population levels.

Intra- and postoperative application of Mitomycin C in the middle meatus reduces adhesions and antrostomy stenosis after FESS.

PubMed

Konstantinidis, I; Tsakiropoulou, E; Vital, I; Triaridis, S; Vital, V; Constantinidis, J

2008-06-01

Obstruction of the osteomeatal complex is the commonest anatomic finding in revision endoscopic sinus surgery. This study assesses the efficacy of topical mitomycin C in the middle meatus, intra- and postoperatively in the prevention of adhesion formation and restenosis of the maxillary sinus antrostomy. At the end of endoscopic surgery for chronic rhinosinusitis and four weeks postoperatively 30 patients received a pledget soaked with 1 ml of mitomycin C (0.5 mg/ml) in the middle meatus for 5 minutes while a pledget soaked in saline was placed in the contralateral side. Patients were assessed at least 6 months postoperatively by a blinded observer for the presence of synechiae and antrostomy stenosis. Medical records were reviewed for episodes of recurrent sinusitis. Adhesions were observed in 8 patients. All adhesions rated as moderate to severe (4 patients) were observed in the control side (p = 0.043). Restenosis was observed in 2 sides treated with mitomycin C and in 9 control sides (p = 0.032). Recurrent symptoms of sinusitis occurred in three patients on the saline side. Mitomycin C is safe and effective in the prevention of severe adhesions and antrostomy stenosis when applied twice, during surgery and the early postoperative period.

Giant Aneurysmal Bone Cyst of the Anterior Cranial Fossa and Paranasal Sinuses Presenting in Pregnancy: Case Report and Literature Review

PubMed Central

Hnenny, Luke; Roundy, Neil; Zherebitskiy, Victor; Grafe, Marjorie; Mansoor, Atiya; Dogan, Aclan

2015-01-01

Background and Purpose Aneurysmal bone cysts (ABCs) rarely involve the cranium and have seldom been reported in pregnancy. Clinical Presentation We describe a case of a 28-year-old woman who presented at 37 weeks of gestation with 3 months of gradually worsening vision, 10 months of proptosis, and restricted ocular motility on the left. Brain imaging revealed a multicystic enhancing mass measuring 5.9 × 5.3 × 3.7 cm, centered on the cribriform plate on the left, extending into the anterior cranial fossa superiorly as well as the left nasal cavity, maxillary, sphenoid, and frontal sinuses. Her clinical course is described in detail; 3-month postoperative imaging demonstrated no residual mass. Conclusion A literature review revealed five previous cases of ABCs associated with pregnancy. We report a rare case of a giant ABC of fibrous dysplasia involving the paranasal sinuses and anterior cranial fossa. We postulate on the possible influence of pregnancy on the clinical course. PMID:26623230

Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome.

PubMed

Benevides, Gabriel Núncio; Salgado, German Alcoba; Ferreira, Cristiane Rúbia; Felipe-Silva, Aloísio; Gilio, Alfredo Elias

2015-01-01

The symptoms of a previously healthy 14-year-old female with an initial history of tooth pain and swelling of the left maxillary evolved to a progressive headache and altered neurological findings characterized by auditory hallucinations, sleep disturbances, and aggressiveness. She was brought to the emergency department after 21 days of the initial symptoms. An initial computed tomography (CT) scan showed frontal subdural empyema with bone erosion. The symptoms continued to evolve to brain herniation 24 hours after admission. A second CT scan showed a left internal jugular vein thrombosis. The outcome was unfavorable and the patient died on the second day after admission. The autopsy findings depicted rarefaction of the cranial bone at the left side of the frontal sinus, and overt meningitis. The severe infection was further complicated by thrombophlebitis of the left internal jugular vein up to the superior vena cava with septic embolization to the lungs, pneumonia, and sepsis. This case report highlights the degree of severity that a trivial infection can reach. The unusual presentation of the sinusitis may have wrongly guided the approach of this unfortunate case.

Internal anatomy of the hornbill casque described by radiography, contrast radiography, and computed tomography.

PubMed

Gamble, Kathryn C

2007-03-01

Hornbills are distinguished from most other avian taxa by the presence of a casque on the dorsal maxillary beak, which, in all but 1 of the 54 extant hornbill species, is described as essentially an air-filled cavity enclosed by minimal cancellous bone. The external casque has been described in detail, but little has been described about its internal anatomy and the communications between the casque and the paranasal sinuses. In this study, 10 intact casque and skull specimens of 7 hornbill species were collected opportunistically at necropsy. The anatomy of the casque and the skull for each of the specimens was examined by radiography, contrast radiography, and computed tomography. After imaging, 8 specimens were submitted for osteologic preparation to directly visualize the casque and the skull interior. Through this standardized review, the baseline anatomy of the internal casque was described, including identification of a novel casque sinus within the paranasal sinus system. These observations will assist clinicians in the diagnosis and treatment of diseases of the casque in hornbill species.

Early Orthodontic Tooth Movement into Regenerative Bony Defects: A Case Report.

PubMed

Tsai, Hui-Chen; Yao, Chung-Chen Jane; Wong, Man-Ying

Early orthodontic tooth movement following regenerative surgery is controversial. In this case, during protraction of the maxillary right first premolar to substitute for the long-term missing maxillary right canine, Bio-Oss and Bio-Gide were used for lateral ridge augmentation at the area of the maxillary right lateral incisor and to cover the denuded surface at the buccal side of the first premolar. Orthodontic tooth movement (OTM) commenced 2 weeks after regenerative surgery. After 8 months, new bone formation was observed on the root surface of the first premolar during implant surgery. A cone beam computed tomography scan taken 1.5 years postsurgery revealed good maintenance of regenerative bone at the same site. This satisfactory outcome of early OTM following regenerative surgery suggests biomechanical stimulation may not jeopardize the regenerative effect.

Magnetic resonance imaging of the nose and paranasal sinuses.

PubMed Central

Lloyd, G A

1989-01-01

Seventy-five patients with a wide range of sinus disease have been investigated by magnetic resonance (MR): these included congenital conditions, allergic and inflammatory sinus disease, fungus infections, and the necrotizing granulomata. In addition, a variety of benign and malignant tumours have been examined, and in the more recent sinus malignancies the paramagnetic contrast agent, Gadolinium (Gd) DTPA (Schering Health Care) has been used. This experience of magnetic resonance scanning has shown that it is superior to computed tomography in demonstrating the extent of malignant disease in the nose and sinuses; most especially when Gd DTPA is used, reaching an accuracy of over 96% by biopsy correlation. An additional advantage of this technique is the wide coverage of the head and neck for the assessment of malignant disease, provided by direct 3 plane imaging and the multislice facility. The main disadvantage of magnetic resonance of the sinuses is the poor demonstration of calcification and bone. For this reason the MR scans may need to be augmented by high resolution CT performed specifically to show bone detail. Images Figure 2. Figure 3. PMID:2926770

Extensive surgical and comprehensive postoperative medical management for cystic fibrosis chronic rhinosinusitis

PubMed Central

Virgin, Frank W.; Rowe, Steven M.; Wade, Mary B.; Gaggar, Amit; Leon, Kevin J.; Young, K. Randall

2012-01-01

Background: Chronic rhinosinusitis has a major impact on the quality of life of patients with cystic fibrosis (CF) and may contribute to progression of chronic lung disease. Despite multiple sinus surgeries, maxillary sinus involvement is a recurrent problem. The modified endoscopic medial maxillectomy (MEMM) permits debridement in the clinic, improves mucus clearance with nasal irrigations, and increases access for topical delivery of therapeutics. However, clinical outcomes of aggressive sinus surgery with regimented postoperative medical treatment have not been systematically evaluated. Methods: CF patients completed the 22-Item Sinonasal Outcome Test questionnaires before sinus surgery (and bilateral MEMM) and at sequential postoperative visits. Objective measures included Lund-Kennedy endoscopic score and pulmonary function tests (forced expiratory volume at 1 second percent [FEV1%] predicted). Culture-directed antibiotic therapy, prednisone, and topical irrigations were initiated postoperatively. Results: Twenty-two patients (mean age, 26.5 years; 4.9 prior sinus operations) underwent MEMM and sinus surgery. Symptom scores were significantly reduced at 60 days (primary outcome, 64.7 ± 18.4 presurgery versus 27.5 ± 15.3 postsurgery; p < 0.0001) and up to a year postoperatively (27.6 ± 12.6; p < 0.0001). Endoscopic scores were also reduced after surgery (10.4 ± 1.1 presurgery versus 5.7 ± 2.4 [30 days], 5.7 ± 1.4 [60 days], 5.8 ± 1.3 [120 days], and 6.0 ± 1.1 [1 year]; p < 0.0001)]. There were no differences in FEV1% predicted up to 1 year postoperatively, but hospital admissions secondary to pulmonary exacerbations significantly decreased (2.0 ± 1.4 versus 3.2 ± 2.4, respectively; p < 0.05). Conclusion: Prospective evaluation indicates sinus surgery with MEMM is associated with marked improvement in sinus disease outcomes. Additional studies are necessary to confirm whether this treatment paradigm is associated with improved CF pulmonary disease. PMID:22391086

NCCN Guidelines Insights: Head and Neck Cancers, Version 1.2018.

PubMed

Colevas, A Dimitrios; Yom, Sue S; Pfister, David G; Spencer, Sharon; Adelstein, David; Adkins, Douglas; Brizel, David M; Burtness, Barbara; Busse, Paul M; Caudell, Jimmy J; Cmelak, Anthony J; Eisele, David W; Fenton, Moon; Foote, Robert L; Gilbert, Jill; Gillison, Maura L; Haddad, Robert I; Hicks, Wesley L; Hitchcock, Ying J; Jimeno, Antonio; Leizman, Debra; Maghami, Ellie; Mell, Loren K; Mittal, Bharat B; Pinto, Harlan A; Ridge, John A; Rocco, James; Rodriguez, Cristina P; Shah, Jatin P; Weber, Randal S; Witek, Matthew; Worden, Frank; Zhen, Weining; Burns, Jennifer L; Darlow, Susan D

2018-05-01

The NCCN Guidelines for Head and Neck (H&N) Cancers provide treatment recommendations for cancers of the lip, oral cavity, pharynx, larynx, ethmoid and maxillary sinuses, and salivary glands. Recommendations are also provided for occult primary of the H&N, and separate algorithms have been developed by the panel for very advanced H&N cancers. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding evaluation and treatment of nasopharyngeal carcinoma. Copyright © 2018 by the National Comprehensive Cancer Network.

An incidental finding on a diagnostic CBCT: a case report.

PubMed

Lyros, Ioannis; Fora, Eleni; Damaskos, Spyridon; Stanko, Peter; Tsolakis, Apostolos

2014-05-01

It is known that Cone Beam Computed Tomography (CBCT) provides reliable spatial data and has many clinical applications for dental and particularly orthodontic patients. The present article provides a short review of the literature and reports an unusual CBCT finding in an orthodontic patient referred for the assessment of impacted upper canines. A unilateral lesion in the left maxillary sinus, was an incidental finding. Following a histological examination, which revealed unilateral nasal polyps, surgical removal was performed as the treatment of choice.

Extensive Adenomatoid Odontogenic Tumor of the Maxilla: A Case Report of Conservative Surgical Excision and Orthodontic Alignment of Impacted Canine.

PubMed

Moon, Jee-Won

2014-07-01

The present report describe the surgical therapy, clinical course, orthodontic treatment and morphological characteristics of an adenomatoid odontogenic tumor in the maxilla of an 11-year-old patient. The cystic tumor filled the maxillary sinus and involved a tooth. Marsupialization was accompanied by partial enucleation and applied traction to the affected tooth by a fixed orthodontic appliance. Healing was uneventful and no local recurrence was observed during a 1-year period of follow-up control.

Subdural abscess secondary to covert dental sepsis

PubMed Central

Sprott, Mae S.; Hall, K.; Newman, P. K.; Welbury, R. R.; Ingham, H. R.

1981-01-01

The bacterial flora of a subdural abscess in a 17-year-old male, with radiological evidence of unilateral infection of the maxillary and frontal air sinuses, was typical of that encountered in the dental sulcus. Extensive examination revealed no primary focus of infection other than apical infection in the 2 upper first molar teeth, which were extracted. Treatment with ampicillin, gentamicin and metronidazole rapidly controlled the subdural infection, and resolution, as evidenced by computerized tomography, was complete at 10 months. PMID:7335566

Comparison of Lateral Window and Osteotome Techniques in Sinus Augmentation: Histological and Histomorphometric Evaluation

PubMed Central

Esfahanizadeh, N.; Rokn, A. R.; Paknejad, M.; Motahari, P.; Daneshparvar, H.; Shamshiri, AR.

2012-01-01

Objective: The aim of this study was to compare the lateral window and osteotome techniques for sinus lifting using histological and histomorphometric methods. Materials and Methods: In this clinical trial 10 patients (a total number of 14 sinus areas) who needed implant treatment in the atrophic posterior maxilla were enrolled. In all the cases the residual bone height between the sinus floor and the alveolar crest was less than 5 mm. Sinus augmentation was performed. The treatment modality for a given residual bone height was selected randomly and Bio-Oss was applied in all the cases as the graft material. After a healing period of about 10 months, in all the cases, the implants were placed and biopsies of alveolar crestal bone were obtained at the same time; biopsy specimens were evaluated using histological and histomorphometric methods. Fisher’s exact and Mann-Whitney U tests were used to compare distribution of variables in the two groups. Statistical significance was defined at P<0.05. Results: The new bone was located in direct contact with the biomaterial without any gaps. This viable bone consisted of lacunae containing osteocytes. Infiltration of inflammatory cells did not exhibit any significant differences between the two techniques. Foreign body reaction was not observed in any cases. Histomorphometric evaluations demonstrated that The mean values of the new bone in the lateral window and osteotome techniques were 30±6.0 and 25.2±5.2, respectively, with no significant differences between the two groups.. Moreover, the average quantity of residual biomaterial and connective tissue were similar for the two groups. Conclusion: The nature and the volume of the new bone in lateral window and osteotome techniques were the same. PMID:23119133

Maxillary distraction osteogenesis for treatment of cleft lip and palate in a patient with X-linked agammaglobulinemia.

