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.

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.

Systematic evaluation of a tissue-engineered bone for maxillary sinus augmentation in large animal canine model.

PubMed

Wang, Shaoyi; Zhang, Zhiyuan; Xia, Lunguo; Zhao, Jun; Sun, Xiaojuan; Zhang, Xiuli; Ye, Dongxia; Uludağ, Hasan; Jiang, Xinquan

2010-01-01

The objective of this study is to systematically evaluate the effects of a tissue-engineered bone complex for maxillary sinus augmentation in a canine model. Twelve sinus floor augmentation surgeries in 6 animals were performed bilaterally and randomly repaired with the following 3 groups of grafts: group A consisted of tissue-engineered osteoblasts/beta-TCP complex (n=4); group B consisted of beta-TCP alone (n=4); group C consisted of autogenous bone obtained from iliac crest as a positive control (n=4). All dogs had uneventful healings following the surgery. Sequential polychrome fluorescent labeling, maxillofacial CT, microhardness tests, as well as histological and histomorphometric analyses indicated that the tissue-engineered osteoblasts/beta-TCP complex dramatically promoted bone formation and mineralization and maximally maintained the height and volume of elevated maxillary sinus. By comparison, both control groups of beta-TCP or autologous iliac bone showed considerable resorption and replacement by fibrous or fatty tissue. We thus conclude that beta-TCP alone could barely maintain the height and volume of the elevated sinus floor, and that the transplantation of autogenous osteoblasts on beta-TCP could promote earlier bone formation and mineralization, maximally maintain height, volume and increase the compressive strength of augmented maxillary sinus. This tissue engineered bone complex might be a better alternative to autologous bone for the clinical edentulous maxillary sinus augmentation. Copyright (c) 2009 Elsevier Inc. All rights reserved.

Trifactorial classification system for osteotome sinus floor elevation based on an observational retrospective analysis of 926 implants followed up to 10 years.

PubMed

French, David; Nadji, Nabil; Liu, Shawn X; Larjava, Hannu

2015-06-01

A novel osteotome trifactorial classification system is proposed for transcrestal osteotome-mediated sinus floor elevation (OSFE) sites that includes residual bone height (RBH), sinus floor anatomy (contour), and multiple versus single sites OSFE (tenting). An analysis of RBH, contour, and tenting was retrospectively applied to a cohort of 926 implants placed using OSFE without added bone graft and followed up to 10 years. RBH was divided into three groups: high (RBH > 6 mm), mid (RBH = 4.1 to 6 mm), and low (RBH = 2 to 4 mm). The sinus "contour" was divided into four groups: flat, concave, angle, and septa. For "tenting", single versus multiple adjacent OSFE sites were compared. The prevalence of flat sinus floors increased as RBH decreased. RBH was a significant predictor of failure with rates as follows: low- RBH = 5.1%, mid-RBH = 1.5%, and high-RBH = 0.4%. Flat sinus floors and single sites as compared to multiple sites had higher observed failure rates but neither achieved statistical significance; however, the power of the study was limited by low numbers of failures. The osteotome trifactorial classification system as proposed can assist planning OSFE cases and may allow better comparison of future OSFE studies.

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.

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

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

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.

Histomorphometric analysis after maxillary sinus floor augmentation using cancellous bone-block allograft.

PubMed

Chaushu, Gavriel; Vered, Marilena; Mardinger, Ofer; Nissan, Joseph

2010-08-01

Cancellous bone-block allografts may contribute to improved initial implant stability during sinus augmentation in cases with posterior atrophic maxillary ridge height < or =4 mm. The present study histologically and histomorphometrically evaluates the application of cancellous bone-block allografts for maxillary sinus-floor augmentation. Thirty-one consecutive patients, 16 females and 15 males (age range, 25 to 65 years; mean age: 54 +/- 9 years) underwent sinus augmentation with simultaneous implant placement with cancellous bone-block allografts. After 9 months, a second-stage surgery was performed. The previous window location was determined. A cylindrical sample core was collected. All specimens were prepared for histologic and histomorphometric examinations. Seventy-two of 76 implants were clinically osseointegrated (94.7%). All patients received a fixed implant-supported prosthesis. The mean t values of newly formed bone, residual cancellous bone-block allograft, marrow and connective tissue were 26.1% +/- 15% (range: 10% to 58%); 24.7% +/- 19.4% (range: 0.6% to 71%), and 49.2% +/- 20.4% (range: 14.9% to 78.9%), respectively. No statistically significant histomorphometric differences regarding newly formed bone were found between genders (27.02% in males versus 25.68% in females; P = 0.446), ages (29.82% in subjects < or =40 years old versus 24.43% in subjects >40 years old; P = 0.293), presence of membrane perforations (25.5% in non-perforated sinuses versus 27.3% in perforated sinuses; P = 0.427), and residual alveolar bone height (25.85% for residual alveolar bone height <2 mm versus 26.48% for residual alveolar bone height of 2 to 4 mm; P = 0.473). The cancellous bone-block allograft is biocompatible and osteoconductive and permits new bone formation in sinus augmentations with simultaneous implant-placement procedures in extremely atrophic posterior maxillae.

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

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.

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.

The effect of patient age on bone formation using a fully synthetic nanocrystalline bone augmentation material in maxillary sinus grafting.

PubMed

Wolf, Michael; Wurm, Alexander; Heinemann, Friedhelm; Gerber, Thomas; Reichert, Christoph; Jäger, Andreas; Götz, Werner

2014-01-01

Maxillary sinus floor augmentation is a treatment that has been proposed for patients in whom the alveolar bone height is insufficient. This procedure is commonly used in patients aged 40 to 70 years and older. However, little information exists whether the factor of age might influence the outcome of augmentation procedures. The aim of this study was to investigate whether the patient's age has an effect on bone formation and incorporation in maxillary sinus floor augmentation procedures. A fully synthetic nanocrystalline bone augmentation material (NanoBone, Artoss) was used for sinus floor augmentation in patients with a subantral vertical bone height of at least 3 mm and maximum of 7 mm. After 7 months healing time, biopsy specimens were taken and were divided into two groups according to the patient's age. Exclusion criteria were poor general health (eg, severe renal/and or liver disease), history of a radiotherapy in the head region, chemotherapy at the time of surgical procedure, noncompensated diabetes mellitus, symptoms of a maxillary sinus disease, active periodontal or systemic diseases, smoking, and poor oral hygiene. Histologic analyses with hematoxylin-eosin stain were performed. Multinucleated osteoclast-like cells were identified by histochemical staining (tartrate-resistant acid phosphatase [TRAP]). Quantitative and age-dependent assessment of bone formation, residual bone grafting material, and soft tissue formation following sinus augmentation was performed using histomorphometric analysis and the Bonferroni adjustment of the Student t test. Twenty biopsy specimens from 17 patients were taken and divided into two groups according to age (group 1: 41 to 52 years; group 2: 66 to 71 years) containing 10 specimens each, which were analyzed in triplicate resulting in a total of 30 specimens per group. A regeneration process with varying amounts of newly formed bone surrounded by marrow-like tissue was present in all augmented regions. No signs of inflammation or immune reactions were visible. Residual particles of the augmentation material could be observed within the specimens. An age-dependent difference in investigated parameters between the two age groups could not be documented. The histologic examinations confirm that the fully synthetic nanocrystalline bone augmentation material used in this study is biocompatible and allows maxillary sinus augmentation in patients aged 41 to 70 years.

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.

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.

Schneiderian membrane detachment using transcrestal hydrodynamic ultrasonic cavitational sinus lift: a human cadaver head study and histologic analysis.

PubMed

Troedhan, Angelo; Kurrek, Andreas; Wainwright, Marcel; Jank, Siegfried

2014-08-01

Recent studies have suggested the osteogenic layer of the periosteum at the base of the sinus membrane to play a key role in bone regeneration after sinus lift procedures. Thus, atraumatic detachment of the sinus membrane with an intact periosteum seems mandatory. The present histologic study of fresh human cadaver heads investigated the detachment behavior and histologic integrity of the detached periosteum after application of the transcrestal hydrodynamic ultrasonic cavitational sinus lift (tHUCSL-INTRALIFT). A total of 15 sinuses in 8 fresh human cadaver heads were treated using tHUCSL-INTRALIFT. After surgery, they were checked macroscopically for damage to the sinus membrane and then processed for histologic inspection under light microscopy. A total of 150 histologic specimens, randomly selected from the core surgical sites, were investigated using hematoxylin-eosin (HE), Azan, and trichrome staining. None of the 150 inspected specimens showed any perforation or dissection of the periosteum from the subepithelial connective tissue and respiratory epithelium and were fully detached from the bony antrum floor. The connecting Sharpey fibers revealed to be cleanly separated from the sinus floor in all specimens. The results of the present study suggest tHUCSL-INTRALIFT should be used to perform predictable and safe detachment of the periosteum from the bony sinus floor as a prerequisite for undisturbed and successful physiologic subantral bone regeneration. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

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.

Equine-derived bone mineral matrix for maxillary sinus floor augmentation: a clinical, radiographic, histologic, and histomorphometric case series.

PubMed

Nevins, Myron; Heinemann, Friedhelm; Janke, Ulrich W; Lombardi, Teresa; Nisand, David; Rocchietta, Isabella; Santoro, Giacomo; Schupbach, Peter; Kim, David M

2013-01-01

The objective of this proof-of-principle multicenter case series was to examine the bone regenerative potential of a newly introduced equine-derived bone mineral matrix (Equimatrix) to provide human sinus augmentation for the purpose of implant placement in the posterior maxilla. There were 10 patients requiring 12 maxillary sinus augmentations enrolled in this study. Histologic results at 6 months demonstrated abundant amounts of vital new bone in intimate contact with residual graft particles. Active bridging between residual graft particles with newly regenerated bone was routinely observed in intact core specimens. A mean value of 23.4% vital bone formation was observed at 6 months. This compared favorably with previous results using xenografts to produce bone in the maxillary sinus for the purpose of dental implant placement. Both the qualitative and quantitative results of this case series suggest comparable bone regenerative results at 6 months to bovine-derived xenografts.

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.

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 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

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.

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.

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

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.

A prospective 1-year clinical and radiographic study of implants placed after maxillary sinus floor augmentation with synthetic biphasic calcium phosphate or deproteinized bovine bone.

PubMed

Lindgren, Christer; Mordenfeld, Arne; Hallman, Mats

2012-03-01

The technique of using bone grafts or different biomaterials for augmentation of the maxillary sinus prior to implant placement is well accepted by clinicians. However, clinical documentation of some bone substitutes is still lacking. This prospective study was designed to evaluate the success rate of implants placed after maxillary sinus augmentation with a novel synthetic biphasic calcium phosphate (BCP) or deproteinized bovine bone (DBB), the latter acting as control. Nine edentulous patients and two partially edentulous patients with a mean age of 67 years with a bilateral need for sinus augmentation, < 5 mm residual bone in the floor of the sinus and a crestal width ≥ 4 mm, were included in the study. After bilateral elevation of the Schneiderian membrane, all patients were randomized for augmentation with synthetic BCP in one side and DBB in the contralateral side. After 8 months of graft healing, 62 implants with an SLActive surface were placed. Implant survival, graft resorption, plaque index, bleeding on probing, sulcus bleeding index, probing pocket depth, and implant success rate were evaluated after 1 year of functional loading. After a mean of 118 days, all patients received their fixed prosthetic constructions. One implant was lost in each biomaterial, giving an overall survival rate of 96.8%. Success rates for implants placed in BCP and DBB were 91.7 and 95.7%, respectively. No significant difference in marginal bone loss was found around implants placed in BCP, DBB, or residual bone, respectively. The mean graft resorption was 0.43 mm (BCP) and 0.29 mm (DBB). In this limited study, implant success rate was not dependent on the biomaterial used for maxillary sinus augmentation. Similar results were found after 1 year of functional loading for implants placed after sinus augmentation using BCP or DBB. © 2010 Wiley Periodicals, Inc.

The friction free osteotome technique: introduction of a modified approach.

PubMed

Thalmair, Tobias; Fickl, Stefan; Bolz, Wolfgang; Wachtel, Hannes

2009-01-01

The current literature suggests that the bone-condensing approach while performing internal sinus floor elevation may not be beneficial for the future implant site. Furthermore, even with refined procedures, a predictable and controlled infraction of the sinus floor prior to graft placement still seems to be technique sensitive. In this context, the present article presents a modified technique along with the use of parallel osteotomes devoid of any contact to the lateral osteotomy wall. Therefore, compression of the adjacent bone will be avoided and the tactility of the site for the surgeon will be preserved as the osteotome is solely in contact with the subsinus cortex.

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.

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

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.

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.

Histomorphometric analysis of newly formed bone after bilateral maxillary sinus augmentation using two different osteoconductive materials and internal collagen membrane.

PubMed

Kolerman, Roni; Samorodnitzky-Naveh, Gili R; Barnea, Eitan; Tal, Haim

2012-02-01

Deproteinized bovine bone mineral (DBBM) and human freeze-dried bone allograft (FDBA) were compared in five patients undergoing bilateral maxillary sinus floor augmentation using DBBM on one side and FDBA on the contralateral side. After 9 months, core biopsy specimens were harvested. Mean newly formed bone values were 31.8% and 27.2% at FDBA and DBBM sites, respectively (P = .451); mean residual graft particle values were 21.5% and 24.2%, respectively (P = .619); and mean connective tissue values were 46.7% and 48.6%, respectively (P = .566). Within the limits of the present study, it is suggested that both graft materials are equally suitable for sinus augmentation.

Predictive value of ridge dimensions on autologous bone graft resorption in staged maxillary sinus augmentation surgery using Cone-Beam CT.

PubMed

Klijn, R J; van den Beucken, J J J P; Bronkhorst, E M; Berge, S J; Meijer, G J; Jansen, J A

2012-04-01

No studies are available that provide predictive parameters regarding the expected amount of resorption after maxillary sinus augmentation surgery using autologous bone grafts. Therefore, the aim of this study was to determine parameters influencing the outcome of the bone graft resorption process. In 20 patients, three-dimensional analysis of alveolar ridge dimensions and bone graft volume change in the atrophic posterior maxilla was performed by Cone-Beam Computerized Tomography imaging. Ridge dimensions were assessed before maxillary sinus augmentation surgery. Bone graft volumes were compared after maxillary sinus floor augmentation surgery and a graft healing interval of several months. To analyze the relation between bone volume changes with the independent variables, patients' gender, age, alveolar crest height and width, and graft healing time interval, a multi-level extension of linear regression was applied. A residual bone height of 6.0 mm (SD = 3.6 mm) and 6.2 mm (SD = 3.6 mm) was found at the left and right sides, respectively. Moreover, alveolar bone widths of 6.5 mm (SD = 2.2 mm) and 7.0 mm (SD = 2.3 mm) at the premolars, and 8.8 mm (SD = 2.2 mm) and 8.9 mm (SD = 2.5 mm) at the molars regions were found at the left and right site, respectively. Bone graft volume decreased by 25.0% (SD = 21.0%) after 4.7 months (SD = 2.7, median = 4.0 months) of healing time. The variables "age" (P = 0.009) and mean alveolar crest "bone height" (P = 0.043), showed a significant influence on bone graft resorption. A decrease of 1.0% (SE = 0.3%) of bone graft resorption was found for each year the patient grew older, and an increase in bone graft resorption of 1.8% (SE = 0.8%) was found for each mm of original bone height before sinus floor augmentation. Graft resorption occurs when using autologous bone grafts for maxillary sinus augmentation. Alveolar crest bone height and patient age have a significant effect on graft resorption, with increased resorption for higher alveolar crest bone height and decreased resorption for older patients. Consequently, patient characteristics that affect the process of bone graft resorption should be given full consideration, when performing sinus augmentation surgery. © 2011 John Wiley & Sons A/S.

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.

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.

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.

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.

The effect of cigarette smoking and native bone height on dental implants placed immediately in sinuses grafted by hydraulic condensation.

PubMed

Lin, Thomas H S; Chen, Leon; Cha, Jennifer; Jeffcoat, Marjorie; Kao, Daniel W K; Nevins, Myron; Fiorellini, Joseph P

2012-06-01

The purpose of this study was to determine the effect of cigarette smoking and residual native bone height on the survival of dental implants placed immediately in grafted sinuses. In this retrospective study, 334 subject records were screened, and 75 subjects (155 implants) were included. Data collection based on treatment notes and radiographs included age, sex, smoking status, sinus floor bone height, dental implant information, and implant survival. The survival rates of implants for nonsmokers and smokers at stage-two surgery were 93% and 84%, respectively. After 12 months of functional loading, the survival rates of implants for nonsmokers and smokers were 87% (81 of 93) and 79% (49 of 62), respectively (P < .000). Analysis revealed that the effect of smoking on implant survival is significant when the preoperative bone height is less than 4 mm, with an 82.4% implant survival rate in nonsmokers compared to 60% in smokers (P < .05). Smoking should be considered as a high risk factor when implants are placed immediately in grafted sinuses, particularly in areas of limited bone height.

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.

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.

Bilateral sinus elevation evaluating plasma rich in growth factors technology: a report of five cases.

PubMed

Anitua, Eduardo; Prado, Roberto; Orive, Gorka

2012-03-01

The purpose of this study was to evaluate the potential effects of plasma rich in growth factors (PRGF) technology and its autologous formulations in five consecutive patients in which bilateral sinus lift augmentation was carried out. Five consecutive patients received bilateral sinus floor augmentation. All patients presented a residual bone height of class D (1-3 mm). The effects of PRGF combined with bovine anorganic bone (one side) were compared with the biomaterial alone (contralateral side). The effects of using liquid PRGF to maintain the bone window and autologous fibrin membrane to seal the defect were evaluated. A complete histological and histomorphometrical analysis was performed 5 months after surgery. One patient was excluded from the study as the Schneiderian membrane of the control side was perforated during the surgery. In two patients, the biopsies obtained from the control sides 5 months postsurgery were not acceptable for processing. PRGF technology facilitated the surgical approach of sinus floor elevation. The control area was more inflamed than the area treated with PRGF technology. Patients referred also to an increased sensation of pain in the control area. PRGF-treated samples had more new vital bone than controls. In patient number 1, image processing revealed 21.4% new vital bone in the PRGF area versus 8.4% in the control area, whereas in patient number 2, 28.4% new vital bone was quantified in the PRGF area compared with the 8.2% of the control side. The immunohistochemical processing of the biopsies revealed that the number of blood vessels per square millimeter of connective tissue was 116 vessels in the PRGF sample versus 7 in the control biopsy. These preliminary results suggest that from a practical point of view, PRGF may present a role in reducing tissue inflammation after surgery, increasing new bone formation and promoting the vascularization of bone tissue. © 2010 Wiley Periodicals, Inc.

Effects of leukocyte-platelet rich fibrin on postoperative complications of direct sinus lifting.

PubMed

Gurler, Gokhan; Delilbasi, Cagri

2016-08-01

Blood products have been widely used in soft tissue and bone regeneration in oral and maxillofacial surgery. The purpose of this study is to evaluate the effects of leukocyte-platelet rich fibrin (L-PRF) following direct sinus lifting procedure. Twenty-eight patients were included in the study. Direct sinus lifting was performed via lateral window approach under conscious sedation and local anesthesia. Bony window and sinus floor elevation were performed using piezosurgery device. Two groups were formed. In the first group an allogenous bone graft and L-PRF mixture was used as grafting material. The L-PRF membrane was used to close the lateral window. In the second group, only allogenous bone was used for grafting and resorbable collagen membrane was used to close the lateral window. Pain, swelling, sleeping, eating, phonetics, activities of daily living, missed work days and soft tissue healing were evaluated postoperatively. Data of 24 patients were evaluated. Improvements were seen in the studied parameters in the L-PRF group; however, the difference was not significant between the two groups (P>0.05). The use of L-PRF and allogenous bone graft in combination with L-PRF membrane does not significantly improve postoperative complications following direct sinus lifting.

A lateral approach for sinus elevation using PRGF technology.

PubMed

Anitua, Eduardo; Prado, Roberto; Orive, Gorka

2009-10-01

A lateral approach for sinus elevation using plasma rich in growth factors (PRGF) technology is described. The long-term survival of dental implants installed following a two-stage procedure after sinus elevation using this procedure is reported, using implant loss as the outcome variable. A retrospective cohort study design was used. Eighteen patients received 43 implants (BTI implants, Biotechnology Institute, Vitoria, Spain) with sinus floor elevation. All patients presented a residual bone height of class D (1-3 mm). Implants were installed using a low-speed drilling procedure (50 rpm) without irrigation. Finally, the histological and histomorphometric evaluation of eight samples from PRGF grafted sinus involved in the study was carried out 5-6 months posttreatment. The overall survival rate of dental implants was 100%. The mean follow-up period for all implants was 33 +/- 7 months ranging from 24 to 44 months. In addition, the histomorphometrical evaluation of the samples evidenced a 25.24 +/- 4.62% of vital newly formed bone, 50.31 +/- 15.56% of soft connective tissue, and the remaining 24.46 +/- 12.79% of bovine anorganic bone. Based on these results, this new approach for sinus elevation and implant installation using PRGF technology can be considered safe, simple, effective, and predictable.

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.

[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.

[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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

Maxillary Sinus Augmentation for Dental Implant Rehabilitation of the Edentulous Ridge: A Comprehensive Overview of Systematic Reviews.

PubMed

Ting, Miriam; Rice, Jeremy G; Braid, Stanton M; Lee, Cameron Y S; Suzuki, Jon B

2017-06-01

The objective of this systemic review was to perform a comprehensive overview of systematic reviews and meta-analyses of the maxillary sinus augmentation procedure for implant rehabilitation in humans. The following were evaluated in this overview: (1) anatomic variables affecting sinus augmentation, (2) histomorphometric analysis of the grafted sinus, (3) volumetric changes after sinus grafting, and (4) implant survival beyond 1 year. Electronic databases were searched for systematic reviews and meta-analyses of implant-related sinus augmentation published from 1976 to September 2015. The studies selected must identify itself as a systemic review or meta-analysis in the title or abstract and must pertain to sinus augmentation. Thirty-three publications fulfilled the review criteria. The AMSTAR ratings for the 33 chosen reviews scored greater than 3 of 11, with 8 reviews scoring greater or equal to 8 of 11. The outcome of this overview suggested that the following will increase the success of sinus augmentation and survival of implants placed in the grafted sinus: (1) the use of barrier membranes over the lateral window when using a lateral approach to graft the sinus, (2) the use of particulate autogenous bone with or without other substitute graft materials, (3) sinus augmentation without the use of grafting materials may be considered provided that the space between the sinus membrane and floor can be maintained, (4) the use of rough-surfaced implants, (5) simultaneous implant placement with residual bone height greater than 4 mm, and (6) the cessation of smoking.

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.

Trans-zygomatic middle cranial fossa approach to access lesions around the cavernous sinus and anterior parahippocampus: a minimally invasive skull base approach.

PubMed

Melamed, Itay; Tubbs, R Shane; Payner, Troy D; Cohen-Gadol, Aaron A

2009-08-01

Exposure of the cavernous sinus or anterior parahippocampus often involves a wide exposure of the temporal lobe and mobilization of the temporalis muscle associated with temporal lobe retraction. The authors present a cadaveric study to illustrate the feasibility, advantages and landmarks necessary to perform a trans-zygomatic middle fossa approach to lesions around the cavernous sinus and anterior parahippocampus. The authors performed bilateral trans-zygomatic middle fossae exposures to reach the cavernous sinus and parahippocampus in five cadavers (10 sides). We assessed the morbidity associated with this procedure and compared the indications, advantages, and disadvantages of this method versus more extensive skull base approaches. A vertical linear incision along the middle portion of the zygomatic arch was extended one finger breadth inferior to the inferior edge of the zygomatic arch. Careful dissection inferior to the arch allowed preservation of facial nerve branches. A zygomatic osteotomy was followed via a linear incision through the temporalis muscle and exposure of the middle cranial fossa floor. A craniotomy along the inferolateral temporal bone and middle fossa floor allowed extradural dissection along the middle fossa floor and exposure of the cavernous sinus including all three divisions of the trigeminal nerve. Intradural inspection demonstrated adequate exposure of the parahippocampus. Exposure of the latter required minimal or no retraction of the temporal lobe. The trans-zygomatic middle fossa approach is a simplified skull base exposure using a linear incision, which may avoid the invasivity of more extensive skull base approaches while providing an adequate corridor for resection of cavernous sinus and parahippocampus lesions. The advantages of this approach include its efficiency, ease, minimalism, preservation of the temporalis muscle, and minimal retraction of the temporal lobe.

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.

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.

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.

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.

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.

[Perioperative nursing of internal sinus floor elevation surgery with piezosurgery].

PubMed

He, Jing; Lei, Yiling; Wang, Liqiong

2013-12-01

This study aims to summarize the nursing experience in the internal sinus floor elevation surgery with piezosurgery. The medical records of 48 patients who underwent sinus floor elevation surgery with piezosurgery in the Department of Implantation, West China Hospital of Stomatology, Sichuan University, were reviewed. The preoperative, intraoperative, and postoperative nursing methods were summarized. All 48 patients underwent smooth surgeries and did not encounter complications. Careful preoperative preparation, careful and meticulous intraoperative nursing cooperation, and provision of sufficient health education after surgery to the patients are the key factors that ensure the success of internal sinus floor elevation surgery with piezosurgery.

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.

Imaging Evaluation of the Location and Fenestration of Sellar Floor during Endonasal Transsphenoidal Surgery in Patients with Pituitary Adenomas.

PubMed

Wang, Shousen; Qin, Yong; Xiao, Deyong; Wu, Zhifeng; Wei, Liangfeng

2018-05-03

To evaluate the clinical value of three-dimensional (3D) CT reconstruction of the sphenoidal sinus separation in localizing sellar floor during endonasal transsphenoidal surgery, and determine the size and location of sellar floor fenestration. After exclusion,51 patients were eligible for study inclusion. A pre-operative CT scan of the paranasal sinus and CT scan and MRI of the pituitary gland were obtained. Sphenoidal sinus separation was reconstructed using Mimics 15.0 software and the quantity, shape, and orientation were observed and compared with intra-operative data, the purpose of which was to guide the localization of sellar floor. Anatomic variation of the sphenoidal sinus and adjacent structures, tumor and sella turcica morphology, minimal distance between the cavernous segment of the internal carotid artery（CSICA） bilaterally, and the shortest distance from the midline were measured. Based upon the shape of the sphenoidal sinus separation, sellar floor was accurately localized in all cases. Intra-operative sphenoidal sinus separation was consistent with pre-operative 3D CT reconstruction images. The sellar floor was extremely small in two patients, and insufficient fenestration of the sellar floor negatively affected tumor resection. Pre-operative 3D CT reconstruction is helpful for accurate and rapid localization of the saddle floor. The anatomic variation of sphenoidal sinus and adjacent structures, the characteristics of tumor and Sella, the minimum distance between bilateral CSICA and the shortest distance from the midline are helpful for the establishment of individualized Sellar bottom fenestration. Copyright © 2018. Published by Elsevier Inc.

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.

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.

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

Effect of a Particulate and a Putty-Like Tricalcium Phosphate-Based Bone-grafting Material on Bone Formation, Volume Stability and Osteogenic Marker Expression after Bilateral Sinus Floor Augmentation in Humans

PubMed Central

Knabe, Christine; Adel Khattab, Doaa; Kluk, Esther; Struck, Rainer; Stiller, Michael

2017-01-01

This study examines the effect of a hyaluronic acid (HyAc) containing tricalcium phosphate putty scaffold material (TCP-P) and of a particulate tricalcium phosphate (TCP-G) graft on bone formation, volume stability and osteogenic marker expression in biopsies sampled 6 months after bilateral sinus floor augmentation (SFA) in 7 patients applying a split-mouth design. 10% autogenous bone chips were added to the grafting material during surgery. The grain size of the TCP granules was 700 to 1400 µm for TCP-G and 125 to 250 µm and 500 to 700 µm (ratio 1:1) for TCP-P. Biopsies were processed for immunohistochemical analysis of resin-embedded sections. Sections were stained for collagen type I (Col I), alkaline phosphatase (ALP), osteocalcin (OC) and bone sialoprotein (BSP). Furthermore, the bone area and biomaterial area fraction were determined histomorphometrically. Cone-beam CT data recorded after SFA and 6 months later were used for calculating the graft volume at these two time points. TCP-P displayed more advantageous surgical handling properties and a significantly greater bone area fraction and smaller biomaterial area fraction. This was accompanied by significantly greater expression of Col I and BSP and in osteoblasts and osteoid and a less pronounced reduction in grafting volume with TCP-P. SFA using both types of materials resulted in formation of sufficient bone volume for facilitating stable dental implant placement with all dental implants having been in function without any complications for 6 years. Since TCP-P displayed superior surgical handling properties and greater bone formation than TCP-G, without the HyAc hydrogel matrix having any adverse effect on bone formation or graft volume stability, TCP-P can be regarded as excellent grafting material for SFA in a clinical setting. The greater bone formation observed with TCP-P may be related to the difference in grain size of the TCP granules and/or the addition of the HyAc. PMID:28758916

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.

Management of the orbital floor in silent sinus syndrome.

PubMed

Thomas, Robert D; Graham, Scott M; Carter, Keith D; Nerad, Jeffrey A

2003-01-01

Enophthalmos in a patient with an opacified hypoplastic maxillary sinus, without sinus symptomatology, describes the silent sinus syndrome. A current trend is to perform endoscopic maxillary antrostomy and orbital floor reconstruction as a single-staged operation. A two-staged approach is performed at our institution to avoid placement of an orbital floor implant in the midst of potential infection and allow for the possibility that enophthalmos and global ptosis may resolve with endoscopic antrostomy alone, obviating the need for orbital floor reconstruction. A retrospective review identified four patients with silent sinus syndrome evaluated between June 1999 and August 2001. Patients presented to our ophthalmology department with ocular asymmetry, and computerized tomography (CT) scanning confirmed the diagnosis in each case. There were three men and one woman, with ages ranging from 27 to 40 years. All patients underwent endoscopic maxillary antrostomy. Preoperative enophthalmos determined by Hertel's measurements ranged from 3 to 4 mm. After endoscopic maxillary antrostomy, the range of reduction in enophthalmos was 1-2 mm. Case 2 had a preoperative CT scan and a CT scan 9 months after left endoscopic maxillary antrostomy. Volumetric analysis of the left maxillary sinus revealed a preoperative volume of 16.85 +/- 0.06 cm3 and a postoperative volume of 19.56 +/- 0.07 cm3. This represented a 16% increase in maxillary sinus volume postoperatively. Orbital floor augmentation was avoided in two patients because of satisfactory improvement in enophthalmos. In the other two patients, orbital reconstruction was performed as a second-stage procedure. There were no complications. Orbital floor augmentation can be offered as a second-stage procedure for patients with silent sinus syndrome. Some patients' enophthalmos may improve with endoscopic antrostomy alone.

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.

The incidence and morphology of maxillary sinus septa in dentate and edentulous maxillae: a cadaveric study with a brief review of the literature

PubMed Central

Wabale, Rajendra Namdeo; Siddiqui, Abu Ubaida; Farooqui, Mujjebuddeen Samsudeen

2015-01-01

Objectives The aim of this study is to determine the incidence, location, and orientation of maxillary sinus septa in formalin embalmed cadavers. Materials and Methods The study was conducted on 210 cadaveric heads available in our department. After taking the mid-sagittal section the specimens were opened from the medial aspect and the sinus cavity was explored for the presence of maxillary sinus septa, their anatomical plane, location and dimensions. Results The mean linear distance between maxillary sinus floor and its anatomical ostium was 26.76±5.21 mm and 26.91±4.96 mm on right and left side, respectively. A total of 59 maxillary sinus septa (28.1%) were observed in 210 maxillary specimens. Septae were most common, 33 septa (55.9%), in the middle region (between first and second molar tooth) of the sinus cavity. The maxillary sinus membrane (Schneiderian membrane) adhered tightly to the maxillary sinus and over the septae. Significantly more maxillary sinus septa were observed in edentulous maxillae in comparison to the dentate upper jaw. Conclusion Knowledge of location of maxillary sinus ostium is mandatory for the rhinologist for drainage of secretions in maxillary sinusitis. The morphological details of maxillary sinus septa, particularly their location and anatomical planes, will guide dentists in performance of safe implant surgeries. The maxillary antrum septa of category I and II may complicate the procedure of inversion of bone plate and elevation of sinus membrane during maxillary augmentation surgeries. The category III septa observed in the sagittal plane were embedded by one of the branches of the infraorbital nerve in it, and if accidentally cut will lead to infraorbital nerve palsy in maxillary sinus surgeries. PMID:25741466

Sellar Floor Reconstruction with the Medpor Implant Versus Autologous Bone After Transnasal Transsphenoidal Surgery: Outcome in 200 Consecutive Patients.

PubMed

Liebelt, Brandon D; Huang, Meng; Baskin, David S

2015-08-01

The Medpor porous polyethylene implant provides benefits to perform sellar floor reconstruction when indicated. This material has been used for cranioplasty and reconstruction of skull base defects and facial fractures. We present the most extensive use of this implant for sellar floor reconstruction and document the safety and benefits provided by this unique implant. The medical charts for 200 consecutive patients undergoing endonasal transsphenoidal surgery from April 2008 through December 2011 were reviewed. Material used for sellar floor reconstruction, pathologic diagnosis, immediate inpatient complications, and long-term complications were documented and analyzed. Outpatient follow-up was documented for a minimum of 1-year duration, extending in some patients up to 5 years. Of the 200 consecutive patients, 136 received sellar floor cranioplasty using the Medpor implant. Postoperative complications included 6 complaints of sinus irritation or drainage, 1 postoperative cerebrospinal fluid leak requiring operative re-exploration, 1 event of tension pneumocephalus requiring operative decompression, 1 case of aseptic meningitis, 1 subdural hematoma, and 1 case of epistaxis. The incidence of these complications did not differ from the autologous nasal bone group in a statistically significant manner. Sellar floor reconstruction remains an important part of transsphenoidal surgery to prevent postoperative complications. Various autologous and synthetic options are available to reconstruct the sellar floor, and the Medpor implant is a safe and effective option. The complication rate after surgery is equivalent to or less frequent than other methods of reconstruction and the implant is readily incorporated into host tissue after implantation, minimizing infectious risk. Copyright © 2015 Elsevier Inc. All rights reserved.

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.

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.

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.

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.

Frontal sinuses and head-butting in goats: a finite element analysis.

PubMed

Farke, Andrew A

2008-10-01

Frontal sinuses in goats and other mammals have been hypothesized to function as shock absorbers, protecting the brain from blows during intraspecific combat. Furthermore, sinuses are thought to form through removal of ;structurally unnecessary' bone. These hypotheses were tested using finite element modeling. Three-dimensional models of domesticated goat (Capra hircus) skulls were constructed, with variable frontal bone and frontal sinus morphology, and loaded to simulate various head-butting behaviors. In general, models with sinuses experienced higher strain energy values (a proxy for shock absorption) than did models with unvaulted frontal bones, and the latter often had higher magnitudes than models with solid vaulted frontal bones. Furthermore, vaulted frontal bones did not reduce magnitudes of principal strain on the surface of the endocranial cavity relative to models with unvaulted frontal bones under most loading conditions. Thus, these results were only partially consistent with sinuses, or the bone that walls the sinuses, acting as shock absorbers. It is hypothesized that the keratinous horn sheaths and cranial sutures are probably more important for absorbing blows to the head. Models with sinuses did exhibit a more ;efficient' distribution of stresses, as visualized by histograms in which models with solid frontal bones had numerous unloaded elements. This is consistent with the hypothesis that sinuses result at least in part from the removal of mechanically unnecessary bone.

Comparison of two kinds of bovine bone in maxillary sinus augmentation: a histomorphometric study.

PubMed

Moon, Jee-Won; Sohn, Dong-Seok; Heo, Jeung-Uk; Kim, Jin Sun

2015-02-01

The purpose of this study was to compare the histomorphometric from sinus augmentation with calcium-phosphate nanocrystal-coated bovine bone (Biocera) and anorganic bovine bone matrix (Bio-Oss). Bilateral maxillary sinus augmentations were performed on 5 patients with delayed placement of implants. The lateral bony window was created using a piezoelectric saw, and the sinus membrane was elevated to make a new compartment. Bio-Oss was grafted in one sinus as the control group and Biocera was grafted in the opposite sinus as the test group. The bony window was repositioned over the bone graft. In all cases, samples were taken for biopsy at the time of implant placement, 6 to 8 months after the grafting procedure. Independent t tests were used to examine between-group differences. None of the 5 patients had complications during healing period. Histomorphometrically, the Bio-Oss group showed 28.46% (±5.28%) of newly formed bone. Biocera group showed 29.94% (±8.72%) of newly formed bone. Newly formed bone along inner surface of repositioned bony window area showed more mature and dense bone structure than new bone formed along bone graft. This study revealed that both bovine bone grafts were considered as suitable bone graft materials for maxillary sinus augmentation.