PubMed

Sato, Yutaka; Mishimagi, Takashi; Katsuki, Yuko; Harada, Kiyoshi

2014-07-01

X-linked agammaglobulinemia (XLA) is a congenital immune deficiency disorder caused by abnormal antibody production. It is a rare disease with an estimated frequency of 1 in 379,000 that has X-linked recessive heredity and develops only in males. The clinical problems include bacterial infection such as otitis media, sinusitis, and bronchitis. In recent years it has become possible to diagnose XLA in the early stage and intravenous immunoglobulin replacement therapy has permitted survival to adulthood. However, there have been no reports of oral surgery in patients with XLA. Here, we describe a case in which immunoglobulin replacement therapy given pre- and postoperatively was used to control infection in oral surgery and maxillary distraction osteogenesis performed for improving occlusion and appearance of a cleft lip and palate in a patient with XLA. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Sphenoid Sinus and Sphenoid Bone Fractures in Patients with Craniomaxillofacial Trauma

PubMed Central

Cantini Ardila, Jorge Ernesto; Mendoza, Miguel Ángel Rivera; Ortega, Viviana Gómez

2013-01-01

Background and Purpose Sphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is any relationship between various isolated or combined fractures of facial skeleton and sphenoid bone and sphenoid sinus fractures. Methods We retrospectively studied hospital charts of all patients who reported to the trauma center at Hospital de San José with facial fractures from December 2009 to August 2011. All patients were evaluated by computed tomography scan and classified into low-, medium-, and high-energy trauma fractures, according to the classification described by Manson. Design This is a retrospective descriptive study. Results The study data were collected as part of retrospective analysis. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Thirty-eight patients were excluded. A total of 212 patients had facial fractures; 33 had a combination of sphenoid sinus and sphenoid bone fractures, and facial fractures were identified within this group (15.5%). Gender predilection was seen to favor males (77.3%) more than females (22.7%). The mean age of the patients was 37 years. Orbital fractures (78.8%) and maxillary fractures (57.5%) were found more commonly associated with sphenoid sinus and sphenoid bone fractures. Conclusions High-energy trauma is more frequently associated with sphenoid fractures when compared with medium- and low-energy trauma. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures. PMID:24436756

Detection of the posterior superior alveolar artery in the lateral sinus wall using computed tomography/cone beam computed tomography: a prevalence meta-analysis study and systematic review.

PubMed

Varela-Centelles, P; Loira-Gago, M; Seoane-Romero, J M; Takkouche, B; Monteiro, L; Seoane, J

2015-11-01

A systematic search of MEDLINE, Embase, and Proceedings Web of Science was undertaken to assess the prevalence of the posterior superior alveolar artery (PSAA) in the lateral sinus wall in sinus lift patients, as identified using computed tomography (CT)/cone beam computed tomography (CBCT). For inclusion, the article had to report PSAA detection in the bony wall using CT and/or CBCT in patients with subsinus edentulism. Studies on post-mortem findings, mixed samples (living and cadaveric), those presenting pooled results only, or studies performed for a sinus pathology were excluded. Heterogeneity was checked using an adapted version of the DerSimonian and Laird Q test, and quantified by calculating the proportion of the total variance due to between-study variance (Ri statistic). Eight hundred and eleven single papers were reviewed and filtered according to the inclusion/exclusion criteria. Ten studies were selected (1647 patients and 2740 maxillary sinuses (study unit)). The pooled prevalence of PSAA was 62.02 (95% confidence interval (CI) 46.33-77.71). CBCT studies detected PSAA more frequently (78.12, 95% CI 61.25-94.98) than CT studies (51.19, 95% CI 42.33-60.05). Conventional CT revealed thicker arteries than CBCT. It is concluded that PSAA detection is more frequent when CBCT explorations are used. Additional comparative studies controlling for potential confounding factors are needed to ascertain the actual diagnostic value of radiographic explorations for assessing the PSAA prior to sinus floor elevation procedures. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

[A case of pycnodysostosis--observation of the skull by CT scan].

PubMed

Anegawa, S; Bekki, Y; Furukawa, Y; Yokota, S; Torigoe, R

1987-07-01

A 13-year-old boy was presented to the Department of Neurosurgery, Saiseikai Fukuoka General Hospital for further examinations concerning abnormal findings in the skull radiogram taken when he struck his head. His physical features showed some characteristics the same as those of pycnodysostosis as follows--proportionate dwarfism, prominent forehead, short spoon-shaped fingers, bilateral exophthalmos. A skull radiogram revealed widely open cranial sutures with no healing of the fracture and craniotomy which was performed for an acute epidural hematoma 6 years ago. Furthermore, the mandible was hypoplastic with a virtual loss of mandibular angle. CT of the soft tissues showed somewhat dilated cortical sulci and ventricles without any structural abnormalities in the brain. CT of bone algorithm revealed specific characteristics of this disease. The paranasal sinuses were quite hypoplastic. Especially in the maxillary sinuses, frontal sinuses and mastoid air cells, none of developments of sinuses were noted, even though the middle and internal ear seemed to be normal. Moreover, the ethmoid and sphenoid sinuses were noted, although their developments were poor. The appearance of skull base was normal, including the inlets and outlets of cranial nerves or vessels and synchondroses. However, the density of the skull base, especially in the diploe, was higher than normal in Hansfield number. Furthermore, detailed measurements of skull base demonstrated that the skull base itself was also dwarfism. Pycnodysostosis is a generalized skeletal disease whose cardinal features are moderate generalized osteosclerosis and dwarfism. However, the detailed observation on the cranium by CT has not been reported. In our study, the development of sinuses in bones with intramembranous ossification are worse than that with endochondral ossification.(ABSTRACT TRUNCATED AT 250 WORDS)

The Neanderthal face is not cold adapted.

PubMed

Rae, Todd C; Koppe, Thomas; Stringer, Chris B

2011-02-01

Many morphological features of the Pleistocene fossil hominin Homo neanderthalensis, including the reputed large size of its paranasal sinuses, have been interpreted as adaptations to extreme cold, as some Neanderthals lived in Europe during glacial periods. This interpretation of sinus evolution rests on two assumptions: that increased craniofacial pneumatization is an adaptation to lower ambient temperatures, and that Neanderthals have relatively large sinuses. Analysis of humans, other primates, and rodents, however, suggests that the first assumption is suspect; at least the maxillary sinus undergoes a significant reduction in volume in extreme cold, in both wild and laboratory conditions. The second assumption, that Neanderthal sinuses are large, extensive, or even 'hyperpneumatized,' has held sway since the first specimen was described and has been interpreted as the causal explanation for some of the distinctive aspects of Neanderthal facial form, but has never been evaluated with respect to scaling. To test the latter assumption, previously published measurements from two-dimensional (2D) X-rays and new three-dimensional (3D) data from computed tomography (CT) of Neanderthals and temperate-climate European Homo sapiens are regressed against cranial size to determine the relative size of their sinuses. The 2D data reveal a degree of craniofacial pneumatization in Neanderthals that is both commensurate with the size of the cranium and comparable in scale with that seen in temperate climate H. sapiens. The 3D analysis of CT data from a smaller sample supports this conclusion. These results suggest that the distinctive Neanderthal face cannot be interpreted as a direct result of increased pneumatization, nor is it likely to be an adaptation to resist cold stress; an alternative explanation is thus required. Copyright © 2010 Elsevier Ltd. All rights reserved.

Does rapid maxillary expansion affect nasopharyngeal airway? A prospective Cone Beam Computerised Tomography (CBCT) based study.

PubMed

Almuzian, Mohammed; Ju, Xiangyang; Almukhtar, Anas; Ayoub, Ashraf; Al-Muzian, Lubna; McDonald, Jim P

2018-02-01

There is limited literature discussing the three dimnesional (3D) impact of rapid maxillary expansion (RME) on upper airway. The purpose of this prospective Cone Beam Computerised Tomography (CBCT) based study is to assess the immediate 3D effects and to correlate the volumteric changes in the upper naspharyngeal airway spaces secondary to RME. Seventeen participants (8 male, 9 female, with a mean age of 12.6 ± 1.8 years), who required RME for the management of narrow maxillary arch, were recruited for this study. The prescribed expansion regimen was quarter turn (0.25 mm), twice a day until over-expansion was achieved. The mean period for the active phase was 14 days with a range of 12-21 days. Pretreatment (T1) and immediate post-expansion (T2) CBCT images were obtained and then processed using ITK snap and OnDemand3D softwar packages. Paired t-test and Interclass Correlation Coefficient (ICC) were used to assess the reproducibility of the measurements, student t-test (P < 0.05) and Pearson Correlation Coefficient (PCC) were applied to evaluate the volumetric changes in the nasopharyngeal airway spaces, linear dentolaveolar changes and correlate these changes. Though, the data of one patient was excluded from the study, owing to major differences (>5 degrees) in the head and neck posture between T1 and T2 CBCT scans, the study' findings shows that bonded RME is an effective dentoalveolar expander in growing patients (P= 0.01) with an average expansion of 3.7 mm and 2.8 mm in males and females respectively. Likewise, the upper nasopharynx (UNP) expanded significantly (15.2% in males and 12% in females). In comparison, the upper retropalatal space (URP) was significantly reduced, by almost one sixth of its original volume, more in males than females, 11.2% and 2.8% respectively. A strong direct correlation between the maxillary sinus volumetric changes, and between appliance expansion and dentoalveolar expansion were evident (PCC = 0.86, 0.75, respectively). There was also a moderate correlation between changes in the UNP and URP spaces. RME was found to be an effective dentoalveolar expander and significantly augment the UNP and minimize the URP space. A similar comparative clinical study with long-term follow-up would be beneficial in accurately deteremining the clinical impact of RME on the airway and breathing as well as the stability of these effects. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Maxillary distraction complications in cleft patients.

PubMed

Jeblaoui, Y; Morand, B; Brix, M; Lebeau, J; Bettega, G

2010-06-01

Cleft lip and palate (CLP) patients often present with a class III malocclusion in connection with a three dimensional maxillary hypoplasia. Twenty-five to 60% of these patients need maxillary advancement. Two solutions are possible: orthognathic surgery and maxillary distraction. The purpose of this study was to evaluate the complications of maxillary distraction in CLP patients. Data was collected from the records of patients treated in our surgery unit between 2000 and 2007. Among the eight patients (four male and four female), five presented with a bilateral CLP, two with a unilateral CLP, and one with a unilateral cleft lip associated to a soft palate cleft. The average age at surgery was 17 years. All underwent a Le Fort I osteotomy with a pterygomaxillary disjunction. An external distractor was used for the first two patients and an internal distractor for the six following patients. After a seven-day latency, activation was implemented at a rate of 1mm twice a day. The average period of consolidation was four months. Maxillary advancement ranged between 7 and 19mm, with an average of 12.6mm. The average follow-up was four years. Complications were noted in seven patients: one intra-operative hemorrhage, one avulsion of a tooth anchored at the pterygoid process during osteotomy, three cases of device dysfunction, two cases of significant pain during activation, one loosening of the orthodontic arch in an external system, two cases of labial ulceration, and one maxillary sinusitis due to migration of a wisdom tooth. Complications of maxillary distraction in CLP patients were very frequent. Most were related to the device and did not interfere with the final result. This must be taken into account when indicating distraction and choosing the device. Two types of complications can occur during distraction: those related to the osteotomy and those related to the device. The complications related to the osteotomy are linked to the cicatricial ground of previous surgery. They are not specific to distraction. The comfort of the internal device is undeniable, but the design of some models must be reviewed to improve their tolerance. Copyright 2010 Elsevier Masson SAS. All rights reserved.

[Maxillary distraction complications in cleft patients].

PubMed

Jeblaoui, Y; Morand, B; Brix, M; Lebeau, J; Bettega, G

2008-09-01

Cleft lip and palate (CLP) patients often present with a class III malocclusion in connection with a three dimensional maxillary hypoplasia. Twenty-five to 60% of these patients require a maxillary advancement. Two solutions are possible: orthognathic surgery and maxillary distraction. The purpose of this study was to evaluate the complications of the maxillary distraction in CLP patients. Data was collected from the records of patients treated at our Surgery Unit between 2000 and 2007. Among the eight patients (four male and four female), five presented a bilateral CLP, two a unilateral CLP and one a unilateral cleft lip associated to a soft palate cleft. The average age at surgery was 17 years old. All had a Le Fort I osteotomy with a pterygomaxillary disjunction. The first two patients had external distractors and the six following internal ones. After a seven-day latency, activation was led to the rate of 1mm per day twice. The period of consolidation was four months on average. The maxillary advancement varied between 7 and 19 mm with an average of 12.6mm. The average follow-up was four years. We encountered difficulties and/or complications in seven patients: one intraoperatively haemorrhage, one avulsion of a tooth fixed at the pterygoid process during the osteotomy, three device failures, two cases of significant pains during activation, one dissociation of the dental anchorage of an external system, two labial ulcerations and one maxillary sinusitis by migration of the 18. Difficulties of maxillary distraction in CLP patients are very frequent. The majority is related to the distractors and did not interfere with the final result. But this frequency must be taken into account in the indication and in the choice of the material. Two types of complications can occur during distraction: those related to the osteotomy and those related to the material. The complications related to the osteotomy are in connection with the cicatricial ground of the CLP. They are not specific of the distraction. We especially managed complications related to the material. The social benefit of the internal distractors is undeniable, but the design of certain models must be reexamined to improve their tolerance.

Carvedilol analog modulates both basal and stimulated sinoatrial node automaticity.

PubMed

Shinohara, Tetsuji; Kim, Daehyeok; Joung, Boyoung; Maruyama, Mitsunori; Vembaiyan, Kannan; Back, Thomas G; Wayne Chen, S R; Chen, Peng-Sheng; Lin, Shien-Fong

2014-05-01

The membrane voltage clock and calcium (Ca(2+)) clock jointly regulate sinoatrial node (SAN) automaticity. VK-II-36 is a novel carvedilol analog that suppresses sarcoplasmic reticulum (SR) Ca(2+) release but does not block the β-receptor. The effect of VK-II-36 on SAN function remains unclear. The purpose of this study was to evaluate whether VK-II-36 can influence SAN automaticity by inhibiting the Ca(2+) clock. We simultaneously mapped intracellular Ca(2+) and membrane potential in 24 isolated canine right atriums using previously described criteria of the timing of late diastolic intracellular Ca elevation (LDCAE) relative to the action potential upstroke to detect the Ca(2+) clock. Pharmacological interventions with isoproterenol (ISO), ryanodine, caffeine, and VK-II-36 were performed after baseline recordings. VK-II-36 caused sinus rate downregulation and reduced LDCAE in the pacemaking site under basal conditions (P < 0.01). ISO induced an upward shift of the pacemaking site in SAN and augmented LDCAE in the pacemaking site. ISO also significantly and dose-dependently increased the sinus rate. The treatment of VK-II-36 (30 μmol/l) abolished both the ISO-induced shift of the pacemaking site and augmentation of LDCAE (P < 0.01), and it suppressed the ISO-induced increase in sinus rate (P = 0.02). Our results suggest that the sinus rate may be partly controlled by the Ca(2+) clock via SR Ca(2+) release during β-adrenergic stimulation.

Carvedilol Analogue Modulates both Basal and Stimulated Sinoatrial Node Automaticity

PubMed Central

Shinohara, Tetsuji; Kim, Daehyeok; Joung, Boyoung; Maruyama, Mitsunori; Vembaiyan, Kannan; Back, Thomas G.; Chen, S.R. Wayne; Chen, Peng-Sheng; Lin, Shien-Fong

2013-01-01

Background The membrane voltage clock and calcium (Ca2+) clock jointly regulate sinoatrial node (SAN) automaticity. VK-II-36 is a novel carvedilol analog that suppress sarcoplasmic reticulum (SR) Ca2+ release but does not block β-receptor. The effect of VK-II-36 on SAN function remains unclear. The purpose of this study was to evaluate whether VK-II-36 can influence SAN automaticity through inhibiting the Ca2+ clock. Methods and Results We simultaneously mapped intracellular Ca2+ and membrane potential in 24 isolated canine right atriums, using previously described criteria of the timing of late diastolic intracellular Ca elevation (LDCAE) relative to the action potential upstroke to detect the Ca2+ clock. Pharmacological intervention with isoproterenol (ISO), ryanodine, caffeine, and VK-II-36 were performed after baseline recordings. VK-II-36 caused sinus rate downregulation and reduced LDCAE in the pacemaking site under basal condition (P<0.01). ISO induced an upward shift of the pacemaking site in SAN and augmented LDCAE in pacemaking site. ISO also significantly and dose-dependently increased the sinus rate. The treatment of VK-II-36 (30 μmol/L) abolished both the ISO-induced shift of pacemaking site and augmentation of LDCAE (P<0.01), and suppressed the ISO-induced increase in sinus rate (P=0.02). Conclusions Our results suggest that sinus rate may be partly controlled by Ca2+ clock via SR Ca2+ release during β-adrenergic stimulation. PMID:23836067

Synthetic bone substitute material comparable with xenogeneic material for bone tissue regeneration in oral cancer patients: First and preliminary histological, histomorphometrical and clinical results

PubMed Central

Ghanaati, Shahram; Barbeck, Mike; Lorenz, Jonas; Stuebinger, Stefan; Seitz, Oliver; Landes, Constantin; Kovács, Adorján F.; Kirkpatrick, Charles J.; Sader, Robert A.

2013-01-01

Background: The present study was first to evaluate the material-specific cellular tissue response of patients with head and neck cancer to a nanocrystalline hydroxyapatite bone substitute NanoBone (NB) in comparison with a deproteinized bovine bone matrix Bio-Oss (BO) after implantation into the sinus cavity. Materials and Methods: Eight patients with tumor resection for oral cancer and severely resorbed maxillary bone received materials according to a split mouth design for 6 months. Bone cores were harvested prior to implantation and analyzed histologically and histomorphometrically. Implant survival was followed-up to 2 years after placement. Results: Histologically, NB underwent a higher vascularization and induced significantly more tartrate-resistant acid phosphatase-positive (TRAP-positive) multinucleated giant cells when compared with BO, which induced mainly mononuclear cells. No significant difference was observed in the extent of new bone formation between both groups. The clinical follow-up showed undisturbed healing of all implants in the BO-group, whereas the loss of one implant was observed in the NB-group. Conclusions: Within its limits, the present study showed for the first time that both material classes evaluated, despite their induction of different cellular tissue reactions, may be useful as augmentation materials for dental and maxillofacial surgical applications, particularly in patients who previously had oral cancer. PMID:24205471

Antibiotics for upper respiratory tract infections: an overview of Cochrane reviews.

PubMed

Arroll, B

2005-03-01

The aim of this paper is to review the four Cochrane reviews of antibiotics for upper respiratory tract infections. Each Cochrane review was read and summarized, and results presented as odds ratios (as in the Internet version) and, where relevant, numbers needed to treat. The reviews of antibiotics for acute otitis media have concluded that benefit is not great with a number needed to treat for a benefit (NNTB) of 15. Recent US guidelines are recommending a delay in prescriptions in children over the age of 6 months. For streptococcal tonsillitis, the Cochrane reviewers suggest that antibiotic use seems to be discretionary rather than prohibited or mandatory. This is because the benefit in terms of symptoms is only about 16h (NNTB from 2 to 7 at day 3 for pain) compared with placebo, and that serious complications, such as rheumatic fever and glomerulonephritis, are now rare in developed countries. The reviewers do, however, suggest that antibiotics are considered in populations in whom these complications are more common. This is an area of debate, as the Infectious Disease Society of America (2002) recommends routine treatment. [Clin. Infect. Dis. 35 (2002) 113] There is good evidence and consensus that there is no indication for antibiotics for the common cold. The situation with acute purulent rhinitis is less clear, as new evidence suggests that antibiotics may be effective for acute purulent rhinitis (NNTB from 6 to 8). However, as most people with acute purulent rhinitis improve without antibiotics, giving antibiotics is not justified as an initial treatment. For acute maxillary sinusitis, the evidence suggests that antibiotics are effective for people with radiologically confirmed sinusitis. The reviewers suggest that clinicians should weigh up the modest benefits (NNTB from 3 to 6) against the potential for adverse effects. The use of antibiotics for acute otitis media, sore throat and streptococcal tonsillitis, common cold and acute purulent rhinitis, and acute maxillary sinusitis seems to be discretionary rather than prohibited or mandatory, at least for non-severe cases.

[Localized invasive intracranial aspergillosis with multiple cranial nerve failure -- case report and review of the literature].

PubMed

Winkler, F; Seelos, K; Hempel, J M; Pfister, H-W

2002-12-01

Contrary to the more frequent hematogenously spread cerebral aspergillosis, localized invasive intracranial aspergillosis is a fungal infection that can also occur in patients who are not severely immunosuppressed. This illness can be effectively treated in some of these patients by early and rigorous therapy. Localized invasion of the fungus, generally from one of the nasal sinuses, causes intracranial growth mainly along the base of the skull and larger vessels,where fibrous, granulomatous tissue develops. This generally leads to damage of the cranial nerves (primarily I-VI) as well as localized pain syndromes. We report on the clinical course documented by MRI of a patient with localized invasive intracranial aspergillosis who had multiple failure of cranial nerves following surgery for an aspergilloma of the maxillary sinus. Clinical course, imaging findings, and treatment of the illness are discussed with a review of the relevant literature.

Quantitation of mandibular symphysis volume as a source of bone grafting.

PubMed

Verdugo, Fernando; Simonian, Krikor; Smith McDonald, Roberto; Nowzari, Hessam

2010-06-01

Autogenous intramembranous bone graft present several advantages such as minimal resorption and high concentration of bone morphogenetic proteins. A method for measuring the amount of bone that can be harvested from the symphysis area has not been reported in real patients. The aim of the present study was to intrasurgically quantitate the volume of the symphysis bone graft that can be safely harvested in live patients and compare it with AutoCAD (version 16.0, Autodesk, Inc., San Rafael, CA, USA) tomographic calculations. AutoCAD software program quantitated symphysis bone graft in 40 patients using computerized tomographies. Direct intrasurgical measurements were recorded thereafter and compared with AutoCAD data. The bone volume was measured at the recipient sites of a subgroup of 10 patients, 6 months post sinus augmentation. The volume of bone graft measured by AutoCAD averaged 1.4 mL (SD 0.6 mL, range: 0.5-2.7 mL). The volume of bone graft measured intrasurgically averaged 2.3 mL (SD 0.4 mL, range 1.7-2.8 mL). The statistical difference between the two measurement methods was significant. The bone volume measured at the recipient sites 6 months post sinus augmentation averaged 1.9 mL (SD 0.3 mL, range 1.3-2.6 mL) with a mean loss of 0.4 mL. AutoCAD did not overestimate the volume of bone that can be safely harvested from the mandibular symphysis. The use of the design software program may improve surgical treatment planning prior to sinus augmentation.

Crestal sinus lift with sequential drills and simultaneous implant placement in sites with <5 mm of native bone: a multicenter retrospective study.

PubMed

Bernardello, Fabio; Righi, Davide; Cosci, Ferdinando; Bozzoli, Paolo; Soardi, Carlo Maria; Carlo, Maria Soardi; Spinato, Sergio

2011-12-01

The aim of this multicenter retrospective clinical study was to evaluate the survival rate of implants placed in the posterior maxilla with a residual bone height of <5 mm. One hundred seventeen patients, recruited from 6 different centers, had 134 implants placed below the maxillary sinus. The patient population consisted of 52 men and 65 women ranging in age from 39 to 78 years (mean age, 53.2 years). Sinus lift procedures were performed following a crestal approach using a specific sequence of drills (Cosci's technique). All implants were submerged. Periapical radiographs were obtained with a paralleling technique and were digitized. The pattern of bone remodeling was subsequently evaluated. The average (±SD) follow-up time was 48.2 months (±29.30 months; range, 24 to 120 months). Of the original 134 implants placed, 5 implants (3.7%) failed. The implant survival rate was 96.3%. The average residual bone height was 3.46 mm (±0.91 mm) at baseline. The average height of the alveolar crest in the treated implant sites was 9.94 ± 2.29 mm. The radiographic bone gain was 6.48 ± 2.38 mm. The investigation suggests that this crestal drill approach can be a successful sinus lifting procedure in a severe atrophic maxilla with <5 mm of crestal bone height.

Management of sinonasal complications after endoscopic orbital decompression for Graves' orbitopathy.

PubMed

Antisdel, Jastin L; Gumber, Divya; Holmes, Janalee; Sindwani, Raj

2013-09-01

Endoscopic orbital decompression (EnOD) has proven to be safe and effective for the treatment of Graves' orbitopathy; however, complications do occur. Although the literature focuses on orbital complications, sinonasal complications including postobstructive sinusitis, hemorrhage, and cerebrospinal fluid (CSF) leak can also be challenging to manage. This study examines the incidence and management of sinonasal complications in these patients. Retrospective review. Clinical data, surgical findings, and postoperative outcomes were reviewed of patients who underwent EnOD for Graves' disease between March 2004 and November 2010. The incidence and management of postoperative sinonasal complications requiring an intervention were examined. The study group consisted of 50 consecutive patients (86 decompression procedures): 11 males and 39 females with an average age of 48.6 years (SD = 12.9). Incidence of significant sinonasal complications was 3.5% (5/86): with one patient experiencing postoperative hemorrhage requiring operative management, three patients with postoperative obstructive sinusitis, and one patient with nasal obstruction secondary to nasal adhesions that required lysis. The maxillary sinus was the most commonly involved and was managed using the mega-antrostomy technique. In the case of frontal sinusitis, an endoscopic transaxillary approach was utilized to avoid injury to decompressed orbital contents. All complications were successfully managed without sequelae. Sinonasal complications following EnOD are uncommon. In the setting of a decompressed orbit, even routine types of postoperative issues can be challenging and require additional considerations. Successful management of postoperative sinusitis related to outflow obstruction may require more extensive approaches and novel techniques. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Spontaneous CSF-leaks and meningoencephaloceles in sphenoid sinus by persisting Sternberg's canal.

PubMed

Tomazic, Peter Valentin; Stammberger, Heinz

2009-12-01

Cerebrospinal fluid (CSF) leaks and meningoencephaloceles of the lateral recess of sphenoid sinuses are rare findings. A congenital bony defect in the lateral wall of sphenoid sinus called Sternberg's canal could be the origin of these lesions. Their endoscopic transnasal management is challenging though less traumatic than transcranial approaches. The aim of this study was to define Sternberg's canal as a potential source for these rare lesions and to describe their endoscopic endonasal management. In a retrospective analysis clinical charts of 27 patients with CSF-leaks and / or meningoencephaloceles operated between March 2002 and October 2008 at the University ENT-hospital Graz have been reviewed. All patients were treated by an endoscopic endonasal approach. Five patients (4 female / 1 male) were identified with spontaneous CSF-leaks from sphenoid sinus and meningoencephaloceles. In all five cases, Sternberg's canal was the site of leakage, with the bony and dural defects always located laterally between the maxillary and Vidian nerves. Mean age was 51.2 years and mean body mass index (BMI) was 31.9 kg/m2. All patients were operated using a multilayer closure technique. Two patients had recurrences after 12 days and 7 months, respectively, managed by endoscopic revision surgery resulting in a 100% closure rate after one revision (mean follow-up: 6.5 months). Persisting Sternberg's canal can be the source of spontaneous CSF-leaks and meningoencephaloceles in the lateral recess of sphenoid sinus especially when associated with extensive pneumatisation. Endoscopic management is technically challenging, nevertheless its advantages are a good view of the surgical field while being less traumatic than transcranial approaches.

Comparison of hand and semiautomatic tracing methods for creating maxillofacial artificial organs using sequences of computed tomography (CT) and cone beam computed tomography (CBCT) images.

PubMed

Szabo, Bence T; Aksoy, Seçil; Repassy, Gabor; Csomo, Krisztian; Dobo-Nagy, Csaba; Orhan, Kaan

2017-06-09

The aim of this study was to compare the paranasal sinus volumes obtained by manual and semiautomatic imaging software programs using both CT and CBCT imaging. 121 computed tomography (CT) and 119 cone beam computed tomography (CBCT) examinations were selected from the databases of the authors' institutes. The Digital Imaging and Communications in Medicine (DICOM) images were imported into 3-dimensonal imaging software, in which hand mode and semiautomatic tracing methods were used to measure the volumes of both maxillary sinuses and the sphenoid sinus. The determined volumetric means were compared to previously published averages. Isometric CBCT-based volume determination results were closer to the real volume conditions, whereas the non-isometric CT-based volume measurements defined coherently lower volumes. By comparing the 2 volume measurement modes, the values gained from hand mode were closer to the literature data. Furthermore, CBCT-based image measurement results corresponded to the known averages. Our results suggest that CBCT images provide reliable volumetric information that can be depended on for artificial organ construction, and which may aid the guidance of the operator prior to or during the intervention.

Regional Anatomical Observation of Morphology of Greater Palatine Canal and Surrounding Structures.