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

Bone augmentation as an adjunct to dental implant rehabilitation in patients with diabetes mellitus: A review of literature

PubMed Central

Ladha, Komal; Sharma, Ankit; Tiwari, Bhawana; Bukya, Dwaraka N

2017-01-01

The aim of the present article is to review the success of bone augmentation performed as an adjunct to dental implant rehabilitation in patients with diabetes mellitus. A literature review was conducted in PubMed on this topic, which yielded a total of 102 publications. For inclusion, publications had to be human studies, written in English language and should report on the success of bone augmentation as an adjunct to dental implant rehabilitation in diabetic patients. After screening the titles and abstracts, 11 full texts publications were obtained, of which seven were included in the review. These studies provided data on various bone augmentation techniques such as sinus floor elevation (SFE), guided bone regeneration (GBR), and onlay bone grafting. Even though the current review revealed that there are not many studies reporting data relevant to the analyzed topic, the data obtained suggests that; (1) staged GBR technique should be considered more feasible and predictable for bone augmentation, (2) clinicians must take meticulous care when planning and conducting SFE, and (3) block bone augmentation technique should be avoided. PMID:29386810

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.

The Use of Recombinant Human Platelet-Derived Growth Factor for Maxillary Sinus Augmentation.

PubMed

Kubota, Atsushi; Sarmiento, Hector; Alqahtani, Mohammed Saad; Llobell, Arturo; Fiorellini, Joseph P

The maxillary sinus augmentation procedure has become a predictable treatment to regenerate bone for implant placement. The purpose of this study was to evaluate the effect of recombinant human platelet-derived growth factor BB (rhPDGF-BB) combined with a deproteinized cancellous bovine bone graft for sinus augmentation. The lateral window approach was used for maxillary sinuses with minimal residual bone. After a healing period of 4 months, dental implants were placed and then restored following a 2-month osseointegration period. The result demonstrated increased bone height and ISQ values and a 100% survival rate. This study indicates that the addition of rhPDGF-BB to deproteinized cancellous bovine bone accelerated the healing period in maxillary sinuses with minimal native bone.

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.

Brain abscess as the initial presentation of a macroprolactinoma: Case report.

PubMed

Rubio-Almanza, Matilde; Cámara-Gómez, Rosa; de San Román-Mena, Laila Pérez; Simal-Julián, Juan Antonio; Ramos-Prol, Agustín; Botella-Asunción, Carlos; Merino-Torres, Juan Francisco

2015-01-01

Macroprolactinomas may behave invasively and infiltrate the skull base, causing a subsequent thinning that can also lead to a bone defect and a direct route of entry for pathogens. We describe the case of a 34-year-old male admitted to hospital with fever (38°C), headache, stiffness in the neck, diplopia and neurological impairment. Brain magnetic resonance imaging showed two bilateral abscesses in the fronto-parietal areas with intracranial venous sinus thrombosis and a pituitary adenoma that extended from the suprasellar region, eroding the sellar floor into the sphenoid sinus. Laboratory hormone measurements showed increased levels of prolactin and low levels of FSH, LH and testosterone. The patient received antibiotic treatment and surgery was performed. The patient developed central deafness as a neurological deficit. It is advisable to include pituitary adenoma in the differential diagnosis of meningitis even though its onset as intracranial abscess and rectus sinus thrombosis is extremely rare. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. 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.

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.

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.

[The treatment principles of frontal sinus tract after the frontal approach craniotomy].

PubMed

Yu, Huanxin; Li, Haiyan; Liu, Gang

2015-12-01

To investigate the causes, clinical manifestation and treatment principles of frontal sinus tract after the frontal approach craniotomy. The clinic data of 13 patients with frontal skin sinus tract after the frontal approach craniotomy were retrospectively analyzed. All of them were described in the clinical record to have undergone frontal sinus mucosa pushing down or shaving and bone wax filling in the frontal sinus during the surgery, of whom 3 cases had history of frontal abscess incision drainage. All patients were performed endoscopic frontal sinus surgery and forehead skin sinus tract excision and suture. All of the patients successfully recovered after one-stage operation, and the frontal skin sinus tract was healed. The frontal approach craniotomy with postoperative frontal sinus tract was related with the improper use of bone wax tamponade and sealing of frontal sinus. The treatment principles were to remove bone wax, remove inflammatory granulation tissue around the sinus tract, and to open frontal sinus and promote frontal sinus drainage.

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.

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.

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.

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.

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.

[Causes and management of frontal sinusitis after transfrontal craniotomy].

PubMed

Liu, T C; Yu, X F; Gu, Z W; Bai, W L; Wang, Z H; Cao, Z W

2018-02-01

Objective: The aim of this study is to investigate the causes and the strategy of frontal sinusitis after transfrontal craniotomy by endoscopic frontal sinus surgery and traditional surgery with facial incision. Method: A total of thirty-four patients with frontal sinusitis after transfrontal craniotomy were admitted, with the symptom of purulence stuff, headache and upper eyelid discharging. The onset time was 2.6 years on average. The frontal sinus CT and MRI images showed frontal sinusitis. Twenty-seven patients were treated with endoscopic frontal sinus surgery, and seven patient was treated with combined endoscopic and traditional frontal sinus surgery. In the revision surgery, the bone wax and inflammatory granulation tissue were cleaned out in both operational methods. The cure standard was that the postoperative frontal sinus inflammation disappeared and the drainage of the volume recess was unobstructed. Result: Thirty-four patients had a history of transfrontal craniotomy, and there was a record of bone wax packing in every operation. Among twenty-seven patients with endoscopic frontal sinus surgery, Twenty-five cases cured and two cases were operated twice. Seven patients were cured with combined endoscopic and traditional frontal sinus surgery. Conclusion: The frontal sinusitis after transfrontal craniotomy may be related to the inadequate sinus management, especially bone wax to be addressed to the frontal sinus ramming leading to frontal sinus mucosa secretion obstruction and poor drainage. Endoscopic frontal sinus surgery is a way of minimally invasive surgery. The satisfying curative effect can be obtained by endoscopic removal of bone wax, inflammatory granulation tissue, and the enlargement of frontal sinus aperture after exposure to the frontal sinus, and some cases was treated with both operation method.

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.

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.

Reconstructed bone chip detachment is a risk factor for sinusitis after transsphenoidal surgery.

PubMed

Hsu, Yao-Wen; Ho, Ching-Yin; Yen, Yu-Shu

2014-01-01

Sphenoid sinusitis is a complication associated with endoscopic transsphenoidal pituitary surgery. Studies that address the relationship between methods of sellar defect reconstruction and postoperative sinusitis are rare. The purpose of this study was to investigate the incidence, the possible risk factors, and the causative pathogens of sphenoid sinusitis after endoscopic transsphenoidal pituitary surgery. Prospective cohort study. We performed a prospective analysis of 182 patients with benign pituitary tumor who underwent endoscopic transsphenoidal pituitary surgery and sellar defect reconstruction with bone chip, from July 2008 through July 2011. All patients were followed up with nasal endoscopy for at least 6 weeks. Fifty-seven (31.3%) patients developed postoperative sphenoid sinusitis. Comparing the sinusitis and nonsinusitis groups, we found that bone chip detachment was a significant risk factor for postoperative sinusitis, with a relative risk of 2.86 (64.1% vs. 22.4%). The most common pathogens present in cases of postoperative sinusitis were methicillin-sensitive Staphylococcus aureus, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus. Regular follow-up with nasal endoscopy can prevent delayed diagnosis of postoperative sphenoid sinusitis. Culture-directed antibiotics with aggressive endoscopic debridement are an effective treatment for these patients. An optimal reconstruction strategy should be further developed to reduce bone chip detachment and secondary sinusitis. © 2013 The American Laryngological, Rhinological and Otological Society, 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.

Efficacy of sellar opening in the pituitary adenoma resection of transsphenoidal surgery influences the degree of tumor resection.

PubMed

Wang, Shousen; Qin, Yong; Xiao, Deyong; Wei, Liangfeng

2017-07-24

Endonasal transsphenoidal microsurgery is often adopted in the resection of pituitary adenoma, and has showed satisfactory treatment and minor injuries. It is important to accurately localize sellar floor and properly incise the bone and dura matter. Fifty-one patients with pituitary adenoma undergoing endonasal transsphenoidal microsurgery were included in the present study. To identify the scope of sellar floor opening, CT scan of the paranasal sinus and MRI scan of the pituitary gland were performed for each subject. Intraoperatively, internal carotid artery injury, leakage of cerebrospinal fluid, and tumor texture were recorded, and postoperative complications and residual tumors were identified. The relative size of sellar floor opening significantly differed among the pituitary micro-, macro- and giant adenoma groups, and between the total and partial tumor resection groups. The ratio of sellar floor opening area to maximal tumor area was significantly different between the total and partial resection groups. Logistic regression analysis revealed that the ratio of sellar floor opening area to the largest tumor area, tumor texture, tumor invasion and age were independent prognostic factors. The vertical distance between the top point of sellar floor opening and planum sphenoidale significantly differed between the patients with and without leakage of cerebrospinal fluid. These results together indicated that relatively insufficient sellar floor opening is a cause of leading to residual tumor, and the higher position of the opening and closer to the planum sphenoidale are likely to induce the occurrence of leakage of cerebrospinal fluid.

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

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.

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.

A novel classification of frontal bone fractures: The prognostic significance of vertical fracture trajectory and skull base extension.

PubMed

Garg, Ravi K; Afifi, Ahmed M; Gassner, Jennifer; Hartman, Michael J; Leverson, Glen; King, Timothy W; Bentz, Michael L; Gentry, Lindell R

2015-05-01

The broad spectrum of frontal bone fractures, including those with orbital and skull base extension, is poorly understood. We propose a novel classification scheme for frontal bone fractures. Maxillofacial CT scans of trauma patients were reviewed over a five year period, and frontal bone fractures were classified: Type 1: Frontal sinus fracture without vertical extension. Type 2: Vertical fracture through the orbit without frontal sinus involvement. Type 3: Vertical fracture through the frontal sinus without orbit involvement. Type 4: Vertical fracture through the frontal sinus and ipsilateral orbit. Type 5: Vertical fracture through the frontal sinus and contralateral or bilateral orbits. We also identified the depth of skull base extension, and performed a chart review to identify associated complications. 149 frontal bone fractures, including 51 non-vertical frontal sinus (Type 1, 34.2%) and 98 vertical (Types 2-5, 65.8%) fractures were identified. Vertical fractures penetrated the middle or posterior cranial fossa significantly more often than non-vertical fractures (62.2 v. 15.7%, p = 0.0001) and had a significantly higher mortality rate (18.4 v. 0%, p < 0.05). Vertical fractures with frontal sinus and orbital extension, and fractures that penetrated the middle or posterior cranial fossa had the strongest association with intracranial injuries, optic neuropathy, disability, and death (p < 0.05). Vertical frontal bone fractures carry a worse prognosis than frontal bone fractures without a vertical pattern. In addition, vertical fractures with extension into the frontal sinus and orbit, or with extension into the middle or posterior cranial fossa have the highest complication rate and mortality. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

The influence of bone substitute materials on the bone volume after maxillary sinus augmentation: a microcomputerized tomography study.

PubMed

Kühl, Sebastian; Brochhausen, Christoph; Götz, Hermann; Filippi, Andreas; Payer, Michael; d'Hoedt, Bernd; Kreisler, Matthias

2013-03-01

This study aims to evaluate the effect of adding bone substitute materials (BSM) to particulated autogenous bone (PAB) on the volume fraction (Vf) of newly formed bone after maxillary sinus augmentation. Thirty healthy patients undergoing maxillary sinus augmentation were included. PAB (N = 10), mixtures of PAB and beta-tricalciumphosphate (PAB/β-TCP) (N = 10), as well as PAB and β-TCP and hydroxyapatite (PAB/HA/β-TCP) (N = 10) were randomly used for sinus augmentation. A sample of the graft material was maintained from each patient at time of maxillary sinus augmentation, and Vfs of the PAB and/or BSM in the samples were determined by means of microcomputerized tomography (μ-CT). Five months later, samples of the grafted areas were harvested during implantation using a trephine bur. μ-CT analysis of these samples was performed, and the Vf of bone and BSM were compared with the data obtained 5 months earlier from the original material. The mean Vf of the bone showed a statistically significant increase (p < 0.05) in all groups after a healing period of 5 months without statistically significant difference between the groups. With regard to the increase of bone volume, it is not relevant if PAB is used alone or combined with β-TCP or HA/β-TCP. The amount of PAB and associated donor site morbidity may be reduced by adding BSM for maxillary sinus augmentation.

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.

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.

Osteotomy in direct sinus lift. A comparative study of the rotary technique and ultrasound

PubMed Central

Peñarrocha-Diago, Miguel; Sanchez-Recio, Cristina; Peñarrocha-Oltra, David; Romero-Millán, Javier

2012-01-01

Purpose: The present study investigates sinus membrane rupture in direct maxillary sinus lift with the rotary technique and with ultrasound, examining the survival of implants placed after sinus augmentation, and analyzing the bone gain obtained after the operation and 12 months after placement of the prosthetic restoration. Material and Methods: A retrospective study was made of 45 patients requiring maxillary sinus lift or augmentation for implant-prosthetic rehabilitation. Use was made of the hand piece and ostectomy drills for the rotary technique, and of specific tips for ultrasound. The implant success criteria were based on those developed by Buser. The bone gain obtained as a result of sinus lift was calculated from the postoperative panoramic X-rays. Results: A total of 57 direct elevations of the maxillary sinus were carried out: 32 with the rotary technique and 25 with ultrasound. Perforations of Schneider’s membrane with the rotary technique and ultrasound occurred in 7% and 1.7% of the cases, respectively, with membrane integrity being preserved in 91.2%. Of the 100 implants placed, 5 failed after one year of follow-up in the rotary technique group, while one implant failed in the ultrasound group. The rotary technique in turn afforded a bone gain of 5.9 mm, versus 6.7 mm with ultrasound. Conclusions: Perforations of the membrane sinusal in direct lift were more frequent with the rotary technique (7%) than with ultrasound (1.7%). Implant survival and bone gain were both greater when ultrasound was used. Key words:Bone sectioning, maxillary sinus augmentation, piezosurgery. PMID:22143735

Piezosurgery in implant dentistry

PubMed Central

Stübinger, Stefan; Stricker, Andres; Berg, Britt-Isabelle

2015-01-01

Piezosurgery, or the use of piezoelectric devices, is being applied increasingly in oral and maxillofacial surgery. The main advantages of this technique are precise and selective cuttings, the avoidance of thermal damage, and the preservation of soft-tissue structures. Through the application of piezoelectric surgery, implant-site preparation, bone grafting, sinus-floor elevation, edentulous ridge splitting or the lateralization of the inferior alveolar nerve are very technically feasible. This clinical overview gives a short summary of the current literature and outlines the advantages and disadvantages of piezoelectric bone surgery in implant dentistry. Overall, piezoelectric surgery is superior to other methods that utilize mechanical instruments. Handling of delicate or compromised hard- and soft-tissue conditions can be performed with less risk for the patient. With respect to current and future innovative surgical concepts, piezoelectric surgery offers a wide range of new possibilities to perform customized and minimally invasive osteotomies. PMID:26635486

[Traumatic intracerebral pneumocephalus communicating with two different paranasal sinuses: a case report].

PubMed

Wakamoto, H; Miyazaki, H; Hayashi, T; Shimamoto, Y; Ishiyama, N

1998-02-01

We report a case of a 17-year-old male who had hit the front of his head in a traffic accident. CT scan revealed contusional hemorrhage and pneumocephalus of the left frontal lobe 10 hours after the accident. A month later he complained of rhinorrhea and CT scan revealed intracerebral pneumocephalus. One day he complained of headache and began to vomit after he sneezed. CT scan revealed that the pneumocephalus had become worse and air had spread throughout the subarachnoid space. Bone CT scan revealed the air communicated from the frontal sinus to the intracerebral air cavity. 3D-CT scan revealed bone defect in the roof of the ethmoid sinus. The intraoperative findings revealed that the intracerebral air cavity communicated with the frontal sinus and ethmoid sinus. Though the brain which dropped into the paranasal sinus, adhered to the dura mater around the bone defect, a part of the brain had come off from the dura mater around the frontal sinus. We suspected that the intracerebral air cavity communicated with the frontal sinus initially. When the air cavity communicated with the ethmoid sinus secondarily, intracranial pressure abated and air came into the subarachnoid space from the frontal sinus.

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.

Atmospheric pressure as a force that fills developing bones with marrow and air.

PubMed

Kurbel, Sven; Radić, Radivoje; Kristek, Branka; Ivezić, Zdravko; Selthofer, Robert; Kotromanović, Zeljko

2004-01-01

Many theories try to explain the existence and function of paranasal sinuses. This paper is an attempt to correlate process of paranasal sinus development in human with bone pneumatization processes in animals. It is here proposed that this mechanism starts in utero and continues after birth. During endochondral development, a solid hyaline cartilage model transforms into long bones. Central chondrocytes hypertrophy and their lacunae become confluent. Dissolving of the cartilage intercellular matrix forms a primitive marrow cavity. It is soon invaded by the periostal bud. Once circulation is established in the developing bone, the dissolved hyaline matrix can be slowly washed away from the bone cavity. Circulation in the bone cavity can develop slight subatmospheric pressures, similar to negative interstitial pressures in subcutaneous tissues. The amniotic fluid conducts atmospheric pressure to the fetal body. The pressure is trying to fill enlarging bone cavities through the existing vascular openings, or to create new openings. Bone walls of developing paranasal bones are to weak to resist the pressure gradient on their walls. New openings form on the weakest spots allowing airway mucosa to form initial paranasal sinuses. The enlarging cavities of long bones that are remote from the body surface and airway also develop a slightly subatmospheric pressure that fills them with cellular elements. These elements enter bone through the feeding vessels and form bone marrow. During after birth skeletal growth, bone remodeling shapes paranasal sinuses in a process of slow evolution that do not require measurable pressure gradients. When two sinuses come in vicinity, their growth rate declines, since the remaining thin and fragile bone lamella between them does not retract anymore.

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.

Randomized controlled multicenter study comparing short dental implants (6 mm) versus longer dental implants (11-15 mm) in combination with sinus floor elevation procedures. Part 2: clinical and radiographic outcomes at 1 year of loading.

PubMed

Schincaglia, Gian Pietro; Thoma, Daniel S; Haas, Robert; Tutak, Marcin; Garcia, Abel; Taylor, Thomas D; Hämmerle, Christoph H F

2015-11-01

To compare, clinically and radiographically, short dental implants (6 mm) to long implants (11-15 mm) placed with sinus grafting. Participants with 5-7 mm of bone height in the posterior maxilla were randomly allocated to receive short implants (GS) or long implants with sinus grafting (GG). Implants were loaded with single crowns 6 months after placement (PR). Patients were re-evaluated 12 months after loading (FU-1). Outcome variables included: Implant survival rate (CSR), marginal bone level alteration (MBL), periodontal probing depth (PPD), bleeding on probing (BoP), plaque control record (PCR) and crown-to-implant ratios (C/I). Statistical analysis was performed using parametric tests. In 97 subjects, 132 implants were re-evaluated at FU-1. The CSR was 100%. The MBL from implant placement (IP) to (PR) was -0.22 ± 0.4 mm for GG and -0.3 ± 0.45 mm for GS (p < 0.001). MBL from IP to FU-1 was -0.37 ± 0.59 mm for GG and -0.22 ± 0.3 mm for GS (p < 0.001). Intergroup comparisons showed non-significant differences for MBL (p > 0.05), PPD (p = 1) and PCR (p = 0.09). BoP was higher in the GS (p = 0.04). The C/I was 0.99 ± 0.17 for GG and 1.86 ± 0.23 for GS (p < 0.001). No correlation was observed between C/I and MBL, (GG: p = 0.13; GS: p = 0.38). Both treatment modalities provided similar outcomes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

Transcranial and Epidural Approach for Spontaneous Cerebrospinal Fluid Leakage Due to Meningoencephalocele of the Lateral Sphenoid Sinus.

PubMed

Shintoku, Ryosuke; Tosaka, Masahiko; Shimizu, Tatsuya; Yoshimoto, Yuhei

2018-01-01

We experienced a case of sphenoid sinus type meningoencephalocele manifesting as severe cerebrospinal fluid (CSF) rhinorrhea. A 35-year-old man became aware of serous nasal discharge 1 year previously, which had gradually worsened. The nasal discharge was diagnosed as CSF rhinorrhea. Head computed tomography (CT) showed several small depressions in the bone of the left middle cranial fossa, and the largest depression extended through the bone to the lateral sphenoid sinus. Head magnetic resonance imaging revealed that the meningoencephalocele projected to the lateral sphenoid sinus, through this small bone defect of the middle cranial fossa. We performed a combined craniotomy and epidural approach without intradural procedures using neuronavigation. Multiple meningoencephaloceles protruded into small depressions in the middle skull base. The small protrusions not passing through the sphenoid sinus were coagulated. The largest protrusion causing the CSF leakage was identified by neuronavigation. This meningoencephalocele was cut. Both the dural and bone sides were closed with double layers to prevent CSF leakage. The CSF rhinorrhea completely stopped after the surgery. In our case, identification of the leak site was easy with neuronavigation based on bone window CT. The epidural approach also has significant advantages with double layer closure, including both the dural and bone sides. If the site of CSF leakage is outside the foramen rotundum (as with the most common type of lateral sphenoid sinus meningoencephalocele), we recommend the epidural approach using neuronavigation for surgical treatment.

The Impact of Middle Turbinate Concha Bullosa on the Severity of Inferior Turbinate Hypertrophy in Patients with a Deviated Nasal Septum.

PubMed

Tomblinson, C M; Cheng, M-R; Lal, D; Hoxworth, J M

2016-07-01

Inferior turbinate hypertrophy and concha bullosa often occur opposite the direction of nasal septal deviation. The objective of this retrospective study was to determine whether a concha bullosa impacts inferior turbinate hypertrophy in patients who have nasal septal deviation. The electronic medical record was used to identify sinus CT scans exhibiting nasal septal deviation for 100 adult subjects without and 100 subjects with unilateral middle turbinate concha bullosa. Exclusion criteria included previous sinonasal surgery, tumor, sinusitis, septal perforation, and craniofacial trauma. Nasal septal deviation was characterized in the coronal plane by distance from the midline (severity) and height from the nasal floor. Measurement differences between sides for inferior turbinate width (overall and bone), medial mucosa, and distance to the lateral nasal wall were calculated as inferior turbinate hypertrophy indicators. The cohorts with and without concha bullosa were similarly matched for age, sex, and nasal septal deviation severity, though nasal septal deviation height was greater in the cohort with concha bullosa than in the cohort without concha bullosa (19.1 ± 4.3 mm versus 13.5 ± 4.1 mm, P < .001). Compensatory inferior turbinate hypertrophy was significantly greater in the cohort without concha bullosa than in the cohort with it as measured by side-to-side differences in turbinate overall width, bone width, and distance to the lateral nasal wall (P < .01), but not the medial mucosa. Multiple linear regression analyses found nasal septal deviation severity and height to be significant predictors of inferior turbinate hypertrophy with positive and negative relationships, respectively (P < .001). Inferior turbinate hypertrophy is directly proportional to nasal septal deviation severity and inversely proportional to nasal septal deviation height. The effect of a concha bullosa on inferior turbinate hypertrophy is primarily mediated through influence on septal morphology, because the nasal septal deviation apex tends to be positioned more superior from the nasal floor in these patients. © 2016 by American Journal of Neuroradiology.

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.

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.

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.

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.

Alveolar ridge and maxillary sinus augmentation using rhBMP-2: a systematic review.

PubMed

Freitas, Rubens Moreno de; Spin-Neto, Rubens; Marcantonio Junior, Elcio; Pereira, Luís Antônio Violin Dias; Wikesjö, Ulf M E; Susin, Cristiano

2015-01-01

The aim of this systematic review was to evaluate clinical and safety data for recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) carrier when used for alveolar ridge/maxillary sinus augmentation in humans. Clinical studies/case series published 1980 through June 2012 using rhBMP-2/ACS were searched. Studies meeting the following criteria were considered eligible for inclusion: >10 subjects at baseline and maxillary sinus or alveolar ridge augmentation not concomitant with implant placement. Seven of 69 publications were eligible for review. rhBMP-2/ACS yielded clinically meaningful bone formation for maxillary sinus augmentation that would allow placement of regular dental implants without consistent differences between rhBMP-2 concentrations. Nevertheless, the statistical analysis showed that sinus augmentation following autogenous bone graft was significantly greater (mean bone height: 1.6 mm, 95% CI: 0.5-2.7 mm) than for rhBMP-2/ACS (rhBMP-2 at 1.5 mg/mL). In extraction sockets, rhBMP-2/ACS maintained alveolar ridge height while enhancing alveolar ridge width. Safety reports did not represent concerns for the proposed indications. rhBMP-2/ACS appears a promising alternative to autogenous bone grafts for alveolar ridge/maxillary sinus augmentation; dose and carrier optimization may expand its efficacy, use, and clinical application. © 2013 Wiley Periodicals, Inc.

Cemento-ossifying Fibroma Of Paranasal Sinus Presenting Acutely As Orbital Cellulitis.

PubMed

Khanna, Maneesh; Buddhavarapu, Shanker Rao; Hussain, Sheik Akbar; Amir, Emran

2009-01-01

Fibro-osseous lesions of the face and paranasal sinuses are relatively uncommon. These lesions have overlapping clinical, radiologic and pathologic features causing difficulty in diagnosis. Neoplastic fibro-osseous paranasal sinus lesions can be benign or malignant. The benign fibro-osseous lesions described are: ossifying fibroma (and its histologic variants) and fibrous dysplasia. The variants of ossifying fibroma differ in the nature of calcified material (i.e. cementum versus bone), in the location of the lesion (oral versus paranasal sinus or orbital), other morphologic variations (presence of psammomatoid concretions) and biologic behavior (aggressive versus stable). Presence of cementum or bone classifies the lesion as cementifying fibroma or ossifying fibroma respectively while lesions with mixture of both cementum and bone are called cemento-ossifying fibroma. We describe a case of a young adult male with cemento-ossifying fibroma of paranasal sinus presenting acutely as left orbital cellulitis with proptosis.

Cemento-ossifying Fibroma Of Paranasal Sinus Presenting Acutely As Orbital Cellulitis

PubMed Central

Khanna, Maneesh; Buddhavarapu, Shanker Rao; Hussain, Sheik Akbar; Amir, Emran

2009-01-01

Fibro-osseous lesions of the face and paranasal sinuses are relatively uncommon. These lesions have overlapping clinical, radiologic and pathologic features causing difficulty in diagnosis. Neoplastic fibro-osseous paranasal sinus lesions can be benign or malignant. The benign fibro-osseous lesions described are: ossifying fibroma (and its histologic variants) and fibrous dysplasia. The variants of ossifying fibroma differ in the nature of calcified material (i.e. cementum versus bone), in the location of the lesion (oral versus paranasal sinus or orbital), other morphologic variations (presence of psammomatoid concretions) and biologic behavior (aggressive versus stable). Presence of cementum or bone classifies the lesion as cementifying fibroma or ossifying fibroma respectively while lesions with mixture of both cementum and bone are called cemento-ossifying fibroma. We describe a case of a young adult male with cemento-ossifying fibroma of paranasal sinus presenting acutely as left orbital cellulitis with proptosis. PMID:22470655

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

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.

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.

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

Managment of frontal sinus fracture: obliteration sinus with cancellous bone graft.

PubMed

Muminagic, Sahib; Masic, Tarik; Babajic, Emina; Asotic, Mithat

2011-01-01

Frontal sinus fractures make up about 2-15% of all facial fractures.This is relatively low frequency of occurrence, but it has a large potential of complication and may involve not only the frontal sinuse but more importantly the brain and the eyes. The management depends of the complexity. If anterior wall is fractured with grossly involved nasofrontal duct (NFD) in the injury it is paramount to occlude NFD. Very often, sinus obliteration is done at the same time. In our expirience autogenous cancellous bone graft is considered to be the best grafting material. It has the less short - or long-term complications and the donor site morbidity is insignificant.

Evaluation of the treatment modalities for neurosensory disturbances of the inferior alveolar nerve following retromolar bone harvesting for bone augmentation.

PubMed

Nogami, Shinnosuke; Yamauchi, Kensuke; Shiiba, Shunji; Kataoka, Yoshihiro; Hirayama, Bunichi; Takahashi, Tetsu

2015-03-01

The purpose of this study was to evaluate the treatment modalities for neurosensory disturbances (NSDs) of the inferior alveolar nerve occurring after retromolar bone harvesting for bone augmentation procedures before implant placement. One hundred four patients, of which 49 and 55 exhibited vertical or horizontal alveolar ridge defects in the mandible and maxilla, respectively, were enrolled. Nineteen patients underwent block bone grafting, 38 underwent guided bone generation or autogenous bone grafting combined with titanium mesh reconstruction, and 47 underwent sinus floor augmentation. Using a visual analog scale, we examined subjective symptoms and discomfort related to sensory alteration within the area of the NSDs in these patients. NSDs were clinically investigated using a two-point discrimination test with blunt-tipped calipers. In addition, neurometry was used for evaluation of trigeminal nerve injury. We tested three treatment modalities for NSDs: follow-up observation (no treatment), medication, and stellate ganglion block (SGB). A week after surgery, 26 patients (25.0%) experienced NSDs. Five patients received no treatment, 10 patients received medication, and 11 patients received SGB. Three months after surgery, patients in the medication and SGB group achieved complete recovery. Current perception threshold values recovered to near-baseline values at 3 months: recovery was much earlier in this group than in the other two groups. SGB can accelerate recovery from NSDs. Our results justify SGB as a reasonable treatment modality for NSDs occurring after the harvesting of retromolar bone grafts. Wiley Periodicals, Inc.

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.

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.

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.

In-vitro and in-vivo design and validation of an injectable polysaccharide-hydroxyapatite composite material for sinus floor augmentation.

PubMed

Fricain, J C; Aid, R; Lanouar, S; Maurel, D B; Le Nihouannen, D; Delmond, S; Letourneur, D; Amedee Vilamitjana, J; Catros, S

2018-04-07

Polysaccharide-based composite matrices consisting of natural polysaccharides, pullulan and dextran supplemented with hydroxyapatite (Matrix-HA) have recently been developed. The principal objective of this study was to evaluate the capacities of this composite material to promote new bone formation in a sinus lift model in the sheep. Secondary objectives were to evaluate in vitro properties of the material regarding cell adhesion and proliferation. In this report, once such composite matrix was prepared as injectable beads after dispersion in a physiological buffer, and evaluated using a large animal model (sheep) for a sinus lift procedure. In vitro studies revealed that these microbeads (250-550μm in diameter) allow vascular cell adhesion and proliferation of Endothelial Cells (EC) after 1 and 7 days of culture. In vivo studies were performed in 12 adult sheep, and newly formed tissue was analyzed by Cone Beam Computed Tomography (CBCT scanning electron microscopy (SEM) and by histology 3 and 6 months post-implantation. CBCT analyses at the implantation time revealed the radiolucent properties of these matrices. Quantitative analysis showed an increase of a dense mineralized tissue in the Matrix-HA group up to 3 months of implantation. The mineralized volume over total volume after 6 months reached comparable values to those obtained for Bio-Oss ® used as positive control. Histological examination confirmed that the Matrix-HA did not induce any long term inflammatory events, and promoted direct contact between the osteoid tissue and lamellar bone structures and beads. After 6 months, we observed a dense network of osteocytes surrounding both biomaterials as well as a newly vascularized formed tissue in close contact to the biomaterials. In conclusion, the absence of animal components in Matrix-HA, the osteoconductive property of Matrix-HA in sheep, resulting in a dense bone and vascularized tissue, and the initial radiolucent property to follow graft integration offer great promises of this composite material for clinical use. Copyright © 2018 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.

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.

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.

Minimally invasive sinus augmentation using ultrasonic piezoelectric vibration and hydraulic pressure: a multicenter retrospective study.

PubMed

Kim, Ji-Min; Sohn, Dong-Seok; Heo, Jeong-Uk; Park, Jun-Sub; Jung, Heui-Seung; Moon, Jee-Won; Lee, Ju-Hyoung; Park, In-Sook

2012-12-01

The purpose of this study was to evaluate the success rate of implants and vertical bone gain of edentulous posterior maxilla using ultrasonic piezoelectric vibration and hydraulic pressure, namely the hydrodynamic piezoelectric internal sinus elevation (HPISE) technique through a crestal approach. A total of 250 maxillary sinuses were augmented using HPISE and 353 implants (averaging 11.8 mm in length and 4.5 mm in diameter), with 12 different systems, were placed simultaneously with or without additional bone grafting. Plain radiograms and cone beam computed tomograms were taken in all patients to evaluate sinus augmentation. Membrane perforation was recorded at 10 of the 353 implant sites. The perforation rate was 2.83%. The total success rate of implantation was 97.2% after an average of 69.3 weeks of loading. The crestally approached sinus augmentation using ultrasonic piezoelectric vibration and hydraulic pressure is an additional method of maxillary sinus augmentation.

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.

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.

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.

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.

[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.

Controlling systematic perioperative anaerobic contamination during sinus-lift procedures by using metronidazole: an innovative approach.

PubMed

Choukroun, Joseph; Simonpieri, Alain; Del Corso, Marco; Mazor, Ziv; Sammartino, Gilberto; Dohan Ehrenfest, David M

2008-09-01

Analysis of tomodensitometric controls following sinus grafts clearly demonstrates a quite systematic lack of homogeneity. Sinus contamination by anaerobic bacteria seems almost unavoidable during bone graft surgery, and this problem may jeopardize the healing process. The aim of this study was to characterize in a systematic way the nonhomogeneities observed at 1, 2, or 3 months postsurgery within allogenous sinus grafts, and to assess the possible influence of a 0.5% sterile solution of metronidazole incorporated in the sinus bone graft. This clinical study was conducted on 72 patients treated with single or bilateral sinus-lifts: 94 sinus elevations performed with freeze-dried bone allograft (Phoenix, TBF, Mions, France), with (test group) or without (control group) metronidazole. In the test group, each bone graft was hydrated with 2 mL of a 0.5% metronidazole solution, i.e., only 10 mg of metronidazole. All the patients went through a first presurgical computerized tomography (CT)-scan followed by a second scan performed at 1, 2, or 3 months postsurgery (which was used as the preimplant reference scan). For 11 patients, 2 postsurgical CT-scans were performed respectively at 10 days and 2 months. Using an arbitrary gray scale (Arbitrary Densitometric Unit) which functions according to the Hounsfield unit principle, the degree of radiographic homogeneity of the grafts was established. Density scattering provides some information on the homogeneity or nonhomogeneity of the bone graft. The 12 grafts performed without metronidazole show significant nonhomogeneities at 1, 2, or 3 months. Moreover, when a CT-scan is performed during the first postoperative days (at 10 days), the presence of air bubbles in the graft is confirmed. The tomodensitometric aspects of all grafts treated with metronidazole in this series are absolutely identical: they show a high degree of homogeneity. Sixty-three cases (76.8%) are homogeneous, and 19 cases (23.2%) are significantly homogeneous. The time at which the control scan is performed (10 days, 1, 2, or 3 months) does not seem to influence significantly the degree of homogeneity assessed. In the control group, some inflammatory events associated with facial oedema were observed in 25% of the cases. In the test group, no such event was recorded for the 82 sinus-lifts treated with metronidazole. A possible correlation may exist between the occurrence of non homogeneities within the bone grafts and the anaerobic bacterial contamination. The local use of a very small quantity of metronidazole (equivalent to only 1/20 of a common 200 mg oral tablet) could provide more security when performing sinus-lift procedures and an improved quality of the graft. This protocol should not be considered as an antibiotherapy, but only as way to limit the initial contamination of bone graft.

Operculum bone carp (cyprinus carprio sp.) scaffold is a new potential xenograft material: a preliminary study

NASA Astrophysics Data System (ADS)

Kartiwa, A.; Abbas, B.; Pandansari, P.; Prahasta, A.; Nandini, M.; Fadhlillah, M.; Subroto, T.; Panigoro, R.