PubMed

Suzuki, Masashi; Omine, Yuya; Shimoo, Yoshiaki; Yamamoto, Masahito; Kaketa, Akihiro; Kasahara, Masaaki; Serikawa, Masamitu; Rhee, Sunki; Matsubayashi, Tadatoshi; Matsunaga, Satoru; Abe, Shinichi

2016-01-01

In maxillary molar region implant therapy, support is sometimes obtained from trabecular bone comprising the maxillary tuberosity, pterygoid process of the sphenoid bone, and pyramidal process of the palatine bone. Great care is necessary in such cases due to the presence of the greater palatine canal, which forms a passageway for the greater palatine artery, vein, and nerve. However, clinical anatomical reports envisioning embedding of pterygomaxillary implants in this trabecular bone region have been limited in number. In this study, the 3-D morphology of the greater palatine canal region, including the maxillary tuberosity region and points requiring particular care in pterygomaxillary implantation, were therefore investigated. Micro-CT was used to image 20 dentulous jaws (40 sides) harvested from the dry skulls of Japanese individuals with a mean age of 28.2 years at time of death. The skulls were obtained from the Jikei University School of Medicine cadaver repository. Three-dimensional reconstruction of the trabecular bone region, including the greater palatine canal, was performed using software for 3-D measurement of trabecular bone structure. Trabecular bone region morphometry was performed with the hamular notch-incisive papilla (HIP) plane as the reference plane. The results showed a truncated-cone structure with the greater palatine foramen as the base extending to the pterygopalatine fossa. This indicates the need for care with respect to proximity of the dental implant body to the greater palatine canal and the risk of perforation if it is embedded in the maxillary tuberosity region at an inclination of 60° toward the lingual side. Moreover, caution must be exercised to avoid possible damage to the medial wall of the maxillary sinus if the inclination of the embedded dental implant body is almost perpendicular to the HIP plane.

Immediate Functional Loading of One-Piece Zirconia Implants in a Full-Arch Maxillary Restoration: A Five-Year Case Report.

PubMed

Peter, Burghard

Immediate loading has proven to be a predictable modality for restorations with titanium dental implants. An increasing number of articles indicate that zirconia implants might osseointegrate to a similar extent in this context. This 5-year case report describes an outpatient maxillary restoration with eight immediately loaded zirconia implants. Implantation followed extensive bone augmentation. At the 5-year follow-up, all implants were still well osseointegrated clinically and radiologically. No major bone loss or peri-implantitis had occurred in spite of temporary insufficient patient compliance. More research and studies are needed to confirm these results.

Effects of Le Fort I Osteotomy on the Nasopharyngeal Airway-6-Month Follow-Up.

PubMed

Almuzian, Mohammed; Almukhtar, Anas; Ju, Xiangyang; Al-Hiyali, Ali; Benington, Philip; Ayoub, Ashraf

2016-02-01

The literature discussing the impact of a single Le Fort I osteotomy on nasopharyngeal airways is limited. This study assessed the volumetric changes in the nasopharyngeal airway after a single Le Fort I osteotomy and explored the correlation between these changes and 3-dimensional surgical movements of the upper jaw. This retrospective study was conducted in 40 patients who had undergone a single Le Fort I (maxillary advancement with or without impaction) to correct Class III malocclusion with maxillary hypoplasia. Preoperative (T1) and 6-month postoperative (T2) cone-beam computed tomographic (CBCT) scans of these patients were used for analysis. Maxillary surgical movements and volumetric changes in the nasopharyngeal airway were measured. The reproducibility of the measurements was evaluated using paired t tests and intraclass correlation coefficients. The Wilcoxon test and Pearson correlation coefficient were applied to evaluate the volumetric changes in the nasopharyngeal airway space and assess the correlations of these changes to the maxillary surgical movements. Six patients were excluded from the study owing to major differences (>5°) in their head and neck posture between the T1 and T2 CBCT scans. The errors of the repeated measurements were insignificant (P > .05), with a high level of agreement (r = 0.99; P < .05) between the repeated digitization of the landmarks. There was a statistically significant impact of a Le Fort I osteotomy on the right maxillary sinus (decreased by 17.8%) and the lower retropalatal space (expanded by 17.3%; P < .05). The correlation between the change in airway volume and the magnitude of surgical maxillary movements was moderate (r = .4). Similarly, there was a moderate correlation between changes in the upper nasopharynx and those in the hypopharynx. The single Le Fort I osteotomy was found to increase the retroglossal airway volume. This could be important for the treatment of obstructive sleep apnea in patients with maxillary deficiency. A long-term follow-up assessment of a larger sample with a functional assessment of airway would be beneficial to confirm these findings. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Maxillary reconstruction with a double-barrel osteocutaneous fibular flap and arteriovenous saphenous loop after a globe-sparing total maxillectomy-A Case Report.

PubMed

Chen, Szu-Han; Hung, Kuo-Shu; Lee, Yao-Chou

2017-05-01

Maxillary reconstruction using titanium mesh or bone grafts can invite unwanted complications, such as graft resorption, infection, and mesh exposure, especially for patients who require postoperative radiotherapy. Here, we reported a 58-year-old male patient who was diagnosed with maxillary sinus squamous cell carcinoma. The patient received cancer ablation by a globe-sparing total maxillectomy and was immediately reconstructed with a double-barrel osteocutaneous fibular flap to simultaneously restore the alveolar ridge, orbital support, and oro-sinonasal separation. The short pedicle length inherent in the double-barrel design of the fibular flap and the depletion of healthy recipient vessels in the midface after cancer ablation were overcome by creating an arteriovenous saphenous loop in the neck region. Though there was venous congestion on postoperative day 2, the postoperative recovery was uneventful after the revision of the venous anastomoses. During the 6-months follow-up, the outcome was functionally and aesthetically satisfactory. We believe that the double-barrel fibular osteocutaneous flap, which avoids using titanium mesh and bone grafts, may be a viable reconstructive option in cancer patients with globe-sparing total maxillectomy defects, especially for those who require postoperative radiotherapy. © 2015 Wiley Periodicals, Inc. Microsurgery 37:334-338, 2017. © 2015 Wiley Periodicals, Inc.

Pediatric maxillary fractures.

PubMed

Yu, Jack; Dinsmore, Robert; Mar, Philip; Bhatt, Kirit

2011-07-01

Pediatric craniofacial structures differ from those of adults in many ways. Because of these differences, management of pediatric craniofacial fractures is not the same as those in adults. The most important differences that have clinical relevance are the mechanical properties, craniofacial anatomy, healing capacity, and dental morphology. This article will review these key differences and the management of pediatric maxillary fractures. From the mechanical properties' perspective, pediatric bones are much more resilient than adult bones; as such, they undergo plastic deformation and ductile failure. From the gross anatomic perspective, the relative proportion of the cranial to facial structures is much larger for the pediatric patients and the sinuses are not yet developed. The differences related to dentition and dental development are more conical crowns, larger interdental spaces, and presence of permanent tooth buds in the pediatric population. The fracture pattern, as a result of all the above, does not follow the classic Le Fort types. The maxillomandibular fixation may require circum-mandibular wires, drop wires, or Ivy loops. Interfragmentary ligatures using absorbable sutures play a much greater role in these patients. The use of plates and screws should take into consideration the future development with respect to growth centers and the location of the permanent tooth buds. Pediatric maxillary fractures are not common, require different treatments, and enjoy better long-term outcomes.

The Immediate Aesthetic and Functional Restoration of Maxillary Incisors Compromised by Periodontitis Using Short Implants with Single Crown Restorations: A Minimally Invasive Approach and Five-Year Follow-Up

PubMed Central

Marincola, Mauro; Lombardo, Giorgio; Pighi, Jacopo; Corrocher, Giovanni; Mascellaro, Anna; Lehrberg, Jeffrey; Nocini, Pier Francesco

2015-01-01

The functional and aesthetic restoration of teeth compromised due to aggressive periodontitis presents numerous challenges for the clinician. Horizontal bone loss and soft tissue destruction resulting from periodontitis can impede implant placement and the regeneration of an aesthetically pleasing gingival smile line, often requiring bone augmentation and mucogingival surgery, respectively. Conservative approaches to the treatment of aggressive periodontitis (i.e., treatments that use minimally invasive tools and techniques) have been purported to yield positive outcomes. Here, we report on the treatment and five-year follow-up of patient suffering from aggressive periodontitis using a minimally invasive surgical technique and implant system. By using the methods described herein, we were able to achieve the immediate aesthetic and functional restoration of the maxillary incisors in a case that would otherwise require bone augmentation and extensive mucogingival surgery. This technique represents a conservative and efficacious alternative to the aesthetic and functional replacement of teeth compromised due to aggressive periodontitis. PMID:26649207

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fukumitsu, Nobuyoshi, E-mail: fukumitsun@yahoo.co.jp; Okumura, Toshiyuki; Mizumoto, Masashi

Purpose: To investigate the clinical features, prognostic factors, and toxicity of treatment for unresectable carcinomas of the nasal cavity and paranasal sinus (NCPS) treated with proton beam therapy (PBT). Methods and Materials: Seventeen patients (13 men, 4 women) with unresectable carcinomas of the NCPS who underwent PBT at University of Tsukuba between 2001 and 2007 were analyzed. The patients' median age was 62 years (range, 30-83 years). The tumors were located in the nasal cavity in 3 patients, the frontal sinus in 1, the ethmoid sinus in 9, and the maxillary sinus in 4. The clinical stage was Stage IVAmore » in 5 cases, IVB in 10, and recurrent in 2. The tumors were deemed unresectable for medical reasons in 16 patients and because of refusal at a previous hospital 4 months earlier in 1 patient. All the patients received PBT irradiation dose of 22-82.5 GyE and a total of 72.4-89.6 GyE over 30-64 fractions (median 78 GyE over 36 fractions) with X-ray, with attention not exceeding the delivery of 50 GyE to the optic chiasm and brainstem. Results: The overall survival rate was 47.1% at 2 years and 15.7% at 5 years, and the local control rate was 35.0% at 2 years and 17.5% at 5 years. Invasion of the frontal or sphenoid sinus was a prognostic factor for overall survival or local control. Late toxicity of more than Grade 3 was found in 2 patients (brain necrosis in 1 and ipsilateral blindness in 1); however, no mortal adverse effects were observed. Conclusion: Proton beam therapy enabled a reduced irradiation dose to the optic chiasm and brainstem, enabling the safe treatment of unresectable carcinomas in the NCPS. Superior or posterior extension of the tumor influenced patient outcome.« less

Chronic active Epstein-Barr virus infection with cutaneous and sinus lymphoproliferation in a white female patient with 25 years' follow-up: an original case report.

PubMed

Picard, C; Gouarin, S; Comoz, F; Barreau, M; Verneuil, L; Troussard, X; Dompmartin, A

2015-11-01

Chronic active Epstein-Barr virus infection (CAEBV) is characterized by chronic infectious mononucleosis-like symptoms associated with very high viral load, as assessed by quantitative polymerase chain reaction. We present an unusual case in a French woman who was followed up over 25 years with cutaneous and sinus lymphoproliferation. This white woman presented with a long history of recurrent cutaneous necrotic papules of the skin, which started during childhood and healed spontaneously with depressed scars. The lesions spread to the left maxillary sinus and were associated with hepatomegaly and splenomegaly with no other visceral locations. Pathological examination of the skin and sinus revealed a dermal monoclonal T-cell lymphoproliferative disorder, CD7(+) and CD20(-) , with no epidermotropism. T-cell receptor rearrangement was positive, showing the monoclonality from the first biopsy. This T-cell proliferation was positive for EBV-encoded small RNA and was associated with a high EBV viral load. Since then, the patient has been in good health, despite a permanently high EBV viral load. Hydroa vacciniforme (HV)-like lymphoma and natural killer/T-cell lymphoma were discussed, but none really fit our case. Natural killer cell lymphoma was ruled out because of the indolent course, but sinus lesions do not exist in HV-like lymphoma. A therapeutic approach is difficult because of the coexistence of viral infection and monoclonal T-cell proliferation. Chemotherapy is not efficient and induces immunosuppression, which may worsen the prognosis. Although rituximab may have an immunomodulatory function, it was not effective in our case. © 2015 British Association of Dermatologists.

Radiographic Evidence of Sinonasal Inflammation in Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome: An Underrecognized Association.

PubMed

Hamada, Satoshi; Tatsumi, Shuji; Kobayashi, Yoshiki; Matsumoto, Hisako; Yasuba, Hirotaka

Sinonasal inflammation on both clinical examinations and imaging significantly impacts both asthma and chronic obstructive pulmonary disease (COPD). The objective of this study was to examine the association between sinonasal inflammation and asthma-COPD overlap syndrome (ACOS). A total of 112 patients with a ratio of forced expiratory volume in 1 s to forced vital capacity of less than 70% were enrolled. COPD, asthma, and ACOS were clinically diagnosed according to the 2014 Global Initiative for Asthma and Global Initiative for Chronic Obstructive Lung Disease guidelines. Sinonasal inflammatory condition was evaluated using sinus computed tomography, and its severity was assessed according to the Lund-Mackay staging (LMS) system. Ethmoid sinus-dominant shadow was defined as the presence of greater LMS scores for the anterior and posterior ethmoid sinuses than for the maxillary sinus. COPD, asthma, and ACOS were diagnosed in 55 (49.1%), 39 (34.8%), and 18 patients (16.1%), respectively. The frequency of radiographic evidence of sinonasal inflammation in patients with COPD, asthma, ACOS was 60.0%, 94.9%, and 72.2%, respectively. Patients with ACOS and COPD had only mild radiographic evidence of sinonasal inflammation (LMS score, 1-7), whereas moderate (LMS score, 8-11) and severe (LMS score, ≥12) radiographic evidence of sinonasal inflammation were detected only in patients with asthma. Furthermore, the frequency of ethmoid sinus-dominant shadow was significantly higher in patients with asthma than in those with COPD and ACOS. Radiographic evidence of sinonasal inflammation was a common comorbidity in ACOS. Future studies are required to examine the role of sinonasal inflammation in ACOS. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

In-office drainage of sinus Mucoceles: An alternative to operating-room drainage.

PubMed

Barrow, Emily M; DelGaudio, John M

2015-05-01

Endoscopic drainage has become the standard of care for the treatment of mucoceles. In many patients this can be performed in the office. This study reviews our experience with in-office endoscopic mucocele drainage. Retrospective chart review. A retrospective review of one surgeon's experience with in-office endoscopic drainage of sinus mucoceles between 2006 and 2014 was performed. Charts were reviewed for patient demographics, previous surgery, mucocele location, bone erosion, and outcomes. Thirty-two patients underwent 36 in-office drainage procedures. All procedures were performed under topical/local anesthesia. The mean age was 55 years (range, 17-92 years). The mean follow-up time was 444 days. Fifty-five percent had previous sinus surgery. The primary sinus involved was the frontal (12), anterior (11), posterior ethmoid (six), maxillary (four), and sphenoid (two). Bone erosion was noted to be present on computed tomography in 18 mucoceles (51%) (16 orbital, seven skull-base). All mucoceles were successfully accessed in the office with the exception of one, which was aborted due to neo-osteogenesis. Five patients (14% of mucoceles) required additional surgery, two for mucocele recurrence and three for septated mucoceles not completely drained in the office. No treatment complications occurred. All but one patient preferred in-office to operating-room drainage. In-office drainage of sinus mucoceles is well tolerated by patients, with high success and low complication rates, even in large mucoceles with bone erosion. The presence of septations and neo-osteogenesis reduce the likelihood of complete drainage and are relative contraindications. Orbital and skull base erosion are not contraindications. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Peri-implant bone length changes and survival rates of implants penetrating the sinus membrane at the posterior maxilla in patients with limited vertical bone height.