2017-02-01

Orbital floor fracture with extensive bone loss, would cause herniation of the orbital tissue into the maxillary sinus. Graft implantation should be done on the orbital fracture with extensive bone loss. Different types of grafts have their own characteristics and advantages. Xenograft has been widely studied for use in bone defects. This study was to investigate cyprinus carprio sp. opercula bone as a potential xenograft. The aim of this study was to investigate based on EDS chemical analysis using a ZAF Standardless Method of Quantitative Analysis (Oxide) and SEM examination conducted in the laboratory of Mathematics, Institute of Technology Bandung. Particularly the mass ratio of Ca and P (5.8/3:47), the result is 1.67. This is equivalent to the stoichiometric Hydroxyapatite (HA) (Aoki H, 1991, Science and medical applications of hydroxyapatite, Tokyo: Institute for Medical and Engineering, Tokyo Medical and Dental University). C N O that there is an element of protein/amino acid collagen compound, serves as a matrix together with HA. As shown in the SEM analysis that the matrix is a porous sheet-shaped (oval) that interconnect with each other, which is good scaffold. The pore is composed of large pores >200 microns and smaller pores between the large pores with a size smaller or equal to 10 microns that can serve for the attachment of osteoblast cell. In conclusion, Opercula bone carp (cyprinus carprio sp.) scaffold could be a new potential xenograft material.

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.

Undersensing of VF in a patient with optimal R wave sensing during sinus rhythm.

PubMed

Dekker, Lukas R C; Schrama, Tim A M; Steinmetz, Frans H L; Tukkie, Raymond

2004-06-01

We describe a case of potentially fatal undersensing of VF by a third generation ICD with predetermined automatic gain control. In this patient, ventricular sensing was optimal, as R wave amplitudes during sinus rhythm were at least 16 mV. Cyclical, high amplitude signals during VF elevated the sensing floor to such an extent that complete undersensing of subsequent lower amplitude local electrograms occurred. This led to bradypacing and complete ICD therapy failure. Therefore, high R wave amplitudes during sinus rhythm do not warrant flawless sensing during VF.

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.

Virtual reality simulation training in Otolaryngology.

PubMed

Arora, Asit; Lau, Loretta Y M; Awad, Zaid; Darzi, Ara; Singh, Arvind; Tolley, Neil

2014-01-01

To conduct a systematic review of the validity data for the virtual reality surgical simulator platforms available in Otolaryngology. Ovid and Embase databases searched July 13, 2013. Four hundred and nine abstracts were independently reviewed by 2 authors. Thirty-six articles which fulfilled the search criteria were retrieved and viewed in full text. These articles were assessed for quantitative data on at least one aspect of face, content, construct or predictive validity. Papers were stratified by simulator, sub-specialty and further classified by the validation method used. There were 21 articles reporting applications for temporal bone surgery (n = 12), endoscopic sinus surgery (n = 6) and myringotomy (n = 3). Four different simulator platforms were validated for temporal bone surgery and two for each of the other surgical applications. Face/content validation represented the most frequent study type (9/21). Construct validation studies performed on temporal bone and endoscopic sinus surgery simulators showed that performance measures reliably discriminated between different experience levels. Simulation training improved cadaver temporal bone dissection skills and operating room performance in sinus surgery. Several simulator platforms particularly in temporal bone surgery and endoscopic sinus surgery are worthy of incorporation into training programmes. Standardised metrics are necessary to guide curriculum development in Otolaryngology. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

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

[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.

The Palatal Window for Treating an Incompletely Augmented Maxillary Sinus.

PubMed

Florio, Salvatore; Suzuki, Takanori; Cho, Sang-Choon

2017-04-01

Maxillary sinus augmentation through a lateral window is reported as one of the most predictable bone augmentation procedures before implant placement. The elevation of the membrane represents a delicate and crucial step that allows the creation of the space for the bone graft material. If the elevation is not completed, the regenerated bone might be inadequate for the implant placement. In this case, a new intervention will be necessary to complete the bone augmentation. Reaccessing from a lateral window, however, would be challenging due to thickness of the buccal boney wall because of the first grafting procedure; therefore, a different approach has to be used. The aim of this case report is to present the palatal window technique for treating incompletely augmented maxillary sinus. The detailed step-by-step diagnostic and surgical procedures are described, and the advantages and limitations of the technique are discussed through a review of the literature.

In Situ Splitting of a Rib Bone Graft for Reconstruction of Orbital Floor and Medial Wall.

PubMed

Uemura, Tetsuji; Yanai, Tetsu; Yasuta, Masato; Harada, Yoshimi; Morikawa, Aya; Watanabe, Hidetaka; Kurokawa, Masato

2017-06-01

In situ splitting of rib bone graft was conducted in 22 patients for the repair of orbital fracture with no other complicating fractures. A bone graft was harvested from the sixth or seventh rib in the right side. The repair of the orbital floor and medial wall was successful in all the cases. Ten patients had bone grafting to the orbital floor, eight had it done onto medial wall, and 4 onto both floor and wall after reduction. The mean length of in situ rib bone graft was 40.9 mm (range, 20-70 mm), the mean width of these was 14.9 mm (range, 8-20 mm). The bone grafting was done by one leaf for 15 cases and two leafs for 7 cases in size of defects. The technique of in situ splitting of a rib bone graft for the repair of the orbital floor and medial wall is a simple and safe procedure, easily taking out the in situ splitting of a rib, and less pain in donor site. It has proved to be an optimal choice in craniofacial reconstruction, especially the defects of orbital floor and medial wall.

Pediatric frontal mucocele secondary to a bifid frontal sinus septum.

PubMed

Plikaitis, Christina M; Purzycki, Adam R; Couture, Daniel; David, Lisa R

2010-09-01

A mucocele is a mucus-containing sac lined with epithelium that arises within a sinus when its drainage is compromised. The frontal sinus is the most common location, with frontal mucocele development occurring when the nasofrontal duct becomes obstructed because of polyps, bone tumors, prior surgery, sinusitis, trauma, or anatomic variation. We report an unusual case of a sterile pediatric frontal mucocele presenting as a slowly enlarging forehead mass due to a bifid frontal sinus septum. A 9-year-old girl presented to the craniofacial clinic for evaluation of a right frontal mass that had been slowly growing over the past year. She was otherwise healthy and had no history of previous trauma or sinus infections. Computed tomography (CT) scan results revealed a localized frontal fluid collection with protrusion and thinning of the anterior frontal bone between 2 midline bony septii. Surgical cranialization of the frontal sinus was performed. The anatomy of her lesion seen both on CT scan and intraoperatively likely explains this unusual case presentation. Instead of the usual inciting event of an intact frontal sinus drainage system becoming blocked, this patient seemed to have a primary developmental lack of any drainage system that led to her mucocele. During formation of her frontal sinus, she developed a bifid septum within the midline that excluded a portion of her frontal sinus from the lateral nasofrontal ducts. With mucus-producing epithelium trapped within these bony confines, pressure began to mount with expansion and thinning of the bone both anteriorly and posteriorly. The lack of any infectious symptoms and sterile culture results may support that this space developed primarily and was never in continuity with the external drainage system. Only 4 other patients have been reported with asymptomatic forehead swelling as the only presenting symptom, with the age ranging from 33 to 79 years. This patient represents the first clinical report of a congenital developmental mucocele.

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

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.

Beyond the sniffer: frontal sinuses in Carnivora.

PubMed

Curtis, Abigail A; Van Valkenburgh, Blaire

2014-11-01

Paranasal sinuses are some of the most poorly understood features of mammalian cranial anatomy. They are highly variable in presence and form among species, but their function is not well understood. The best-supported explanations for the function of sinuses is that they opportunistically fill mechanically unnecessary space, but that in some cases, sinuses in combination with the configuration of the frontal bone may improve skull performance by increasing skull strength and dissipating stresses more evenly. We used CT technology to investigate patterns in frontal sinus size and shape disparity among three families of carnivores: Canidae, Felidae, and Hyaenidae. We provide some of the first quantitative data on sinus morphology for these three families, and employ a novel method to quantify the relationship between three-dimensional sinus shape and skull shape. As expected, frontal sinus size and shape were more strongly correlated with frontal bone size and shape than with the morphology of the skull as a whole. However, sinus morphology was also related to allometric differences among families that are linked to biomechanical function. Our results support the hypothesis that frontal sinuses most often opportunistically fill space that is mechanically unnecessary, and they can facilitate cranial shape changes that reduce stress during feeding. Moreover, we suggest that the ability to form frontal sinuses allows species to modify skull function without compromising the performance of more functionally constrained regions such as the nasal chamber (heat/water conservation, olfaction), and braincase (housing the brain and sensory structures). © 2014 Wiley Periodicals, Inc.

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.

Does wet hair in cold weather cause sinus headache and posterior eye pain? A possible mechanism through selective brain cooling system.

PubMed

Kaya, Abdullah; Calışkan, Halil

2012-12-01

As a general observation, wet hair in cold weather seems to be a predisposing factor for sinus headache and posterior eye pain. We offer a mechanism through selective brain cooling system for this observation. Selective brain cooling (SBC) is a mechanism to protect brain from hyperthermia. Components of SBC are head skin and upper respiratory tract (nose and paranasal sinuses). Cool venous blood from head skin and mucous membranes of nose and paranasal sinuses drains to intracranial dural sinuses and provide brain cooling. Brain will be cooled very much when head skin exposes to hypothermia such a condition like wet hair in cold weather. We suggest that, in order to reduce brain cooling activity, some alterations are being occurred within paranasal sinuses. For this purpose, sinus ostiums may close and mucus may accumulate to reduce air within sinuses. Also there may be some vasomotor changes to prevent heat loss. We hypothesize that this possible alterations may occur within paranasal sinuses as a control mechanism for brain temperature control during exposure of head skin to hypothermia. Paranasal sinuses may also cool brain directly by a very thin layer of bone separates the posterior ethmoid air sinus from the subarachnoid space and only thin plates of bone separate the sphenoidal sinuses from internal carotid artery and cavernous sinuses. Because of their critical role in the SBC, posterior ethmoid air sinus and sphenoidal sinuses may be affected from this alterations more than other paranasal sinuses. This situation may cause posterior eye pain. This mechanism can explain why a person who expose to hypothermia with wet hair or a person who don't use a beret or a hat during cold weather gets sinus headache and posterior eye pain. These symptoms could lead to an incorrect diagnosis of sinusitis. Copyright © 2012 Elsevier Ltd. All rights reserved.

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.

Holmium: yttrium aluminum garnet laser-assisted endoscopic sinus surgery: laboratory experience.

PubMed

Shapshay, S M; Rebeiz, E E; Bohigian, R K; Hybels, R L; Aretz, H T; Pankratov, M M

1991-02-01

Endoscopic sinus surgery has gained wide acceptance since its introduction into the United States. Complex sinus anatomy and troublesome bleeding have been associated with complications, which vary in severity from synechia to blindness and leakage of cerebrospinal fluid. Endoscopic sinus surgery using a holmium: yttrium aluminum garnet pulsed solid-state laser oscillating at 2.1 microns with fiberoptic delivery was performed in the laboratory, and the results were compared with those of conventional endoscopic sinus surgery. Three beagle dogs, six human cadaver heads, and one calf head were used in the in vivo and in vitro studies to evaluate the bone ablation, tissue coagulation, and hemostatic properties of the holmium: yttrium aluminum garnet laser. Modified endoscopic telescopes for sinus surgery, a newly developed handpiece for fiberoptic delivery, and other surgical instruments were used. The results indicate that the holmium: yttrium aluminum garnet laser and new delivery instrumentation provide good hemostasis and controlled soft-tissue ablation and bone removal. The access to all sinuses in the human cadaver model was very good. The canine in vivo study showed delayed but complete healing on the laser-treated side. Clinical evaluation of the holmium: yttrium aluminum garnet laser is warranted to increase the precision and safety of endoscopic sinus surgery.

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.

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.

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

Nasal dermoid cyst extending through the frontal bone with no sinus tract in a Dalmatian.

PubMed

van der Peijl, G J W; Schaeffer, I G F

2011-02-01

A Dalmatian was presented with a subcutaneous swelling in the dorsal midline between the eyes. No opening in the skin was identified at the dorsal nasal planum and there was no discharge. Positive contrast sinography showed contrast material filling a cyst that extended to the frontal bone. At surgery, the cyst had a tubular shape and was embedded in a fibrous dermal tissue strand running into the bony nasal septum. The nasal dermoid sinus cyst was surgically removed by limited dorsal rhinotomy, followed by excision of the remaining strand from a bony recess in the lamina perpendicularis ethmoidalis. It is proposed that this nasal dermoid cyst that extends through the frontal bone with no sinus tract is classified as a type V subtype c. © 2011 British Small Animal Veterinary Association.

Transcoronary sinus delivery of autologous bone marrow and angiogenesis in pig models with myocardial injury

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

Vicario, J.; Piva, J.; Pierini, A.

2002-06-01

Purpose: The aim of the investigation is to study myocardial injury on pig model with two objectives: (1) feasibility of stimulating angiogenesis with fresh autologous bone marrow; (2) administration of the same fresh autologous bone marrow via coronary sinus with transitory occlusion. Methods: A controlled study was done in animal model with three phases, in a study group of 12 pigs (bone marrow administration) as well as in control group of 4 pigs (saline administration). Phase 1--production of coronary stenosis and myocardial injury; Phase 2--two weeks later, administration of bone marrow through coronary sinus with 10 min occlusion in themore » study group and saline solution in the control group. Phase 3--two weeks later, histological staining with hematoxylin-eosin and inmunohistochemical staining with monoclonal antibody for smooth muscle {alpha}-actin were conducted on both study and control groups. Results: The percentage of angionenesis observed in the study group was 91% and 0% in control group. Counting of positive actin in affected and control areas showed statistically significant differences in relation to both groups: study group (1.37 vs. 0.79) and control group (0.47 vs. 0.51). The percentage of mononuclear immature cells observed in the myocardium in the study group was 25% and in the control group was 0%. There was no increment in the coronary collateral circulation when comparing coronary angiography. Conclusions: Autologous bone marrow in animal model with experimental myocardial injury enhances angiogenesis, as well as vessels with smooth muscles. The transitory occlusion of the coronary sinus might be an effective way to administer cells as those from the bone marrow.« less

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

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.

Management of missiles injuries of the facial skeleton: primary, intermediate, and secondary phases.

PubMed

Kummoona, Raja

2010-07-01

This study included 235 patients with missile injuries of the facial skeleton, who were treated in the Maxillofacial Unit of the Hospital of Specialized Surgery in Medical City, Baghdad, Iraq, during a period of 4 years of war, since Iraq became the international battlefield for terrorism. There were 195 men and 40 women, with ages ranging from 1 to 70 years (mean, 39.5 years); all patients had severe facial injuries and posttraumatic missile deformities, including 27 patients with orbital injuries. This study also evaluates the management of the immediate, intermediate, and secondary phases.Deformities of the facial skeleton as a complication of missile injuries were classified into the following cases: 95 patients (40.43%) had bone loss, 72 patients (30.64%) had soft-tissue loss, 33 patients (14.05%) had orbital injuries, and 35 patients (14.90%) had other deformities of scar contracture, fistula, and sinus formation.The bony defects of the mandible were reconstructed by both bone chips carried by osteomesh tray harvested from the iliac crest in 24 patients and by block of corticocancellous bone graft from the iliac crest in 38 patients for reconstruction of the mandible, 4 cases for maxillary reconstruction, and 4 cases of orbital floor defect. K-wire was used in 23 cases for holding missing segments of the mandible. Soft-tissue reconstruction of the face was done in 72 cases, local flaps were used in 30 cases, regional flaps including lateral cervical flap in 10 cases, and cervicofacial flaps in 11 cases. The orbit was reconstructed by bone graft, lyophilized dura, and silastic implant. Low-velocity bullet injury to the frontal part of the head was treated by coronal flap, as an access in 6 cases required craniotomy and dura was reconstructed by galea or temporalis muscle. Scar contracture was treated by scar revision, and sinus tract was excised at the same time of scar revision. Primary phase required an urgent airway management, controlling an active bleeding by surgical intervention; most entrance and exit wounds as well as retained missile were located in the cheek, chin, and mandibular body. Few cases were reported of mortality due to complication related to head injuries.

Ontogeny of the Middle-Ear Air-Sinus System in Alligator mississippiensis (Archosauria: Crocodylia)

PubMed Central

Dufeau, David L.; Witmer, Lawrence M.

2015-01-01

Modern crocodylians, including Alligator mississippiensis, have a greatly elaborated system of pneumatic sinuses invading the cranium. These sinuses invade nearly all the bones of the chondrocranium and several bony elements of the splanchnocranium, but patterns of postnatal paratympanic sinus development are poorly understood and documented. Much of crocodylomorph—indeed archosaurian—evolution is characterized by the evolution of various paratympanic air sinuses, the homologies of which are poorly understood due in large part to the fact that individual sinuses tend to become confluent in adults, obscuring underlying patterns. This study seeks to explore the ontogeny of these sinuses primarily to clarify the anatomical relations of the individual sinuses before they become confluent and thus to provide the foundation for later studies testing hypotheses of homology across extant and extinct Archosauria. Ontogeny was assessed using computed tomography in a sample of 13 specimens covering an almost 19-fold increase in head size. The paratympanic sinus system comprises two major inflations of evaginated pharyngeal epithelium: the pharyngotympanic sinus, which communicates with the pharynx via the lateral (true) Eustachian tubes and forms the cavum tympanicum proprium, and the median pharyngeal sinus, which communicates with the pharynx via the median pharyngeal tube. Each of these primary inflations gives rise to a number of secondary inflations that further invade the bones of the skull. The primary sinuses and secondary diverticula are well developed in perinatal individuals of Alligator, but during ontogeny the number and relative volumes of the secondary diverticula are reduced. In addition to describing the morphological ontogeny of this sinus system, we provide some preliminary exploratory analyses of sinus function and allometry, rejecting the hypothesis that changes in the volume of the paratympanic sinuses are simply an allometric function of braincase volume, but instead support the hypothesis that these changes may be a function of the acoustic properties of the middle ear. PMID:26398659

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.

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.

Texture analysis of computed tomographic images in osteoporotic patients with sinus lift bone graft reconstruction.

PubMed

Marchand-Libouban, Hélène; Guillaume, Bernard; Bellaiche, Norbert; Chappard, Daniel

2013-05-01

Bone implants are now widely used to replace missing teeth. Bone grafting (sinus lift) is a very useful way to increase the bone volume of the maxilla in patients with bone atrophy. There is a 6- to 9-month delay for the receiver grafted site to heal before the implants can be placed. Computed tomography is a useful method to measure the amount of remaining bone before implantation and to evaluate the quality of the receiver bone at the end of the healing period. Texture analysis is a non-invasive method useful to characterize bone microarchitecture on X-ray images. Ten patients in which a sinus lift surgery was necessary before implantation were analyzed in the present study. All had a bone reconstruction with a combination of a biomaterial (beta tricalcium phosphate) and autograft bone harvested at the chin. Computed tomographic images were obtained before grafting (t0), at mid-interval (t1, 4.2 ± 0.7 months) and before implant placement (t2, 9.2 ± 0.6 months). Texture analysis was done with the run-length method. A significant increase of texture parameters at t1 reflected a gain of homogeneity due to the graft and the beginning of bone remodeling. At t2, some parameters remained high and corresponded to the persistence of bone trabeculae while the resorption of biomaterials was identified by other parameters which tended to return to pregraft values. Texture analysis identified changes during the healing of the receiver site. The method is known to correlate with microarchitectural changes in bone and could be a useful approach to characterized osseointegrated grafts.

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

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.

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.

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.

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.

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.

Phyllosilicate and sulfate-hematite deposits within Miyamoto crater in Southern Sinus Meridiani, Mars

USGS Publications Warehouse

Wiseman, S.M.; Arvidson, R. E.; Andrews-Hanna, J. C.; Clark, R.N.; Lanza, N.L.; des Marais, D.; Marzo, G.A.; Morris, R.V.; Murchie, S.L.; Newsom, Horton E.; Noe Dobrea, E.Z.; Ollila, A.M.; Poulet, F.; Roush, T.L.; Seelos, F.P.; Swayze, G.A.

2008-01-01

Orbital topographic, image, and spectral data show that sulfate- and hematite-bearing plains deposits similar to those explored by the MER rover Opportunity unconformably overlie the northeastern portion of the 160 km in diameter Miyamoto crater. Crater floor materials exhumed to the west of the contact exhibit CRISM and OMEGA NIR spectral signatures consistent with the presence of Fe/Mg-rich smectite phyllosilicates. Based on superposition relationships, the phyllosilicate-bearing deposits formed either in-situ or were deposited on the floor of Miyamoto crater prior to the formation of the sulfate-rich plains unit. These findings support the hypothesis that neutral pH aqueous conditions transitioned to a ground-water driven acid sulfate system in the Sinus Meridiani region. The presence of both phyllosilicate and sulfate- and hematite-bearing deposits within Miyamoto crater make it an attractive site for exploration by future rover missions. Copyright 2008 by the American Geophysical Union.

[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.

Clinical applications of cell-based approaches in alveolar bone augmentation: a systematic review.

PubMed

Shanbhag, Siddharth; Shanbhag, Vivek

2015-01-01

Cell-based approaches, utilizing adult mesenchymal stem cells (MSCs), are reported to overcome the limitations of conventional bone augmentation procedures. The study aims to systematically review the available evidence on the characteristics and clinical effectiveness of cell-based ridge augmentation, socket preservation, and sinus-floor augmentation, compared to current evidence-based methods in human adult patients. MEDLINE, EMBASE, and CENTRAL databases were searched for related literature. Both observational and experimental studies reporting outcomes of "tissue engineered" or "cell-based" augmentation in ≥5 adult patients alone, or in comparison with non-cell-based (conventional) augmentation methods, were eligible for inclusion. Primary outcome was histomorphometric analysis of new bone formation. Effectiveness of cell-based augmentation was evaluated based on outcomes of controlled studies. Twenty-seven eligible studies were identified. Of these, 15 included a control group (8 randomized controlled trials [RCTs]), and were judged to be at a moderate-to-high risk of bias. Most studies reported the combined use of cultured autologous MSCs with an osteoconductive bone substitute (BS) scaffold. Iliac bone marrow and mandibular periosteum were frequently reported sources of MSCs. In vitro culture of MSCs took between 12 days and 1.5 months. A range of autogenous, allogeneic, xenogeneic, and alloplastic scaffolds was identified. Bovine bone mineral scaffold was frequently reported with favorable outcomes, while polylactic-polyglycolic acid copolymer (PLGA) scaffold resulted in graft failure in three studies. The combination of MSCs and BS resulted in outcomes similar to autogenous bone (AB) and BS. Three RCTs and one controlled trial reported significantly greater bone formation in cell-based than conventionally grafted sites after 3 to 8 months. Based on limited controlled evidence at a moderate-to-high risk of bias, cell-based approaches are comparable, if not superior, to current evidence-based bone grafting methods, with a significant advantage of avoiding AB harvesting. Future clinical trials should additionally evaluate patient-based outcomes and the time-/cost-effectiveness of these approaches. © 2013 Wiley Periodicals, Inc.

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.

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

Modified three-dimensional skull base model with artificial dura mater, cranial nerves, and venous sinuses for training in skull base surgery: technical note.

PubMed

Mori, Kentaro; Yamamoto, Takuji; Oyama, Kazutaka; Ueno, Hideaki; Nakao, Yasuaki; Honma, Keiichirou

2008-12-01

Experience with dissection of the cavernous sinus and the temporal bone is essential for training in skull base surgery, but the opportunities for cadaver dissection are very limited. A modification of a commercially available prototype three-dimensional (3D) skull base model, made by a selective laser sintering method and incorporating surface details and inner bony structures such as the inner ear structures and air cells, is proposed to include artificial dura mater, cranial nerves, venous sinuses, and the internal carotid artery for such surgical training. The transpetrosal approach and epidural cavernous sinus surgery (Dolenc's technique) were performed on this modified model using a high speed drill or ultrasonic bone curette under an operating microscope. The model could be dissected in almost the same way as a real cadaver. The modified 3D skull base model provides a good educational tool for training in skull base surgery.

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.

Sphenoethmoidal mucoceles with intracranial extension.

PubMed

Close, L G; O'Conner, W E

1983-08-01

Mucoceles of the paranasal sinuses are benign, expansile, locally destructive lesions that are thought to occur secondary to obstruction of the sinus ostia. Nasal and/or ocular signs and symptoms are the usual clinical manifestations of mucoceles arising in the ethmoid and sphenoid sinuses, and intracranial extension is rare. We describe three cases of widely destructive sphenoethmoidal mucoceles extending intracranially, with bone erosion and dural exposure in all cases and brain necrosis in one case.

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.

Computed tomographic detection of sinusitis responsible for intracranial and extracranial infections

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

Carter, B.L.; Bankoff, M.S.; Fisk, J.D.

1983-06-01

Computed tomography (CT) is now used extensively for the evaluation of orbital, facial, and intracranial infections. Nine patients are presented to illustrate the importance of detecting underlying and unsuspected sinusitis. Prompt treatment of the sinusitis is essential to minimize the morbidity and mortality associated with complications such as brain abscess, meningitis, orbital cellulitis, and osteomyelitis. A review of the literature documents the persistence of these complications despite the widespread use of antibiotic therapy. Recognition of the underlying sinusitis is now possible with CT if the region of the sinuses is included and bone-window settings are used during the examination ofmore » patients with orbital and intracranial infection.« less

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.

Sinusitis in patients undergoing allogeneic bone marrow transplantation - a review.

PubMed

Drozd-Sokolowska, Joanna Ewa; Sokolowski, Jacek; Wiktor-Jedrzejczak, Wieslaw; Niemczyk, Kazimierz

Sinusitis is a common morbidity in general population, however little is known about its occurrence in severely immunocompromised patients undergoing allogeneic hematopoietic stem cell transplantation. The aim of the study was to analyze the literature concerning sinusitis in patients undergoing allogeneic bone marrow transplantation. An electronic database search was performed with the objective of identifying all original trials examining sinusitis in allogeneic hematopoietic stem cell transplant recipients. The search was limited to English-language publications. Twenty five studies, published between 1985 and 2015 were identified, none of them being a randomized clinical trial. They reported on 31-955 patients, discussing different issues i.e. value of pretransplant sinonasal evaluation and its impact on post-transplant morbidity and mortality, treatment, risk factors analysis. Results from analyzed studies yielded inconsistent results. Nevertheless, some recommendations for good practice could be made. First, it seems advisable to screen all patients undergoing allogeneic hematopoietic stem cell transplantation with Computed Tomography (CT) prior to procedure. Second, patients with symptoms of sinusitis should be treated before hematopoietic stem cell transplantation (HSCT), preferably with conservative medical approach. Third, patients who have undergone hematopoietic stem cell transplantation should be monitored closely for sinusitis, especially in the early period after transplantation. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

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

Osteologic analysis of ethnic differences in supernumerary ethmoidal foramina: implications for endoscopic sinus and orbit surgery.

PubMed

Mueller, Sarina K; Bleier, Benjamin S

2018-05-01

Knowledge of the position of the ethmoidal arteries is critical to enable safe endoscopic sinus and orbital surgery. The presence of a third or "middle" ethmoid variant has recently become more relevant as endoscopic intraconal surgery continues to advance. The purpose of this study was to quantify the presence of supernumerary (ie, over 2) ethmoid foramina in different ethnicities and genders. Morphometric osteologic measurements were performed in 273 orbits. Prevalence of supernumerary ethmoid foramina and orbital length data were obtained from human skulls of Asian (n = 54), Caucasian (n = 70), African (n = 39), Hispanic (n = 49), and Middle Eastern (n = 61) derivation. Correlations between gender, ethnicity, symmetry, orbital floor, and lamina papyracea length were assessed by analysis of variance, paired t test, and χ 2 test. Supernumerary foramina were identified in 95 of 273 orbits (34.79%). A significantly higher prevalence was seen in Asian (42.59%), African (41.02%), and Hispanic (41.00%) skulls as compared with Caucasian (25.71%) and Middle Eastern (22.95%) skulls (p < 0.05 for all). The length of the orbital floor was significantly shorter in the Asian (3.35 ± 1.52 cm) specimens (p < 0.01). Asians were found to have the highest risk of ethmoid artery injury compared with the other ethnic groups (ratio of number of supernumerary foramina to orbital floor length = 0.72). Supernumerary ethmoidal foramina were common among all orbits studied. Orbits of Asian and African derivation had significantly greater numbers of ethmoidal foramina, both unilaterally and symmetrically and within a shorter orbital length, suggesting a greater proximity between the ethmoidal vessels. Surgeons should be alert to the possible presence of middle ethmoidal vessels during endoscopic sinus and orbital approaches. © 2017 ARS-AAOA, LLC.

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.

Application of Additive Manufacturing in Oral and Maxillofacial Surgery.

PubMed

Farré-Guasch, Elisabet; Wolff, Jan; Helder, Marco N; Schulten, Engelbert A J M; Forouzanfar, Tim; Klein-Nulend, Jenneke

2015-12-01

Additive manufacturing is the process of joining materials to create objects from digital 3-dimensional (3D) model data, which is a promising technology in oral and maxillofacial surgery. The management of lost craniofacial tissues owing to congenital abnormalities, trauma, or cancer treatment poses a challenge to oral and maxillofacial surgeons. Many strategies have been proposed for the management of such defects, but autogenous bone grafts remain the gold standard for reconstructive bone surgery. Nevertheless, cell-based treatments using adipose stem cells combined with osteoconductive biomaterials or scaffolds have become a promising alternative to autogenous bone grafts. Such treatment protocols often require customized 3D scaffolds that fulfill functional and esthetic requirements, provide adequate blood supply, and meet the load-bearing requirements of the head. Currently, such customized 3D scaffolds are being manufactured using additive manufacturing technology. In this review, 2 of the current and emerging modalities for reconstruction of oral and maxillofacial bone defects are highlighted and discussed, namely human maxillary sinus floor elevation as a valid model to test bone tissue-engineering approaches enabling the application of 1-step surgical procedures and seeding of Good Manufacturing Practice-level adipose stem cells on computer-aided manufactured scaffolds to reconstruct large bone defects in a 2-step surgical procedure, in which cells are expanded ex vivo and seeded on resorbable scaffolds before implantation. Furthermore, imaging-guided tissue-engineering technologies to predetermine the surgical location and to facilitate the manufacturing of custom-made implants that meet the specific patient's demands are discussed. The potential of tissue-engineered constructs designed for the repair of large oral and maxillofacial bone defects in load-bearing situations in a 1-step surgical procedure combining these 2 innovative approaches is particularly emphasized. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Simultaneous sinus lift and implant installation: prospective study of consecutive two hundred seventeen sinus lift and four hundred sixty-two implants.

PubMed

Cha, Hyun-Suk; Kim, Andrew; Nowzari, Hessam; Chang, Hoo-Sun; Ahn, Kang-Min

2014-06-01

If less than 4 mm of residual bone is remained in posterior maxilla, two-stage operation is recommended for implant installation. However, if primary stability could be obtained using tapered designed implants, one-stage surgery could be performed with reliable success rate in severely resorbed maxilla. The purpose of this prospective study was to evaluate survival and success rates of the implants simultaneously placed into grafted sinus using rough-surfaced implant. A total of two hundred seventeen consecutive sinus lifting through lateral approach and four hundred sixty-two simultaneous implants were installed from November 2003 for 5.5 years. Xenogenic bone was used solely for bone graft materials. Second surgery was performed around 6 months after operation and porcelain fused metal or gold crown was used for definitive restorations. Cumulative survival and success rates were evaluated according to residual alveolar bone height (RABH), smoking status, and Schneiderian membrane perforation. The mean follow-up was 57.1 ± 15.6 (36-98) months. Of the four hundred sixty-two implants, two hundred sixty-two implants (56.7%: group 1) were installed in posterior maxilla less than 4-mm RABH and two hundred implants (43.3%: group 2) were placed in over 5-mm RABH. The cumulative survival and success rates were 98.91% and 96.54%. There was no statistically significant difference in success rate between group 1 and group 2 (p = .3135). Perforation of the membrane was not related to success (p = .7162), but smoking status is significantly related with implant failure (p = .0003). Sinus lifting with simultaneous implant placement could be used to treat atrophic maxilla in patients with minimal RABH when initial stability could be obtained by using taper designed implants with surgical techniques. Smoking is a possible factor for implant failure. Membrane perforation did not have an adverse effect on implant success if the membrane was repaired with absorbable membrane and fibrin glue. © 2012 Wiley Periodicals, Inc.

Sinus involvement in inflammatory orbital pseudotumor.

PubMed

Eshaghian, J; Anderson, R L

1981-04-01

Orbital pseudotumor is a difficult diagnosis to establish preoperatively. The relationship between sinus disease and orbital pseudotumor is controversial. We describe two patients with unilateral proptosis, diplopia, palpable orbital masses, ocular discomfort, and sinus problems of short duration. Echographically, both had low reflective masses in the orbit and the adjacent sinuses. Roentgenograms and echograms were interpreted as showing erosion of the bony orbital wall. A presumptive diagnosis of sinus malignant neoplasm with orbital extension was made. Sinus histopathologic examination in one case and nasal histopathologic examination in the other showed chronic inflammatory changes compatible with the diagnosis of pseudotumor. At orbitotomy, one patient had vessels communicating between the orbital and sinus lesions, and both patients had irregular pitting of the bone next to the histologically proved orbital pseudotumors. The lytic erosive changes predicted preoperatively were not present. Simultaneous orbital and sinus pseudotumors seem to be a distinct clinicopathologic entity. Those concerned with the diagnosis and management of orbital disease should be aware of this entity.

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.

Three-Dimensional Arrangement of Human Bone Marrow Microvessels Revealed by Immunohistology in Undecalcified Sections

PubMed Central

Wilhelmi, Verena; Seiler, Anja; Lampp, Katrin; Neff, Andreas; Guthe, Michael; Lobachev, Oleg

2016-01-01

The arrangement of microvessels in human bone marrow is so far unknown. We combined monoclonal antibodies against CD34 and against CD141 to visualise all microvessel endothelia in 21 serial sections of about 1 cm2 size derived from a human iliac crest. The specimen was not decalcified and embedded in Technovit® 9100. In different regions of interest, the microvasculature was reconstructed in three dimensions using automatic methods. The three-dimensional models were subject to a rigid semiautomatic and manual quality control. In iliac crest bone marrow, the adipose tissue harbours irregularly distributed haematopoietic areas. These are fed by networks of large sinuses, which are loosely connected to networks of small capillaries prevailing in areas of pure adipose tissue. Our findings are compatible with the hypothesis that capillaries and sinuses in human iliac crest bone marrow are partially arranged in parallel. PMID:27997569

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.

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

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.

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.

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.

The relationship between frontal sinus morphology and skeletal maturation.

PubMed

Buyuk, Suleyman Kutalmıs; Simsek, Huseyin; Karaman, Ahmet

2018-01-03

The aim of this study is to evaluate the relationship between frontal sinus morphology and hand-wrist bone maturation by using postero-anterior (PA) cephalometric radiographs. The study sample consisted of 220 patients divided into eleven groups based on the hand-wrist radiographs. The right and left maximum height, width and area of the frontal sinus parameters were measured in postero-anterior cephalometric radiographs 220 subjects aged 8-18 years. The hand-wrist skeletal maturation stages were evaluated on the hand-wrist radiographs using the method of Fishman. The Kendall tau-b values were analyzed to evaluate the correlation between the hand-wrist skeletal maturation stages and the frontal sinus parameters. The right and left frontal sinus areas and widths were found to be larger in males than in females (p < 0.05). In males, a significant difference was observed in all frontal sinus parameters in different maturation stages (p < 0.001), while a statistically significant correlation was found in females between the left frontal sinus area, right frontal sinus height, right frontal sinus width and different maturation stages (p < 0.05). In conclusion, the relationship between frontal sinus dimensions obtained from PA cephalometric radiographs and hand-wrist maturation stages suggests that frontal sinuses can be used in determining growth and development.

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.

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.

Sinus septi nasi: Anatomical study.

PubMed

Mladina, Ranko; Antunović, Romano; Cingi, Cemal; Bayar Muluk, Nuray; Skitarelić, Neven

2017-04-01

The aim of this study was to perform a pioneering investigation into the incidence of pneumatization in human skulls. A total of 93 human skulls (≥20 years of age, 69 males, 24 females) were included in the study. The skulls were scanned in a fixed position using cone beam computed tomography (CBCT). The pneumatized space parameters within the nasal septum-width, length, and height-were measured. Two types of finding were identified: (a) Pneumatization, named "sinus septi nasi" (SSN), and (b) "spongy bone" (SB). The results showed SSN in 32 of the 93 skulls (34.4%). The SSN formations were from 0.5 to 4.2 mm wide, 3.5 to 18.8 mm long, and 3.8 to 17.7 mm high. Tumefactions filled with SB were found in 61 of the 93 skulls (65.59%). These were not suitable for precise measurements since the outer borders were not strictly and well defined on CT scans (perhaps because of the preparation process). In conclusion, the perpendicular plate of the ethmoidal bone is not always compact bone; in 34.4% of cases, it shows a degree of pneumatization. In contrast, an enlarged formation filled with SB is present in 65.59% of cases. The possible sources of pneumatization of this little-investigated region are discussed: sphenoid sinus, frontal sinus, and vomeronasal organ. Clin. Anat. 30:312-317, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Pathogenesis of chronic rhinosinusitis in patients affected by β-thalassemia major and sickle cell anaemia post allogenic bone marrow transplant.

PubMed

Martino, F; Di Mauro, R; Paciaroni, K; Gaziev, J; Alfieri, C; Greco, L; Floris, R; Di Girolamo, S; Di Girolamo, M

2018-03-01

Sickle cell anemia (SCA) and β -thalassemia major are well-recognized beta-globin gene disorders of red blood cells associated to mortality and morbidity included bone morbidities due to ineffective erythropoiesis and bone marrow expansion, which affect every part of the skeleton. While there are an abundance of described disease manifestations of the head and neck, the manner of paranasal sinuses involvement and its relations to β-thalassemia and SCA process was not studied yet. Therefore, the aim of this study was to investigate a possible increased risk of rhinosinusitis and the real pathogenetic mechanism of it, comparing these two hematological diseases using msCT, gold standard for paranasal sinuses evaluation. A retrospective analysis of 90 patients affected by β-thalassemia major or SCA (respectively 59 and 31) underwent allogeneic bone marrow transplantation (BMT), and 44 control subjects was performed. Both patient categories and control group have been subjected to hematological and radiological evaluation using 64-multidetector-row CT scanner without contrast injection. Statistical analysis reveals that patients of the two study groups exhibit a significantly increased risk of sinusitis in comparison with the normal controls (RR: 3.55 for β-thalassemic pediatric subjects; RR: 3.35 for SCA pediatric subjects). A significant difference (p < 0,5) was found between the β -thalassemic patients on the one side, and SCA and control group on the other side, with regard to the evaluation of the typical anatomic alteration of maxillary sinus: β-thalassemic children had significant increase in the bone thickness of anterior and lateral sinus walls and significant reduction in volume and density compared to SCA patients and control group, with normal conditions of these parameters. In these hematological patients, there is an increased incidence of sinonasal infections due their therapy-induced immunosuppression post transplantation. In β-thalassemic patients, furthermore, the specific anatomical variants play an important confounding factor in radiological interpretation of CT images. Therefore, a cranio-facial CT scan evaluation could be a useful tool in the management of upper airway infections after BMT and should be a routinely exams in order to avoid useless surgical or antibiotic approaches. Copyright © 2018 Elsevier B.V. All rights reserved.

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

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.

Muscle Insertion Line as a Simple Landmark To Identify the Transverse Sinus When Neuronavigation Is Unavailable.

PubMed

Kivelev, Juri; Kivisaari, Riku; Niemelä, Mika; Hernesniemi, Juha

2016-10-01

Skull opening in occipital and suboccipital regions might be associated with risk of damage to the transverse venous sinus and the confluence of sinuses. We analyze the value of magnetic resonance (MR) imaging in localizing the venous sinuses in relation to the superior muscle insertion line (MIL) on the occipital bone. We retrospectively analyzed head MR images of 100 consecutive patients imaged for any reason from 1 January 2013. All MR images were interpreted by a radiologist (R.K.). The superior MIL was identified at the midline and on both midpupillar lines, which represent the most frequent sites of skin incision and craniotomy (median and lateral suboccipital craniotomy, respectively). Patients comprised 56 women (56%) and 44 men (44%). Their mean age was 54 (range 18-84) years. The muscles of the posterior skull were readily visible and clearly identified in both T1 and T2 images of all patients. Identification of the insertion zone and its relation to the venous structures was most readily made in the sagittal plane. We found that the upper muscle insertion line on occipital bone corresponds to the underlying venous sinus and can be used as a reliable anatomic landmark. We identified it in 100% of preoperative MR images of heads with an intact occiput. Copyright © 2016 Elsevier Inc. All rights reserved.

Salvage of infected craniotomy bone flaps with the wash-in, wash-out indwelling antibiotic irrigation system. Technical note and case series of 12 patients.

PubMed

Auguste, Kurtis I; McDermott, Michael W

2006-10-01

When complicated by infection, craniotomy bone flaps are commonly removed, discarded, and delayed cranioplasty is performed. This treatment paradigm is costly, carries the risks associated with additional surgery, and may cause cosmetic deformities. The authors present their experience with an indwelling antibiotic irrigation system used for the sterilization and salvage of infected bone flaps as an alternative to their removal and replacement. The authors retrospectively reviewed the medical records for 12 patients with bone flap infections following craniotomy who received treatment with the wash-in, wash-out indwelling antibiotic irrigation system. Infected flaps were removed and scrubbed with povidone-iodine solution and soaked in 1.5% hydrogen peroxide while the wound was debrided. The bone flaps were returned to the skull and the irrigation system was installed. Antibiotic medication was infused through the system for a mean of 5 days. Intravenous antibiotic therapy was continued for 2 weeks and oral antibiotics for 3 months postoperatively. Wound checks were performed at clinic follow-up visits, and there was a mean follow-up period of 13 months. Eleven of the 12 patients who had undergone placement of the bone flap irrigation system experienced complete resolution of the infection. In five patients there was involvement of the nasal sinus cavities, and in four there was a history of radiation treatment. In the one patient whose infection recurred, there was both involvement of the nasal sinuses and a history of extensive radiation treatment. Infected bone flaps can be salvaged, thus avoiding the cost, risk, and possible disfigurement associated with flap removal and delayed cranioplasty. Although prior radiation treatment and involvement of the nasal sinuses may interfere with wound healing and clearance of the infection, these factors should not preclude the use of irrigation with antibiotic agents for bone flap salvage.

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.

Dural opening/removal for combined petrosal approach: technical note.

PubMed

Terasaka, Shunsuke; Asaoka, Katsuyuki; Kobayashi, Hiroyuki; Sugiyama, Taku; Yamaguchi, Shigeru

2011-03-01

Detailed descriptions of stepwise dural opening/removal for combined petrosal approach are presented. Following maximum bone work, the first dural incision was made along the undersurface of the temporal lobe parallel to the superior petrosal sinus. Posterior extension of the dural incision was made in a curved fashion, keeping away from the transverse-sigmoid junction and taking care to preserve the vein of Labbé. A second incision was made perpendicular to the first incision. After sectioning the superior petrosal sinus around the porus trigeminus, the incision was extended toward the posterior fossa dura in the middle fossa region. The tentorium was incised toward the incisura at a point just posterior to the entrance of the trochlear nerve. A third incision was made longitudinally between the superior petrosal sinus and the jugular bulb. A final incision was initiated perpendicular to the third incision in the presigmoid region and extended parallel to the superior petrosal sinus connecting the second incision. The dural complex consisting of the temporal lobe dura, the posterior fossa dura, and the freed tentorium could then be removed. In addition to extensive bone resection, our strategic cranial base dural opening/removal can yield true advantages for the combined petrosal approach.

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.

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.

Correlations of External Landmarks With Internal Structures of the Temporal Bone.

PubMed

Piromchai, Patorn; Wijewickrema, Sudanthi; Smeds, Henrik; Kennedy, Gregor; O'Leary, Stephen

2015-09-01

The internal anatomy of a temporal bone could be inferred from external landmarks. Mastoid surgery is an important skill that ENT surgeons need to acquire. Surgeons commonly use CT scans as a guide to understanding anatomical variations before surgery. Conversely, in cases where CT scans are not available, or in the temporal bone laboratory where residents are usually not provided with CT scans, it would be beneficial if the internal anatomy of a temporal bone could be inferred from external landmarks. We explored correlations between internal anatomical variations and metrics established to quantify the position of external landmarks that are commonly exposed in the operating room, or the temporal bone laboratory, before commencement of drilling. Mathematical models were developed to predict internal anatomy based on external structures. From an operating room view, the distances between the following external landmarks were observed to have statistically significant correlations with the internal anatomy of a temporal bone: temporal line, external auditory canal, mastoid tip, occipitomastoid suture, and Henle's spine. These structures can be used to infer a low lying dura mater (p = 0.002), an anteriorly located sigmoid sinus (p = 0.006), and a more lateral course of the facial nerve (p < 0.001). In the temporal bone laboratory view, the mastoid tegmen and sigmoid sinus were also regarded as external landmarks. The distances between these two landmarks and the operating view external structures were able to further infer the laterality of the facial nerve (p < 0.001) and a sclerotic mastoid (p < 0.001). Two nonlinear models were developed that predicted the distances between the following internal structures with a high level of accuracy: the distance from the sigmoid sinus to the posterior external auditory canal (p < 0.001) and the diameter of the round window niche (p < 0.001). The prospect of encountering some of the more technically challenging anatomical variants encountered in temporal bone dissection can be inferred from the distance between external landmarks found on the temporal bone. These relationships could be used as a guideline to predict challenges during drilling and choosing appropriate temporal bones for dissection.

Frontal sinus osteoma in a 16th century skeleton from Zagreb, Croatia.

PubMed

Premužić, Zrinka; Rajić Šikanjić, Petra; Mašić, Boris

2013-03-01

The analysis of 16th century graves from Zagreb, Croatia, revealed a case of frontal sinus osteoma in a middle-aged female. This lesion was discovered during visual examination, due to postmortem breakage of the frontal bone. The significance of this finding is based on the fact that frontal sinus osteomas are very rarely reported in the palaeopathological literature, despite the fact that they account for 80% of all paranasal sinus osteomas in modern populations. This paper presents results of macroscopic and radiographic analyses of the lesion, accompanied by a detailed differential diagnosis. Although tumours are commonly considered diseases of modern lifestyles, the described case confirms their occurrence in the past. Copyright © 2013 Elsevier Inc. All rights reserved.

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.

[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.

Stent-Assisted Coil Embolization of a Transverse-Sigmoid Sinus Diverticulum Presenting with Pulsatile Tinnitus.

PubMed

Li, Baomin; Lv, Xianli; Wu, Zhongxue; Cao, Xiangyu; Wang, Jun; Ge, Aili; Liu, Xinfeng; Li, Sheng

When tinnitus is pulse-synchronous, a vascular etiology is suggested. We present a case of persistent and troublesome pulsatile tinnitus caused by a transverse-sigmoid sinus diverticulum that was endovascularly treated with stent-assisted coiling. A 39-yearold woman presented with a 4-year history of progressive pulsatile tinnitus involving the right ear. Slight pulsatile bruit was heard on the right mastoid bone by auscultation. Cerebral angiography demonstrated a diverticulum of the transverse-sigmoid sinus. The procedure was performed with an 8F guiding catheter (Cordis, USA) catheterized into the right sigmoid sinus. The diverticulum was completely coiled following deployment of a 5.5 mm-50 mm Leo stent. This patient awakened without any neurological deficit and with immediate resolution of her tinnitus. This case report describes a stent-assisted coil embolization of venous sinus diverticulum, which provides immediate resolution of pulsatile tinnitus.

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.

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.

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

[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)

A surgical technique to expand the operative corridor for supracerebellar infratentorial approaches: technical note.

PubMed

Rey-Dios, Roberto; Cohen-Gadol, Aaron A

2013-10-01

The supracerebellar infratentorial approach is a commonly used route in neurosurgery. It provides a narrow and deep corridor to the dorsal midbrain and pineal region. The authors describe a surgical technique to expand the operative corridor and the surgeon's working angles during this approach. Thirteen cases of patients who underwent resection of their lesions using this extended approach were reviewed. During their suboccipital craniotomy, additional bone over the transverse sinus (paramedian approach) and the confluence of the sinuses (midline approach) were removed. Two sutures (tentorial stay sutures) were anchored to the tentorium anterior to the transverse sinus and tension was applied. A video narrated by the senior author describes the details of technique. This additional bone removal and tentorial stay sutures led to gentle elevation of the tentorium and partial mobilization of the dural venous sinuses superiorly. This technique enhanced operative viewing through improved illumination and expanded working angles for microsurgical instruments while minimizing the need for fixed retractors and extensive cerebellar retraction. All patients underwent satisfactory removal of their lesions. No patient suffered from any related complication. The use of stay sutures anchored on the tentorium is a simple and effective technique that expands the surgical corridor during supracerebellar infratentorial approaches.

HLA-typing analysis following allogeneic bone grafting for sinus lifting.

PubMed

Piaia, Marcelo; Bub, Carolina Bonet; Succi, Guilherme de Menezes; Torres, Margareth; Costa, Thiago Henrique; Pinheiro, Fabricio Costa; Napimoga, Marcelo Henrique

2017-03-01

According to the Brazilian Association of Organ Transplants, in 2015, 19,408 bone transplants were performed in Brazil, over 90% by Dental Surgeons. The surgical technique itself has a respectable number of reports regarding its clinical efficacy, as measured by long-term survival of dental implants in grafted areas. Uncertainty remains, however, as to whether fresh frozen grafts from human bone donors remain immunologically innocuous in the body of the host. Six male with no previous medical history of note, including systemic diseases, surgery or blood transfusion were selected. These patients underwent reconstructive procedures (sinus lifting) using fresh frozen human bone from a tissue bank. All patients had venous blood samples collected prior to surgery and 6 months after the procedure. Anti-HLA analysis for the detection of HLA (human leukocyte antigen) antibodies was performed using methods such as the LABScreen PRA Class I and Class II, LABScreen Single Antigen Class I and Class II, Luminex Platform. Reactive individuals to the screening tests (LABScreen PRA) were further investigated to determine the specificity of the antibodies detected (LABScreen Single Antigen) with a cutoff value of median fluorescence intensity ≥500. As a result, it was observed that two patients (33%) were positive in screening tests, one presenting with anti-HLA Class I and II sensitization and the other with anti-HLA class II. The specificity analysis showed that the patients sensitized to HLA class II presented 4 specificities, 3 of which immunologically relevant. In the second individual, 23 specificities were identified, 6 of which immunologically important for HLA class I and 4 specificities for HLA class II, 3 of these were immunologically important. All specificities detected had average fluorescence. These findings are suggestive that sinus-lifting procedures with allogeneic bone can induce immunological sensitization.

In vitro and in vivo evaluation of strontium-containing nanostructured carbonated hydroxyapatite/sodium alginate for sinus lift in rabbits.

PubMed

Valiense, Helder; Barreto, Mauricio; Resende, Rodrigo F; Alves, Adriana T; Rossi, Alexandre M; Mavropoulos, Elena; Granjeiro, José M; Calasans-Maia, Mônica D

2016-02-01

Various synthetic bone substitutes have been developed to reconstruct bone defects. One of the most prevalent ceramics in bone treatment is hydroxyapatite (HA) that is a useful material as bone substitute, however, with a low rate of biodegradation. Its structure allows isomorphic cationic and anionic substitutions to be easily introduced, which can alter the crystallinity, morphology, biocompatibility, and osteoconductivity. The objective of this study was to investigate the in vitro and in vivo biological responses to strontium-containing nanostructured carbonated HA/sodium alginate (SrCHA) spheres (425<ϕ <600 μm) that were used for sinus lifts in rabbits using nanostructured carbonated HA/sodium alginate (CHA) as a reference. Cytocompatibility was determined using a multiparametric assay after exposing murine preosteoblasts to the extracts of these materials. Twelve male and female rabbits underwent bilateral sinus lift procedures and were divided into two groups (CHA or SrCHA) and in two experimental periods (4 and 12 weeks), for microscopic and histomorphometric analyses. The in vitro test revealed the overall viability of the cells exposed to the CHA and SrCHA extracts; thus, these extracts were considered cytocompatible, which was confirmed by three different parameters in the in vitro tests. The histological analysis showed chronic inflammation with a prevalence of macrophages around the CHA spheres after 4 weeks, and this inflammation decreased after 12 weeks. Bone formation was observed in both groups, and smaller quantities of SrCHA spheres were observed after 12 weeks, indicating greater bioresorption of SrCHA than CHA. SrCHA spheres are biocompatible and osteoconductive and undergo bioresorption earlier than CHA spheres. © 2015 Wiley Periodicals, Inc.

Maxillary Sinus Lift with Beta-Tricalcium Phosphate (β-TCP) in Edentulous Patients: A Nanotomographic and Raman Study.

PubMed

Pascaretti-Grizon, Florence; Guillaume, Bernard; Terranova, Lisa; Arbez, Baptiste; Libouban, Hélène; Chappard, Daniel

2017-09-01

Sinus lift elevation restores bone mass at the maxilla in edentulate patients before the placement of dental implants. It consists of opening the lateral side of the sinus and grafting beta-tricalcium phosphate granules (β-TCP) under the olfactory membrane. Bone biopsies were obtained in five patients after 60 weeks. They were embedded undecalcified in poly(methyl methacrylate) (pMMA); blocks were analyzed by nanocomputed tomography (nanoCT); specific areas were studied by Raman microspectroscopy. Remnants of β-TCP were osseointegrated and covered with mineralized bone; osteoid tissue was also filling the inner porosity. Macrophages having engulfed numerous β-TCP grains were observed in marrow spaces. β-TCP was identified by nanoCT as osseointegrated particles and as granules in the cytoplasm of macrophages. Raman microspectroscopy permitted to compare the spectra of β-TCP and bone in different areas. The ratio of the ~820 cm -1 band of pMMA (-CH 2 groups) on the ν1 phosphate band at 960 cm -1 reflected tissue hydration because water was substituted by MMA during histological processing. In bone, the ratio of the ~960 cm -1 phosphate to the amide 1 band and the ratio ν2 phosphate band by the 1240-1250 amide III band reflect the mineralization degree. Specific bands of β-TCP were found in osseointegrated β-TCP granules and in the grains phagocytized by the macrophages. The hydration degree was maximal for β-TCP phagocytized by macrophages. Raman microspectroscopy associated with nanoCT is a powerful tool in the analysis of the biomaterial degradation and osseointegration.

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

Ball, J.B. Jr.

Direct oblique sagittal CT was used to evaluate trauma to 77 orbits. Sixty-seven orbital wall fractures with intact orbital rims (36 floor, 22 medial wall, nine roof) were identified in 47 orbits. Since persistent diplopia and/or enophthalmos may warrant surgical repair of orbital floor fractures, optimal imaging should include an evaluation of extraocular muscle status, the nature and amount of displaced orbital contents, and an accurate definition of fracture margins. For orbital floor fractures, a combination of the direct oblique sagittal and direct coronal projections optimally displayed all fracture margins, the fracture's relationship to the inferior orbital rim and medialmore » orbital wall, and the amount of displacement into the maxillary sinus. Inferior rectus muscle status with 36 floor fractures was best seen on the direct oblique sagittal projection in 30 fractures (83.3%) and was equally well seen on sagittal and coronal projections in two fractures (5.5%). Floor fractures were missed on 100% of axial, 5.5% of sagittal, and 0% of coronal projections. Since the direct oblique sagittal projection complements the direct coronal projection in evaluating orbital floor fractures, it should not be performed alone. A technical approach to the CT evaluation or orbital wall fractures is presented.« less

A spinal cord fate map in the avian embryo: while regressing, Hensen's node lays down the notochord and floor plate thus joining the spinal cord lateral walls.

PubMed

Catala, M; Teillet, M A; De Robertis, E M; Le Douarin, M L

1996-09-01

The spinal cord of thoracic, lumbar and caudal levels is derived from a region designated as the sinus rhomboidalis in the 6-somite-stage embryo. Using quail/chick grafts performed in ovo, we show the following. (1) The floor plate and notochord derive from a common population of cells, located in Hensen's node, which is equivalent to the chordoneural hinge (CNH) as it was defined at the tail bud stage. (2) The lateral walls and the roof of the neural tube originate caudally and laterally to Hensen's node, during the regression of which the basal plate anlage is bisected by floor plate tissue. (3) Primary and secondary neurulations involve similar morphogenetic movements but, in contrast to primary neurulation, extensive bilateral cell mixing is observed on the dorsal side of the region of secondary neurulation. (4) The posterior midline of the sinus rhomboidalis gives rise to somitic mesoderm and not to spinal cord. Moreover, mesodermal progenitors are spatially arranged along the rest of the primitive streak, more caudal cells giving rise to more lateral embryonic structures. Together with the results reported in our study of tail bud development (Catala, M., Teillet, M.-A. and Le Douarin, N.M. (1995). Mech. Dev. 51, 51-65), these results show that the mechanisms that preside at axial elongation from the 6-somite stage onwards are fundamentally similar during the complete process of neurulation.

Skull Base Anatomy.

PubMed

Patel, Chirag R; Fernandez-Miranda, Juan C; Wang, Wei-Hsin; Wang, Eric W

2016-02-01

The anatomy of the skull base is complex with multiple neurovascular structures in a small space. Understanding all of the intricate relationships begins with understanding the anatomy of the sphenoid bone. The cavernous sinus contains the carotid artery and some of its branches; cranial nerves III, IV, VI, and V1; and transmits venous blood from multiple sources. The anterior skull base extends to the frontal sinus and is important to understand for sinus surgery and sinonasal malignancies. The clivus protects the brainstem and posterior cranial fossa. A thorough appreciation of the anatomy of these various areas allows for endoscopic endonasal approaches to the skull base. Copyright © 2016 Elsevier Inc. All rights reserved.

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 cause of headache: Pott's puffy tumour.

PubMed

McDermott, Cian; O'Sullivan, Ronan; McMahon, Geraldine

2007-06-01

Osteomyelitis of the frontal bone (eponymously known as Pott's puffy tumour) is an extremely rare and potentially life-threatening complication of frontal sinusitis. The entity was first described by Sir Percival Pott, an 18th century neurosurgeon. It is today considered a historical vignette with the introduction of modern antimicrobial agents. Early diagnosis and immediate active treatment are necessary to prevent severe neurologic sequelae. We report on a case of Pott's puffy tumour in a previously healthy young man with a progressively worsening headache and swelling of the frontal bone. Computed tomography and magnetic resonance imaging revealed features characteristic of this condition. Following emergency sinus trephination and 6 weeks of parenteral and enteral antibiotic therapy, the patient achieved a complete recovery.

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.

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.

[The establishment and meaning of the three-dimensional finite element model of pelvic floor levator ani muscle in an old healthy woman].

PubMed

Chen, Wei; Wn, Lijun; Yan, Zhihan; Wang, Jusong; Fu, Yalan; Chen, Xiongfei; Liu, Kun; Wu, Zhipeng

2011-10-01

This paper is to establish a three-dimensional finite element model (3D-FEM) of pelvic floor levator ani muscles in an old healthy women. We acquired the image data of the pelvic bones and pelvic floor muscles from CT and MRI scanning in a non-pregnant old healthy female volunteers. The 3-D reconstruction and mesh optimization of the whole pelvic bones and muscles with application of image processing software Mimics12.0 and Geomagic9.0 were obtained. Then we built the 3D-FEM of the musculoskeletal system of the pelvic bones and levator ani muscles with Ansys11.0 software. We obtained an accurate 3D-FEM of pelvic bones and levator ani muscles in the older healthy woman. The results showed that it was reliable to build 3D-FEM with CT and MRI scanning data and this model could vividly reflect the huge space anatomy of the real pelvic floor levator ani muscles. It avoids the defects to gain the model from the body of anatomical specimens in the past. The image data of model are closer to vivisection, and the model is more conducive to the latter finite element analysis.

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

[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.

Spontaneous pneumocephalus after commercial air travel complicated by meningitis.

PubMed

Javan, Ramin; Duszak, Richard; Eisenberg, Alan D; Eggers, Frank M

2011-12-01

Pneumocephalus usually results from trauma, infection, neoplasm, or iatrogenic causes. Barotrauma-induced spontaneous pneumocephalus is extremely rare, usually seen in divers or occassionally with air travel. We report a case of a 61-yr-old female presenting with confusion, fever, and respiratory failure one day after developing sudden nausea, vomiting, and headache during descent on a commercial airliner. Pneumocephalus and meningitis were present on admission. Sinus computed tomography (CT) showed pansinusitis and a tiny bone defect in the posterior wall of the right sphenoid sinus, through which a cisternogram later showed free communication with the prepontine cistern. An orbital CT 2 yr earlier after a fall showed the bone defect, with no other areas of abnormality or fracture. After repair of defects by otolaryngology and appropriate antibiotics, she did well and was eventually discharged. Changes in aircraft cabin pressure likely resulted in rupture of dura and arachnoid layers beneath the pre-existing bony defect, predisposed by existing sinus disease. The pathophysiology, implications, and potential sources of spontaneous pneumocephalus, as well as risks of postcraniotomy and post-trauma air-travel, are discussed.

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.

Radiographic, computed tomographic and surgical anatomy of the equine sphenopalatine sinus in normal and diseased horses.

PubMed

Tucker, R; Windley, Z E; Abernethy, A D; Witte, T H; Fiske-Jackson, A R; Turner, S; Smith, L J; Perkins, J D

2016-09-01

Knowledge of imaging anatomy, surgical anatomy and disorders affecting the sphenopalatine sinus are currently lacking. To describe the computed tomographic (CT) and surgical anatomy of the sphenopalatine sinus and diagnosis, treatment and outcome in clinical cases with sphenopalatine sinus disease. Cadaver observational study and retrospective case series. The sphenopalatine sinuses of 10 normal cadaver heads were examined with digital radiography, CT and sinoscopic examination prior to anatomical sectioning. Sphenopalatine sinus anatomy was described and compared between cadaver specimens across the imaging modalities. Medical records (January 2004-2014) of cases diagnosed with sphenopalatine sinus disease were reviewed. The anatomy of the sphenopalatine sinus was variable. The borders of the sphenopalatine sinus were not identifiable on plain radiographs, whereas CT provided useful anatomical information. The palatine portion of the sphenopalatine sinus was consistently accessible sinoscopically and the sphenoidal portion was accessible in 6/10 cadaver heads. Fourteen cases of sphenopalatine sinus disease were identified, presenting with one or more clinical signs of exophthalmos, blindness, unilateral epistaxis or unilateral nasal discharge. Diagnoses included neoplasia (7), progressive ethmoidal haematoma (4), sinus cyst (2) and empyema (1). Computed tomography provided diagnostic information but could not differentiate the nature of soft tissue masses. Standing sinoscopic access to the palatine portion of the sphenopalatine sinus was possible for evaluation, biopsy and resection of abnormal soft tissues. Surgical access to the sphenoidal portion was limited. Eight horses were alive at 1 year after diagnosis, with a worse outcome associated with CT evidence of bone loss and a diagnosis of neoplasia. Sphenopalatine sinus disease should be considered a rare cause of the clinical signs described. Knowledge of the anatomical variation of the sphenopalatine sinus is vital for interpreting CT images. A combination of CT and sinoscopy provides the most comprehensive approach for diagnosis and treatment of sphenopalatine sinus disease. © 2015 EVJ Ltd.

[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.

[Ethmoid sinus mucocele penetrating to the orbit and anterior cranial fossa - case report].

PubMed

Paradowska-Opałka, Beata; Kawczyński, Maciej; Jaworowska, Ewa

2013-01-01

Paranasal sinus mucocele is the cystic formation lined by inflammatory changed mucoperiosteum. This is slow-growing pathology with a tendency to bone erosion. The symptoms are dependent on the direction of the penetration, and are as follows: increasing headaches, deformations of frontal or orbital region, ophthalmic manifestations such as lacrimation, decreased visual acuity, exophthalmos, ocular movement limitation, diplopia. The most common location of the mucocele is fronto-ethmoid region. The most useful diagnostic tests are a magnetic resonance imaging (MRI) and a computed tomography (CT) which show the progress of the disease and bone destructions. Surgery is the only method of treatment (external approach or FESS). This paper reports the case of a 74-year-old woman with ethmoid mucocele penetrating into the orbit, frontal sinus and anterior cranial fossa with compression of frontal lobe of the brain. The patient underwent CT and MRI and was treated with endoscopic intranasal marsupialization of the cyst. There are no clinical signs of disease recurrence 7 months after surgery. The endoscopic surgical management in treatment of sinus mucocele is a good alternative to the operation from external approach because of its low invasiveness, low complication risk, rapid healing and good therapeutic effects. Copyright © 2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

The “Dot in Circle” Sign on MRI in Maduramycosis: A Characteristic Finding

PubMed Central

Jain, Vikash; Makwana, Gopee E.; Bahri, Nandini; Mathur, Manish K.

2012-01-01

Mycetoma or Maduramycosis is a localized chronic suppurative infection characterized by exuberant granulation tissue, discharging sinuses, and bone involvement later in the course of the disease. Early clinical diagnosis before the appearance of sinuses and grains (aggregates of organism surrounded by granulation tissue, which are discharged from the draining sinuses) is difficult. Delay in diagnosis may lead to amputation of the affected part. Definitive diagnosis is through biopsy and microbiological examination. However, at times diagnosis may still be difficult. The recently described “dot in circle” sign on magnetic resonance imaging (MRI) is easy to recognize and highly specific. We present a case of mycetoma foot with characteristic MRI features. PMID:23230548

A Novel Method of Orbital Floor Reconstruction Using Virtual Planning, 3-Dimensional Printing, and Autologous Bone.

PubMed

Vehmeijer, Maarten; van Eijnatten, Maureen; Liberton, Niels; Wolff, Jan

2016-08-01

Fractures of the orbital floor are often a result of traffic accidents or interpersonal violence. To date, numerous materials and methods have been used to reconstruct the orbital floor. However, simple and cost-effective 3-dimensional (3D) printing technologies for the treatment of orbital floor fractures are still sought. This study describes a simple, precise, cost-effective method of treating orbital fractures using 3D printing technologies in combination with autologous bone. Enophthalmos and diplopia developed in a 64-year-old female patient with an orbital floor fracture. A virtual 3D model of the fracture site was generated from computed tomography images of the patient. The fracture was virtually closed using spline interpolation. Furthermore, a virtual individualized mold of the defect site was created, which was manufactured using an inkjet printer. The tangible mold was subsequently used during surgery to sculpture an individualized autologous orbital floor implant. Virtual reconstruction of the orbital floor and the resulting mold enhanced the overall accuracy and efficiency of the surgical procedure. The sculptured autologous orbital floor implant showed an excellent fit in vivo. The combination of virtual planning and 3D printing offers an accurate and cost-effective treatment method for orbital floor fractures. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

New operational techniques of implantation of biomaterials and titanium implants in the jaw with the atrophy of the bone and soft tissues

NASA Astrophysics Data System (ADS)

Nikityuk, D. B.; Urakov, A. L.; Reshetnikov, A. P.; Kopylov, M. V.; Baimurzin, D. Yu.

2015-11-01

The research into dynamics of quality of clinical use in 2003 - 2012 of autologous and xenogeneic biomaterials at dental transplantation and implantation among 1,100 of adult patients was made. The analysis results show that at autologous bone transplantation implant survival is observed only in 72% of cases, and the "necessary" result of bone repair occurred only in 6 - 9 months. Transplantation of biomaterials of OsteoBiol® (materials "mp3", "Genos" and "Evolution") provided engraftment and bone regeneration in 100 % of cases and allowed the use of dental implantation immediately after transplantation even in case of reduction in the patient's alveolar crest down to 2.0 mm. Replace Select implants of Nobel Biocare® were used at plantation. In order to exclude Schneiderian membrane's perforation lighting of Highmore's sinus with the cold blue-violet light from inside at sinus elevation is recommended as well as deepening of dental instruments into the bone only until the blue-violet light appears under them. To exclude deficiency of soft tissue under the cervical part of the ceramic crown application of special anti-fissure technology involving biomaterial flap dissection and its laying around the implant is suggested.

Experimental Transmission of Bighorn Sheep Sinus Tumors to Bighorn Sheep (Ovis canadensis canadensis) and Domestic Sheep.

PubMed

Fox, K A; Wootton, S; Marolf, A; Rouse, N; LeVan, I; Spraker, T; Miller, M; Quackenbush, S

2016-11-01

Bighorn sheep sinus tumors are a recently described disease affecting the paranasal sinuses of Rocky Mountain bighorn sheep (Ovis canadensis canadensis). Several features of this disease suggest an infectious cause, although a specific etiologic agent has not been identified. To test the hypothesis that bighorn sheep sinus tumors are caused by an infectious agent, we inoculated 4 bighorn sheep lambs and 4 domestic sheep lambs intranasally with a cell-free filtrate derived from a naturally occurring bighorn sheep sinus tumor; we held 1 individual of each species as a control. Within 18 months after inoculation, all 4 inoculated domestic sheep (100%) and 1 of the 4 inoculated bighorn sheep (25%) developed tumors within the ethmoid sinuses or nasal conchae, with features similar to naturally occurring bighorn sheep sinus tumors. Neither of the uninoculated sheep developed tumors. Histologically, the experimentally transmitted tumors were composed of stellate to spindle cells embedded within a myxoid matrix, with marked bone production. Tumor cells stained positively with vimentin, S100, alpha smooth muscle actin, and osteocalcin, suggesting origin from a multipotent mesenchymal cell. A periosteal origin for these tumors is suspected. Immunohistochemical staining for the envelope protein of JSRV (with cross-reactivity to ENTV) was equivocal, and PCR assays specific for these agents were negative. © The Author(s) 2016.

[Delayed endoscopic reconstruction of the anterior wall of the frontal sinus: Technical note].

PubMed

Mommers, X-A; Zwetyenga, N; Meningaud, J-P

2015-11-01

Reconstruction of the anterior wall of the frontal sinus usually requires a coronal incision. This extended approach may lead to paresthesia, unsightly scars, bruises and cicatricial alopecia. These complications encouraged several authors to endoscopic management of this kind of fractures. We present a delayed technique of reconstruction of the anterior wall of the frontal sinus by means of endoscopic hydroxyapatite filling. Two incisions were performed behind the hair line. Subperiosteal dissection using a periosteal elevator was performed. A 30° angled endoscope was used to visualize the depression. The latter was filled by Hydroset® (Stryker, USA) as a bone substitute. In the absence of contra-indication, the reconstruction of the anterior wall of the frontal sinus by means of endoscopic hydroxyapatite filling has many advantages including uneventful outcome, reduction of the hospital stay and a fast learning curve. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Orbital necrotizing fasciitis and osteomyelitis caused by arcanobacterium haemolyticum: a case report.

PubMed

Stone, Lindsay A; Harshbarger, Raymond J

2015-01-01

The facial region is infrequently affected by necrotizing infections. Orbital necrotizing infections are even rarer, seen following trauma, local skin infection, and sinusitis. The authors report a unique case of orbital necrotizing fasciitis and osteomyelitis resulting from Arcanobacterium Haemolyticum ethmoid sinusitis. No prior occurrences of Arcanobacterial species orbital necrotizing fasciitis/osteomyelitis have been reported.A 16-year-old boy presented to the ER with a 3-day history of fever, chills, headache, and sinus pressure. CT scan revealed soft tissue swelling of the right orbit, forehead, and ethmoid sinusitis. Within 24 hours of admission, he suffered rapidly progressive swelling and erythema of the right orbit and forehead with diminished visual acuity, despite broad-spectrum antibiotics. Orbital exploration revealed frankly necrotic fascia and periosteum along the superior aspect. Lateral canthotomy, cantholysis, decompression of the optic nerve, and soft tissue debridement with bone biopsy was performed. Operative specimens isolated Arcanobacterium Haemolyticum. Pathologic examination revealed right orbital osteomyelitis.

[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.

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

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.

Computer image-guided surgery for total maxillectomy.

PubMed

Homma, Akihiro; Saheki, Masahiko; Suzuki, Fumiyuki; Fukuda, Satoshi

2008-12-01

In total maxillectomy, the entire upper jaw including the tumor is removed en bloc from the facial skeleton. An intraoperative computed tomographic guidance system (ICTGS) can improve orientation during surgical procedures. However, its efficacy in head and neck surgery remains controversial. This study evaluated the use of an ICTGS in total maxillectomy. Five patients with maxillary sinus neoplasms underwent surgery using a StealthStation ICTGS. The headset was used for anatomic registration during the preoperative CT scan and surgical procedure. The average accuracy was 0.95 mm. The ICTGS provided satisfactory accuracy until the end of resection in all cases, and helped the surgeon to confirm the anatomical location and decide upon the extent of removal in real time. It was particularly useful when the zygoma, maxillary frontal process, orbital floor, and pterygoid process were divided. All patients remained alive and disease free during short-term follow-up. The ICTGS played a supplementary role in total maxillectomy, helping the surgeon to recognize target points accurately in real time, to determine the minimum accurate bone-resection line, and to use the most direct route to reach the lesion. It could also reduce the extent of the skin incision and removal, thus maintaining oncological safety.

Effects of directly autotransplanted tibial bone marrow aspirates on bone regeneration and osseointegration of dental implants.