PubMed

Kim, Hae-Young; Yang, Jin-Yong; Chung, Bo-Yoon; Kim, Jeong Chan; Yeo, In-Sung

2013-04-01

The aim of this study was to measure the peri-implant bone length surrounding implants that penetrate the sinus membrane at the posterior maxilla and to evaluate the survival rate of these implants. Treatment records and orthopantomographs of 39 patients were reviewed and analyzed. The patients had partial edentulism at the posterior maxilla and limited vertical bone height below the maxillary sinus. Implants were inserted into the posterior maxilla, penetrating the sinus membrane. Four months after implant insertion, provisional resin restorations were temporarily cemented to the abutments and used for one month. Then, a final impression was taken at the abutment level, and final cement-retained restorations were delivered with mutually protected occlusion. The complications from the implant surgery were examined, the number of failed implants was counted, and the survival rate was calculated. The peri-implant bone lengths were measured using radiographs. The changes in initial and final peri-implant bone lengths were statistically analyzed. Nasal bleeding occurred after implant surgery in three patients. No other complications were found. There were no failures of the investigated implants, resulting in a survival rate of 100%. Significantly more bone gain around the implants (estimated difference=-0.6 mm, P=0.025) occurred when the initial residual bone height was less than 5 mm compared to the >5 mm groups. No significant change in peri-implant bone length was detected when the initial residual bone height was 5 mm or larger. This study suggests that implants penetrating the sinus membrane at the posterior maxilla in patients with limited vertical bone height may be safe and functional.

Application of a real-time three-dimensional navigation system to various oral and maxillofacial surgical procedures.

PubMed

Ohba, Seigo; Yoshimura, Hitoshi; Ishimaru, Kyoko; Awara, Kousuke; Sano, Kazuo

2015-09-01

The aim of this study was to confirm the effectiveness of a real-time three-dimensional navigation system for use during various oral and maxillofacial surgeries. Five surgeries were performed with this real-time three-dimensional navigation system. For mandibular surgery, patients wore acrylic surgical splints when they underwent computed tomography examinations and the operation to maintain the mandibular position. The incidence of complications during and after surgery was assessed. No connection with the nasal cavity or maxillary sinus was observed at the maxilla during the operation. The inferior alveolar nerve was not injured directly, and any paresthesia around the lower lip and mental region had disappeared within several days after the surgery. In both maxillary and mandibular cases, there was no abnormal hemorrhage during or after the operation. Real-time three-dimensional computer-navigated surgery allows minimally invasive, safe procedures to be performed with precision. It results in minimal complications and early recovery.

Sinonasal organised haematoma: clinical features and successful application of modified transnasal endoscopic medial maxillectomy.

PubMed

Suzuki, M; Nakamura, Y; Ozaki, S; Yokota, M; Murakami, S

2017-08-01

Although organised haematoma often induces bone thinning and destruction similar to malignant diseases, the aetiology of organised haematoma and the optimal treatment remain unclear. This paper presents the clinical features of individuals with organised haematoma, and describes cases in which a novel modified approach was successfully applied for resection of organised haematoma in the maxillary sinus. Pre-operative examination data were evaluated retrospectively. Modified transnasal endoscopic medial maxillectomy was employed. Fourteen patients with organised haematoma were treated. Contrast-enhanced computed tomography showed heterogeneous enhancement in all patients. Eight patients underwent modified transnasal endoscopic medial maxillectomy, without complications such as facial numbness, tooth numbness, facial tingling, lacrimation and eye discharge. Dissection of the apertura piriformis and anterior maxillary wall was not necessary for any of these eight patients. No recurrence was observed. Pre-operative examinations can be helpful in determining the likelihood of organised haematoma. Modified transnasal endoscopic medial maxillectomy appears to be a safe and effective method for organised haematoma resection.

Alveolar rhabdomyosarcoma: origin and prognostic implications of molecular findings.

PubMed

Eguía-Aguilar, Pilar; López-Martínez, Briceida; Retana-Contreras, Carmen; Perezpeña-Diazconti, Mario

We present the case of a 2-year-old male patient with a facial tumor partially treated with chemotherapy before his admission to our institution. The tumor involved from the frontal region to the maxillary floor, the orbit, and the maxillary and sphenoid sinuses. The histopathological diagnosis revealed a stage IV alveolar rhabdomyosarcoma with infiltration to bone marrow and cerebrospinal fluid. He was managed with four cycles of adriamycin, actinomycin, cyclophosphamide and vincristine; cisplatin and irinotecan were added to the last cycle. The tumor had a 50% size reduction, but the patient died after a neutropenia and fever episode. The aggressive behavior of alveolar rhabdomyosarcoma has been associated with the expression of oncogenic fusion proteins resulting from chromosomal translocations, particularly t(2;13) (q35;q14) PAX3/FOXO1, and t(1;13) (p36;q14) PAX7/FOXO1 which were present in this patient. Copyright © 2016 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

Three-Dimensional Reconstruction of Post-Traumatic Deficient Anterior Maxilla.

PubMed

Rachmiel, Adi; Shilo, Dekel; Aizenbud, Dror; Pen, Mark; Rachmiel, Dana; Emodi, Omri

2017-12-01

Maxillary retrognathism appears in 14.3% of patients exhibiting malocclusion after trauma treatment. This report describes the application of alveolar distraction osteogenesis (ADO) for treating the severely deficient anterior maxilla after trauma injuries in the vertical and anteroposterior planes. This is a retrospective study of patients exhibiting severe vertical and anteroposterior maxillary bone deficiency after trauma injuries and treated by ADO as a first stage with additional Le Fort I advancement when required. Predictor variables included ADO for alveolar augmentation and Le Fort I advancement for anteroposterior discrepancy after ADO. Outcome variables included dental implant failure and anteroposterior maxillary relations. Twelve patients with severe atrophic anterior maxilla secondary to trauma injuries were included and treated using ADO. In accordance to the size of the horizontal deficiency, 1 or 2 distractors were used. Vertical alveolar distraction was performed and the transported segments were elongated at a rate of 0.5 mm/day to a mean total of 13.9 mm (12 to 15 mm). In 4 of 12 cases, there was a severe anteroposterior discrepancy larger than 8 mm that could not be fully corrected using an anterior inclination during the vertical elongation. Therefore, a second stage of conventional Le Fort I advancement was performed. Thirty-eight dental implants were inserted, with a survival rate of 97.37% (median follow-up, 6.2 yr). This report describes treatment of the deficient anterior maxilla after trauma injuries in the vertical and anteroposterior planes, including implant-based dental rehabilitation. The main advantages include simultaneous bone and mucosa augmentation, no donor site morbidity, considerably higher vertical augmentation compared with other methods, and minimal relapse. Using an additional Le Fort I advancement in severe cases permits a useful method for proper repositioning of the maxilla, thus resulting in superior intermaxillary relations. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Treatment of Severely Resorbed Maxilla Due to Peri-Implantitis by Guided Bone Regeneration Using a Customized Allogenic Bone Block: A Case Report

PubMed Central

Blume, Oliver; Hoffmann, Lisa; Donkiewicz, Phil; Wenisch, Sabine; Back, Michael; Franke, Jörg; Schnettler, Reinhard

2017-01-01

The objective of this case report is to introduce a customized CAD/CAM freeze-dried bone allograft (FDBA) block for its use in Guided Bone Regeneration (GBR) procedures for severely deficient maxillary bones. Additionally, a special newly developed remote incision technique is presented to avoid wound dehiscence. The results show optimal integration behavior of the FDBA block after six months and the formation of new vital bone. Thus, the results of the present case report confirm the use of the customized CAD/CAM bone block for augmentation of complex defects in the maxillary aesthetic zone as a successful treatment concept. PMID:29065477

Treatment of Severely Resorbed Maxilla Due to Peri-Implantitis by Guided Bone Regeneration Using a Customized Allogenic Bone Block: A Case Report.

PubMed

Blume, Oliver; Hoffmann, Lisa; Donkiewicz, Phil; Wenisch, Sabine; Back, Michael; Franke, Jörg; Schnettler, Reinhard; Barbeck, Mike

2017-10-21

The objective of this case report is to introduce a customized CAD/CAM freeze-dried bone allograft (FDBA) block for its use in Guided Bone Regeneration (GBR) procedures for severely deficient maxillary bones. Additionally, a special newly developed remote incision technique is presented to avoid wound dehiscence. The results show optimal integration behavior of the FDBA block after six months and the formation of new vital bone. Thus, the results of the present case report confirm the use of the customized CAD/CAM bone block for augmentation of complex defects in the maxillary aesthetic zone as a successful treatment concept.

A novel bone scraper for intraoral harvesting: a device for filling small bone defects.

PubMed

Zaffe, Davide; D'Avenia, Ferdinando

2007-08-01

To evaluate histologically the morphology and characteristics of bone chips harvested intraorally by Safescraper, a specially designed cortical bone collector. Bone chips harvested near a bone defect or in other intraoral sites were grafted into a post-extractive socket or applied in procedures for maxillary sinus floor augmentation or guided bone regeneration. Core biopsies were performed at implant insertion. Undecalcified specimens embedded in PMMA were studied by histology, histochemistry and SEM. Intraoral harvesting by Safescraper provided a simple, clinically effective regenerative procedure with low morbidity for collecting cortical bone chips (0.9-1.7 mm in length, roughly 100 microm thick). Chips had an oblong or quadrangular shape and contained live osteocytes (mean viability: 45-72%). Bone chip grafting produced newly formed bone tissue suitable for implant insertion. Trabecular bone volume measured on biopsies decreased with time (from 45-55% to 23%). Grafted chips made up 50% or less of the calcified tissue in biopsies. Biopsies presented remodeling activities, new bone formation by apposition and live osteocytes (35% or higher). In conclusion, Safescraper is capable of collecting adequate amounts of cortical bone chips from different intraoral sites. The procedure is effective for treating alveolar defects for endosseous implant insertion and provides good healing of small bone defects after grafting with bone chips. The study indicates that Safescraper is a very useful device for in-office bone harvesting procedures in routine peri-implant bone regeneration.

Three-dimensional sinus imaging as an adjunct to two-dimensional imaging to accelerate education and improve spatial orientation.

PubMed

Yao, William C; Regone, Rachel M; Huyhn, Nancy; Butler, E Brian; Takashima, Masayoshi

2014-03-01

Develop a novel three-dimensional (3-D) anatomical model to assist in improving spatial knowledge of the skull base, paranasal sinuses, and adjacent structures, and validate the utilization of 3-D reconstruction to augment two-dimensional (2-D) computed tomography (CT) for the training of medical students and otolaryngology-head and neck surgery residents. Prospective study. A study of 18 subjects studying sinus anatomy was conducted at a tertiary academic center during the 2011 to 2012 academic year. An image processing and 3-D modeling program was used to create a color coded 3-D scalable/layerable/rotatable model of key paranasal and skull base structures from a 2-D high-resolution sinus CT scan. Subjects received instruction of the sinus anatomy in two sessions, first through review of a 2-D CT sinus scan, followed by an educational module of the 3-D reconstruction. After each session, subjects rated their knowledge of the sinus and adjacent structures on a self-assessment questionnaire. Significant improvement in the perceived understanding of the anatomy was noted after the 3-D educational module session when compared to the 2-D CT session alone (P < .01). Every subject believed the addition of 3-D imaging accelerated their education of sinus anatomy and recommended its use to others. The impression of the learners was that a 3-D educational module, highlighting key structures, is a highly effective tool to enhance the education of medical students and otolaryngology residents in sinus and skull base anatomy and its adjacent structures, specifically in conceptualizing the spatial orientation of these structures. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Blindness associated with nasal/paranasal lymphoma in a stallion.

PubMed

Sano, Yuto; Okamoto, Minoru; Ootsuka, Youhei; Matsuda, Kazuya; Yusa, Shigeki; Taniyama, Hiroyuki

2017-03-23

A 29-year-old stallion presented with bilateral blindness following the chronic purulent nasal drainage. The mass occupied the right caudal nasal cavity and right paranasal sinuses including maxillary, palatine and sphenoidal sinuses, and the right-side turbinal and paranasal septal bones, and cribriform plate of ethmoid bone were destructively replaced by the mass growth. The right optic nerve was invaded and involved by the mass, and the left optic nerve and optic chiasm were compressed by the mass which was extended and invaded the skull base. Histologically, the optic nerves and optic chiasm were degenerated, and the mass was diagnosed as lymphoma which was morphologically and immunohistochemically classified as a diffuse large B-cell lymphoma. Based on these findings, the cause of the blindness in the stallion was concluded to be due to the degeneration of the optic nerves and chiasm associated with lymphoma occurring in the nasal and paranasal cavities. To the best of our knowledge, this is the first report of the equine blindness with optic nerve degeneration accompanied by lymphoma.

A histomorphometric comparison of Bio-Oss alone versus Bio-Oss and platelet-derived growth factor for sinus augmentation: a postsurgical assessment.

PubMed

Froum, Stuart J; Wallace, Stephen; Cho, Sang-Choon; Rosenburg, Edwin; Froum, Scott; Schoor, Robert; Mascarenhas, Patrick; Tarnow, Dennis P; Corby, Patricia; Elian, Nicolas; Fickl, Stefan; Ricci, John; Hu, Bin; Bromage, Timothy; Khouly, Ismael

2013-01-01

The purpose of this study was to assess vital bone formation at 4 to 5 months and 7 to 9 months following sinus augmentation with anorganic bovine bone matrix (ABBM) with and without recombinant human platelet-derived growth factor (rhPDGF). Twenty-four subjects received bilateral sinus elevation surgery with ABBM on one side and ABBM and rhPDGF on the contralateral side. Twelve patients had core sampling at 4 to 5 months and 12 patients at 7 to 9 months postoperatively. In subjects with cores taken at 4 to 5 months, mean vital bone, connective tissue, and residual graft were 11.8%, 54.1%, and 33.6%, respectively, with ABBM alone. Cores of sinuses filled with ABBM and rhPDGF showed mean 21.1% vital bone, 51.4% connective tissue, and 24.8% residual graft. Paired t test showed a statistically significant difference in vital bone. In cores taken at 7 to 9 months, the values for ABBM alone and ABBM + rhPDGF were 21.4% vs 19.5% vital bone, 28.4% vs 44.2% connective tissue, and 40.3% residual graft vs 35.5%. There was no statistically significant difference in vital bone at 7 to 9 months after surgery. Test and control groups showed clinically acceptable levels of vital bone both at 4 to 5 months and 7 to 9 months postsurgery. However, vital bone formation was significantly greater in the 4- to 5-month sections of ABBM + rhPDGF vs the Bio-Oss alone. In the 7- to 9-month specimens, this difference disappeared. More rapid formation of vital bone with the addition of rhPDGF may allow for earlier implant placement.