PubMed

Payer, Michael; Lohberger, Birgit; Strunk, Dirk; Reich, Karoline M; Acham, Stephan; Jakse, Norbert

2014-04-01

Aim of the pilot trial was to evaluate applicability and effects of directly autotransplanted tibial bone marrow (BM) aspirates on the incorporation of porous bovine bone mineral in a sinus lift model and on the osseointegration of dental implants. Six edentulous patients with bilaterally severely resorbed maxillae requiring sinus augmentation and implant treatment were included. During surgery, tibial BM was harvested and added to bone substitute material (Bio-Oss(®) ) at the randomly selected test site. At control sites, augmentation was performed with Bio-Oss(®) alone. The cellular content of each BM aspirate was checked for multipotency and surface antigen expression as quality control. Histomorphometric analysis of biopsies from the augmented sites after 3 and 6 months (during implantation) was used to evaluate effects on bone regeneration. Osseointegration of implants was evaluated with Periotest(®) and radiographic means. Multipotent cellular content in tibial BM aspirates was comparable to that in punctures from the iliac crest. No significant difference in amount of new bone formation and the integration of bone substitute particles was detected histomorphometrically. Periotest(®) values and radiographs showed successful osseointegration of inserted implants at all sites. Directly autotransplanted tibial BM aspirates did not show beneficial regenerative effects in the small study population (N = 6) of the present pilot trial. However, the proximal tibia proved to be a potential donor site for small quantities of BM. Future trials should clarify whether concentration of tibial BM aspirates could effect higher regenerative potency. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Nasal Floor Augmentation for the Reconstruction of the Atrophic Maxilla: A Case Series

PubMed Central

El-Ghareeb, Moustafa; Pi-Anfruns, Joan; Khosousi, Mohammed; Aghaloo, Tara; Moy, Peter

2012-01-01

Purpose The severely atrophic edentulous maxilla imposes a challenge for dental implant rehabilitation. Nasal floor augmentation (NFA) is a method of augmenting bone height in the anterior maxilla. Autogenous bone has been commonly used as a graft material. Because of variations in results and lack of insufficient studies reporting the use of bone substitutes to graft the nasal floor, this study aims to evaluate the survival and success of dental implants placed in nasally grafted maxillae with osteoconductive bone substitutes. Materials and Methods Six patients with completely edentulous maxillae and inadequate height in the anterior to support implants underwent NFA. The nasal floor was exposed through an intraoral approach and grafted with osteoconductive bone graft substitutes. Twenty-four dental implants were placed, restored with a bar-retained implant-supported overdenture after a traditional healing period, and followed up after prosthetic loading. Patient satisfaction was evaluated with a questionnaire, and responses were expressed on a visual analog scale from 1 to 10. Bone levels were quantified radiographically based on a score ranging from 1 to 3, where 3 represented the highest bone support. Implants were evaluated for thread exposure and soft tissue health and were considered successful if the following criteria were met: absence of mobility; lack of symptoms; bone score of 3; and healthy peri-implant soft tissue without thread exposure. Results The age of patients ranged from 48 to 84 years, with a mean of 71.2 years. Three patients underwent NFA and simultaneous implant placement, whereas the other 3 had a mean healing period of 6.5 months before implant placement. Post-loading follow-up ranged from 4 to 29 months, with a mean of 14.2 months. The implant survival rate was 100%, with no complications. Ninety-three percent of the responses to the treatment satisfaction questionnaire had a score of 7 or greater. Bone scores ranged from 2 to 3, with 87.5% of implants having a score of 3 and 12.5% having a score of 2. None of the implants had a bone score of 1. Conclusions The use of osteoconductive bone substitutes for NFA, as shown in this small case series, is a reliable method for reconstruction of the anterior atrophic maxilla for implant-supported overdentures. PMID:22177805

Usefulness of the anterolateral thigh flap with vascularized fascia lata for reconstruction of orbital floor and nasal surface after total maxillectomy.

PubMed

Joo, Young-Hoon; Cho, Kwang-Jae; Park, Jun-Ook; Kim, Min-Sik

2013-09-01

The aim of this study was to describe a technique using the fascia lata (FL) component of the anterolateral thigh (ALT) flap to re-create the orbital floor and lateral nasal wall after total maxillectomy. Retrospective analysis of medical records. A total of 22 patients underwent maxillary reconstruction using a composite ALT-FL flap following cancer resection. All patients underwent total maxillectomies via the Weber-Ferguson approach. The ALT flap was harvested with the deep fascia of the thigh with the aim of using it for lining of the orbital floor and lateral nasal cavity. The FL was sutured to the palatine bone inferiorly, nasal bone and zygomatic bone superiorly, and nasopharyngeal mucosa posteriorly to provide an orbital floor and make a neonasal cavity. There was 100% free flap survival. Speech was normal in eight (36%) patients, near normal in 10 (46%), and intelligible in four (18%). Seventeen (77%) patients gained a good facial appearance, and five (23%) a fair appearance. Sixteen (73%) patients complained of mild nasal crust formation, and the rest (27%) developed moderate crust. Microvascular reconstruction using a composite ALT-FL flap provided a reliable fascial component for orbital floor and nasal surface reconstruction of total maxillectomy defects. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

A randomized, blinded study of canal wall up versus canal wall down mastoidectomy determining the differences in viewing middle ear anatomy and pathology.

PubMed

Hulka, G F; McElveen, J T

1998-09-01

Canal wall down and intact canal wall tympanomastoidectomy represent two surgical approaches to middle ear pathology. The authors hypothesize that there is a difference in the ability to view structures in the middle ear between these two methods. Depending on the individual, many surgeons have used the two different techniques of intact canal wall and canal wall down tympanomastoidectomy for approaching the middle ear. However, opinions conflict as to which approach provides the best visualization of different locations in the middle ear. This study prospectively evaluated temporal bones to determine the differences in visualizing structures of the middle ear using these two approaches. Twelve temporal bones underwent a standardized canal wall down tympanomastoidectomy using a reversible canal wall down technique. All bones were viewed in two dissections: intact canal wall and canal wall down preparations. Four points previously had been marked on each temporal bone in randomly assigned colors. These points include the sinus tympani, posterior crus of stapes, lateral epitympanum, and the Eustachian tube orifice. An observer blinded to the purpose of the study, color, and number of locations recorded the color and location of marks observed within the temporal bones. Randomized bones of two separate settings were viewed such that each bone was viewed in both the canal wall down and the intact canal wall preparations. A significant difference was noted in the ability to observe middle ear pathology between the intact canal wall versus canal wall down tympanomastoidectomy, with the latter showing superiority (p < 0.001). Of the four subsites, the sinus tympani, posterior crus of stapes, and lateral epitympanum were observed more frequently with the canal wall down. There was no significant difference in the ability to observe the Eustachian tube orifice between the two techniques. Statistical analysis shows good reproducibility and randomization of this study. The canal wall down tympanomastoidectomy allowed for superior viewing of the three locations, sinus tympanic, posterior crus of stapes, and lateral at the tympanum, as they were marked in the study. This study shows the potential for improved visualization via the canal wall down tympanomastoidectomy. A significant amount of literature written by individuals and otology group practices is available retrospectively comparing the advantages and disadvantages of intact canal wall versus canal wall down mastoidectomy procedures for approaching middle ear pathology. In the interest of objectively evaluating the differences between these two approaches, we have studied temporal bones in a prospective randomized, blinded study comparing the two. Twelve bones were used and observed twice, once in each of 2 sessions. All bones were viewed in two dissections: intact canal wall and canal wall down mastoidectomy. Four points were marked on each temporal bone in three different colors applied in a randomized order to eliminate observer expectation. The four points marked include sinus tympani, posterior crus of the stapes footplate, lateral epitympanum, and Eustachian tube orifice. Both intact canal wall and canal wall down bones were provided randomly to the observer at each viewing session. Before the observer was allowed to see the dissections, those requiring replacement of the canal for the first session of the study had this done in a method using native posterior bony canal. Temporal bones were presented to an expert otologist in a randomized fashion with each temporal bone being placed in a temporal bone bowl holder and specialized framework, allowing for rotation and repositioning approximating the experience in an operating room setting. For each temporal bone, the observer filled in a questionnaire describing his or her observations by denoting both location and color of marks observed. (ABSTRACT TRUNCATED)

Angiofibroma Localized in the Sphenoid Sinus

PubMed Central

Aksoy, Fadlullah; Vural, Omer; Ozturan, Orhan

2017-01-01

Juvenile nasopharyngeal angiofibroma is the most common benign tumor of the nasopharynx with complaints of unilateral nasal obstruction and recurrent nosebleeds in the young male population. Despite being a benign tumor, it can be aggressively destructive in surrounding tissues and bones by acting locally. The gold standard treatment method is the surgical excision of the tumor. This case report is a case of angiofibroma, a 32-year-old asymptomatic male patient with no evidence of clinical signs and endoscopic examination, which is recognized as a localized vascular mass lesion in the right sphenoid sinus on the cranial MR imaging. We prepared this case report that may represent an angiofibroma localized only within the sphenoid sinus which is very rare in the literature. PMID:29359061

Computed tomographic diagnosis of unilateral cavernous sinus syndrome caused by a chondrosarcoma in a dog: a case report.

PubMed

Hernández-Guerra, Angel María; Del Mar López-Murcia, María; Planells, Alicia; Corpa, Juan Manuel; Liste, Fernando

2007-07-01

An eight-year old Rottweiler dog was presented with signs of enophthalmia, ptosis, anisocoria and mydriasis of the right eye, which showed visual disturbance, reduced or absent reflexes, and ophthalmoplegia. Consensual pupillary light reflex was also absent in the left eye. These neurological deficits were compatible with cavernous sinus syndrome. Computed tomography images of the cavernous sinus and the optical fissure revealed a mildly calcified mass arising from the right presphenoid bone extending further caudally into the orbital foramina. This extension of the mass affected the normal function of several cranial nerves. The dog was euthanased within one year of the initial presentation following development of forebrain signs. A chondrosarcoma was diagnosed histologically after necropsy.

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

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

Missile war injuries of the face.

PubMed

Kummoona, Raja K

2011-11-01

In a society struggling to rebuild its country after 3 decades of years of dictatorships and wars, Iraqi maxillofacial and craniofacial surgeons play a critical role in treatment of many most serious terrorist missile injuries of the face by ongoing conflict in Iraq. This study reflects our surgical techniques of treating explosive missile injuries and other combat- and terrorism-related injuries and also evaluates the immediate and secondary phase managements of patients with missile injuries. This study includes 235 patients with missile war injuries of the face during a period of 4 years; all injured patients were treated in the Maxillofacial Unit of Surgical Specialties Hospital, Medical City, Baghdad. There were 195 men and 40 women; their ages ranged from 1 to 70 years (mean, 39.5 years). Posttraumatic missile facial deformities were classified as follows: 95 patients (40.43%) had bone loss; 72 patients (30.64%) had soft tissue loss; 33 patients (14.05%) had orbital injuries; and 35 patients (14.90%) had other deformities of scar contracture, fistula, and sinus formation. Two techniques were used for reconstruction of the bony defect, either by bone chips carried by osteomesh tray harvested from the iliac crest or by free block of corticocancellous bone graft from the iliac crest. Soft tissue reconstruction was done by local flaps and regional flaps such as lateral cervical and cervicofacial flaps, and the orbit was reconstructed by bone graft, lyophilized dura, and sialastic implant. Scar contracture was treated by scar revision and sinus tract excised at the same time of scar revision. In conclusion, the primary phase required an urgent airway management, controlling an active bleeding by surgical intervention; most entrance and exit wounds as well as retained missiles were located in the cheek, chin, and mandibular body, with few cases of mortality due to complications related to head injuries. The secondary phase management of deformities of the face as a complication of missile injuries was classified as bone loss, soft tissue loss, combined bone and soft tissue loss, and others (sinus tracts and poor scars).

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.

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.

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

Effects of dose reduction on multi-detector computed tomographic images in evaluating the maxilla and mandible for pre-surgical implant planning: a cadaveric study.

PubMed

Koizumi, Hiroshi; Sur, Jaideep; Seki, Kenji; Nakajima, Koh; Sano, Tsukasa; Okano, Tomohiro

2010-08-01

To assess effects of dose reduction on image quality in evaluating maxilla and mandible for pre-surgical implant planning using cadavers. Six cadavers were used for the study using multi-detector computed tomography (CT) operated at 120 kV and the variable tube current of 80, 40, 20 and 10 mA. A slice thickness of 0.625 mm and pitch 1 were used. Multi-planar images perpendicular and parallel to dentitions were created. The images were evaluated by five oral radiologists in terms of visibility of the anatomical landmarks including alveolar crest, mandibular canal, floors of the maxillary sinus and nasal cavity, contours/cortical layer of jaw bones and the details of trabecular bone. Observers were asked to determine the quality of the images in comparison with 80 mA images based on the criteria: excellent, good, fair or non-diagnostic. The average scores of all observers were calculated for each specimen in all exposure conditions. The 40 mA images could visualize such landmarks and were evaluated to be same or almost equivalent in quality to the 80 mA images. Even the 20 mA images could be accepted just for diagnostic purpose for implant with substantial deterioration of the image quality. The 10 mA images may not be accepted because of the obscured contour caused by image noise. Significant dose reduction by lowering mA can be utilized for pre-surgical implant planning in multi-detector CT.

Blast Loading and Response of Underground Concrete-Arch Protective Structures

DTIC Science & Technology

1959-06-05

to approximate the load due to pasive earth pressure developed in the region of outward deflection of the arch. This Is assumed as a radial sinus...to represent a specimen from the wall matter , and preserve the gradation. Sufficient live reinforcement, the floor-slab reinforcement, and the storage...chemicals, or other foreign materials shall cleaned of latance, foreign matter , and loose parti- not be mixed with the concrete to prevent freezing. cles

Regional variations in degradation and density of Martian craters.

NASA Technical Reports Server (NTRS)

Mcgill, G. E.; Wise, D. U.

1972-01-01

Martian craters visible on Mariner 6 and 7 imagery show a spectrum of topographic types from very fresh to highly degraded. A method of numerical scoring of rim, wall, and floor is proposed to yield a degradation number to classify each crater. Plots of degradation class vs density of large craters are similar for all four regions studied, whereas similar plots for small craters show marked differences between regions. The data suggest general continuity of crater formation and degradation, along with locally sporadic formation and/or degradation of the smallest craters classified. Deucalionis Regio, with an excess of fresh, small craters, experienced an episode of small crater formation (or nondegradation) most recently; Margaritifer Sinus was similarly disturbed at some more remote time. Meridiani Sinus and Hellespontus-Noachis show little or no sign of excess fresh, small craters.

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.

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.

Facial Fractures: Pearls and Perspectives.

PubMed

Chaudhry, Obaid; Isakson, Matthew; Franklin, Adam; Maqusi, Suhair; El Amm, Christian

2018-05-01

After studying this article, the participant should be able to: 1. Describe the A-frame configuration of anterior facial buttresses, recognize the importance of restoring anterior projection in frontal sinus fractures, and describe an alternative design and donor site of pericranial flaps in frontal sinus fractures. 2. Describe the symptoms and cause of pseudo-Brown syndrome, describe the anatomy and placement of a buttress-spanning plate in nasoorbitoethmoid fractures, and identify appropriate nasal support alternatives for nasoorbitoethmoid fractures. 3. Describe the benefits and disadvantages of different lower lid approaches to the orbital floor and inferior rim, identify late exophthalmos as a complication of reconstructing the orbital floor with nonporous alloplast, and select implant type and size for correction of secondary enophthalmos. 4. Describe closed reduction of low-energy zygomatic body fractures with the Gillies approach and identify situations where internal fixation may be unnecessary, identify situations where plating the inferior orbital rim may be avoided, and select fixation points for osteosynthesis of uncomplicated displaced zygomatic fractures. 5. Understand indications and complications of use for intermaxillary screw systems, understand sequencing panfacial fractures, describe the sulcular approach to mandible fractures, and describe principles and techniques of facial reconstruction after self-inflicted firearm injuries. Treating patients with facial trauma remains a core component of plastic surgery and a significant part of the value of a plastic surgeon to a health system.

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.

[Partsch's chronic granulomatous inflammation, the cutaneous manifestation of a dental cause].

PubMed

Buch, R S R; Fischer, B; Kleis, W K G; Reichert, T E

2003-08-01

Dentogenous inflammatory diseases can lead to typical dermatological facial symptoms with formation of cutaneous sinuses. Partsch's chronic granulomatous inflammation can result from conducted inflammation of a nonvital tooth via a chronic apical inflammation. In this rare disease, the granulomatous tissue perforates the bone, channels through the overlying skin, and drains via cutaneous or oral sinuses. A frequent localization of the cutaneous sinus is the skin inferior to the body of the mandible, and it is caused by an inflammation of the lower molars. Treatment consists of identifying the responsible teeth and eliminating the focus of infection. Chronically progressive periradicular granuloma and/or radicular cysts can be present with impressive dermatological symptoms. Therefore, X-ray examinations are necessary to exclude possible dentogenic causes in cases of badly healing processes of the face or neck.

The pterygoclival ligament: a novel landmark for localization of the internal carotid artery during the endoscopic endonasal approach.

PubMed

Tayebi Meybodi, Ali; Little, Andrew S; Vigo, Vera; Benet, Arnau; Kakaizada, Sofia; Lawton, Michael T

2018-05-18

OBJECTIVE The transpterygoid extension of the endoscopic endonasal approach provides exposure of the petrous apex, Meckel's cave, paraclival area, and the infratemporal fossa. Safe and efficient localization of the lacerum segment of the internal carotid artery (ICA) is a crucial part of such exposure. The aim of this study is to introduce a novel landmark for localization of the lacerum ICA. METHODS Ten cadaveric heads were prepared for transnasal endoscopic dissection. The floor of the sphenoid sinus was drilled to expose an extension of the pharyngobasilar fascia between the sphenoid floor and the pterygoid process (the pterygoclival ligament). Several features of the pterygoclival ligament were assessed. In addition, 31 dry skulls were studied to assess features of the bony groove harboring the pterygoclival ligament. RESULTS The pterygoclival ligament was identified bilaterally during drilling of the sphenoid floor in all specimens. The ligament started a few millimeters posterior to the posterior end of the vomer alae and invariably extended posterolaterally and superiorly to blend into the fibrous tissue around the lacerum ICA. The mean length of the ligament was 10.5 ± 1.7 mm. The mean distance between the anterior end of the ligament and midline was 5.2 ± 1.2 mm. The mean distance between the posterior end of the ligament and midline was 12.3 ± 1.4 mm. The bony pterygoclival groove was identified at the confluence of the vomer, pterygoid process of the sphenoid, and basilar part of the occipital bone, running from posterolateral to anteromedial. The mean length of the groove was 7.7 ± 1.8 mm. Its posterolateral end faced the anteromedial aspect of the foramen lacerum medial to the posterior end of the vidian canal. A clinical case illustration is also provided. CONCLUSIONS The pterygoclival ligament is a consistent landmark for localization of the lacerum ICA. It may be used as an adjunct or alternative to the vidian nerve to localize the ICA during endoscopic endonasal surgery.

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.

Association between clinical characteristics, computed tomography characteristics, and histologic diagnosis for cats with sinonasal disease.

PubMed

Tromblee, Tonya C; Jones, Jeryl C; Etue, Ashley E; Forrester, S Dru

2006-01-01

The purpose of this retrospective study was to determine the association between clinical characteristics, computed tomography (CT) characteristics, and histologic diagnosis in 43 cats with sinonasal disease. All cats were evaluated with CT and nasopharyngeal endoscopic examination, with histologic diagnosis based on nasal biopsy. Fifteen cats were diagnosed with sinonasal neoplasia and 28 cats were diagnosed with rhinitis. Clinical characteristics determined to be significantly associated with neoplasia were unilateral ocular discharge (odds ratio [OR] 9.6) and the presence of a nasopharyngeal mass during endoscopic examination (OR 18.9). CT characteristics found to be significantly associated with neoplasia included: unilateral lysis of ethmoturbinates (OR 11.0), unilateral lysis of the dorsal (OR 8.3) and lateral maxilla (OR 6.9), lysis of the vomer bone (OR 6.7) and ventral maxilla (OR 28.8), and bilateral lysis of the orbital lamina (OR 4.1); unilateral abnormal soft tissue/fluid within the sphenoid sinus (OR 15.3), frontal sinus (OR 10.4), and/or and retrobulbar space (OR 12.2). Lysis of the maxillary turbinates, nasal septum, nasal bone, palatine bone, and cribriform plate were not significantly associated with sinonasal neoplasia.

Headache Attributed to Fibrous Dysplasia of the Ethmoid Bone Mimicking Menstrual Migraine Without Aura.

PubMed

Kim, Kyung Soo

2016-06-01

The authors experienced a patient of fibrous dysplasia originating from the ethmoid bone which presented with severe headache with some features suggestive of menstrual migraine without aura. Fibrous dysplasia originating from the ethmoid bone is a rare disease entity, but may cause severe headache that can be misdiagnosed as "menstrual migraine" because of similar symptoms in female patients. Because the primary objective of surgery is symptomatic relief, conservative transnasal endoscopic approach may be considered an alternative to more invasive external surgical techniques in carefully selected patients, especially originating from the nasal cavity and paranasal sinuses.

Analysis of methods to assess frontal sinus extent in osteoplastic flap surgery: transillumination versus 6-ft Caldwell versus image guidance.

PubMed

Melroy, Christopher T; Dubin, Marc G; Hardy, Stuart M; Senior, Brent A

2006-01-01

The aim of this study was to compare three common methods (transillumination, plain radiographs, and computerized tomography [CT] image guidance) for estimating the position and extent of pneumatization of the frontal sinus in osteoplastic flap surgery. Axial CT scans and 6-ft Caldwell radiographs were performed on 10 cadaver heads. For each head, soft tissue overlying the frontal bone was raised and the anticipated position and extent of the frontal sinus at four points was marked using three common methods. The silhouette of the frontal sinus from the Caldwell plain radiograph was excised and placed in position. Four points at the periphery also were made using information obtained from a passive optically guided image-guided surgery device, and transillumination via a frontal trephination also was used to estimate sinus extent. The true sinus size was measured at each point and compared with experimental values. The use of CT image guidance generated the least difference between measured and actual values (mean = 1.91 mm; SEM = 0.29); this method was found statistically superior to Caldwell (p = 0.040) and transillumination (p = 0.007). Image guidance did not overestimate the size of the sinus (0/36) and was quicker than the Caldwell approach (8.5 versus 11.5 minutes). There was no learning curve appreciated with image guidance. Accurate and precise estimation of the position and extent of the frontal sinus is crucial when performing osteoplastic flap surgery. Use of CT image guidance was statistically superior to Caldwell and transillumination methods and proved to be safe, reproducible, economic, and easy to learn.

Piezolelectric surgery in dentistry: a review.

PubMed

Carini, F; Saggese, V; Porcaro, G; Baldoni, M

2014-01-01

In the last ten years was observed a significant increase of publications about piezoelectric bone surgery. The purpose of this review was to define the state of art and to realize a comparison between piezoelectric devices and manual or rotating traditional techniques, analyzing advantages and disadvantages from a clinical and histological point of view for various dental procedures. The literature review has been carried out using medical databases on line: MEDLINE and COCHRANE LIBRARY. The authors selected 37 publications about dental field and consistent with inclusion criteria established. From the clinical point of view, the analysis of selected publications concerning procedures such as maxillary sinus lift, alveolar ridge expansion, samples of autologous bone, etc, showed surgical trauma reduction, especially towards to soft and nervous tissues, surgical mini-invasiveness, cut precision and selectivity and speed of learning guaranteed by piezoelectric devices compared to traditional ones. Histologically, however, the study of biology and postintervention bone tissue healing showed a lower loss of bone with piezoelectric instruments than with conventional devices, as well as a better healing quality by reducing patient's postsurgery morbidity. The use of piezoelectric devices seems thus to simplify different sinus lift surgical procedures and to allow greater predictability, although some studies reveal that there are not substantial differences in comparison of long-term results between conventional and piezoelectric instruments and also criticize their increase in operation time.

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.

Nasal polyposis (or chronic olfactory rhinitis).

PubMed

Jankowski, R; Rumeau, C; Gallet, P; Nguyen, D T

2018-06-01

The concept of chronic rhinosinusitis with or without polyps is founded on the structural and functional unicity of the pituitary mucosa and its united response to environmental aggression by allergens, viruses, bacteria, pollution, etc. The present review sets this concept against the evo-devo three-nose theory, in which nasal polyposis is distinguished as specific to the olfactory nose and in particular to the non-olfactory mucosa of the ethmoid, which is considered to be not a sinus but rather the skull-base bone harboring the olfactory mucosa. The evo-devo approach enables simple and precise positive diagnosis of nasal polyposis and its various clinical forms, improves differential diagnosis by distinguishing chronic diseases of the respiratory nose and those of the paranasal sinuses, hypothesizes an autoimmune origin specifically aimed at olfactory system auto-antigens, and supports the surgical concept of nasalization against that of functional sinus and ostiomeatal-complex surgery. The ventilation function of the sinuses seems minor compared to their production, storage and active release of nitric oxide (NO) serving to oxygenate arterial blood in the pulmonary alveoli. This respiratory function of the paranasal sinuses may indeed be their most important. NO trapped in the ethmoidal spaces also accounts for certain radiographic aspects associated with nasal polyposis. Copyright © 2018. Published by Elsevier Masson SAS.

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.

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.

Quantitation of mandibular ramus volume as a source of bone grafting.

PubMed

Verdugo, Fernando; Simonian, Krikor; Smith McDonald, Roberto; Nowzari, Hessam

2009-10-01

When alveolar atrophy impairs dental implant placement, ridge augmentation using mandibular ramus graft may be considered. In live patients, however, an accurate calculation of the amount of bone that can be safely harvested from the ramus has not been reported. The use of a software program to perform these calculations can aid in preventing surgical complications. The aim of the present study was to intra-surgically quantify the volume of the ramus bone graft that can be safely harvested in live patients, and compare it to presurgical computerized tomographic calculations. The AutoCAD software program quantified ramus bone graft in 40 consecutive patients from computerized tomographies. Direct intra-surgical measurements were recorded thereafter and compared to software data (n = 10). In these 10 patients, the bone volume was also measured at the recipient sites 6 months post-sinus augmentation. The mandibular second and third molar areas provided the thickest cortical graft averaging 2.8 +/- 0.6 mm. The thinnest bone was immediately posterior to the third molar (1.9 +/- 0.3 mm). The volume of ramus bone graft measured by AutoCAD averaged 0.8 mL (standard deviation [SD] 0.2 mL, range: 0.4-1.2 mL). The volume of bone graft measured intra-surgically averaged 2.5 mL (SD 0.4 mL, range: 1.8-3.0 mL). The difference between the two measurement methods was significant (p < 0.001). The bone volume measured 6 months post-sinus augmentation averaged 2.2 mL (SD 0.4 mL, range: 1.6-2.8 mL) with a mean loss of 0.3 mL in volume. The mandibular second molar area provided the thickest cortical graft. A cortical plate of 2.8 mm in average at combined second and third molar areas provided 2.5 mL particulated volume. The use of a design software program can improve surgical treatment planning prior to ramus bone grafting. The AutoCAD software program did not overestimate the volume of bone that can be safely harvested from the mandibular ramus.

[Clinical analysis of nasal mucosa contact headache].

PubMed

Gu, Qingjia; Wen, Bei; Li, Jingxian; Fan, Jiangang; He, Gang

2013-07-01

To investigate the efficacy of nasal mucosa contact point headache with the treatment of endoscopic sinus surgery. Clinical data of 75 cases with nasal mucosa contact point headache treated in our department from Jan 2008 to Nov 2011 were retrospectively analyzed. These patients were performed with endoscopic sinus surgery. All patients were followed up for more than six months. They all achieved significant efficacy and no complications occurred. Nasal mucosa contact point headache and primary headache had different clinical features and different treatment. Misdiagnosis were easily made if not being carefully analyzed. Three lines tension relaxing septorhinoplasty combined with nasal bone fracture correction can achieve satisfactory curative effect and can effectively prevent the occurrence of complications. Therefore, it is necessary to strengthen the awareness of this disease. Nasal structure abnormality is the main reason of nasal mucosa contact point headache. The implementation of individualized nasal endoscopic sinus surgery can achieve satisfactory curative effect.

[Bone cement implant as an alternative for orbital floor reconstruction: A case report].

PubMed

Vargas-Solalinde, Enrique; Huichapa-Padilla, Marisol E; Garza-Cantú, Daniel; Reyna-Martínez, Víctor H; Alatorre-Ricardo, Julio; González-Treviño, Juan Luis

2017-12-01

The management of orbitary fractures is one of the most challenging in facial trauma; the variety of reconstruction materials for its treatment is broad and is constantly improving, but despite this there is no consensus for its use or literature that sustains it. To present the use and design of a preformed bone implant as an alternative for the reconstruction of orbital floor fractures in the pediatric age group. A 7-year old male who suffered a right hemifacial contusion trauma with clinical and tomographic diagnosis of right pure blowout type orbital floor fracture with inferior rectus muscle entrapment and right post-traumatic palpebral ptosis. Successful surgical reconstruction was performed 7 days later with a pre-constructed bone cement implant. Eight weeks after surgery the patient presented with mild residual palpebral ptosis, no ocular movement limitations and no diplopia. The use of a bone cement implant can be considered appropriate for the reconstruction of these fractures, as another alternative to be used by the ophthalmologist among the variety of all the other materials used for this purpose. We consider that our optimism based on the results obtained in this case obligates us to increase the number of patients treated in order to gather more evidence and do larger follow up. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. 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.

An Assessment of Regional Variations in Martian Modified Impact Crater Morphology

NASA Astrophysics Data System (ADS)

Craddock, Robert A.; Bandeira, Lourenço.; Howard, Alan D.

2018-03-01

Impact craters on Mars have been extensively modified by ancient geologic processes that may have included rainfall and surface runoff, snow and ice, denudation by lava flows, burial by eolian material, or others. Many of these processes can leave distinct signatures on the morphometry of the modified impact crater as well as the surrounding landscape. To look for signs of potential regional differences in crater modification processes, we conducted an analysis of different morphometric parameters related to modified impact craters located in the Margaritifer Sinus, Sinus Sabaeus, Iapygia, Mare Tyrrhenum, Aeolis, and Eridania quadrangles, including depth, crater wall slope, crater floor slope, the curvature between the interior wall and the crater floor slope, and the curvature between the interior wall and surrounding landscape. A Welch's t test analysis comparing these parameters shows that fresh impact craters (Type 4) have consistent morphologies regardless of their geographic location examined in this study, which is not unexpected. Modified impact craters both in the initial (Type 3) and terminal stages (Type 1) of modification also have statistically consistent morphologies. This would suggest that the processes that operated in the late Noachian were globally ubiquitous, and that modified craters eventually reached a stable crater morphology. However, craters preserved in advanced (but not terminal) stages of modification (Type 2) have morphologies that vary across the quadrangles. It is possible that these variations reflect spatial differences in the types and intensity of geologic processes that operated during the Noachian, implying that the ancient climate also varied across regions.

Anatomy of the inferior petro-occipital vein and its relation to the base of the skull: application to surgical and endovascular procedures of the skull base.

PubMed

Tubbs, R Shane; Watanabe, Koichi; Loukas, Marios; Cohen-Gadol, Aaron A

2014-07-01

Although the inferior petro-occipital vein has been recently used for vascular access to the cavernous sinus, few detailed descriptions of its anatomy are in the literature. We aimed to investigate the morphology and relationships of this vessel. Twelve latex-injected cadaveric heads (24 sides) were dissected to identify the inferior petro-occipital vein and anatomic details documented. The petro-occipital vein was identified on 83.3% of sides. Generally this vein united the internal carotid venous plexus to the superior jugular bulb. However, on 10% of sides, the anterior part of this vein communicated directly with the cavernous sinus, and on 15%, the posterior vein drained into the inferior petrosal sinus at its termination into the superior jugular bulb. The petro-occipital vein was separated from the overlying inferior petrosal sinus by a thin plate of bone. On 40% of sides, small venous connections were found between these two venous structures. The vein was usually larger if a nondominant transverse sinus was present. The overlying inferior petrosal sinus was smaller in diameter when an underlying inferior petro-occipital vein was present. On 20% of sides, the posterior aspect of the vein communicated with the hypoglossal canal veins. On three sides, diploic veins from the clivus drained into the inferior petro-occipital vein. The inferior petro-occipital vein is present in most humans. This primarily extracranial vessel communicates with intracranial venous sinuses and should be considered an emissary vein. Knowledge of this vessel's exact anatomy may be useful to cranial base surgeons and endovascular specialists. Copyright © 2013 Wiley Periodicals, Inc.

Gorilla endoscopic sinus surgery: a life-saving collaboration between human and veterinary medicine.

PubMed

Davis, Greg E; Baik, Fred M; Liddell, Robert M; Ayars, Andrew G; Branch, Kelley R; Pottinger, Paul S; Hillel, Allen D; Helmick, Kelly; Collins, Darin

2018-03-23

Chronic rhinosinusitis is a common disease process in humans; however, in the primate population of gorillas, it has rarely been described. This case describes lifesaving sinus surgery on a critically ill gorilla performed by a human otolaryngology team in collaboration with the gorilla's veterinary medicine team. The 35-year-old western silverback gorilla was treated for 3 months with aggressive medical therapy for a worsening sinus infection. When his condition became severe, a computed tomography (CT) scan was performed showing advanced chronic rhinosinusitis with nasal polyps vs other masses and some bone erosion. As his condition deteriorated further, a tertiary otolaryngology team performed sinus surgery using the latest technology available, including image guidance, steroid-eluting sinus stents, and balloon sinus dilation. The postoperative course was complicated by subcutaneous infection and eventual fistulization. Fortunately, with culture-directed antibiotic therapy his condition gradually improved. One year later he required revision sinus surgery. At that point allergy testing was performed followed by appropriate allergy medical therapy. Now, 3 years out from his initial surgery, he continues to do well and has fathered a young female gorilla. This case represents a unique collaboration between human physicians and veterinarians. The combined medical approach was critical to heal this ailing gorilla. This case discusses many of the challenges and offers recommendations for physicians who may be involved with similar care of animals in the future. The success of the surgical and medical treatment of this gorilla's life-threatening sinus infection required many experts, careful planning, and corporate generosity. The interaction between human and animal medicine would not have been successful without the close and trusting collaborations between human and veterinary health providers. We encourage human healthcare providers to seek volunteer opportunities through their local zoos by engaging in discussions with their local veterinarians. © 2018 ARS-AAOA, LLC.

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.

A three-dimensional analysis of the endolymph drainage system in Ménière disease.

PubMed

Monsanto, Rafael da Costa; Pauna, Henrique F; Kwon, Geeyoun; Schachern, Patricia A; Tsuprun, Vladimir; Paparella, Michael M; Cureoglu, Sebahattin

2017-05-01

To measure the volume of the endolymph drainage system in temporal bone specimens with Ménière disease, as compared with specimens with endolymphatic hydrops without vestibular symptoms and with nondiseased specimens STUDY DESIGN: Comparative human temporal bone analysis. We generated three-dimensional models of the vestibular aqueduct, endolymphatic sinus and duct, and intratemporal portion of the endolymphatic sac and calculated the volume of those structures. We also measured the internal and external aperture of the vestibular aqueduct, as well as the opening (if present) of the utriculoendolymphatic (Bast's) valve and compared the measurements in our three study groups. The volume of the vestibular aqueduct and of the endolymphatic sinus, duct, and intratemporal endolymphatic sac was significantly lower in the Ménière disease group than in the endolymphatic hydrops group (P <.05). The external aperture of the vestibular aqueduct was also smaller in the Ménière disease group. Bast's valve was open only in some specimens in the Ménière disease group. In temporal bones with Ménière disease, the volume of the vestibular aqueduct, endolymphatic duct, and intratemporal endolymphatic sac was lower, and the external aperture of the vestibular aqueduct was smaller as compared with bones from donors who had endolymphatic hydrops without vestibular symptoms and with nondiseased bones. The open status of the Bast's valve in the Ménière disease group could be secondary to higher retrograde endolymph pressures caused by smaller drainage systems. These anatomic findings could correlate with the reason that some patients with hydrops develop clinical symptoms, whereas others do not. N/A Laryngoscope, 127:E170-E175, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Inverting papilloma of the temporal bone: Report of four new cases and systematic review of the literature.

PubMed

Carlson, Matthew L; Sweeney, Alex D; Modest, Mara C; Van Gompel, Jamie J; Haynes, David S; Neff, Brian A

2015-11-01

Inverting papillomas (IPs) are benign locally invasive tumors that most commonly present within the sinonasal cavity. Temporal bone involvement is exceedingly rare, with fewer than 30 cases reported within the English literature to date. Case series and systematic review of the literature. Four consecutive subjects with temporal bone inverting papilloma (TBIP) were treated, and an additional 28 previously published cases were identified in the literature. Main outcome measures were disease presentation, diagnostic evaluation, management strategy, and outcome. A total of 32 cases were analyzed. The median age at diagnosis was 54 years (mean 54.1; range 19-81 years). Nineteen (59%) patients had synchronous or metachronous sinonasal IP, whereas 13 (41%) had isolated temporal bone disease without sinus involvement. Over half of the patients undergoing microsurgical resection experienced at least one recurrence. Compared to patients with a history of sinus IP, subjects with primary TBIP were younger at time of presentation (44 vs. 58 years; P=0.012); were more commonly female (62% vs. 32%; P=0.15); and were less likely to have intracranial spread (8% vs. 26%; P=0.36), cranial neuropathy (8% vs. 26%; P=0.36), human papillomavirus positivity (11% vs. 57%; P=0.11), or associated carcinoma (0% vs. 47%; P=0.004). Inverting papilloma of the lateral skull base is rare and can pose a significant therapeutic challenge. Primary lesions of the temporal bone appear to follow a less aggressive clinical course when compared to those arising in association with sinonasal disease. Gross total resection is the preferred method of treatment, when feasible, given the high rate of recurrence with subtotal resection and risk of associated malignancy. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Workspace definition for navigated control functional endoscopic sinus surgery

NASA Astrophysics Data System (ADS)

Gessat, Michael; Hofer, Mathias; Audette, Michael; Dietz, Andreas; Meixensberger, Jürgen; Stauß, Gero; Burgert, Oliver

2007-03-01

For the pre-operative definition of a surgical workspace for Navigated Control ® Functional Endoscopic Sinus Surgery (FESS), we developed a semi-automatic image processing system. Based on observations of surgeons using a manual system, we implemented a workflow-based engineering process that led us to the development of a system reducing time and workload spent during the workspace definition. The system uses a feature based on local curvature to align vertices of a polygonal outline along the bone structures defining the cavities of the inner nose. An anisotropic morphologic operator was developed solve problems arising from artifacts from noise and partial volume effects. We used time measurements and NASA's TLX questionnaire to evaluate our system.

[The physiological significance of paranasal sinuses in man: speculations for 1800 years].

PubMed

Glück, U

1991-06-22

The function of the paranasal sinuses has been a controversial subject since the time of Galen (130-201 AD). A review of the literature reveals quite different beliefs about their biological purpose, and eight hypotheses have received particular attention: 1) They lighten the bones of the skull; 2) improve the resonance of the voice; 3) humidify and warm inspired air; 4) increase the area of the olfactory membrane; 5) serve as shock absorbers in mechanical impacts; 6) act as thermal insulators of the brain; 7) promote facial growth and architecture; and 8) persist as evolutionary relics or faults. Scrutiny of these hypotheses shows that none has a scientific basis.

A nasal dermoid sinus in an English bull terrier.

PubMed

Burrow, R D

2004-11-01

A five-year-old, entire female English bull terrier was presented with a six-week history of intermittent facial swelling and nasal pain, following an incident of nasal trauma. A small opening was present at the mucocutaneous junction on the dorsal nasal planum. Examination under general anaesthesia allowed catheterisation of this opening and confirmed the presence of a tract passing caudally. Plain radiographic examination of the region was unremarkable. Positive contrast sinography demonstrated contrast material filling a midline tract that passed caudally and subcutaneously towards the nasal bone. This tract was surgically excised. Histopathological examination of the excised tissue, together with the clinical findings, led to the diagnosis of nasal dermoid sinus.

Advanced immediate functional loading: requirements for long-term success in modern implant dentistry.

PubMed

Romanos, Georgios E

2014-01-01

There are benefits to be derived from the use of advanced surgical protocols in conjunction with immediate functional loading using various dental implant designs and implant-abutment connections. Clinical protocols with simultaneous bone grafting, immediate implant placement, and/or sinus augmentations when a shortened treatment period is needed are included in this report, with the aim of providing understanding of the main protocol characteristics and prerequisites for long-term success in implant dentistry. This article presents three clinical cases that illustrate possibilities for advanced immediate loading using different implant designs. It demonstrates treatment of severe bone defects and the facilitation of placing implants in regenerated bone that can be immediately loaded.

A rare case of osteoma in the frontal sinus: anatomical and histological description.

PubMed

Funieru, Cristian; Bănică, Bogdan; Cumpătă, Cristian-Niky; Sfeatcu, Ruxandra Ionela; Dumitrache, Adina Mihaela; Răescu, Mihaela; Dascălu, Ionela Teodora; Simion, George; Ţuculină, Mihaela Jana

2014-01-01

The purpose of this paper is to present a rare case of osteoma localized in the left frontal sinus. A 22-year-old woman who arrived at the Department of Neurosurgery of the University Emergency Hospital, Bucharest, Romania, presented a vertical asymmetry of the eyeballs but displayed no clinical signs like pain or diplopia. The computer tomography exam was used for preoperatory diagnostic. Histopathology was performed after surgery using Hematoxylin and Eosin staining. The Nikon Eclipse microscope was used to examine the slides. The histopathology exam shows a compact osteoma with dense and non-Haversian bone tissue and parallel bony trabeculae. A few spaces for the marrow were also found. The osteocytes were small and no fibrous cells were discovered. The computer tomography and histopathology exam were the investigations that lead us to a true diagnostic of dense osteoma. This tumor was the first case of frontal sinus osteoma histologically described in the Romanian population.

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

REVIVE Trial: Retrograde Delivery of Autologous Bone Marrow in Patients With Heart Failure.

PubMed

Patel, Amit N; Mittal, Sanjay; Turan, Goekmen; Winters, Amalia A; Henry, Timothy D; Ince, Hueseyin; Trehan, Naresh

2015-09-01

Cell therapy is an evolving option for patients with end-stage heart failure and ongoing symptoms despite optimal medical therapy. Our goal was to evaluate retrograde bone marrow cell delivery in patients with either ischemic heart failure (IHF) or nonischemic heart failure (NIHF). This was a prospective randomized, multicenter, open-label study of the safety and feasibility of bone marrow aspirate concentrate (BMAC) infused retrograde into the coronary sinus. Sixty patients were stratified by IHF and NIHF and randomized to receive either BMAC infusion or control (standard heart failure care) in a 4:1 ratio. Accordingly, 24 subjects were randomized to the ischemic BMAC group and 6 to the ischemic control group. Similarly, 24 subjects were randomized to the nonischemic BMAC group and 6 to the nonischemic control group. All 60 patients were successfully enrolled in the study. The treatment groups received BMAC infusion without complications. The left ventricular ejection fraction in the patients receiving BMAC demonstrated significant improvement compared with baseline, from 25.1% at screening to 31.1% at 12 months (p=.007) in the NIHF group and from 26.3% to 31.1% in the IHF group (p=.035). The end-systolic diameter decreased significantly in the nonischemic BMAC group from 55.6 to 50.9 mm (p=.020). Retrograde BMAC delivery is safe. All patients receiving BMAC experienced improvements in left ventricular ejection fraction, but only those with NIHF showed improvements in left ventricular end-systolic diameter and B-type natriuretic peptide. These results provide the basis for a larger clinical trial in HF patients. This work is the first prospective randomized clinical trial using high-dose cell therapy delivered via a retrograde coronary sinus infusion in patients with heart failure. This was a multinational, multicenter study, and it is novel, translatable, and scalable. On the basis of this trial and the safety of retrograde coronary sinus infusion, there are three other trials under way using this route of delivery. ©AlphaMed Press.

The Pitfalls and Important Distances in Temporal Bone HRCT of the Subjects with High Jugular Bulbs - Preliminary Report.

PubMed

Inal, Mikail; Muluk, Nuray B; Dağ, Ersel; Arıkan, Osman K; Kara, Simay A

2015-01-01

High jugular bulb (HJB) may be detected unilaterally or bilaterally in temporal bone high resolution computerized tomography (HRCT). In this retrospective study, we investigated the pitfalls and important surgical distances in patients with unilateral and bilateral HJB via temporal bone HRCT. In this preliminary report, the study group consisted of 20 adult patients (12 male, 8 female), or 40 ears, all of which underwent temporal bone HRCT. We divided them into groups that consisted of bilateral HJB (14 ears), unilateral HJB (13 ears), and control (No HJB, 13 ears). The anotomical relationships of the sigmoid sinus, jugular bulb, and carotid artery with several landmarks in the temporal bone were studied via temporal bone axial and coronal HRCT. The shortest distances between certain points were measured. These measurements were analyzed in respect to pneumatization. Dehiscence on the jugular bulb (JB) and internal carotid artery (ICA) and the dominance of JB were also evaluated for all of the groups. In the axial sections of the temporal bone HRCTs, the sigmois sinus (SS)-external auditory canal (EAC) distance of the bilateral HJB group (14.00±1.17 mm) was significantly lower than that of the control group (16.46±2.14 mm). The JB-posteromedial points of the umbo on the ear drum (ED) distance of the bilateral HJB (6.28±1.72 mm) and the unilateral HJB groups (7.23±2.00 mm) were significantly lower than that of the control group (11.15±2.30 mm). In the coronal sections of the temporal bone HRCT, the JB-F distance of the bilateral HJB group (5.42±2.10 mm) was significantly lower than that of the control group (8.30±2.28 mm). As the mastoid pneumatisation and mastoid volume increased, the percentage of ICA-dehiscence and the percentage of JB-dehiscence increased. In subjects with well-pneumatised mastoids, the doctors should be aware of the increased risk of ICA-dehiscence and JB-dehiscence. These measurements should be done in greater series to yield more thorough knowledge.

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.

Cranial pneumatization and auditory perceptions of the oviraptorid dinosaur Conchoraptor gracilis (Theropoda, Maniraptora) from the Late Cretaceous of Mongolia

NASA Astrophysics Data System (ADS)

Ramanah, D.; Raghunath, S.; Mee, D. J.; Rösgen, T.; Jacobs, P. A.

2007-09-01

The distribution of air-filled structures in the craniofacial and neurocranial bones of the oviraptorid ZPAL MgD-I/95, discovered at the Hermiin Tsav locality, Mongolia, is restored. Based on the complete obliteration of most of the cranial sutures, the specimen is identified as an adult individual of Conchoraptor gracilis Barsbold 1986. Except for the orbitosphenoids and epipterygoids, the preserved bones of the neurocranium are hollow. Three types of tympanic recess are present in Conchoraptor, a characteristic shared with troodontids, dromaeosaurids, and avian theropods. The contralateral middle ear cavities are interconnected by the supraencephalic pathway that passes through the dorsal tympanic recesses, the posterodorsal prootic sinuses and the parietal sinus. The spatial arrangements of the middle ear cavity and a derived neurocranial pneumatic system in Conchoraptor indicate enhancements of acoustic perception in the lower-frequency registers and of auditory directionality. We further speculate that this improvement of binaural hearing could be explained as an adaptation required for accurate detection of prey and/or predators under conditions of low illumination. The other potentially pneumatic structures of the Conchoraptor cranium include (1) recessus-like irregularities on the dorsal surface of the nasal and frontal bones (a putative oviraptorid synapomorphy; pos); (2) a subotic recess; (3) a sub-condylar recess; and (4) a posterior condylar recess (pos).

[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.

Restoration of the centre of rotation in primary total hip arthroplasty: the influence of acetabular floor depth and reaming technique.

PubMed

Meermans, G; Doorn, J Van; Kats, J-J

2016-12-01

One goal of total hip arthroplasty is to restore normal hip anatomy. The aim of this study was to compare displacement of the centre of rotation (COR) using a standard reaming technique with a technique in which the acetabulum was reamed immediately peripherally and referenced off the rim. In the first cohort the acetabulum was reamed to the floor followed by sequentially larger reamers. In the second cohort the acetabulum was only reamed peripherally, starting with a reamer the same size as the native femoral head. Anteroposterior pelvic radiographs were analysed for acetabular floor depth and vertical and horizontal position of the COR. Horizontally, the mean medial displacement of the COR was 0.8 mm (standard deviation (sd) 1.4) in the peripheral remaing group and 5.0 mm (sd 3.30) in the standard reaming group (p < 0.001). Vertically, the mean superior displacement of the COR was 0.7 mm (sd 1.3) in the peripheral reaming group and 3.7 mm (sd 2.6) in the standard reaming group (p < 0.001). In the standard reaming group, there was a strong correlation between the pre-operative acetabular floor depth and displacement of the COR (p < 0.001). Reaming the acetabulum to the floor can lead to significant displacement of the COR medially and superiorly. This displacement is related to the pre-operative acetabular floor depth and cannot always be compensated by using a high offset stem. Cite this article: Bone Joint J 2016;98-B:1597-603. ©2016 The British Editorial Society of Bone & Joint Surgery.

Radiological features of the skull in Klinefelter's syndrome and male hypogonadism.

PubMed

Kosowicz, J; Rzymski, K

1975-07-01

Skull radiographs were performed in 21 cases of Klinefelter's syndrome and in 30 cases of eunuchoidism. The radiographic changes of the skull in Klinefelter's syndrome are: temporal flattening, decreased width of the vault, narrowing of the mandible, decreased length of the skull, shortening of the anterior fossa cranii, decrease in the angle of the base, thinning of the vault bones at the major fontanelle, premature and excessive calcification of the coronal suture, deepening of the posterior fossa and shortening of the mandibular rami. In hypogonadotropic eunuchoidism the skull radiographs show: small mastoid processes, fine bones of the vault, small sella turcica, club-shaped clinoid processes, excessive development of sphenoidal sinuses and in the fourth and later decades of life a diminished bone density (osteoporosis).

Skull base trauma: diagnosis and management.

PubMed

Samii, Madjid; Tatagiba, Marcos

2002-03-01

The singular anatomical relationship of the base of the skull is responsible for the particular problems that may arise after injury. Extensive dural laceration and severe neurovascular damage may accompany skull base injuries. Trauma to the anterior skull base is frequently related to the paranasal sinuses, and trauma to the middle and the posterior skull base usually affects the petrous bone. Injury to the anterior fossa including the paranasal sinuses may produce CSF leakage, damage the olfactory nerves, optic nerves, and orbita contents. Fractures may affect the carotid canal, injure the internal carotid artery and result in carotid-cavernous fistula. Trauma to the petrous bone may cause facial palsy and deafness, and CSF leakage with otorrhoea or paradoxal rhinoliquorrhoea. Trauma to the posterior fossa may lacerate the major venous sinuses, and affect the cranio-cervical stability. Each one of these injuries will need a particular strategy. Decision making for management as a whole must consider all aspects, including the fact that these injuries frequently involve polytraumatized patients. Decisions regarding the timing of surgery and the sequence of the surgical procedures must be made with great care. Modern surgical techniques and recent technologies including functional preservation of the olfactory nerves in frontobasal trauma, visual evoked potentials, assisted optic nerve decompression, facial nerve reconstruction, interventional technique for intravascular repair of vascular injuries, and recent developments in cochlea implants and brain stem implants, all contributed significantly to improve outcome and enhance the quality of life of patients. This article reviews basic principles of management of skull base trauma stressing the role of these advanced techniques.

Technical assessment of a cone-beam CT scanner for otolaryngology imaging: image quality, dose, and technique protocols.

PubMed

Xu, J; Reh, D D; Carey, J P; Mahesh, M; Siewerdsen, J H

2012-08-01

As cone-beam CT (CBCT) systems dedicated to various imaging specialties proliferate, technical assessment grounded in imaging physics is important to ensuring that image quality and radiation dose are quantified, understood, and justified. This paper involves technical assessment of a new CBCT scanner (CS 9300, Carestream Health, Rochester, NY) dedicated to imaging of the ear and sinuses for applications in otolaryngology-head and neck surgery (OHNS). The results guided evaluation of technique protocols to minimize radiation dose in a manner sufficient for OHNS imaging tasks. The technical assessment focused on the imaging performance and radiation dose for each of seven technique protocols recommended by the manufacturer: three sinus protocols and four ear (temporal bone) protocols. Absolute dose was measured using techniques adapted from AAPM Task Group Report No. 111, involving three stacked 16 cm diameter acrylic cylinders (CTDI phantoms) and a 0.6 cm(3) Farmer ionization chamber to measure central and peripheral dose. The central dose (D(o)) was also measured as a function of longitudinal position (z) within and beyond the primary radiation field to assess, for example, out-of-field dose to the neck. Signal-difference-to-noise ratio (SDNR) and Hounsfield unit (HU) accuracy were assessed in a commercially available quality assurance phantom (CATPHAN module CTP404, The Phantom Laboratory, Greenwich, NY) and a custom phantom with soft-tissue-simulating plastic inserts (Gammex RMI, Madison, WI). Spatial resolution was assessed both qualitatively (a line-pair pattern, CATPHAN module CTP528) and quantitatively (modulation transfer function, MTF, measured with a wire phantom). Imaging performance pertinent to various OHNS imaging tasks was qualitatively assessed using an anthropomorphic phantom as evaluated by two experienced OHNS specialists. The technical assessment motivated a variety of modifications to the manufacturer-specified protocols to provide reduced radiation dose without compromising pertinent task-based imaging performance. The revised protocols yielded D(o) ranging 2.9-5.7 mGy, representing a ∼30% reduction in dose from the original technique chart. Out-of-field dose was ∼10% of D(o) at a distance of ∼8 cm from the field edge. Soft-tissue contrast resolution was fairly limited (water-brain SDNR ∼0.4-0.7) while high-contrast performance was reasonably good (SDNR ∼2-4 for a polystyrene insert in the CATPHAN). The scanner does not demonstrate (or claim to provide) accurate HU and exhibits a systematic error in CT number that could potentially be addressed by further calibration. The spatial resolution is ∼10-16 lp∕cm as assessed in a line-pair phantom, with MTF exceeding 10% out to ∼20 lp∕cm. Qualitative assessment by expert readers suggested limited soft-tissue visibility but excellent high-contrast (bone) visualization with isotropic spatial resolution suitable to a broad spectrum of pertinent sinus and temporal bone imaging tasks. The CBCT scanner provided spatial and contrast resolution suitable to visualization of high-contrast morphology in sinus, maxillofacial, and otologic imaging applications. Rigorous technical assessment guided revision of technique protocols to reduce radiation dose while maintaining image quality sufficient for pertinent imaging tasks. The scanner appears well suited to high-contrast sinus and temporal bone imaging at doses comparable to or less than that reported for conventional diagnostic CT of the head.

3D Topography of the Young Adult Anal Sphincter Complex Reconstructed from Undeformed Serial Anatomical Sections

PubMed Central

Wu, Yi; Dabhoiwala, Noshir F.; Hagoort, Jaco; Shan, Jin-Lu; Tan, Li-Wen; Fang, Bin-Ji; Zhang, Shao-Xiang; Lamers, Wouter H.

2015-01-01

Background Pelvic-floor anatomy is usually studied by artifact-prone dissection or imaging, which requires prior anatomical knowledge. We used the serial-section approach to settle contentious issues and an interactive 3D-pdf to make the results widely accessible. Method 3D reconstructions of undeformed thin serial anatomical sections of 4 females and 2 males (21–35y) of the Chinese Visible Human database. Findings Based on tendinous septa and muscle-fiber orientation as segmentation guides, the anal-sphincter complex (ASC) comprised the subcutaneous external anal sphincter (EAS) and the U-shaped puborectal muscle, a part of the levator ani muscle (LAM). The anococcygeal ligament fixed the EAS to the coccygeal bone. The puborectal-muscle loops, which define the levator hiatus, passed around the anorectal junction and inserted anteriorly on the perineal body and pubic bone. The LAM had a common anterior attachment to the pubic bone, but separated posteriorly into puborectal and “pubovisceral” muscles. This pubovisceral muscle was bilayered: its internal layer attached to the conjoint longitudinal muscle of the rectum and the rectococcygeal fascia, while its outer, patchy layer reinforced the inner layer. ASC contraction makes the ano-rectal bend more acute and lifts the pelvic floor. Extensions of the rectal longitudinal smooth muscle to the coccygeal bone (rectococcygeal muscle), perineal body (rectoperineal muscle), and endopelvic fascia (conjoint longitudinal and pubovisceral muscles) formed a “diaphragm” at the inferior boundary of the mesorectum that suspended the anorectal junction. Its contraction should straighten the anorectal bend. Conclusion The serial-section approach settled contentious topographic issues of the pelvic floor. We propose that the ASC is involved in continence and the rectal diaphragm in defecation. PMID:26305117

A giant cranial aneurysmal bone cyst associated with fibrous dysplasia.

PubMed

Składzieriń, J; Olés, K; Zagólski, O; Moskała, M; Sztuka, M; Strek, P; Wierzchowski, W; Tomik, J

2008-01-01

An aneurysmal bone cyst (ABC) is a rare, benign fibro-osseous lesion, considered a vascular phenomenon secondary to fibrous dysplasia or a giant-cell tumour, and occurs mainly in long bones and vertebrae. In this case report a 16-year-old male presented with massive epistaxis. He was admitted with a 3-year history of chronic rhinitis, headaches, right ocular pain and recurrent epistaxis. CT scans showed a predominantly cystic, expansive mass obstructing both nasal cavities, extending to all paranasal sinuses and both orbits, with evidence of anterior cranial fossa skull base destruction. The patient underwent a craniofacial resection of the tumour performed with an external approach and an immediate reconstruction of the dural defect. Histology confirmed the lesion was an ABC associated with fibrous dysplasia. The patient's recovery was complete. A large facial aneurysmal bone cyst can damage the facial skeleton and skull base, and requires excision by a combined external approach.

Piezosurgery applied to implant dentistry: clinical and biological aspects.

PubMed

Pereira, Cassiano Costa Silva; Gealh, Walter Cristiano; Meorin-Nogueira, Lamis; Garcia-Júnior, Idelmo Rangel; Okamoto, Roberta

2014-07-01

Piezosurgery is a new and modern technique of bone surgery in implantology. Selective cutting is possible for different ultrasonic frequencies acting only in hard tissues (mineralized), saving vital anatomical structures. With the piezoelectric osteotomy technique, receptor site preparation for implants, autogenous bone graft acquistition (particles and blocks), osteotomy for alveolar bone crest expansion, maxillary sinus lifting, and dental implant removal can be performed accurately and safely, providing excellent clinical and biological results, especially for osteocyte viability. The aim of this review was, through literature review, to present clinical applications of piezosurgery in implant dentistry and outline their advantages and disadvantages over conventional surgical systems. Moreover, this study addressed the biological aspects related to piezosurgery that differentiate it from those of bone tissue approaches. Overall, piezosurgery enables critical operations in simple and fully executable procedures; and effectively, areas that are difficult to access have less risk of soft tissue and neurovascular tissue damage via piezosurgery.

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.

Skull fracture with effacement of the superior sagittal sinus following drone impact: a case report.

PubMed

Chung, Lawrance K; Cheung, Yuri; Lagman, Carlito; Au Yong, Nicholas; McBride, Duncan Q; Yang, Isaac

2017-09-01

The popularity of unmanned aerial vehicles, or drones, raises safety concerns as they become increasingly common for commercial, personal, and recreational use. Collisions between drones and people may result in serious injuries. A 13-year-old male presented with a comminuted depressed skull fracture causing effacement of the superior sagittal sinus secondary to a racing drone impact. The patient experienced a brief loss of consciousness and reported lower extremity numbness and weakness after the accident. Imaging studies revealed bone fragments crossing the superior sagittal sinus with a short, focal segment of blood flow interruption. Neurosurgical intervention was deferred given the patient's improving neurological deficits, and the patient was treated conservatively. He was discharged home in stable condition. Drones may represent a hazard when operated inappropriately due to their capacity to fly at high speeds and altitudes. Impacts from drones can carry enough force to cause skull fractures and significant head injuries. The rising popularity of drones likely translates to an increased incidence of drone-related injuries. Thus, clinicians should be aware of this growing trend.

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.

[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.

Is Routine Use of High Resolution Computerized Tomography of Temporal Bone in Patients of Atticoantral Chronic Suppurative Otitis Media without Intracranial Complications Justified?

PubMed

Bathla, Meeta; Doshi, Hiren; Kansara, Atul

2018-03-01

Role of high resolution computerized tomography (HRCT) of temporal bone is established in cases of atticoantral chronic suppurative otitis media (CSOM) with intracranial complications. Routine use of HRCT in management of patients of atticoantral CSOM without intracranial complications has been an issue of debate. The aim of this study was to evaluate the routine use of HRCT of temporal bone in such cases. This study was a prospective study done at LG hospital, AMC MET Medical College, Ahmedabad to evaluate and compare the temporal bone findings in HRCT and intraoperative findings in 100 patients with atticoantral CSOM. All patients underwent HRCT screening followed by surgical exploration of middle ear cleft. In extent of disease HRCT showed very high sensitivity and specificity for epitympanum (100, 94%) and mesotympanum (98, 98%) areas. It gave valuable information of disease extent in hidden areas like sinus tympani and facial recess of mesotympanum. HRCT satisfactorily delineated malleus and incus erosion but had 75% sensitivity for detecting erosion of stapes suprastructure, though specificity was of 97%. For bony anatomical landmarks HRCT showed very high sensitivity and specificity for detecting erosion of lateral semicircular canal, tegmen tympani and sinus plate. Detection of facial canal erosion on HRCT had moderate sensitivity of 75%. We concluded that routine use of HRCT is justified as a reliable preoperative tool in patients with atticoantral CSOM without intracranial complications and it helps to plan type of surgical intervention. HRCT has limited role to distinguish between granulations and cholesteatoma and also to delineate stapes supra structure and facial nerve canal.

Mucoepidermoid Carcinoma in the Skull of an Orange-winged Amazon Parrot (Amazona amazonica).

PubMed

Nau, Melissa R; Carpenter, James W; Lin, Denise; Narayanan, Sanjeev; Hallman, Mackenzie

2017-09-01

A 33-year-old female intact orange-winged Amazon parrot (Amazona amazonica) presented for a slowly growing mass over the right eye. A computed tomography scan performed with and without intravenous contrast revealed a heterogeneous mixed soft tissue and mineral-dense mass with a small area of non-contrast-enhancing fluid density located between the orbits at the caudal aspect of the nasal passages, with associated lysis of the right caudal nasal passage and the right frontal bone. Following euthanasia, the mass was found to consist of soft tissue between the right eye and nostril over the right frontal bone. Lysis of the underlying bone resulted in a bony defect leading into the infraorbital sinus along the dorsorostral aspect of the right eye. Histopathology revealed an unencapsulated, poorly demarcated, highly cellular neoplasm composed of islands and trabeculae of neoplastic cells embedded in abundant loose fibrovascular stroma which completely obliterated the cortical bone and sinuses of the rostral skull and infiltrated the surrounding muscle and soft tissue. Histologically, the tumor was consistent with a high-grade mucoepidermoid carcinoma, characterized by the presence of epidermoid, intermediate, and mucous-producing cell types. No evidence of metastasis was identified. The tissue of origin was suspected to be salivary or nasal mucous glands, but was difficult to confirm due to distortion of normal tissue architecture as a result of the tumor. Although mucoepidermoid carcinomas are a common salivary gland tumor in human medicine, they are not well recognized in avian species, and no specific case reports exist describing this pathology in an Amazon parrot. Despite the lack of distinct salivary glands in most avian species, mucoepidermoid carcinomas can occur, can cause significant clinical disease, and should be included as a differential diagnosis for avian patients presenting with similar lesions.

Sclerosteosis involving the temporal bone: histopathologic aspects.

PubMed

Nager, G T; Hamersma, H

1986-01-01

Sclerosteosis is a rare, potentially lethal, autosomal recessive, progressive craniotubular sclerosing bone dysplasia with characteristic facial and skeletal features. The temporal bone changes include a marked increase in overall size, extensive sclerosis, narrowing of the external auditory canal, and severe constriction of the internal auditory meatus, fallopian canal, eustachian tube, and middle ear cleft. Attenuation of the bony canals of the 9th, 10th, and 11th cranial nerves, reduction in size of the internal carotid artery, and severe obliteration of the sigmoid sinus and jugular bulb also occur. Loss of hearing, generally bilateral, is a frequent symptom. It often manifests in early childhood and initially is expressed as sound conduction impairment. Later, a sensorineural hearing loss and loss of vestibular nerve function often develop. Impairment of facial nerve function is another feature occasionally present at birth. In the beginning, a unilateral intermittent facial weakness may occur which eventually progresses to a bilateral permanent facial paresis. The histologic examination of the temporal bones from a patient with sclerosteosis explains the mechanisms involved in the progressive impairment of sound conduction and loss of cochlear, vestibular, and facial nerve function. There is a decrease of the arterial blood supply to the brain and an obstruction of the venous drainage from it. The histopathology reveals the obstacles to decompression of the middle ear cleft, ossicular chain, internal auditory and facial canals, and the risks, and in many instances the contraindications, to such procedures. On the other hand, decompression of the sigmoid sinus and jugular bulb should be considered as an additional life-saving procedure in conjunction with the prophylactic craniotomy recommended in all adult patients.

Cross-sectional imaging of extracted jawbone of a pig by optical coherence tomography

NASA Astrophysics Data System (ADS)

Tachikawa, Noriko; Yoshimura, Reiko; Ohbayashi, Kohji

2011-03-01

Dental implantation has become popular in dental treatments. Although careful planning is made to identify vital structures such as the inferior alveolar nerve or the sinus, as well as dimensions of the bone, prior to commencement of surgery, dental implantation is not fully free from risks. If a diagnostic tool is available to objectively measure bone feature before surgery and dimensions during surgery, considerable fraction of the risks may be avoided. Optical coherence tomography (OCT) is a candidate for the purpose, which enables cross-sectional imaging of bone. In this work, we performed in vitro cross-sectional imaging of extracted pig's jawbone with swept source OCT using superstructure-grating distributed Bragg reflector (SSG-DBR) laser as the source. The relatively long wavelength range of 1600nm of the laser is suitable for deeper bone imaging. We confirmed an image penetration depth of about 3 mm in physical length, which satisfies one of the criterions to apply OCT for in vivo diagnosis of bone during surgery.

Environmental Assessment for Installation of a New Jet Engine Test Cell, Edwards Air Force Base, California

DTIC Science & Technology

2012-09-01

suspended in the runoff waters around the lakebeds, sealing lakebed surface cracks and filling fissures. Shallow flooding along with consistent winds are...of the recorded specimens consist of isolated fragments of tooth enamel or bone that are not securely dated. Irvingtonian fossil localities have...require frequent repair as well. Concrete floors are cracking throughout all four test cells. Entry doors sag and drag on buckled floors. One-half

The vascularization of the os calcaneum and the clinical consequences.

PubMed

Andermahr, J; Helling, H J; Rehm, K E; Koebke, Z

1999-06-01

This study was conducted to analyze extraosseous and intraosseous vascularization of the os calcaneum and to elucidate possible clinical manifestations. The arteries of 13 lower leg and foot specimens of human cadavers were injected with a polymer and subjected to maceration or were embedded in plastic. The examination revealed that 45% of the bone is vascularized via medial arteries and 45% via lateral arteries, whereas the remaining 10% is supplied by the sinus tarsi artery. From the medial side, two or three vessels branch off the posterior tibial artery, penetrate the calcaneus below the sustentaculum, and supply the medial part of the posterior joint. The lateral calcaneal artery normally is a branch from the posterior tibial artery. In two of 13 specimens, this lateral supply comes from the peroneal artery. The medial and lateral intraosseous arterial supply for the calcaneus is equal. Inside the bone there is a water-shed zone where the medial and lateral arterial supply meet in the midline. Only 10% of the blood flow is supplied by vessels in the sinus tarsi. Clinically, interruption of the lateral calcaneal artery during the conventional lateral surgical approach for a calcaneus fracture may result in ischemic bone necrosis. The lateral calcaneal artery could supply a local microvascular flap to cover soft tissue defects of the heel. A compartment syndrome after a calcaneus fracture may be caused by bleeding from the medial calcaneal arteries into the quadratus plantae compartment.

Disseminated sinus histiocytosis with massive lymphadenopathy: its pathologic aspects.

PubMed

Buchino, J J; Byrd, R P; Kmetz, D R

1982-01-01

Sinus histiocytosis with massive lymphadenopathy (SHML) is generally regarded as a benign, self-limited, pseudolymphomatous process requiring little or no therapy. We studied a 13-year-old black boy with a ten-year clinical course of SHML that had varying, intermittent sites of extranodal involvement, including bone, submandibular gland, trachea, eye, and spinal cord. At the time of death, which was attributed to SHML, additional extranodal sites of involvement included thymus, kidney, heart, liver, and base of brain. Microscopic examination of the SHML lesions at the time of autopsy revealed varying stages of development, from proliferation to involution. This case illustrates that SHML may involve multiple organ systems, can kill, and that histologic evaluation of disease activity at one site cannot be used as an indicator of activity at another.

[Lateral column lengthening osteotomy of calcaneus].

PubMed

Hintermann, B

2015-08-01

Lengthening of the lateral column for adduction of forefoot and restoration of the medial arch. Stabilization of the ankle joint complex. Supple flatfoot deformity (posterior tibial tendon dysfunction stage II). Instability of the medial ankle joint complex (superficial deltoid and spring ligament). Posttraumatic valgus and pronation deformity of the foot. Rigid flatfoot deformity (posterior tibial tendon dysfunction stage III and IV). Talocalcaneal and naviculocalcaneal coalition. Osteoarthritis of calcaneocuboid joint. Exposition of calcaneus at sinus tarsi. Osteotomy through sinus tarsi and widening until desired correction of the foot is achieved. Insertion of bone graft. Screw fixation. Immobilization in a cast for 6 weeks. Weight-bearing as tolerated from the beginning. In the majority of cases, part of hindfoot reconstruction. Reliable and stable correction. Safe procedure with few complications.

Comparison of Two Base Materials Regarding Their Effect on Root Canal Treatment Success in Primary Molars with Furcation Lesions

PubMed Central

Sonmez, Hayriye; Sari, Saziye

2016-01-01

Introduction. The aim of this study was to compare MTA with another base material, IRM, which is generally used on pulpal floor after root canal treatment, regarding their effect on the success of root canal treatment of primary teeth with furcation lesions. Materials and Methods. Fifty primary teeth with furcation lesions were divided into 2 groups. Following root canal treatment, the pulpal floor was coated with MTA in the experimental group and with IRM in the control group. Teeth were followed up considering clinical (pain, pathological mobility, tenderness to percussion and palpation, and any soft tissue pathology and sinus tract) and radiographical (pathological root resorption, reduced size or healing of existing lesion, and absence of new lesions at the interradicular or periapical area) criteria for 18 months. For the statistical analysis, Fisher's exact test and Pearson's chi-square tests were used and a p value of <0.05 was considered to be statistically significant. Results. Although there were no statistically significant differences between two groups in terms of treatment success, lesions healed significantly faster in the MTA group. Conclusion. In primary teeth with furcation lesions, usage of MTA on the pulpal floor following root canal treatment can be a better alternative since it induced faster healing. PMID:27957486

Comparison of Two Base Materials Regarding Their Effect on Root Canal Treatment Success in Primary Molars with Furcation Lesions.

PubMed

Arikan, Volkan; Sonmez, Hayriye; Sari, Saziye

2016-01-01

Introduction. The aim of this study was to compare MTA with another base material, IRM, which is generally used on pulpal floor after root canal treatment, regarding their effect on the success of root canal treatment of primary teeth with furcation lesions. Materials and Methods. Fifty primary teeth with furcation lesions were divided into 2 groups. Following root canal treatment, the pulpal floor was coated with MTA in the experimental group and with IRM in the control group. Teeth were followed up considering clinical (pain, pathological mobility, tenderness to percussion and palpation, and any soft tissue pathology and sinus tract) and radiographical (pathological root resorption, reduced size or healing of existing lesion, and absence of new lesions at the interradicular or periapical area) criteria for 18 months. For the statistical analysis, Fisher's exact test and Pearson's chi-square tests were used and a p value of <0.05 was considered to be statistically significant. Results. Although there were no statistically significant differences between two groups in terms of treatment success, lesions healed significantly faster in the MTA group. Conclusion. In primary teeth with furcation lesions, usage of MTA on the pulpal floor following root canal treatment can be a better alternative since it induced faster healing.

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

[Experience of Fusion image guided system in endonasal endoscopic surgery].