Augmented reality as an aid in maxillofacial surgery: validation of a wearable system allowing maxillary repositioning.

PubMed

Badiali, Giovanni; Ferrari, Vincenzo; Cutolo, Fabrizio; Freschi, Cinzia; Caramella, Davide; Bianchi, Alberto; Marchetti, Claudio

2014-12-01

We present a newly designed, localiser-free, head-mounted system featuring augmented reality as an aid to maxillofacial bone surgery, and assess the potential utility of the device by conducting a feasibility study and validation. Our head-mounted wearable system facilitating augmented surgery was developed as a stand-alone, video-based, see-through device in which the visual features were adapted to facilitate maxillofacial bone surgery. We implement a strategy designed to present augmented reality information to the operating surgeon. LeFort1 osteotomy was chosen as the test procedure. The system is designed to exhibit virtual planning overlaying the details of a real patient. We implemented a method allowing performance of waferless, augmented-reality assisted bone repositioning. In vitro testing was conducted on a physical replica of a human skull, and the augmented reality system was used to perform LeFort1 maxillary repositioning. Surgical accuracy was measured with the aid of an optical navigation system that recorded the coordinates of three reference points (located in anterior, posterior right, and posterior left positions) on the repositioned maxilla. The outcomes were compared with those expected to be achievable in a three-dimensional environment. Data were derived using three levels of surgical planning, of increasing complexity, and for nine different operators with varying levels of surgical skill. The mean error was 1.70 ± 0.51 mm. The axial errors were 0.89 ± 0.54 mm on the sagittal axis, 0.60 ± 0.20 mm on the frontal axis, and 1.06 ± 0.40 mm on the craniocaudal axis. The simplest plan was associated with a slightly lower mean error (1.58 ± 0.37 mm) compared with the more complex plans (medium: 1.82 ± 0.71 mm; difficult: 1.70 ± 0.45 mm). The mean error for the anterior reference point was lower (1.33 ± 0.58 mm) than those for both the posterior right (1.72 ± 0.24 mm) and posterior left points (2.05 ± 0.47 mm). No significant difference in terms of error was noticed among operators, despite variations in surgical experience. Feedback from surgeons was acceptable; all tests were completed within 15 min and the tool was considered to be both comfortable and usable in practice. We used a new localiser-free, head-mounted, wearable, stereoscopic, video see-through display to develop a useful strategy affording surgeons access to augmented reality information. Our device appears to be accurate when used to assist in waferless maxillary repositioning. Our results suggest that the method can potentially be extended for use with many surgical procedures on the facial skeleton. Further, our positive results suggest that it would be appropriate to proceed to in vivo testing to assess surgical accuracy under real clinical conditions. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Craniofacial and brain abnormalities in Laron syndrome (primary growth hormone insensitivity).

PubMed

Kornreich, L; Horev, G; Schwarz, M; Karmazyn, B; Laron, Z

2002-04-01

To investigate abnormalities in the craniofacial structures and in the brain in patients with Laron syndrome. Eleven patients with classical Laron syndrome, nine untreated adults aged 36-68 years and two children aged 4 and 9 years (the latter treated by IGF-I), were studied. Magnetic resonance images of the brain were obtained in all the patients. One patient also underwent computed tomography. The maximal diameter of the maxillary and frontal sinuses was measured and compared with reference values, the size of the sphenoid sinus was evaluated in relation to the sella, and the mastoids were evaluated qualitatively (small or normal). The brain was evaluated for congenital anomalies and parenchymal lesions. In the adult untreated patients, the paranasal sinuses and mastoids were small; in six patients, the bone marrow in the base of the skull was not mature. The diploe of the calvaria was thin. On computed tomography in one adult patient, the sutures were still open. A minimal or mild degree of diffuse brain parenchymal loss was seen in ten patients. One patient demonstrated a lacunar infarct and another periventricular high signals on T2-weighted images. Two patients had cerebellar atrophy. The present study has demonstrated the important role IGF-I plays in the development of the brain and bony structures of the cranium.

The efficacy of short (6 mm) dental implants with a novel thread design.

PubMed

Bechara, Soheil; Nimčenko, Tatjana; Kubilius, Ričardas

2017-01-01

To assess efficacy of short (6 mm) implants with a novel macrostructure and thread design placed in a compromised bone situations of edentulous posterior regions of maxilla (3-4 mm of bone height under sinus floor) as compared to results of clinical situations treated with simultaneous maxillary sinus grafting and placement of long (≥10 mm) implants of the same company. Clinical cases of conducted clinical study. Patients with compromised bone height in edentulous posterior regions of maxilla were randomly divided into two groups. Short (6mm length) implant treatment conducted in the test group and simultaneous sinus lift with standard length implant placement treatment in the control group. In general implant stability quotient (ISQ) and marginal bone level (MBL) changes values in both groups were comparable. However, significant negative correlation was found between implant's diameter and MBL changes. Implant's length has little if none impact on initial implant anchorage, especially in greatly compromised residual bone situations. Results have confirmed that implant initial stability mainly depends on implant's macro-design and further its development on implant's micro-design: namely, implant diameter rather than length, tapered shape and improved thread design determines primarily acquired mechanical anchorage, while bioactive surface treatment ensures development of biological stability.

Two-stage implant systems.

PubMed

Fritz, M E

1999-06-01

Since the advent of osseointegration approximately 20 years ago, there has been a great deal of scientific data developed on two-stage integrated implant systems. Although these implants were originally designed primarily for fixed prostheses in the mandibular arch, they have been used in partially dentate patients, in patients needing overdentures, and in single-tooth restorations. In addition, this implant system has been placed in extraction sites, in bone-grafted areas, and in maxillary sinus elevations. Often, the documentation of these procedures has lagged. In addition, most of the reports use survival criteria to describe results, often providing overly optimistic data. It can be said that the literature describes a true adhesion of the epithelium to the implant similar to adhesion to teeth, that two-stage implants appear to have direct contact somewhere between 50% and 70% of the implant surface, that the microbial flora of the two-stage implant system closely resembles that of the natural tooth, and that the microbiology of periodontitis appears to be closely related to peri-implantitis. In evaluations of the data from implant placement in all of the above-noted situations by means of meta-analysis, it appears that there is a strong case that two-stage dental implants are successful, usually showing a confidence interval of over 90%. It also appears that the mandibular implants are more successful than maxillary implants. Studies also show that overdenture therapy is valid, and that single-tooth implants and implants placed in partially dentate mouths have a success rate that is quite good, although not quite as high as in the fully edentulous dentition. It would also appear that the potential causes of failure in the two-stage dental implant systems are peri-implantitis, placement of implants in poor-quality bone, and improper loading of implants. There are now data addressing modifications of the implant surface to alter the percentage of osseointegration. New types of reinforcements for dental implants and the use of growth factors to augment bone regeneration so that implants can be placed more easily are now being actively investigated.

[A historic case of Wegener's granulomatosis: the physicist who discovered the electromagnetic waves: Heinrich Hertz].

PubMed

Feldmann, H

2005-06-01

A diary and an extensive correspondence of Heinrich Hertz and his family provide a meticulous documentation of his life, made available by Albrecht Folsing in 1997 through a carefully investigated biography, which permit the conclusion that H. Hertz died of Wegener's granulomatosis, 45 years before this disease had been explored. WEGENER'S GRANULOMATOSIS: The symptoms of the granulomatosis, that was first described by Friedrich Wegener in 1936 and 1939 are presented in short with literal quotations of the author: It begins with a refractory cold that will last until the end, then follow involvement of the paranasal sinuses, ears, mucous lining of mouth and pharynx, slight fever, weakness, in the final phase dissemination with nephritis, septic fever, arthritis, myalgia, paralyses leading to total immobility, exitus. The etiology is not fully understood but probably based on immunoreaction. H. HERTZ: CURRICULUM VITAE: Born in Hamburg, Germany, in 1857: after secondary school academic training in physics at Dresden, Munic and Berlin. 1885 professor of physics in Karlsruhe, then starting in 1889 at Bonn. 1887/88 exploration of the electromagnetic waves, now the basis for all radio communication, and exploration of the photoelectric effect, the basis of solar techniques. Numerous highranking distinctions. H. HERTZ: The case history is presented in detail based on numerous literal quotations from personal letters and the diary. After a few banal affections involving the teeth and toes the systemic disease became manifest in summer 1892 with a refractory cold which remained the focus of treatment until death. Granulation tissue in the nose that was excised several times: no tuberculosis, no carcinoma. Otitis with purulent mastoiditis, in October 1892 mastoidectomy, persistent purulence. Early in 1893 diagnosis of nephritis. Extraction of a superior tooth, punturing of the maxillary sinus, then twice radical opening of the maxillary sinus. Painful ankylosis and paralyses ending in complete immobility, hyperthermy, exitus on Jan. 1 1894. The case history is repeated in short and discussed. At that time a diagnosis and an effective therapy were not available. Today the disease could have been kept under control applying immunosuppressive and antibiotic treatment.

Influence of a collagen membrane positioned subjacent the sinus mucosa following the elevation of the maxillary sinus. A histomorphometric study in rabbits.

PubMed

Iida, Takahisa; Carneiro Martins Neto, Evandro; Botticelli, Daniele; Apaza Alccayhuaman, Karol Alí; Lang, Niklaus P; Xavier, Samuel P

2017-12-01

To evaluate the healing after elevation of the sinus mucosa when a collagen membrane was placed between the sinus mucosa and a xenograft used as filler. Eighteen rabbits were used. Sinus mucosa elevation was performed bilaterally, and a collagen membrane was applied subjacent to the sinus mucosa only at a randomly selected test site. At both sites, a collagenated corticocancellous porcine bone was placed within the elevated space and the access window was covered with a collagen membrane. The animals were sacrificed after 2, 4, and 8 weeks of healing, six animals for group. Ground sections were prepared. At the histomorphometric evaluation, the elevated area after 2 and 8 weeks was 11.8 and 8.8 mm 2 at the test, and 10.0 and 5.3 mm 2 at the control sites, respectively. The available area was obtained subtracting the remaining area occupied by the membrane from the elevated area and, after 8 weeks, was 6.7 ± 0.9 mm 2 . After 8 weeks of healing, the mineralized new bone within the elevated space was 18.2 ± 5.5% at the test and 26.7 ± 7.7% at the control sites. Within the available space at the test site, the percentage was 27.3 ± 7.0% after 8 weeks of healing. At 2 and 8 weeks of healing, within the elevated space, the xenograft proportion was 30.9 ± 4.4% and 6.9 ± 2.8% at the test, and 35.2 ± 7.3% and 9.6 ± 4.9% at the control sites, respectively. The placement of a collagen membrane subjacent the sinus mucosa did not reveal any major morphometric difference. The collagen membrane was not completely resorbed after 8 weeks. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Diagnostic aspects of pharyngeal tumors].

PubMed

Savin, A A; Kradinov, A I; Vasil'ev, A Iu; Rogozhin, V A; Ivankov, A P

1999-01-01

In the work there are summarized the results of the examination of the 28 patients suffering with the pharynx tumors (angiophybroma of the pharynx, tumor of rhinopharynx with spreading to the cells of ethmoidal labyrinth and maxillary sinus, tumor of the pharynx spreading upon the rhinopharynx and intracranially) aged from 14 till 62. There are described the methods of roentgenologic investigation, computed and magnetic resonance tomography. There are shown the possibilities of different diagnostic methods in pharynx tumors, in estimation of the localization specification, prevalence, structure, degree of invasion into the neoplasms gathering round the cells, as well as the definition of the bony destruction.

[Iatrogenic risks during the obturation of the root canal system].

PubMed

Aesaert, G

2000-01-01

A hermetic seal is the main goal of obturation of the root canal system. For that purpose guttapercha still remains the filling material of choice. Most filling techniques use plasticized guttapercha and a condensation technique to fulfil the requirements of hermetic seal. The heat to plasticize and the forces applied to condense that material may have an influence on the periodontal ligament and/or the remaining tooth structure. Furthermore can overfilling of guttapercha and more likely the sealer, affect the periodontal tissue. Although rare, mandibular nerve damage and adverse effects on the sinus maxillaris can be the result of inadequate treatment.

Rectus abdominus free flap in the reconstruction of the orbit following subtotal exenteration.

PubMed

Weichel, Eric D; Eiseman, Andrew S; Casler, John D; Bartley, George B

2011-01-01

An 18-year-old woman with recurrent embryonal rhabdomyosarcoma underwent a right subtotal exenteration sparing the eyelids and conjunctiva to remove the tumor. A rectus abdominus muscle free flap was secured to the right temporalis muscle. The temporalis muscle was then advanced into the temporal fossa defect and the rectus abdominus flap placed into the right orbital cavity and right maxillary sinus. An ocular conformer was then placed and a lateral tarsorrhaphy was performed. This surgical technique provides rapid socket rehabilitation with good cosmesis and enables the use of a standard ocular prosthesis.

Biomechanical evaluation of implant-supported prosthesis with various tilting implant angles and bone types in atrophic maxilla: A finite element study.

PubMed

Gümrükçü, Zeynep; Korkmaz, Yavuz Tolga; Korkmaz, Fatih Mehmet

2017-07-01

The purpose of this study is to evaluate and compare bone stress that occurs as a result of using vertical implants with simultaneous sinus augmentation with bone stress generated from oblique implants without sinus augmentation in atrophic maxilla. Six, three-dimensional (3D) finite element (FE) models of atrophic maxilla were generated with SolidWorks software. The maxilla models were varied for two different bone types. Models 2a, 2b and 2c represent maxilla models with D2 bone type. Models 3a, 3b and 3c represent maxilla models with D3 bone type. Five implants were embedded in each model with different configurations for vertical implant insertion with sinus augmentation: Model 2a/Model 3a, 30° tilted insertion; Model 2b/Model 3b and 45° tilted insertion; Model 2c/Model 3c. A 150 N load was applied obliquely on the hybrid prosthesis. The maximum von Mises stress values were comparatively evaluated using color scales. The von Mises stress values predicted by the FE models were higher for all D3 bone models in both cortical and cancellous bone. For the vertical implant models, lower stress values were found in cortical bone. Tilting of the distal implants by 30° increased the stress in the cortical layer compared to vertical implant models. Tilting of the distal implant by 45° decreased the stress in the cortical bone compared to the 30° models, but higher stress values were detected in the 45° models compared to the vertical implant models. Augmentation should be the first treatment option in atrophic maxilla in terms of biomechanics. Tilted posterior implants can create higher stress values than vertical posterior implants. During tilting implant planning, the use of a 45° tilted implant results in better biomechanical performance in peri-implant bone than 30° tilted implant due to the decrease in cantilever length. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Imploding antrum syndrome: three cases with different management approaches].