PubMed

Wen, Jingying; Zhen, Hongtao; Shi, Lili; Cao, Pingping; Cui, Yonghua

2015-08-01

To review endonasal endoscopic surgeries aided by Fusion image guided system, and to explore the application value of Fusion image guided system in endonasal endoscopic surgeries. Retrospective research. Sixty cases of endonasal endoscopic surgeries aided by Fusion image guided system were analysed including chronic rhinosinusitis with polyp (n = 10), fungus sinusitis (n = 5), endoscopic optic nerve decompression (n = 16), inverted papilloma of the paranasal sinus (n = 9), ossifying fibroma of sphenoid bone (n = 1), malignance of the paranasal sinus (n = 9), cerebrospinal fluid leak (n = 5), hemangioma of orbital apex (n = 2) and orbital reconstruction (n = 3). Sixty cases of endonasal endoscopic surgeries completed successfully without any complications. Fusion image guided system can help to identify the ostium of paranasal sinus, lamina papyracea and skull base. Fused CT-CTA images, or fused MR-MRA images can help to localize the optic nerve or internal carotid arteiy . Fused CT-MR images can help to detect the range of the tumor. It spent (7.13 ± 1.358) minutes for image guided system to do preoperative preparation and the surgical navigation accuracy reached less than 1mm after proficient. There was no device localization problem because of block or head set loosed. Fusion image guided system make endonasal endoscopic surgery to be a true microinvasive and exact surgery. It spends less preoperative preparation time, has high surgical navigation accuracy, improves the surgical safety and reduces the surgical complications.

A Bone-Thickness Map as a Guide for Bone-Anchored Port Implantation Surgery in the Temporal Bone

PubMed Central

Guignard, Jérémie; Arnold, Andreas; Weisstanner, Christian; Caversaccio, Marco; Stieger, Christof

2013-01-01

The bone-anchored port (BAP) is an investigational implant, which is intended to be fixed on the temporal bone and provide vascular access. There are a number of implants taking advantage of the stability and available room in the temporal bone. These devices range from implantable hearing aids to percutaneous ports. During temporal bone surgery, injuring critical anatomical structures must be avoided. Several methods for computer-assisted temporal bone surgery are reported, which typically add an additional procedure for the patient. We propose a surgical guide in the form of a bone-thickness map displaying anatomical landmarks that can be used for planning of the surgery, and for the intra-operative decision of the implant’s location. The retro-auricular region of the temporal and parietal bone was marked on cone-beam computed tomography scans and tridimensional surfaces displaying the bone thickness were created from this space. We compared this method using a thickness map (n = 10) with conventional surgery without assistance (n = 5) in isolated human anatomical whole head specimens. The use of the thickness map reduced the rate of Dura Mater exposition from 100% to 20% and suppressed sigmoid sinus exposures. The study shows that a bone-thickness map can be used as a low-complexity method to improve patient’s safety during BAP surgery in the temporal bone. PMID:28788390

A Bone-Thickness Map as a Guide for Bone-Anchored Port Implantation Surgery in the Temporal Bone.

PubMed

Guignard, Jérémie; Arnold, Andreas; Weisstanner, Christian; Caversaccio, Marco; Stieger, Christof

2013-11-19

The bone-anchored port (BAP) is an investigational implant, which is intended to be fixed on the temporal bone and provide vascular access. There are a number of implants taking advantage of the stability and available room in the temporal bone. These devices range from implantable hearing aids to percutaneous ports. During temporal bone surgery, injuring critical anatomical structures must be avoided. Several methods for computer-assisted temporal bone surgery are reported, which typically add an additional procedure for the patient. We propose a surgical guide in the form of a bone-thickness map displaying anatomical landmarks that can be used for planning of the surgery, and for the intra-operative decision of the implant's location. The retro-auricular region of the temporal and parietal bone was marked on cone-beam computed tomography scans and tridimensional surfaces displaying the bone thickness were created from this space. We compared this method using a thickness map ( n = 10) with conventional surgery without assistance ( n = 5) in isolated human anatomical whole head specimens. The use of the thickness map reduced the rate of Dura Mater exposition from 100% to 20% and suppressed sigmoid sinus exposures. The study shows that a bone-thickness map can be used as a low-complexity method to improve patient's safety during BAP surgery in the temporal bone.

Pathologic mandibular fracture after biting crab shells following ramal bone graft.

PubMed

Kwon, Ik Jae; Lee, Byung Ho; Eo, Mi Young; Kim, Soung Min; Lee, Jong Ho; Lee, Suk Keun

2016-10-01

The mandibular ramus is considered an appropriate choice for reconstruction of maxillofacial defects because of sufficient amounts of material and fewer donor site complications. Although bone harvesting from the mandibular ramus has many advantages, in rare cases it can result in pathologic fracture of the mandible. Here, we present a case of 59-year-old man who suffered a pathologic mandible fracture related to biting hard foods, such as crab shells, after a sinus bone lifting with ramal bone graft procedure performed 2 weeks prior. He underwent closed reduction by intermaxillary fixation with an arch bar over the course of 4 weeks. Three months later, the patients had a stable occlusion with normal mouth opening and sensation. To prevent this complication, the osteotomy should be performed in such a way that it is not too vertical during ramal bone harvesting. Furthermore, we wish to emphasize the importance of patients being instructed to avoid chewing hard foods for at least 4 weeks after ramal bone harvesting. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Juvenile psammomatoid ossifying fibroma of the neurocranium. Report of four cases.

PubMed

Hasselblatt, Martin; Jundt, Gernot; Greiner, Christoph; Rama, Burckhard; Schmäl, Frank; Iglesias-Rozas, José R; van de Nes, Johannes A P; Paulus, Werner

2005-06-01

Juvenile psammomatoid ossifying fibroma (JPOF) is a benign fibroosseous lesion predominantly arising within the paranasal sinuses in children and young adults. Neurocranial occurrence is exceedingly rare and a location within the neurocranial portion of the temporal bone has not been described. The authors report on one case of sinonasal JPOF secondarily extending into the cranial cavity and three cases primarily affecting the neurocranial bones to increase clinical awareness of this uncommon tumor, which may be easily mistaken for meningioma. Moreover, the absence of activating missense mutations of the GNAS1 gene in two cases strongly argues against a relationship between JPOF and fibrous dysplasia.

Distinguishing rhinitis and nasal neoplasia by radiography.

PubMed

Russo, M; Lamb, C R; Jakovljevic, S

2000-01-01

To compare the incidence of radiographic signs in dogs with rhinitis and primary nasal neoplasia and to assess the performance of observers for distinguishing these conditions, the nasal radiographs of 72 dogs with either rhinitis (n = 42) or primary nasal neoplasia (n = 30) were examined by two independent observers using custom-designed forms to record their interpretations. Rhinitis was associated with a higher incidence of focal or multifocal lesions, localised soft tissue opacities, lucent foci, and a lack of frontal sinus involvement. Neoplasia was associated with soft tissue opacities and loss of turbinate detail that affected the entire ipsilateral nasal cavity, signs of invasion of the bones surrounding the nasal cavity, and soft tissue/fluid opacities within the ipsilateral frontal sinus. The signs with the highest positive predictive value (PPV) for rhinitis were absence of frontal sinus lesions and lucent foci in nasal cavity (PPV of each 82%), and invasion of surrounding bones for neoplasia (PPV 88%). There were no significant differences in the position of the lesion within the nasal cavity, incidence of unilateral versus bilateral lesions, calcified lesions, or absence of teeth. There was moderate agreement between observers about the diagnosis (kappa 0.59). Areas (SE) under ROC curves were 0.94 (0.03) and 0.96 (0.03) for observers A and B, respectively (not significantly different; P = 0.68). These results indicate a high accuracy for radiologists examining dogs with nasal diseases. Differentiation of rhinitis and nasal neoplasia should be based on finding combinations of radiologic signs that together have a high PPV. Differences in interpretation between experienced observers in this study suggest that certain signs are potential sources of error.

[A case of bilateral panophthalmoplegia caused by paranasal malignant lymphoma extending into the skull base].

PubMed

Shibata, M; Shimoda, M; Sato, O

1992-06-01

A case of bilateral panophthalmoplegia developed after paranasal malignant lymphoma is described, and previously reported cases are reviewed. A 74-year-old female was hospitalized with the chief complaints of bilateral ptosis and bilateral deep orbital pain that had developed over a 10-day period. Neurological examination revealed bilateral dilated pupils, panophthalmoplegia, and hypalgesia in the area of the ophthalmic nerve on both sides. Laboratory studies and endocrinological examination were free from abnormal findings. Skull X-ray films showed a soft tissue lesion in the sphenoidal and ethmoidal sinus and this was associated with bony structure destruction in the surrounding area. Computed tomography demonstrated a heterogeneously enhanced mass lesion in the paranasal sinus extending into the intrasellar region and bilateral cavernous sinus. Meticulous investigation has so far revealed no distant lesions either in the thoracic or abdominal lesions. Subtotal tumor resection was undergone via the transsphenoidal route at which time tumor extension into the nasal cavity and sellar floor destruction were confirmed. Diffuse and mixed B-cell type malignant lymphoma was the pathological diagnosis. Postoperatively, improvement of abnormalities of pupils, panophthalmoplegia, and ptosis was achieved but this was only transient. Despite focal radiation therapy and repeated chemotherapy, the patient died 14-months after the diagnosis was made. On reviewing the literature, it is shown that the incidence of bilateral panophthalmoplegia among patients who develop disturbance of ocular movement is extremely low (0.4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Retrospective clinical study of an implant with a sandblasted, large-grit, acid-etched surface and internal connection: analysis of short-term success rate and marginal bone loss.

PubMed

Lee, Jae-Wang; An, Jun Hyeong; Park, Sang-Hoon; Chong, Jong-Hyon; Kim, Gwang-Seok; Han, JeongJoon; Jung, Seunggon; Kook, Min-Suk; Oh, Hee-Kyun; Ryu, Sun-Youl; Park, Hong-Ju

2016-12-01

The purpose of this retrospective study was to evaluate the clinical utility of an implant with a sandblasted, large-grit, acid-etched (SLA) surface and internal connection. Six patients who received dental implants in the Department of Oral and Maxillofacial Surgery, Chonnam National University Dental Hospital, were analyzed by factors influencing the success rate and marginal bone loss. Factors included patient's age, sex, implant installation site, whether bone graft was done, type of bone graft materials, approaching method if sinus lift was done, and the size of the fixture. In addition, the marginal bone loss was analyzed by using a radiograph. All implants were successful, and the cumulative survival rate was 100 %. Average marginal bone loss of 6 months after the installation was 0.52 mm and 20 months after the functional loading was 1.06 mm. Total marginal bone resorption was 1.58 mm on average. There was no statistically significant difference in mesial and distal marginal bone loss. The short-term clinical success rate of the implant with an SLA surface and internal connection was satisfactory. Moreover, the marginal bone loss was also consistent with the implant success criteria.

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.

Emerging Perspectives in Scaffold for Tissue Engineering in Oral Surgery.

PubMed

Ceccarelli, Gabriele; Presta, Rossella; Benedetti, Laura; Cusella De Angelis, Maria Gabriella; Lupi, Saturnino Marco; Rodriguez Y Baena, Ruggero

2017-01-01

Bone regeneration is currently one of the most important and challenging tissue engineering approaches in regenerative medicine. Bone regeneration is a promising approach in dentistry and is considered an ideal clinical strategy in treating diseases, injuries, and defects of the maxillofacial region. Advances in tissue engineering have resulted in the development of innovative scaffold designs, complemented by the progress made in cell-based therapies. In vitro bone regeneration can be achieved by the combination of stem cells, scaffolds, and bioactive factors. The biomimetic approach to create an ideal bone substitute provides strategies for developing combined scaffolds composed of adult stem cells with mesenchymal phenotype and different organic biomaterials (such as collagen and hyaluronic acid derivatives) or inorganic biomaterials such as manufactured polymers (polyglycolic acid (PGA), polylactic acid (PLA), and polycaprolactone). This review focuses on different biomaterials currently used in dentistry as scaffolds for bone regeneration in treating bone defects or in surgical techniques, such as sinus lift, horizontal and vertical bone grafts, or socket preservation. Our review would be of particular interest to medical and surgical researchers at the interface of cell biology, materials science, and tissue engineering, as well as industry-related manufacturers and researchers in healthcare, prosthetics, and 3D printing, too.

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.

Current aspects in reconstructive surgery for nasal cavity and paranasal sinus cancer

NASA Astrophysics Data System (ADS)

Shtin, V. I.; Novikov, V. A.; Gjunter, V. E.; Choinzonov, E. L.; Ryabova, A. I.; Sirkashev, V. A.; Surkova, P. V.; Vasilev, R. V.; Menkova, E. N.

2017-09-01

Tumors of the nasal cavity and paranasal sinuses present a challenge to treat them. A combination of surgery and radiation therapy can improve treatment outcomes in 49-56% [1, 2] of the patients with locally advanced nasal cavity and paranasal sinus cancer. The midface reconstruction poses a formidable challenge to the reconstructive surgeon due to the region's complex skeletal and soft-tissue anatomy. The rehabilitation program including the reconstruction of the resected orbital walls using the porous and mesh implants from titanium nickelid (TiNi) was developed at the Cancer Research institute jointly with the Research Institute of Medical Materials. The technique was proven effective, allowing the natural position of the eye and visual function to be preserved in 90% [1-3] of the patients. A long period of reparative processes and risk of developing inflammation in the implant area, as well as the need to decrease length of surgery, contributed to the development of a novel approach to repairing the midface bone structures using the implant based on the microporous wire and TiNi mesh. Eighteen patients with nasal cavity and paranasal sinus cancer were treated using the combined thin implants. The novel technique allowed the time of the implant installation to be reduced to 5-10 min. The structure of the implant contributed to prevention of inflammatory processes in 97% [1, 2] of cases. Thus, the natural position of the eyeball and visual function were preserved in 100% [1, 3, 4] of patients. The use of the TiNi implants in reconstructive surgery for patients with nasal cavity and paranasal sinus cancer led to reduced time of surgery and rehabilitation, increased level of social adaptation of patients and improved cosmetic and functional results.

Primary Orbital Chondromyxoid Fibroma: A Rare Case.

PubMed

Mullen, Martin G; Somogyi, Marie; Maxwell, Sean P; Prabhu, Vikram; Yoo, David K

A 56-year-old male with history of chronic sinusitis was found to have a 3 cm left orbital lesion on CT. Subsequent MRI demonstrated a multilobulated enhancing soft tissue lesion at the superotemporal region of the left orbit. Initial biopsy was reported as a low-grade sarcoma. On further evaluation, a consensus was made that the lesion was likely a benign mixed mesenchymal type tumor but should nonetheless be surgically removed. Left lateral orbitotomy was performed which revealed a tumor originating in the lateral orbital bone with segments eroding through the wall of the orbit. Intraoperative frozen sections revealed myoepitheliod tissue with locally aggressive features and the tumor was completely removed. The final histopathologic analysis of the tissue was consistent with a chondromyxoid fibroma. Chondomyxoid fibroma is a rare entity in the orbital bones and is more commonly seen in long bones.

Bone Symposium 󈨟 Held in Portland Oregon, on 17-20 July 1991

DTIC Science & Technology

1992-03-01

removed. Persistent drainage and/or sinus tract(s) are common. Multiple species of bacteria are usually isolated from biopsies of infected granulations...patients even years of intermittent drainage . The possibility of attenuating the infection is reduced when the integrity of the soft tissue surrounding...successful transfers had persistent drainage . Only 12 * patients walked without assistive devices in followup.51 The advantage of the Ilizarov technique is

Predictors of round window accessibility for adult cochlear implantation based on pre-operative CT scan: a prospective observational study.

PubMed

Park, Edward; Amoodi, Hosam; Kuthubutheen, Jafri; Chen, Joseph M; Nedzelski, Julian M; Lin, Vincent Y W

2015-05-28

Cochlear implantation has become a mainstream treatment option for patients with severe to profound sensorineural hearing loss. During cochlear implant, there are key surgical steps which are influenced by anatomical variations between each patient. The aim of this study is to determine if there are potential predictors of difficulties that may be encountered during the cortical mastoidectomy, facial recess approach and round window access in cochlear implant surgery based upon pre-operative temporal bone CT scan. Fifty seven patients undergoing unilateral cochlear implantation were analyzed. Difficulty with 1) cortical mastoidectomy, 2) facial recess approach, and 3) round window access were scored intra-operatively by the surgeon in a blinded fashion (1 = "easy", 2 = "moderate", 3 = "difficult"). Pre-operative temporal bone CT scans were analyzed for 1) degree of mastoid aeration; 2) location of the sigmoid sinus; 3) height of the tegmen; 4) the presence of air cells in the facial recess, and 5) degree of round window bony overhang. Poor mastoid aeration and lower tegmen position, but not the location of sigmoid sinus, are associated with greater difficulty with the cortical mastoidectomy. Presence of an air cell around the facial nerve was predictive of easier facial recess access. However, the degree of round window bony overhang was not predictive of difficulty associated with round window access. Certain parameters on the pre-operative temporal bone CT scan may be useful in predicting potential difficulties encountered during the key steps involved in cochlear implant surgery.

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.

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.

Foreign Body Giant Cell-Related Encapsulation of a Synthetic Material Three Years After Augmentation.

PubMed

Lorenz, Jonas; Barbeck, Mike; Sader, Robert A; Kirkpatrick, Charles J; Russe, Philippe; Choukroun, Joseph; Ghanaati, Shahram

2016-06-01

Bone substitute materials of different origin and chemical compositions are frequently used in augmentation procedures to enlarge the local bone amount. However, relatively little data exist on the long-term tissue reactions. The presented case reports for the first time histological and histomorphometrical analyses of a nanocrystaline hydroxyapatite-based bone substitute material implanted in the human sinus cavity after an integration period of 3 years. The extracted biopsy was analyzed histologically and histomorphometrically with focus on the tissue reactions, vascularization, new bone formation, and the induction of a foreign body reaction. A comparably high rate of connective tissue (48.25%) surrounding the remaining bone substitute granules (42.13%) was observed. Accordingly, the amount of bone tissue (9.62%) built the smallest fraction within the biopsy. Further, tartrate-resistant acid phosphatase-positive and -negative multinucleated giant cells (4.35 and 3.93 cells/mm(2), respectively) were detected on the material-tissue interfaces. The implantation bed showed a mild vascularization of 10.03 vessels/mm(2) and 0.78%. The present case report shows that after 3 years, a comparable small amount of bone tissue was observable. Thus, the foreign body response to the bone substitute seems to be folded without further degradation or regeneration.

Human Studies of Vertical and Horizontal Alveolar Ridge Augmentation Comparing Different Types of Bone Graft Materials: A Systematic Review.

PubMed

Chavda, Suraj; Levin, Liran

2018-02-01

Alveolar ridge augmentation can be completed with various types of bone augmentation materials (autogenous, allograft, xenograft, and alloplast). Currently, autogenous bone is labeled as the "gold standard" because of faster healing times and integration between native and foreign bone. No systematic review has currently determined whether there is a difference in implant success between various bone augmentation materials. The purpose of this article was to systematically review comparative human studies of vertical and horizontal alveolar ridge augmentation comparing different types of bone graft materials (autogenous, allograft, xenograft, and alloplast). A MEDLINE search was conducted under the 3 search concepts of bone augmentation, dental implants, and alveolar ridge augmentation. Studies pertaining to socket grafts or sinus lifts were excluded. Case reports, small case series, and review papers were excluded. A bias assessment tool was applied to the final articles. Overall, 219 articles resulted from the initial search, and 9 articles were included for final analysis. There were no discernible differences in implant success between bone augmentation materials. Generally, patients preferred nonautogenous bone sources as there were fewer hospital days, less pain, and better recovery time. Two articles had industrial support; however, conclusions of whether that support influenced the outcomes could not be determined. Future comparative studies should compare nonautogenous bone sources and have longer follow-up times.

Variations of the superficial middle cerebral vein: classification using three-dimensional CT angiography.

PubMed

Suzuki, Y; Matsumoto, K

2000-05-01

Classification of variations of the superficial middle cerebral vein (SMCV) remains ambiguous. We propose a new classification system based on embryologic development for preoperative examination. Three-dimensional CT angiography was used to evaluate 500 SMCVs (in 250 patients). The outflow vessels from the SMCV were classified into seven types on the basis of embryologic development. The 3D CT angiograms in axial stereoscopic and oblique views and multiple intensity projection images were evaluated by the same neurosurgeon on two occasions. Inconsistent interpretations were regarded as equivocal. Three-dimensional CT angiography clearly depicted the SMCV running along the lesser wing or the middle cranial fossa. However, the outflow vessel could not be confirmed as the sphenoparietal, cavernous, or emissary type in 39 (8%) of the sides. SMCVs running in the middle cranial fossa to join the transverse sinus or superior petrosal sinus were accurately identified. SMCVs were present in 456 sides: 62% entered the sphenoparietal sinus or the cavernous sinus and 12% joined the emissary vein. Nine vessels were the superior petrosal type, 10 the basal type, 12 the squamosal type, and 44 the undeveloped type. Three-dimensional CT angiography can depict the vessels and their anatomic relationship to the bone structure, allowing identification of the SMCV variant in individual patients. Preoperative planning for skull base surgery requires such information to reduce the invasiveness of the procedure. With the use of our classification system, 3D CT angiography can provide exact and practical information concerning the SMCV.

Sigmoid sinus cortical plate dehiscence induces pulsatile tinnitus through amplifying sigmoid sinus venous sound.

PubMed

Tian, Shan; Wang, Lizhen; Yang, Jiemeng; Mao, Rui; Liu, Zhaohui; Fan, Yubo

2017-02-08

Sigmoid sinus cortical plate dehiscence (SSCPD) is common in pulsatile tinnitus (PT) patients, and is treated through SSCPD resurfacing surgery in clinic, but the bio-mechanism is not clear as so far. This study aimed to clarify the bio-mechanism of PT sensation induced by SSCPD, and quantify the relationship of cortical plate (CP) thickness and PT sensation intensity. It was hypothesized that SSCPD would induce PT through significantly amplifying sigmoid sinus (SS) venous sound in this study. Finite element (FE) analysis based on radiology data of typical patient was used to verify this hypothesis, and was validated with clinical reports. In cases with different CP thickness, FE simulations of SS venous sound generation and propagation procedure were performed, involving SS venous flow field, vibration response of tissue overlying dehiscence area (including SS vessel wall and CP) and sound propagation in temporal bone air cells. It was shown in results that SS venous sound at tympanic membrane was 56.9dB in SSCPD case and -45.2dB in intact CP case, and was inaudible in all thin CP cases. It was concluded that SSCPD would directly induce PT through significantly amplifying SS venous sound, and thin CP would not be the only pathophysiology of PT. This conclusion would provide a theoretical basis for the design of SSCPD resurfacing surgery for PT patients with SSCPD or thin CP. Copyright © 2017 Elsevier Ltd. All rights reserved.

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.

Changes in nasal volume after surgically assisted bone-borne rapid maxillary expansion.

PubMed

Deeb, Wayel; Hansen, Lars; Hotan, Thorsten; Hietschold, Volker; Harzer, Winfried; Tausche, Eve

2010-06-01

The purposes of this study were to detect, locate, and examine the changes in transverse nasal width, area, and volume from bone-borne, surgically assisted rapid maxillary expansion (SARME) with the Dresden distractor by using computer tomography (CT). Sixteen patients (average age, 28.7 years) underwent axial CT scanning before and 6 months after SARME. They also underwent CT fusion on specific bony structures. The nasal bone width was examined in the coronal plane. The cross-sectional images of the nasal cavity were taken of the area surrounding the apertura piriformis, the choanae, and in between. We calculated cross-sectional areas and nasal volume according to these data. All but 2 patients had an increase in nasal volume of at least 5.1% (SD, 4.6%). The largest value of 35.3% (SD, 45.8%) was measured anteriorly on the nasal floor, decreasing cranially and posteriorly. This correlated with the V-shaped opening of the sutura palatina. There was no significant correlation between increase in nasal volume and transversal expansion. Because most of the air we breathe passes over the lower nasal floor, SARME is likely to improve nasal breathing. 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

A Manual for the Performance of Protective Equipment Fit-Mapping

DTIC Science & Technology

2009-10-01

is not right, the grain would be neither perpendicular nor parallel to the floor. This causes unnecessary wrinkles and asymmetry of the right and...Prominent, anterior point on the anterior rim of the ilia. Note: The ilia are one of the three pair of bones that comprise the bony pelvis . 71...the three pair of bones that comprise the bony pelvis . Landmark Name: Iliocristale, Left and Right ISO Definition No. N/A CAESAR Name

Lasers in oral surgery and implantology

NASA Astrophysics Data System (ADS)

Vescovi, Paolo

2016-03-01

The usefulness of laser for oral hard tissue procedure such as caries treatment, impacted teeth extraction, periodontal therapy, peri-implantitis management, sinus lifting is reported by several Authors [1]. Conventionally, mechanical rotary instruments and hand instruments are employed for bone surgery. Rotary instruments have better accessibility and cutting efficiency, but there is a risk of excessive heating of bone tissue and caution must be exercised to avoid the bur becoming entangled with surrounding soft tissues and the reflected flap. The main clinical advantages of the lasers are represented by minimal patient discomfort, good recovery with decreased or absent post-operative pain. In the last ten years are described in the international literature great advantages of Laser Surgery and Low Level Laser Therapy (LLLT) performed with different wavelength in addition to traditional surgical techniques to improve bone and soft tissue healing and for pain and infection control.

Juvenile aggressive cemento-ossifying fibroma of the sphenoid sinus with proptosis: a surgical dilemma

PubMed Central

Singh, Rohit; Ramaswamy, Balakrishnan; Hazarika, Manali

2013-01-01

The term fibro-osseous lesion has currently grown in popularity as an overall designation for a number of rare, histologically benign head and neck lesions that are made up of bone, fibrous tissue and cementum. Cemento-ossifying fibroma is a variant of cementifying fibroma and is a fibro-osseous disease. They are usually small innocuous lesions which follow a slow benign course and are commonly seen in the skull bone rather than the sphenoid. It is rare for these tumours to attain large size, behave aggressively, destroy bone and require a radical surgery. One such rapidly growing juvenile cemento-ossifying lesion of sphenoid in our 10-year-old young patient causing proptosis and impaired vision is reported here because of its uncommon nature and its surgical dilemma. Selection of surgical approach to resect this tumour becomes difficult because it is deeply seated and needs a multidisciplinary approach. PMID:24285811

Juvenile aggressive cemento-ossifying fibroma of the sphenoid sinus with proptosis: a surgical dilemma.

PubMed

Singh, Rohit; Ramaswamy, Balakrishnan; Hazarika, Manali

2013-11-27

The term fibro-osseous lesion has currently grown in popularity as an overall designation for a number of rare, histologically benign head and neck lesions that are made up of bone, fibrous tissue and cementum. Cemento-ossifying fibroma is a variant of cementifying fibroma and is a fibro-osseous disease. They are usually small innocuous lesions which follow a slow benign course and are commonly seen in the skull bone rather than the sphenoid. It is rare for these tumours to attain large size, behave aggressively, destroy bone and require a radical surgery. One such rapidly growing juvenile cemento-ossifying lesion of sphenoid in our 10-year-old young patient causing proptosis and impaired vision is reported here because of its uncommon nature and its surgical dilemma. Selection of surgical approach to resect this tumour becomes difficult because it is deeply seated and needs a multidisciplinary approach.

Cavernous sinus syndrome due to osteochondromatosis in a cat.

PubMed

Perazzi, Anna; Bernardini, Marco; Mandara, Maria T; De Benedictis, Giulia M; De Strobel, Francesca; Zotti, Alessandro

2013-12-01

A 1-year-old sexually intact male Korat cat was referred for ophthalmological consultation due to anisocoria. Mydriasis with external ophthalmoplegia and absence of pupillary light responses in the right eye and nasofacial hypalgesia were seen. Cavernous sinus syndrome (CSS) was suspected. Bilateral deformities of the jaw and phalangeal bones, severe spinal pain and abnormal conformation of the lumbar spine were also present. Radiographic examination revealed several mineralised masses in the appendicular and axial skeleton, indicative of multiple cartilaginous exostoses. For further investigation of the CSS-related neurological deficits, the cat underwent computed tomography (CT) examination of the skull. CT images revealed a non-vascularised, calcified, amorphous mass originating from the right lateral skull base and superimposing on the sella turcica. Based on the severity of diffuse lesions and owing to the clinical signs of extreme pain, the cat was euthanased. A diffuse skeletal and intracranial osteochondromatosis was diagnosed histologically.

[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.

Treatment of a sphenoid sinus mucocele using an endoscope combined with a navigating system: a case report.

PubMed

Nagatani, T; Saito, K; Yoshida, J

2001-09-01

A sphenoid sinus mucocele extending into the middle cranial fossa and the pterygomaxillary fissure was decompressed using an endoscope in combination with a navigation system. A 59-year-old woman was admitted with a 3 month history of retro-ocular pain and right sided exophthalmos. To evaluate the cystic lesion, a fibreoptic endoscope was inserted into the cyst through an erosive defect in the temporal bone. The histopathological appearance of cyst wall tissue confirmed the diagnosis of mucocele. After 4 months, the mucocele had refilled and the exophthalmos had recurred. At reoperation, the cyst was fenestrated using a rigid endoscope combined with a navigation system inserted via a sublabial transmaxillary approach. The proper site of cyst fenestration was precisely determined using the navigation system, permitting complete evacuation of this large lesion with minimal invasiveness. Copyright 2001 Harcourt Publishers Ltd.

[Destructive mastoiditis with thrombosis of the sigmoid sinus in a 8 year-old child presenting with concomitant chicken pox].

PubMed

Bogomil'skiĭ, M R; Polunin, M M; Ivanenko, A M; Poliakov, A A

2014-01-01

The specific clinical feature of mastoidities that developed in a patient presenting with chicken pox was the rapid progress in temporal bone destruction with partial thrombosis of the sigmoid sinusis in the absence of typical manifestations of mastoiditis. The pronounced destructive changes found in a series of CT images were regarded as the indications for urgent antromastoidotomy with the puncture of the sigmoid sinusis.

Correlation between Preoperative High Resolution Computed Tomography (CT) Findings with Surgical Findings in Chronic Otitis Media (COM) Squamosal Type.

PubMed

Karki, S; Pokharel, M; Suwal, S; Poudel, R

Background The exact role of High resolution computed tomography (HRCT) temporal bone in preoperative assessment of Chronic suppurative otitis media atticoantral disease still remains controversial. Objective To evaluate the role of high resolution computed tomography temporal bone in Chronic suppurative otitis media atticoantral disease and to compare preoperative computed tomographic findings with intra-operative findings. Method Prospective, analytical study conducted among 65 patients with chronic suppurative otitis media atticoantral disease in Department of Radiodiagnosis, Kathmandu University Dhulikhel Hospital between January 2015 to July 2016. The operative findings were compared with results of imaging. The parameters of comparison were erosion of ossicles, scutum, facial canal, lateral semicircular canal, sigmoid and tegmen plate along with extension of disease to sinus tympani and facial recess. Sensitivity, specificity, negative predictive value, positive predictive values were calculated. Result High resolution computed tomography temporal bone offered sensitivity (Se) and specificity (Sp) of 100% for visualization of sigmoid and tegmen plate erosion. The performance of HRCT in detecting malleus (Se=100%, Sp=95.23%), incus (Se=100%,Sp=80.48%) and stapes (Se=96.55%, Sp=71.42%) erosion was excellent. It offered precise information about facial canal erosion (Se=100%, Sp=75%), scutum erosion (Se=100%, Sp=96.87%) and extension of disease to facial recess and sinus tympani (Se=83.33%,Sp=100%). high resolution computed tomography showed specificity of 100% for lateral semicircular canal erosion (Sp=100%) but with low sensitivity (Se=53.84%). Conclusion The findings of high resolution computed tomography and intra-operative findings were well comparable except for lateral semicircular canal erosion. high resolution computed tomography temporal bone acts as a road map for surgeon to identify the extent of disease, plan for appropriate procedure that is required and prepare for potential complications that can be encountered during surgery.

Emerging Perspectives in Scaffold for Tissue Engineering in Oral Surgery

PubMed Central

Presta, Rossella

2017-01-01

Bone regeneration is currently one of the most important and challenging tissue engineering approaches in regenerative medicine. Bone regeneration is a promising approach in dentistry and is considered an ideal clinical strategy in treating diseases, injuries, and defects of the maxillofacial region. Advances in tissue engineering have resulted in the development of innovative scaffold designs, complemented by the progress made in cell-based therapies. In vitro bone regeneration can be achieved by the combination of stem cells, scaffolds, and bioactive factors. The biomimetic approach to create an ideal bone substitute provides strategies for developing combined scaffolds composed of adult stem cells with mesenchymal phenotype and different organic biomaterials (such as collagen and hyaluronic acid derivatives) or inorganic biomaterials such as manufactured polymers (polyglycolic acid (PGA), polylactic acid (PLA), and polycaprolactone). This review focuses on different biomaterials currently used in dentistry as scaffolds for bone regeneration in treating bone defects or in surgical techniques, such as sinus lift, horizontal and vertical bone grafts, or socket preservation. Our review would be of particular interest to medical and surgical researchers at the interface of cell biology, materials science, and tissue engineering, as well as industry-related manufacturers and researchers in healthcare, prosthetics, and 3D printing, too. PMID:28337223

Complete Midline Cleft of Lower Lip, Mandible, Tongue, Floor of Mouth with Neck Contracture: A Case Report and Review of Literature

PubMed Central

Rao, Anantheswar Y. N.

2015-01-01

Midline cleft of the lower lip and mandible is an extremely rare condition. Since 1819, when the first case was reported by Couronne, fewer than 80 cases have been described in the world literature so far. The cleft has also been described as facial cleft no. 30 by Paul Tessier. The condition varies in severity from a mild variety in which there is a submucous cleft and notching in the lower lip to a severe variety, involving the tongue, floor of the mouth, mandible, absent hyoid, atrophic neck muscles, and sternum. In this case report, a female child having complete midline cleft of the lower lip and mandible, with bifid tongue stuck to the floor of the mouth, absent hyoid bone and flexion contracture band extending from the confluence of the tip of the tongue, floor of the mouth, cleft mandible to the manubrium sterni is described, with special emphasis on surgical planning and management. PMID:26576245

F-35 Protective Equipment Fit Assessment: Light Weight Coverall

DTIC Science & Technology

2011-06-01

Ankle bone. ................................................. 55 Figure H 1(a-d). Task illustrations for “Range of hand and arm motion...harness Quick Release Buckle (QRB) which in turn is connected to a pair of webbing lanyards which are anchored to the floor of the aircraft. At the...that the “good” range is when the hem falls from 5.5cm to 9.5cm (7.5cm ± 2.5cm) below the ankle bone. Accordingly, the ranges for marginally short and

Morphological and positional relationships between the sigmoid sinus and the jugular bulb.

PubMed

Dai, Pei-Dong; Zhang, Hong-Qi; Wang, Zheng-Min; Sha, Yan; Wang, Ke-Qiang; Zhang, Tian-Yu

2007-12-01

The purpose of this study was to determine the quantitative relationships between the positions of the sigmoid sinus (SS) and jugular bulb (JB) and the influence of mastoid pneumatization upon these structures. The investigations were carried out on 116 healthy adult ears based on the axial images of computed tomography (CT). The reference system locating the displacements of the SS and JB was established and the shape and position of the SS and JB were measured. The volume of pneumatization was quantitatively measured based on the serial digital images of CT. The method of partial correlation analysis was used to find the real relationship of two variables from the complicated dependence relationships. There was a tendency for the SS in the males to be situated more laterally and more backwardly, and the JB in the males was situated more laterally with thicker lateral bone wall when compared to the females. When compared to the left side, the SS on the right side tended to protrude more deeply and was situated more laterally and with less thickness of the lateral bone wall. In male, the right SS was situated more anteriorly than the left SS. In female, the right JB was situated more posteriorly than the left JB. There was a tendency for the SS to be situated more medially, to have a thicker lateral bone wall, and to protrude more superficially in the well-pneumatized bones. When the pneumatization was well, the JB tended to be situated more backwards and have a thicker lateral bone wall. However, there was no significant difference of pneumatization between the high JB group and the low JB group. The SS position and JB position changed synchronously in forward-backward or medial-lateral directions. The results suggest that the factors that influence the shape and position of the SS and JB are multiple. The results suggest that the morphological and positional relationships between the SS and the JB are complicated but could be grasped. The development of the cranial base, the temporal bone pneumatization and non-synchronous dural venous development between the right and left sides are considered to contribute to the morphological and positional changes of the SS and JB.

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

Healing properties of implants inserted concomitantly with anorganic bovine bone. A histomorphometric human study.