PubMed

Chavez-Montoya, Ramiro; Araujo-Ramírez, Osvaldo; Castillo-López, Irma Yolanda; Govea-Camacho, Luis Humberto

Silent sinus or imploding antrum syndrome is a very rare condition, consisting of a usually asymptomatic spontaneous collapse of the sinus walls and floor of the orbit. It is associated with negative pressures, and when this occurs, it presents with manifestations such as enophthalmos, hypoglobus, and tilt flow orbital floor. As its incidence is very low, it is frequently missed as a diagnosis, and in fact there are currently fewer than 150 cases reported in the literature. Three patients have been identified in our practice over a period of two years, with different symptoms that influenced the decision of the treatment modality, which were: watch and wait, endoscopic sinus surgery, or endoscopic sinus surgery plus orbitoplasty. Despite being a rare entity, it stills catches the attention of the ENT, OMF surgery and Ophthalmologist. The diagnosis is mainly radiological, due to the late clinical manifestations and symptomatology. The treatment should be individualised and based on the symptoms and the individual decision of each patient, firstly by Functional Endoscopic sinus surgery, and once sinus permeability is restored, it may require augmentation surgery of the orbital floor, either with autologous bone implant, titanium or other material. It is important to be aware of this pathology, to know and to suspect it, avoiding misdiagnosis. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Treatment of chronic desquamative gingivitis using tissue-engineered human cultured gingival epithelial sheets: a case report.

PubMed

Okuda, Kazuhiro; Momose, Manabu; Murata, Masashi; Saito, Yoshinori; lnoie, Masukazu; Shinohara, Chikara; Wolff, Larry F; Yoshie, Hiromasa

2004-04-01

Human cultured gingival epithelial sheets were used as an autologous grafting material for regenerating gingival tissue in the maxillary left and mandibular right quadrants of a patient with chronic desquamative gingivitis. Six months post-surgery in both treated areas, there were gains in keratinized gingiva and no signs of gingival inflammation compared to presurgery. In the maxillary left quadrant, preoperative histopathologic findings revealed the epithelium was separated from the connective tissue and inflammatory cells were extensive. After grafting with the gingival epithelial sheets, inflammatory cells were decreased and separation between epithelium and connective tissue was not observed. The human cultured gingival epithelial sheets fabricated using tissue engineering technology showed significant promise for gingival augmentation in periodontal therapy.

Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study.

PubMed

Jensen, Anders Torp; Jensen, Simon Storgård; Worsaae, Nils

2016-06-01

This retrospective clinical study aims to evaluate complications after augmentation of localized bone defects of the alveolar ridge. From standardized registrations, the following complications related to bone augmentation procedures were recorded: soft tissue dehiscence, infection, sensory disturbance, additional augmentation procedures needed, and early implant failure. A total of 223 patients (132 women, 91 men; mean age 23.5 years; range 17-65 years) with 331 bone defects had bone augmentation performed into which 350 implants were placed. Soft tissue dehiscence occurred in 1.7 % after GBR procedures, 25.9 % after staged horizontal ridge augmentation, and 18.2 % after staged vertical ridge augmentation. Infections were diagnosed in 2 % after GBR procedures, 12.5 % after sinus floor elevation (SFE) (transcrestal technique), 5 % after staged SFE, 11 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. Additional augmentation procedures were needed in 2 % after GBR procedures, 37 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. A total of six early implant failures occurred (1.7 %), four after GBR procedures (1.6 %), and two (12 %) after staged vertical ridge augmentation. Predictable methods exist to augment localized defects in the alveolar ridge, as documented by low complication rates and high early implant survival rates.

Orbital cellulitis: a rare complication after orbital blowout fracture.

PubMed

Ben Simon, Guy J; Bush, Steven; Selva, Dinesh; McNab, Alan A

2005-11-01

To report the incidence of orbital cellulitis after orbital blowout fracture. Retrospective, noncomparative, interventional case series. All patients with orbital cellulitis and a history of recent orbital fracture. A medical record review of clinical history, imaging studies, and surgical and treatment outcome was performed. Resolution of orbital cellulitis and surgical and imaging findings. Four patients (3 male; mean age, 30 years [range, 4.5-58]) were treated for orbital cellulitis complicating orbital fracture. All patients had evidence of paranasal sinusitis before or after the orbital injury, and 2 also reported forceful nose blowing after sustaining orbital trauma. Although 3 patients received prophylactic oral antibiotics after the fracture, this failed to prevent infection. Sinusitis commenced 1 to 2 weeks before and as late as 5 weeks after orbital injury. All patients were treated with IV antibiotics. Two developed an orbital abscess that required surgical drainage; 1 patient improved after an endonasal maxillary antrostomy. One patient improved on IV antibiotics alone and underwent fracture repair at a later stage. These 4 patients represent 0.8% of all cases of orbital fractures treated in the study period. Orbital cellulitis is a rare complication of orbital fracture, and seems to be more common when paranasal sinus infection preexists or occurs within several weeks of the injury. Oral antibiotics given after the orbital injury may not prevent orbital cellulitis or abscess formation. Surgery may be required to drain orbital abscess or in nonresolving cellulitis to drain the paranasal sinuses. Fracture repair, if indicated, should be delayed, particularly if an alloplastic implant is used.

A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea (1996-2015).

PubMed

Yoon, Young Hoon; Xu, Jun; Park, Soo Kyoung; Heo, Jae Hyung; Kim, Yong Min; Rha, Ki-Sang

2017-11-01

Sinonasal fungus ball (FB) is a type of noninvasive fungal rhinosinusitis affecting immunocompetent hosts. FB, previously considered rare, has been reported with increasing frequency. We reviewed our experience of 538 cases over the past 20 years. We retrospectively examined clinical records including clinical presentations, radiological findings, management, and outcomes of FB patients who have undergone surgery for treatment. The number of FB patients who underwent endoscopic sinus surgery (ESS) was calculated annually. Causal relationships between structural variations and FB were also investigated. The number of FB patients who underwent sinus surgery has increased. The mean age was 58.3 years, and the gender ratio was approximately 2 (female): 1 (male). While the most common presenting symptoms of maxillary sinus FB patients were nasal symptoms, such as postnasal drip and nasal obstruction, sphenoid sinus FB patients presented with headache mostly. On computed tomography (CT) scans, the most common finding was intralesional hyperdensity (77.3%). There was no significant correlation between the presence of FB and structural variations (nasal septal deviation, concha bullosa, Haller cell). Median follow-up period of the patients was 11 months. Recurrence or residual disease occurred in only 6 (1.1%) cases. The number of FB patients who underwent surgery has increased steadily over the past 20 years. FB should be considered in patients with unilateral nasal symptoms and unexplained headaches. A preoperative CT scan is an essential tool in making diagnosis easier and faster. Endoscopic surgery is the treatment of choice, with a low morbidity and recurrence rate. © 2017 ARS-AAOA, LLC.

The utility of cadaver dissection in endoscopic sinus surgery training courses.

PubMed

Zuckerman, Jodi D; Wise, Sarah K; Rogers, G Aaron; Senior, Brent A; Schlosser, Rodney J; DelGaudio, John M

2009-01-01

Understanding paranasal sinus anatomy is crucial for successful outcomes in endoscopic sinus surgery (ESS). This study was designed to evaluate subjective and objective differences in ESS cadaver dissections among participants of varying experience levels in association with the use of image guidance and computer-aided technologies in a physician training cadaver dissection laboratory. Participants in a 2-day cadaver dissection course completed daily predissection surveys evaluating subjective comfort with ESS. Pre- and postdissection computer tomography (CT) scans assessed completeness of dissection. Images were analyzed for maxillary antrostomy, frontal and sphenoid sinusotomy, residual ethmoid cells and partitions, and residual frontal recess cells. Fifty-one sides were dissected. Participant comfort increased significantly from day 1 to 2 for overall ESS (p = 0.001) and for individual sinuses (p < 0.001 to p = 0.047). Participants with more years in practice had fewer unopened ethmoid cells (p = 0.015) and frontal recess cells (p = 0.014) on dissection day 1. Participants with increased comfort in ethmoid dissection had fewer retained ethmoid partitions on day 1 (p = 0.017). Observed differences on dissection day 1 for unopened ethmoid and frontal recess cells and retained ethmoid partitions were not present on day 2. No significant differences were found based on use of image guidance for any parameter. Surgeons with increased comfort and more years in practice had more complete endoscopic cadaver dissections initially. Differences among participants diminished on dissection day 2, indicating the ability to review postdissection CT scans may improve surgeon comfort level and completeness of dissection.

The role of mitomycin C in preventing synechia and stenosis after endoscopic sinus surgery.

PubMed

Anand, Vijay K; Tabaee, Abtin; Kacker, Ashutosh; Newman, Jason G; Huang, Clark

2004-01-01

Synechia and stenosis formation after endoscopic sinus surgery (ESS) represents a potential source of surgical failure. Mitomycin C (MMC) has been used successfully in other fields to decrease postoperative scar formation. We hypothesize that the topical application of MMC reduces the incidence of stenosis and synechia formation after ESS. This study is a randomized, controlled, single-blinded study based in a tertiary care teaching hospital. After routine ESS, a pledget soaked in MMC (0.5%) was randomly placed into the middle meatus of one nasal cavity for 5 minutes and a pledget soaked in saline was placed in the contralateral side in each patient. A blinded observer followed the patients for any evidence of stenosis or synechia formation. The medical records of enrolled patients were reviewed for demographics, diagnosis, prior surgery, type of sinus surgery, complications, incidence of stenosis/synechia, and need for further procedures. Twenty-nine patients were included in the final analysis. The mean follow-up period was 15 months (range, 3-32 months). There were no complications in this series. Eight patients experienced 10 episodes of synechia formation and one patient experienced 1 episode of synechia formation and 1 episode of stenosis of the maxillary sinus ostium. Seven of the 12 episodes of synechia/stenosis occurred on the side of the MMC application and the remaining 5 episodes occurred on the side opposite to the MMC application. This difference was not statistically significant. The topical application of MMC did not decrease the incidence of stenosis and synechia formation after ESS.

Extranodal nasal-type NK/T-cell lymphoma of the palate and paranasal sinuses

PubMed Central

Nikolaos, Nikitakis; Grigorios, Polyzois; Konstantinos, Katoumas; Savvas, Titsinides; Vassiliki, Zolota; Alexandra, Sklavounou; Theodoros, Papadas

2012-01-01

Summary Background: Extranodal nasal-type natural killer (NK)/T-cell lymphoma represents a rare entity, typically originating in the nasal cavity, palate or midfacial region. Signs and symptoms include non-specific rhinitis and/or sinusitis, nasal obstruction, epistaxis, facial swelling and development of deep necrotic ulceration in the midline of the palate, causing an oronasal defect. Differential diagnosis includes fungal infections, Wegener’s granulomatosis, tertiary syphilis, other non-Hodgkin’s lymphomas and malignant epithelial midline tumors. Case Report: We present a case of a 40-year-old man complaining of headache, facial pain, nasal congestion and fever. Examination revealed a large deep necrotic ulcer in the middle of the palate, presenting as an oronasal defect. Endoscopic rhinoscopy revealed crusts in the nasal cavities, moderate perforation of the nasal septum cartilage and contraction of the middle and inferior conchae. Computer tomography showed occupation of the maxillary sinuses, ethmoidal cells and sphenoidal sinus by a hyperdense soft tissue mass. Laboratory investigation revealed increased erythrocyte sedimentation rate. A wide excision of the lesion was performed. Histopathological and immunohistochemical evaluation established the diagnosis of extranodal nasal-type NK/T-cell lymphoma. The patient was treated with CHOP chemotherapy, involved-field radiotherapy and autologous bone marrow transplantation. A removable partial denture with obturator was fabricated and inserted to relieve problems caused by the oronasal defect. Conclusions: Extranodal nasal-type NK/T-cell lymphoma is a very aggressive, rapidly progressing malignant neoplasm with a poor prognosis, which can be improved by early diagnosis and combined treatment. PMID:23569495

Comparison between DICOM-calibrated and uncalibrated consumer grade and 6-MP displays under different lighting conditions in panoramic radiography

PubMed Central

Haapea, M; Liukkonen, E; Huumonen, S; Tervonen, O; Nieminen, M T

2015-01-01

Objectives: To compare observer performance in the detection of anatomical structures and pathology in panoramic radiographs using consumer grade with and without digital imaging and communication in medicine (DICOM)-calibration and 6-megapixel (6-MP) displays under different lighting conditions. Methods: 30 panoramic radiographs were randomly evaluated on three displays under bright (510 lx) and dim (16 lx) ambient lighting by two observers with different years of experience. Dentinoenamel junction, dentinal caries and periapical inflammatory lesions, visibility of cortical border of the floor and pathological lesions in maxillary sinus were evaluated. Consensus between the observers was considered as reference. Intraobserver agreement was determined. Proportion of equivalent ratings and weighted kappa were used to assess reliability. The level of significance was set to p < 0.05. Results: The proportion of equivalent ratings with consensus differed between uncalibrated and DICOM-calibrated consumer grade displays in dentinal caries in the lower molar in dim lighting (p = 0.021) and between DICOM-calibrated consumer grade and 6-MP display in bright lighting (p = 0.038) for an experienced observer. Significant differences were found between uncalibrated and DICOM-calibrated consumer grade displays in dentinal caries in bright lighting (p = 0.044) and periapical lesions in the upper molar in dim lighting (p = 0.008) for a less experienced observer. Intraobserver reliability was better at detecting dentinal caries than at detecting periapical and maxillary sinus pathology. Conclusions: DICOM calibration may improve observer performance in panoramic radiography in different lighting conditions. Therefore, a DICOM-calibrated consumer grade display can be used instead of a medical display in dental practice without compromising the diagnostic quality. PMID:25564888

Postoperative Radiotherapy for Maxillary Sinus Cancer: Long-Term Outcomes and Toxicities of Treatment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bristol, Ian J.; Ahamad, Anesa; Garden, Adam S.

2007-07-01

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 metastasismore » 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.« less

Mesenchymal stem cells with osteogenic potential in human maxillary sinus membrane: an in vitro study.

PubMed

Berbéri, Antoine; Al-Nemer, Fatima; Hamade, Eva; Noujeim, Ziad; Badran, Bassam; Zibara, Kazem

2017-06-01

The aim of our study is to prove and validate the existence of an osteogenic progenitor cell population within the human maxillary Schneiderian sinus membrane (hMSSM) and to demonstrate their potential for bone formation. Ten hMSSM samples of approximately 2 × 2 cm were obtained during a surgical nasal approach for treatment of chronic rhinosinusitis and were retained for this study. The derived cells were isolated, cultured, and assayed at passage 3 for their osteogenic potential using the expression of Alkaline phosphatase, alizarin red and Von Kossa staining, flow cytometry, and quantitative real-time polymerase chain reaction. hMSSM-derived cells were isolated, showed homogenous spindle-shaped fibroblast-like morphology, characteristic of mesenchymal progenitor cells (MPCs), and demonstrated very high expression of MPC markers such as STRO-1, CD44, CD90, CD105, and CD73 in all tested passages. In addition, von Kossa and Alizarin red staining showed significant mineralization, a typical feature of osteoblasts. Moreover, alkaline phosphatase (ALP) activity was significantly increased at days 7, 14, 21, and 28 of culture in hMSSM-derived cells grown in osteogenic medium, in comparison to controls. Furthermore, osteogenic differentiation significantly upregulated the transcriptional expression of osteogenic markers such as ALP, Runt-related transcription factor 2 (Runx-2), bone morphogenetic protein (BMP)-2, osteocalcin (OCN), osteonectin (ON), and osteopontin (OPN), confirming that hMSSM-derived cells are of osteoprogenitor origin. Finally, hMSSM-derived cells were also capable of producing OPN proteins upon culturing in an osteogenic medium. Our data showed that hMSSM holds mesenchymal osteoprogenitor cells capable of differentiating to the osteogenic lineage. hMSSM contains potentially multipotent postnatal stem cells providing a promising clinical application in preimplant and implant therapy.

Presentation of a keratocystic odontogenic tumor with agenesis: a case report

PubMed Central

2014-01-01

Introduction We analyzed the etiopathogenetic, clinical, radiographic, and histopathologic aspects of keratocystic odontogenic tumors, particularly in association with dental anomalies of number, with the aim of providing useful information for their correct diagnosis, treatment, and prognosis within a multidisciplinary approach. Case presentation A 14-year-old Caucasian girl presented for observation of bilateral agenesis of the upper incisors, which was diagnosed by orthopantomography. Approximately one year after starting orthodontic treatment, the patient went to the emergency department because of a phlegmonous tumefaction of the lateroposterior upper left maxillary region. Diagnostic orthopantomography and axial computed tomography scan results of the facial skeleton revealed a large lesion occupying the left maxillary sinus, rhizolysis of dental elements 26 and 27, and dislocation of dental element 28. The lesion and infected sinus mucosa were removed through surgical antral-cystectomy with the Caldwell-Luc approach. Histological examination of the lesion confirmed the suspected diagnosis of keratocystic odontogenic tumor. The 12-month follow-up orthopantomography and computed tomography scan results showed good trabecular bone formation in the lesion area. The 24-month follow-up results showed optimal healing in the area of the lesion, positive pulp vitality tests for teeth 26 and 27, and good periodontal tissue healing, as verified through periodontal probing. Conclusions Combined with our observations from a careful review of the literature, the results of the case study suggest that keratocystic odontogenic tumor and dental agenesis probably do not develop through a common genetic cause. More likely, they are caused by related environmental factors. Management of this case required the multidisciplinary collaboration of different specializations and careful planning to devise a correct therapeutic protocol and reach a favorable prognosis. PMID:24716509

Eradication of pathogens from the nasopharynx after therapy of acute maxillary sinusitis with low- or high-dose amoxicillin/clavulanic acid.

PubMed

Brook, Itzhak; Foote, Perry A; Hausfeld, Jeffrey N

2005-11-01

The growing resistance of Streptococcus pneumoniae to penicillin can be overcome by increasing the dose of the penicillin administered. This generated the recommendation that the adult dose of amoxicillin for the treatment of acute maxillary sinusitis (AMS) be increased from 1.5 g/day to 4.0 g/day. The objective of this study was to investigate whether the higher dose of amoxicillin is more effective than the previously recommended dose in eradicating S. pneumoniae from the nasopharynx of patients who present with AMS. Nasopharyngeal cultures obtained from 58 patients with AMS were studied: 30 received amoxicillin 1.5 g/day given in divided doses three times a day for 10 days (amoxicillin/clavulanic acid 4:1 formulation) and 28 were treated with amoxicillin 4.0 g/day given in divided doses twice a day for 10 days (amoxicillin/clavulanic acid 16:1 formulation). Seventy-one potentially pathogenic organisms were isolated: S. pneumoniae (27 isolates), Haemophilus influenzae non-type b (25), Moraxella catarrhalis (5), Streptococcus pyogenes (5) and Staphylococcus aureus (9). The number of S. pneumoniae isolates in the 1.5 g/day group was reduced from 14 to 9 (2 intermediately resistant and 3 highly resistant). In contrast, the number of S. pneumoniae isolates in the 4.0 g/day group was reduced from 13 to 2 (1 highly resistant) (P<0.05). No differences were noted in the eradication rate of other groups of isolates, which were all susceptible to amoxicillin/clavulanic acid. These data illustrate the superiority of 4.0 g/day amoxicillin/clavulanic acid compared with 1.5 g/day amoxicillin/clavulanic acid in the eradication of S. pneumoniae from the nasopharynx.

[Sinusal penetration of amoxicillin-clavulanic acid. Formulation 1 g./125 mg., twice daily versus formulation 500 mg./125 mg., three times daily].

PubMed

Jehl, F; Klossek, J M; Peynegre, R; Serrano, E; Castillo, L; Bobin, S; Desprez, D; Renault, C; Neel, V; Rouffiac, E; Borie, C

2002-10-19

In order to meet the evolution of pneumococcus resistance to beta-lactam antibiotics, a new formulation of amoxicillin (AMX) and clavulanic acid (CA), with twice as much AMX (1 g/125 mg vs. 500 mg/125 mg) was developed for the treatment of acute pneumonia in patients at risk. This formulation can also be used in the treatment of acute maxillary sinusitis using a 1 g/125 mg regimen twice-daily. Compare the sinusal penetration of AMX and CA (1 g/125 mg twice-daily vs. 500 mg/125 mg three times a day) when administered at both regimens to demonstrate equivalent pharmacokinetic and pharmacodynamic behaviour of the former when compared to the latter. Concentrations of AMX and CA were measured in the anterior ethmoid, maxillary, posterior ethmoid sinus and in the middle nasa concha in 62 patients undergoing surgery for nasosinusal polyps. Patients randomised in two groups corresponding to 2 oral regimens, received either 1 g/125 mg twice a day or 500 mg/125 mg three times a day for 4 days. The last dose in both groups was administered 1 h 30, 3, 5 or 8 hrs prior to surgery. Serum samples were taken simultaneously to tissue samples. AMX and CA were measured by high performance liquid chromatography. Exogenous and above all endogenous blood contamination were taken into account with the hematocrit as well as blood and tissue haemoglobin concentrations. Comparisons of tissue concentrations were made for each sampling time, according to values obtained for a specific tissue with both doses on one hand, and on the other to values obtained with a specific dose in different tissues. The calculated pharmacodynamic parameters, which are considered to be predictive for bacteriological and clinical efficacy, result directly from tissue concentrations of AMX. tissue inhibitory quotients (IQtissue = Tissue concentration/MIC). time above MICs for serum and tissue concentrations (T > MIC). As regards AMX, whatever the dose, at 1 h 30 and at 3 hrs, tissue concentrations did not differ significantly whatever the tissue studied (from 1.1 to 2.5 micrograms/g). Conversely, at 5 and 8 hrs, they were greater than after the 1 g/125 mg regimen given twice-daily (0.06-0.7 vs. 0.7-1.8 micrograms/g). If we consider a given dose, the comparison between the various tissues showed identical concentrations in the four tissues studied at each sampling time, except in two cases with the dose of 500 mg/125 mg 3 times a day. T > MIC for serum and tissue showed higher values than those required for AMX/pneumococcus association (40-50%) with, nevertheless, greater tissue values for the 1 g/125 mg dose given twice-daily when MIC was of 1 microgram/ml (40-52% vs. 50-66%). The maximum tissue inhibitory quotients were also greater with the twice-daily 1 g/125 mg dose, when calculated with MIC 50 or 90 of S. Pneumoniae, H. influenzae, M. catarrhalis or S. pyogenes. As for CA, concentrations were equivalent for both doses at each sampling time and greater than those required in vitro during respectively 4 and 5 hours for beta-lactamases H. influenzae and M. catarrhalis. A least an equivalence between both dose regimens was observed, with occasionally a superiority of the twice-daily 1 g/125 mg dose, in terms of pharmacokinetics, tissue penetration and pharmacodynamics for both AMX and CA. This new regimen therefore appears more appropriate for the treatment of acute maxillary sinusitis in adults.

A nonsurgical endodontic treatment in open-apex and immature teeth affected by dens invaginatus: using a collagen membrane as an apical barrier.

PubMed

Gharechahi, Maryam; Ghoddusi, Jamileh

2012-02-01

The authors' objective in this case report is to demonstrate an effective nonsurgical endodontic treatment in open-apex teeth affected by dens invaginatus (DI) by using a collagen membrane as an apical barrier and using a mineral trioxide aggregate (MTA) apical plug. . The authors present two cases of DI with open apexes in maxillary lateral incisors. In the first case, an adolescent had bilateral Oehlers type II DI and extensive periradicular radiolucency, internal root resorption and a vestibular fistula in the left maxillary lateral incisor. In the second case, an adult had Oehlers type II DI and an incomplete apex in the left maxillary lateral incisor. For both patients, the clinician placed a collagen membrane through the apexes of the left maxillary incisors to provide a resorbable extraradicular barrier against which MTA cement could be packed. The clinician obturated the adolescent's right lateral incisor. In the adolescent, the vestibular sinus tract was closed after one week. At subsequent follow-up examinations, the periradicular regions were completely healed, and postoperative radiographs revealed good bone healing in the lateral incisors. The teeth were asymptomatic and healing was achieved without any need for further endodontic surgical intervention. In the adult patient, the tooth was symptom free after one week, and radiography performed six months after the procedure showed complete healing. and Despite complex anatomy and diagnoses of DI and open apexes, both patients successfully underwent nonsurgical endodontic treatment involving the use of a collagen membrane and an MTA apical plug. Using an extraradicular barrier clinically can help improve the adaptation of MTA in the apexes of open-apex teeth to achieve a complete seal.

Cone-beam computed tomography analysis of the vestibular surgical pathway to the palatine root of the maxillary first molar

PubMed Central

Kalender, Atakan; Aksoy, Umut; Basmaci, Fatma; Orhan, Kaan; Orhan, Ayse Isil

2013-01-01

Objective: The aim of this study was to evaluate the anatomical distance between apices of the palatine root of the maxillary first molars to the buccal bone plate to identify the vestibular surgical pathway in a Turkish adult population using cone-beam computed tomography (CBCT) images. Methods: CBCT scans of 107 (48 male and 59 female) patients were retrospectively analyzed. The overall mean age was 38.6 years. The distance between the vestibular cortex and vestibular side of the palatine root was measured for 192 maxillary first molars both on axial images parallel to the palatal plane and on reformatted cross-sectional images. A Pearson’s chi square test and Mann-Whitney U-test were performed to evaluate differences among age, localization, and measurements. Differences were considered statistically significant at P<.05. Results: The mean distance between the buccal cortex and the buccal side of the palatine root of the superior first molar in both male and female patients was 10.13 and 9.70 mm, respectively. The incidence of interposition of the lateral recess of the maxillary sinus between the roots was 42.2% and 49% in men and women, respectively. Statistically significant sex-related differences were found in the vestibular surgical pathway (P<.05). Conclusions: For precise planning of endodontic surgery, it is crucial to determine the exact dimensions and location of the periapical lesion, as well as its relationship with the roots and other neighboring anatomical structures. CBCT can be a powerful tool for the evaluation of surgical cases in three dimensions with less ionizing radiation and better avoidance of complications during surgery. PMID:23408714

Fetal and neo-natal maxillary ontogeny in extant humans and the utility of prenatal maxillary morphology in predicting ancestral affiliation

PubMed Central

Nicholas, Christina L.

2016-01-01

Objectives The midface of extant H. sapiens is known to undergo shape changes through fetal and neo-natal ontogeny; however, little work has been done to quantify these shape changes. Further, while midfacial traits which vary in frequency between populations of extant humans are presumed to develop prenatally, patterns of population-specific variation maxillary shape across ontogeny are not well documented. Only one study of fetal ontogeny which included specific discussion of the midface has taken a 3D geometric morphometric approach, and that study was limited to one population (Japanese). The present research project seeks to augment our understanding of fetal maxillary growth patterns, most especially in terms of intraspecific variation. Materials and Methods Three-dimensional coordinate landmark data were collected on the right maxillae of 102 fetal and neo-natal individuals from three groups (Euro-American, African-American, “Mixed Ancestry”). Results Shape changes were seen mainly in the lateral wall of the piriform aperture, the anterior nasal spine, and the subnasal alveolar region. The greatest difference across age groups (2nd Trimester, 3rd Trimester, Neonates) was between the second and third trimester. Euro-Americans and African-Americans clustered by population and differences in midfacial morphology related to ancestry could be discerned as early as the second trimester (p=0.002), indicating that population variation in maxillary morphology appears very early in ontogeny. Discussion The midface is a critical region of the skull for assessing ancestry and these results indicate that maxillary morphology may be useful for estimating ancestry for prenatal individuals as young as the second trimester. PMID:27412693

Patterns of local recurrence after primary resection of cancers that arise in the sinonasal region and the maxillary alveolus.

PubMed

McMahon, Jeremy D; Wong, Ling Siew; Crowther, John; Taylor, William M; McManners, Joseph; Devine, John C; Wales, Craig; Maciver, Colin

2013-07-01

Local recurrence remains the most important sign of relapse of disease after treatment of advanced cancer of the maxilla and sinonasal region. In this retrospective study we describe patterns of recurrence in a group of patients who had had open resection for cancer of the sinonasal region and posterior maxillary alveolus with curative intent. Casenotes and imaging studies were reviewed to find out the pattern of any relapse, with particular reference to local recurrence. The minimum follow-up period was 12 months. Of 50 patients a total of 16 developed recurrences, 11 of which were local. Of those 11, a total of 8 were in posterior and superior locations (the orbit, the infratemporal and pterygopalatine fossas, the traversing neurovascular canals of the body of the sphenoid to the cavernous sinus, the Gasserian ganglion, and the dura of the middle cranial fossa). Advanced cancer of the midface often equates with disease at the skull base. Treatment, including surgical tactics, should reflect that. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.