PubMed

Menicucci, G; Mussano, F; Schierano, G; Rizzati, A; Aimetti, M; Gassino, G; Traini, T; Carossa, S

2013-03-01

The present prospective, randomized, double-blind study evaluated the bone-forming process around implants inserted simultaneously with anorganic bovine bone (ABB) in sinus grafting. A total of 18 threaded mini-implants with Osseotite (O) and Nanotite (N) surfaces were placed in seven patients (nine sites). After 12 months, the implants were retrieved and processed for histological analysis. A total of 18 cutting and grinding sections were investigated with bright-field light microscopy, circularly polarized light microscopy (CPLM), confocal scanning laser microscope (CSLM), and scanning electron microscope (SEM) with energy dispersive spectrometer (EDS). The bone-to-implant contact rate in native crestal bone was 62.6 ± 0.4% for N implants and 54.3 ± 0.5% for the O implants (p = 0.001). The collagen fibre density, as assessed by CPLM, was 79.8 ± 6.0 nm for the N group and 74.6 ± 4.6 nm for the O group (p < 0.05). Line scan EDS starting from ABB to newly formed bone showed a decrease in calcium content and an increase of carbon while phosphorus content was constant. While the N surface improved the peri-implant endosseous healing properties in the native bone, when compared to the O surface, it did not improve the healing properties in the bone-graft area. © 2013 Australian Dental Association.

Transconjunctival orbital emphysema caused by compressed air injury: a case report.

PubMed

Mathew, Sunu; Vasu, Usha; Francis, Febson; Nazareth, Colin

2008-01-01

Orbital emphysema following conjunctival tear in the absence of orbital wall fracture, caused by air under pressure is rare. Usually orbital emphysema is seen in facial trauma associated with damage to the adjacent paranasal sinuses or facial bones. To the best of our knowledge, there have been only eight reports of orbital emphysema following use of compressed air during industrial work. The air under pressure is pushed through the subconjunctival space into the subcutaneous and retrobulbar spaces. We present here a rare cause of orbital emphysema in a young man working with compressed air gun. Although the emphysema was severe, there were no orbital bone fracture and the visual recovery of the patient was complete without attendant complications.

Transconjunctival orbital emphysema caused by compressed air injury: A case report

PubMed Central

Vasu, Usha; Francis, Febson; Nazareth, Colin

2008-01-01

Orbital emphysema following conjunctival tear in the absence of orbital wall fracture, caused by air under pressure is rare. Usually orbital emphysema is seen in facial trauma associated with damage to the adjacent paranasal sinuses or facial bones. To the best of our knowledge, there have been only eight reports of orbital emphysema following use of compressed air during industrial work. The air under pressure is pushed through the subconjunctival space into the subcutaneous and retrobulbar spaces. We present here a rare cause of orbital emphysema in a young man working with compressed air gun. Although the emphysema was severe, there were no orbital bone fracture and the visual recovery of the patient was complete without attendant complications. PMID:18417833

Traumatic bone cyst suggestive of a chronic periapical abscess: a case report.

PubMed

Kahler, Bill

2011-08-01

Traumatic bone cysts can mimic the signs and symptoms of an endodontic lesion. This case reports on a 19-year-old male patient who was referred for endodontic assessment of a symptomatic tooth with a gingival swelling and a draining sinus at the furcation of a mandibular second molar. Radiographically, a periradicular radiolucency is evident. A prior history of trauma as well as removal of the wisdom teeth was determined. After careful diagnosis unnecessary endodontic intervention was avoided. Surgical exploration, curettage and the generation of a blood clot resulted in healing at the 6 month review appointment. The tooth remained responsive to pulp sensibility testing at that time. © 2010 The Author. Australian Endodontic Journal © 2010 Australian Society of Endodontology.

Ultrasonographic findings in 50 dogs with retrobulbar disease.

PubMed

Mason, D R; Lamb, C R; McLellan, G J

2001-01-01

Records of 50 dogs with signs of retrobulbar disease that had ultrasonography and diagnosis based on results of cytopathology or histopathology were reviewed retrospectively. Abnormalities were identified ultrasonographically in 43 (86%) dogs. Mass effect was identified in 42% of dogs with neoplasia and 30% of dogs with abscess. Ten of 11 (91%) orbital bone lesions were in dogs with retrobulbar neoplasia. A cavitary lesion was recognized ultrasonographically in 75% of dogs with salivary mucocele and 50% of dogs with retrobulbar abscess. Neoplasms occurred predominantly on the ventral or medial aspect of the orbit, or both, which reflects invasion by nasal or sinus neoplasms. Presence of orbital bone lesions or a mass on the medial aspect of the orbit suggests neoplasia; however, other ultrasonographic signs were nonspecific.

Trautmann's triangle anatomy with application to posterior transpetrosal and other related skull base procedures.

PubMed

Tubbs, R Shane; Griessenauer, Christoph; Loukas, Marios; Ansari, Shaheryar F; Fritsch, Michael H; Cohen-Gadol, Aaron A

2014-10-01

Trautmann's triangle (TT) faces the cerebellopontine angle and is exposed during posterior transpetrosal approaches. However, reports on the morphometric analysis of this structure are lacking in the literature. The goal was to better understand this important operative corridor. TT was exposed from an external approach (transmastoid) in ten cadavers (20 sides) and from an internal approach on 20 dry adult temporal bones. Measurements included calculation of the area of TT and the distance of the endolymphatic sac from the anterior border of the sigmoid sinus. The area range of TT was 45-210 mm(2) (mean 151 mm(2); SD 37 mm(2)). Three types of triangles were identified based on area. Type I triangles had areas less than 75 mm(2), Type II areas were 75-149 mm(2), and Type III areas were 150 mm(2) and greater. These types were observed in 37.5%, 35%, and 27.5% of sides, respectively. The distance from the jugular bulb's anterior border to the posterior border of the posterior semicircular canal ranged from 6 to 11 mm (mean 8.5 mm). The endolymphatic sac was located in the inferior portion of TT and traveled anterior to the sigmoid sinus. The horizontal distance from the anterior edge of the sigmoid sinus to the posterior edge of the endolymphatic sac ranged from 0 to 13.5 mm (mean 9 mm). Additional anatomic knowledge regarding TT may improve neurosurgical procedures in this region by avoiding intrusion into the endolymphatic sac and sigmoid sinus. © 2014 Wiley Periodicals, Inc.

Wooden Foreign Body in the Skull Base: How Did We Miss It?

PubMed

Jusué-Torres, Ignacio; Burks, S Shelby; Levine, Corinna G; Bhatia, Rita G; Casiano, Roy; Bullock, Ross

2016-08-01

Timely detection of intraorbital and skull base wooden foreign bodies is crucial. Wooden foreign bodies are difficult to detect on imaging. The radiologist may fail to identify wooden foreign bodies on two thirds of initial scans and can miss them in almost one third of total cases. A 66-year-old woman sustained a penetrating injury through the left upper eyelid with a small tree branch. The branch was immediately removed in the field, and she was provided with prompt medical care at a local hospital. Initial computed tomography (CT) scan diagnosis was "posttraumatic sinusitis," and this was treated empirically with vancomycin and piperacillin/tazobactam. On the eighth day after injury, she developed progressive swelling and pain of her eyelid with left trigeminal/supraorbital numbness and complete left ophthalmoplegia. A new CT scan showed an open "track" from the region of the left upper orbit/superior rectus to the contralateral sphenoid sinus, which raised suspicion for a retained foreign body. Further imaging confirmed the suspicion. Endoscopic sinus surgery was performed with extraction of the wooden object and evacuation of the left orbital infection. This case indicates that intraorbital and skull base wooden foreign bodies are elusive, demanding a high index of suspicion from both clinicians and radiologists to identify retained material in the setting of ocular or sinus trauma. For better identification of wooden foreign bodies, bone windows on CT should have a width of -1000 Hounsfield units with a soft tissue window level of -500 Hounsfield units. Published by Elsevier Inc.

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

CT analysis of nasal volume changes after surgically-assisted rapid maxillary expansion.

PubMed

Tausche, Eve; Deeb, Wayel; Hansen, Lars; Hietschold, Volker; Harzer, Winfried; Schneider, Matthias

2009-07-01

Aim of this study was to detect the changes in nasal volume due to bone-borne, surgically-assisted rapid palatal expansion (RPE) with the Dresden Distractor using computed tomography (CT). 17 patients (mean age 28.8) underwent axial CT scanning before and 6 months after RPE. The nasal bone width was examined in the coronal plane. Cross-sectional images of the nasal cavity were taken of the area surrounding the piriform aperture, choanae and in between. Bony nasal volume was computed by connecting the three cross-sectional areas. All but two patients showed a 4.8% increase in nasal volume (SD 4.6%). The highest value, 33.3% (SD 45.1%), was measured anteriorly at the level of the nasal floor. This correlated with the midpalatal suture's V-shaped opening. There was no significant correlation between an increase in nasal volume and transverse dental arch expansion. As most of the air we breathe passes the lower nasal floor, an improvement in nasal breathing is likely.

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.

[CAS in rhino-surgical procedures in the growing age].

PubMed

Schipper, J; Maier, W; Gellrich, N-C; Arapakis, I; Hochmuth, A; Laszig, R

2005-01-01

Rhinosurgery in children and adolescents meets special requirements: Limited cooperation and reduced limits for the organ dose for ionizing radiological examinations aggravate diagnostics. On the other side, bone sutures and bone growth areas have to be respected intraoperatively, and regions of bones not yet calcified have to be distinguished from possible tumor infiltration. Computer assisted surgery (CAS) can help to identify these areas safely. 5 patients, from the first to the 20 (th) year of life, suffering from tumors, malformation syndromes or therapy resistant nasal polyposis were treated with CAS in rhinosurgery. In addition to radiological diagnostics, we performed 3D computed tomography of the skull for CAS. CAS enabled us to intraoperatively respect possible areas of bone growth, to identify regions with thin, not bonily developed cranial vault and to safely distinguish bone sutures from ethmoidal cells. CAS helped the surgeon to navigate in the not yet developed paranasal sinus system. CAS is a useful complementary method in rhinosurgery of the developing skull of the child. In spite of the additional 3D computed tomography, the calculated organ dose of the ocular lense amounted to 5 millisievert, so a recommended maximal organ dose for the ocular lense of 15 millisievert was not exceeded.

Migrating pharyngeal foreign bodies: a series of four cases of saw-toothed fish bones.

PubMed

Chung, Sung Min; Kim, Han Su; Park, Eun Hee

2008-09-01

Pharyngeal foreign bodies are common problems seen at emergency rooms or ENT outpatient clinics, and fish bones are the most common foreign bodies encountered in East Asia and in Korea. One of the rare complications of a swallowed sharp fish bone is its migration from the site of entry into the subcutaneous tissues of the neck. We present four unusual cases of ingested fish bones that migrated out of the upper digestive tract to the neck. In the first case, this caused a recurrent deep neck infection for 2 years; in the second case, there was penetration of the facial artery; in the third case, there was a hematoma of the floor of the mouth; in the fourth case, there was a retropharyngeal abscess.

CT findings of the temporal bone in CHARGE syndrome: aspects of importance in cochlear implant surgery.

PubMed

Vesseur, A C; Verbist, B M; Westerlaan, H E; Kloostra, F J J; Admiraal, R J C; van Ravenswaaij-Arts, C M A; Free, R H; Mylanus, E A M

2016-12-01

To provide an overview of anomalies of the temporal bone in CHARGE syndrome relevant to cochlear implantation (CI), anatomical structures of the temporal bone and the respective genotypes were analysed. In this retrospective study, 42 CTs of the temporal bone of 42 patients with CHARGE syndrome were reviewed in consensus by two head-and-neck radiologists and two otological surgeons. Anatomical structures of the temporal bone were evaluated and correlated with genetic data. Abnormalities that might affect CI surgery were seen, such as a vascular structure, a petrosquamosal sinus (13 %), an underdeveloped mastoid (8 %) and an aberrant course of the facial nerve crossing the round window (9 %) and/or the promontory (18 %). The appearance of the inner ear varied widely: in 77 % of patients all semicircular canals were absent and the cochlea varied from normal to hypoplastic. A stenotic cochlear aperture was observed in 37 %. The middle ear was often affected with a stenotic round (14 %) or oval window (71 %). More anomalies were observed in patients with truncating mutations than with non-truncating mutations. Temporal bone findings in CHARGE syndrome vary widely. Vascular variants, aberrant route of the facial nerve, an underdeveloped mastoid, aplasia of the semicircular canals, and stenotic round window may complicate cochlear implantation.

TRAP-Positive Multinucleated Giant Cells Are Foreign Body Giant Cells Rather Than Osteoclasts: Results From a Split-Mouth Study in Humans.

PubMed

Lorenz, Jonas; Kubesch, Alica; Korzinskas, Tadas; Barbeck, Mike; Landes, Constantin; Sader, Robert A; Kirkpatrick, Charles J; Ghanaati, Shahram

2015-12-01

This study compared the material-specific tissue response to the synthetic, hydroxyapatite-based bone substitute material NanoBone (NB) with that of the xenogeneic, bovine-based bone substitute material Bio-Oss (BO). The sinus cavities of 14 human patients were augmented with NB and BO in a split-mouth design. Six months after augmentation, bone biopsies were extracted for histological and histomorphometric investigation prior to dental implant insertion. The following were evaluated: the cellular inflammatory pattern, the induction of multinucleated giant cells, vascularization, the relative amounts of newly formed bone, connective tissue, and the remaining bone substitute material. NB granules were well integrated in the peri-implant tissue and were surrounded by newly formed bone tissue. Multinucleated giant cells were visible on the surfaces of the remaining granules. BO granules were integrated into the newly formed bone tissue, which originated from active osteoblasts on their surface. Histomorphometric analysis showed a significantly higher number of multinucleated giant cells and blood vessels in the NB group compared to the BO group. No statistical differences were observed in regard to connective tissue, remaining bone substitute, and newly formed bone. The results of this study highlight the different cellular reactions to synthetic and xenogeneic bone substitute materials. The significantly higher number of multinucleated giant cells within the NB implantation bed seems to have no effect on its biodegradation. Accordingly, the multinucleated giant cells observed within the NB implantation bed have characteristics more similar to those of foreign body giant cells than to those of osteoclasts.

Reconstruction of large cranial defect with alloplastic material (bone cement-cold cure polymethyl-methacrylate resin).

PubMed

Hallur, Neelakamal; Goudar, Gayatri; Sikkerimath, Basavaraj; Gudi, Santosh S; Patil, Ravi S

2010-06-01

A 40-years-old male patient reported to our department with a chief complaint of persistent palatal fluid discharge and large depressed forehead defect. He gave a history of trauma 20 months back due to head on collision to electric pole and underwent surgery twice for open reduction and fixation of facial skeletal fractures. After 9 months of surgery again a third surgery was performed for the removal of frontal bone due to infection and osteomyelitis at the same site. Extra-oral examination revealed a large fronto-cranial defect extending from superior border of frontal bone to supra-orbital margins bilaterally in length, and from frontal right lateral to frontal left lateral side in width, measuring 8.0 cm in length, 10.5 cm in width and 1.5 to 2.0 cm in depth. Intra-oral sinus fluid discharge was from left posterior palatal region. Preoperative CT was taken and reconstruction of fronto-cranial defect was successfully performed with bone cement. Alloplastic implant reconstruction achieved an excellent esthetic result without any complications.

Orbital Reconstruction: Patient-Specific Orbital Floor Reconstruction Using a Mirroring Technique and a Customized Titanium Mesh.

PubMed

Tarsitano, Achille; Badiali, Giovanni; Pizzigallo, Angelo; Marchetti, Claudio

2016-10-01

Enophthalmos is a severe complication of primary reconstruction of orbital floor fractures. The goal of secondary reconstruction procedures is to restore symmetrical globe positions to recover function and aesthetics. The authors propose a new method of orbital floor reconstruction using a mirroring technique and a customized titanium mesh, printed using a direct metal laser-sintering method. This reconstructive protocol involves 4 steps: mirroring of the healthy orbit at the affected site, virtual design of a patient-specific orbital floor mesh, CAM procedures for direct laser-sintering of the customized titanium mesh, and surgical insertion of the device. Using a computed tomography data set, the normal, uninjured side of the craniofacial skeleton was reflected onto the contralateral injured side, and a reconstructive orbital floor mesh was designed virtually on the mirrored orbital bone surface. The solid-to-layer files of the mesh were then manufactured using direct metal laser sintering, which resolves the shaping and bending biases inherent in the indirect method. An intraoperative navigation system ensured accuracy of the entire procedure. Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography data in 7 treated patients. The technique described here appears to be a viable method to correct complex orbital floor defects needing delayed reconstruction. This study represents the first step in the development of a wider experimental protocol for orbital floor reconstruction using computer-assisted design-computer-assisted manufacturing technology.

Reconstitution of craniofacial osseous contour deformities, sequelae of trauma and post resection for tumors, with an alloplastic-autogenous graft.

PubMed

Leake, D L; Habal, M B

1977-04-01

Our experience using a new technique for reconstructing contour defects of facial bones has been presented. It employs particulate, cancellous bone and an implantable prosthesis accurately fabricated of polyether urethane and polyethylene terephthalate cloth mesh which can be produced in a variety of configurations. A mannequin made of these materials displaying the various parts of the craniofacial complex that have been restored or are currently under investigation is shown in Figure 10. Large cranial vault defects, orbital floors, mandibles including chin augmentation, and nasal bone deformities have been successfully restored in man. Restoration of the pinna of the ear is currently being evaluated in laboratory animals.

Use of third molar transplantation for closure of the oroantral communication after tooth extraction: a report of 2 cases.

PubMed

Kitagawa, Yoshimasa; Sano, Kazuo; Nakamura, Mikiko; Ogasawara, Toshiyuki

2003-04-01

This clinical report introduces a promising and unique method for the immediate closure of the oroantral communication (OAC) after tooth extraction: the use of the transplanted third molar with closed apices. In 2 adult patients, OAC caused by the extraction of an upper molar was immediately closed by using a transplanted third molar with complete root formation. After tooth extraction at the recipient site, OAC with perforated mucosa of the sinus floor was confirmed and the donor third molar was transferred to the prepared recipient socket. Endodontic therapy of the transplanted third molar began at 3 weeks after surgery, and prosthetic treatment was completed at 5 months after the operation. These 2 patients were carefully observed both clinically and radiographically. Closure of the OAC was successfully performed, and the transplanted teeth became fixed with the passage of time in these 2 patients. Root resorption did not occur, and good functional results were obtained without any complications. Tooth transplantation of a mature third molar for closure of the OAC is a simple and excellent method because the transplanted tooth not only closes the communication to the maxillary sinus, but it also satisfactorily functions at the recipient site during mastication, even in adult patients.

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.

The viability of cryopreserved onlay cranial bone allografts: a comparative experimental study versus fresh autografts.

PubMed

Sanz, J; Elejabeitia, J; Bazán, A; García-Tutor, E; Paloma, V

1996-04-01

It is well known that calvarial bone autografts are the bone grafts that are the least reabsorbent and have the best long-term evolution in craniofacial surgery. However, they do have certain limitations: (1) reabsorption results in repeated surgery and the need for new donor areas, (2) a limited amount of autogenous cranial bone is available (due to avoiding areas close to cranial sutures and venous sinuses, and because the temporal bone is very fragile and the cranium has not fully developed in children), and (3) graft extraction increases surgical time and morbidity. Because of this, we present an alternative to calvarial bone autografts: cryopreserved allografts. This paper is an experimental prospective study carried out on sheep with the following goals: (1) to assess the behavior of calvarial onlay bone grafts cryopreserved at -80 degrees C, using fresh autografts implanted under the same conditions as controls; (2) to compare reabsorption percentages statistically over time; and (3) to study qualitatively any histological variations. The results obtained are (1) more reabsorption of allografts when compared to autografts (at 90 days, 21.97% versus 20.21% of grafted volume), although this difference is not statistically significant; (2) a reduction in height in all onlay grafts as a consequence of the loss of the diplöe; (3) the absence of any type of inflammation caused by a reaction to cryopreserved allografts; and (4) bone substitution performed using frozen allografts is histologically similar to that using fresh autografts.

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

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.

Significant improvement of intractable headache after transsphenoidal surgery in patients with pituitary adenomas; preoperative neuroradiological evaluation and intraoperative intrasellar pressure measurement.

PubMed

Hayashi, Yasuhiko; Kita, Daisuke; Iwato, Masayuki; Fukui, Issei; Oishi, Masahiro; Tsutsui, Taishi; Tachibana, Osamu; Nakada, Mitsutoshi

2016-04-01

Headache is the most common symptom of both primary and metastatic brain tumor, and is generally considered the primary symptom in patients with large pituitary adenomas. However, patients with small pituitary adenomas rarely complain of intractable headache, and neurosurgeons are unsure whether such small adenomas actually contribute to headache. If conventional medical treatments for headache prove ineffective, surgical removal of the adenoma can be considered as an alternative management strategy. We conducted a retrospective review of 180 patients who underwent transsphenoidal surgery (TSS) for pituitary adenomas at Kanazawa University Hospital between 2006 and 2014. Patients with acute phase intratumoral hemorrhage were excluded. We identified nine patients with intractable headache as the chief complaint associated with small pituitary adenoma (diameters 15.8 ± 2.6 mm, 11-20 mm), non-functioning in eight, and prolactin-secreting in one. The preoperative neuroradiological studies and headache characteristics were assessed retrospectively, and the intrasellar pressure evaluation was performed during TSS in the last seven patients. All nine patients had complete or substantial resolution of their formerly intractable headache after TSS. Headaches consisted of ocular pain ipsilateral to the adenoma localization within the sella in four cases and bifrontal headache in five. Magnetic resonance imaging of these patients revealed small diaphragmatic foramen, which were so narrow that only the pituitary stalk could pass. Computed tomography scans showed ossification beneath the sellar floor in the sphenoid sinus, presellar type in six cases, and choncal type in three. The adenomas included cysts in seven cases. There was no cavernous sinus invasion. Intrasellar pressure measurements averaged 41.5 ± 8.5 mmHg, range 34-59, significantly higher than in control patients without headache (n = 12), namely 22.2 ± 10.6 mmHg (16-30). In this study, the authors demonstrated the validity of TSS in the treatment of intractable headache associated with pituitary adenoma. The presence of ocular pain, especially ipsilateral to the adenoma, integrity of the diaphragm sella, and ossification in the sphenoid sinus, cyst or hemorrhage and the absence of cavernous sinus invasion were the indications for TSS for patients complaining of intractable headache and having pituitary adenomas.

The Orientation of Nanoscale Apatite Platelets in Relation to Osteoblastic-Osteocyte Lacunae on Trabecular Bone Surface.

PubMed

Shah, Furqan A; Zanghellini, Ezio; Matic, Aleksandar; Thomsen, Peter; Palmquist, Anders

2016-02-01

The orientation of nanoscale mineral platelets was quantitatively evaluated in relation to the shape of lacunae associated with partially embedded osteocytes (osteoblastic-osteocytes) on the surface of deproteinised trabecular bone of adult sheep. By scanning electron microscopy and image analysis, the mean orientation of mineral platelets at the osteoblastic-osteocyte lacuna (Ot.Lc) floor was found to be 19° ± 14° in the tibia and 20° ± 14° in the femur. Further, the mineral platelets showed a high degree of directional coherency: 37 ± 7% in the tibia and 38 ± 9% in the femur. The majority of Ot.Lc in the tibia (69.37%) and the femur (74.77%) exhibited a mean orientation of mineral platelets between 0° and 25°, with the largest fraction within a 15°-20° range, 17.12 and 19.8% in the tibia and femur, respectively. Energy dispersive X-ray spectroscopy and Raman spectroscopy were used to characterise the features observed on the anorganic bone surface. The Ca/P (atomic %) ratio was 1.69 ± 0.1 within the Ot.Lc and 1.68 ± 0.1 externally. Raman spectra of NaOCl-treated bone showed peaks associated with carbonated apatite: ν1, ν2 and ν4 PO4(3-), and ν1 CO3(2-), while the collagen amide bands were greatly reduced in intensity compared to untreated bone. The apatite-to-collagen ratio increased considerably after deproteinisation; however, the mineral crystallinity and the carbonate-to-phosphate ratios were unaffected. The ~19°-20° orientation of mineral platelets in at the Ot.Lc floor may be attributable to a gradual rotation of osteoblasts in successive layers relative to the underlying surface, giving rise to the twisted plywood-like pattern of lamellar bone.

Migration and Differentiation of GFP-transplanted Bone Marrow-derived Cells into Experimentally Induced Periodontal Polyp in Mice.

PubMed

Matsuda, Saeka; Shoumura, Masahito; Osuga, Naoto; Tsujigiwa, Hidetsugu; Nakano, Keisuke; Okafuji, Norimasa; Ochiai, Takanaga; Hasegawa, Hiromasa; Kawakami, Toshiyuki

2016-01-01

Perforation of floor of the dental pulp is often encountered during root canal treatment in routine clinical practice of dental caries. If perforation were large, granulation tissue would grow to form periodontal polyp. Granulation tissue consists of proliferating cells however their origin is not clear. It was shown that the cells in granulation tissue are mainly from migration of undifferentiated mesenchymal cells of the bone marrow. Hence, this study utilized GFP bone marrow transplantation mouse model. The floor of the pulp chamber in maxillary first molar was perforated using ½ dental round bur. Morphological assessment was carried out by micro CT and microscopy and GFP cell mechanism was further assessed by immunohistochemistry using double fluorescent staining with GFP-S100A4; GFP-Runx2 and GFP-CD31. Results of micro CT revealed alveolar bone resorption and widening of periodontal ligament. Histopathological examination showed proliferation of fibroblasts with some round cells and blood vessels in the granulation tissue. At 2 weeks, the outermost layer of the granulation tissue was lined by squamous cells with distinct intercellular bridges. At 4 weeks, the granulation tissue became larger than the perforation and the outermost layer was lined by relatively typical stratified squamous epithelium. Double immunofluorescent staining of GFP and Runx2 revealed that both proteins were expressed in spindle-shaped cells. Double immunofluorescent staining of GFP and CD31 revealed that both proteins were expressed in vascular endothelial cells in morphologically distinct vessels. The results suggest that fibroblasts, periodontal ligament fibroblasts and blood vessels in granulation tissue were derived from transplanted-bone marrow cells. Thus, essential growth of granulation tissue in periodontal polyp was caused by the migration of undifferentiated mesenchymal cells derived from bone marrow, which differentiated into fibroblasts and later on differentiated into other cells in response to injury.

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.

Sonography for diagnosis of benign and malignant tumors of the nose and paranasal sinuses.

PubMed

Liu, Jun-jie; Gao, Yong; Wu, Ya-Fei; Zhu, Shang-Yong

2014-09-01

The purpose of this study was to demonstrate the reliability of sonography for diagnosis of nose and paranasal sinus tumors. Ninety-six consecutive patients with tumors underwent sonography and computed tomography (CT) before surgical treatment. Tumor detectability and imaging findings were evaluated independently and then compared with pathologic findings. Of 96 tumors, 75 were detected by sonography, for a detectability rate of 78.1%; 93 tumors were detected by CT, for a detectability rate of 96.9%. By comparison, sonography showed a trend toward higher detectability of nasal vestibular tumors than CT (87.5% for sonography versus 50.0% for CT) and small lumps on the wing of the nose (78.8% for sonography versus 33.3% for CT). Among the sonographic features, boundary, shape, internal echo, calcification, bone invasion, vascular pattern, and cervical lymph node metastasis all had significantly positive correlations with malignancy (P < .05), but size did not (P = .324). In addition, the vascular resistive index for malignant tumors was significantly higher (mean ± SD, 0.66 ± 0.20) than the index for benign lesions (0.24 ± 0.30; P < .001). Moreover, the detection rate for grade 1-3 (small-large) blood flow in benign lesions was only 43.8%, whereas the rate for malignant tumors was 97.7% (P < .001). The vascular pattern may be a promising predictive indicator for distinguishing benign and malignant tumors of the nose and paranasal sinuses. Consequently, sonography has high value for diagnosis of benign and malignant tumors of the nose and paranasal sinuses, especially for nasal vestibular tumors and small lumps on the wing of the nose. © 2014 by the American Institute of Ultrasound in Medicine.

[A case of traumatic middle meningeal arteriovenous fistula on the side of the head opposite to the injured side].

PubMed

Takeuchi, Satoru; Takasato, Yoshio; Masaoka, Hiroyuki; Hayakawa, Takanori; Otani, Naoki; Yoshino, Yoshikazu; Yatsushige, Hiroshi; Sugawara, Takashi; Aoyagi, Chikashi; Suzuki, Go

2009-10-01

A rare case of a traumatic middle meningeal arteriovenous fistula on the side of the head opposite to the injured side was reported. A 21-year-old man was admitted to our hospital after a traffic accident in which the right side of his head was hit. CT scans and MR images on admission showed a right temporal bone fracture, traumatic subarachnoid hemorrhage, and a left frontal lobe contusion. Three months after the head injury, he complained of tinnitus and exophthalmos. One year after the head injury, left external carotid angiograms showed a dural arteriovenous fistula fed by the left dilated middle meningeal artery and draining into the middle meningeal vein. Early filling of the sphenoparietal sinus, cavernous sinus, superior ophthalmic vein, and the cortical vein were also detected. Transarterial embolization of the left middle meningeal fistula was performed, resulting in the disappearance of the lesion. The postoperative course was uneventful.

Connective Tissue Growth Factor reporter mice label a subpopulation of mesenchymal progenitor cells that reside in the trabecular bone region.

PubMed

Wang, Wen; Strecker, Sara; Liu, Yaling; Wang, Liping; Assanah, Fayekah; Smith, Spenser; Maye, Peter

2015-02-01

Few gene markers selectively identify mesenchymal progenitor cells inside the bone marrow. We have investigated a cell population located in the mouse bone marrow labeled by Connective Tissue Growth Factor reporter expression (CTGF-EGFP). Bone marrow flushed from CTGF reporter mice yielded an EGFP+ stromal cell population. Interestingly, the percentage of stromal cells retaining CTGF reporter expression decreased with age in vivo and was half the frequency in females compared to males. In culture, CTGF reporter expression and endogenous CTGF expression marked the same cell types as those labeled using Twist2-Cre and Osterix-Cre fate mapping approaches, which previously had been shown to identify mesenchymal progenitors in vitro. Consistent with this past work, sorted CTGF+ cells displayed an ability to differentiate into osteoblasts, chondrocytes, and adipocytes in vitro and into osteoblast, adipocyte, and stromal cell lineages after transplantation into a parietal bone defect. In vivo examination of CTGF reporter expression in bone tissue sections revealed that it marked cells highly localized to the trabecular bone region and was not expressed in the perichondrium or periosteum. Mesenchymal cells retaining high CTGF reporter expression were adjacent to, but distinct from mature osteoblasts lining bone surfaces and endothelial cells forming the vascular sinuses. Comparison of CTGF and Osterix reporter expression in bone tissue sections indicated an inverse correlation between the strength of CTGF expression and osteoblast maturation. Down-regulation of CTGF reporter expression also occurred during in vitro osteogenic differentiation. Collectively, our studies indicate that CTGF reporter mice selectively identify a subpopulation of bone marrow mesenchymal progenitor cells that reside in the trabecular bone region. Copyright © 2014 Elsevier Inc. All rights reserved.

Connective Tissue Growth Factor Reporter Mice Label a Subpopulation of Mesenchymal Progenitor Cells that Reside in the Trabecular Bone Region

PubMed Central

Wang, Wen; Strecker, Sara; Liu, Yaling; Wang, Liping; Assanah, Fayekah; Smith, Spenser; Maye, Peter

2014-01-01

Few gene markers selectively identify mesenchymal progenitor cells inside the bone marrow. We have investigated a cell population located in the mouse bone marrow labeled by Connective Tissue Growth Factor reporter expression (CTGF-EGFP). Bone marrow flushed from CTGF reporter mice yielded an EGFP+ stromal cell population. Interestingly, the percentage of stromal cells retaining CTGF reporter expression decreased with age in vivo and was half the frequency in females compared to males. In culture, CTGF reporter expression and endogenous CTGF expression marked the same cell types as those labeled using Twist2-Cre and Osterix-Cre fate mapping approaches, which previously has been shown to identify mesenchymal progenitors in vitro. Consistent with this past work, sorted CTGF+ cells displayed an ability to differentiate into osteoblasts, chondrocytes, and adipocytes in vitro and into osteoblast, adipocyte, and stromal cell lineages after transplantation into a parietal bone defect. In vivo examination of CTGF reporter expression in bone tissue sections revealed it marked cells highly localized to the trabecular bone region and was not expressed in the perichondrium or periosteum. Mesenchymal cells retaining high CTGF reporter expression were adjacent to, but distinct from mature osteoblasts lining bone surfaces and endothelial cells forming the vascular sinuses. Comparison of CTGF and Osterix reporter expression in bone tissue sections indicated an inverse correlation between the strength of CTGF expression and osteoblast maturation. Down-regulation of CTGF reporter expression also occurred during in vitro osteogenic differentiation. Collectively, our studies indicate that CTGF reporter mice selectively identify a subpopulation of bone marrow mesenchymal progenitor cells that reside in the trabecular bone region. PMID:25464947

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.

[Rhinocerebral Mucormycosis].

PubMed

Mertens, Anke; Arens, Christoph; Barche, Doreen; Scheinpflug, Laszlo; Scholz, Friedrich Gunther; Vielhaber, Stefan; Scherlach, Cordula; Tröger, Uwe; Geginat, Gernot; Färber, Jacqueline

2018-05-16

Mucormycosis is a rare but serious type of fungal infection, which can progress rapidly especially in immunsupressed patients.We report about a 47 year old female patient with ptosis on the left eye. The ophthalmological report offered no further pathologic findings. Diabetes mellitus was known and the blood sugar value was very high.A computed tomography of the paranasal sinuses showed a shadow in the ethmoid bone and in an additonally performed MRI-scan, an increase of orbital fat and an extension of the ocular muscle were visible.As the patient lost her ability o look above, an operation of the paranasal sinus was done.The microbial results revealed a Mucormycosis (Lichtheimia). As the patient went blind in the further course, indication for orbital exenteration on the left side and revision of the paranasal sinus was given. High doses of Liposomal Ampthotericin B and Posaconazol were given and blood sugar was monitored very strictly. MRI-scans revealed a further progression of the infection and required additional surgeries and a dura resection accompanied by complications like recurrent septical episodes, renal insufficiency, a bifrontal epidural hematoma and multiple cerebral microinfarcts that impeded the recovery of our patient in the further course. After 8 months she was able to leave the hospital, an epithesis was adjusted and she is without a relapse for 24 month since the diagnosis. © Georg Thieme Verlag KG Stuttgart · New York.

Ectopic Acromegaly Arising from a Pituitary Adenoma within the Bony Intersphenoid Septum of a Patient with Empty Sella Syndrome

PubMed Central

Arzamendi, Audrey E.; Shahlaie, Kiarash; Latchaw, Richard E.; Lechpammer, Mirna; Arzumanyan, Hasmik

2016-01-01

Objective  To describe the work-up and treatment of rare ectopic acromegaly caused by a biopsy-proven somatotroph pituitary adenoma located within the bony intersphenoid septum of a patient with empty sella syndrome (ESS). Methods  We report the presentation, clinical course, diagnostic work-up, and lesion localization and treatment challenges encountered in a 55-year-old patient, with a brief review of relevant literature. Results  A 55-year-old African-American man presented with acromegaly and ESS. Attempts to definitively localize the causative tumor were unsuccessful, though petrosal sinus sampling supported central growth hormone production and imaging suggested bone-enclosed subsellar pituitary tissue. Endoscopic endonasal transphenoidal exploration was undertaken with resection of a somatotroph pituitary microadenoma, and subsequent clinical improvement and biochemical remission. Retrospective review revealed the patient's pituitary to have been located ectopically within a unique bony intersphenoid septum. Conclusion  This report describes the first known case of an ectopic pituitary adenoma located within the midline bony intersphenoid septum, which we postulate to have resulted from anomalous embryological pituitary migration. Intra-intersphenoid septal tumors should be considered in cases of apparent central acromegaly with ESS or absence of tumor tissue within the paranasal sinuses or other peripheral locations. Indexing  Acromegaly, ESS, pituitary adenoma, sphenoid sinus septum. PMID:27468406

Biodegradable nasal stents (MgF2 -coated Mg-2 wt %Nd alloy)-A long-term in vivo study.

PubMed

Durisin, Martin; Reifenrath, Janin; Weber, Constantin M; Eifler, Rainer; Maier, Hans J; Lenarz, Thomas; Seitz, Jan-Marten

2017-02-01

Despite innovative surgical techniques and use of current frontal sinus stents from different materials, the problem of treatment failure with consecutive reoperation remains present. The aim of our study is to investigate biocompatibility, degradation kinetics, and functionality of a newly developed fluoride-coated magnesium-based nasal stent. A minipig anatomy of frontal sinus adapted design and an external surgical approach were developed and established. The functionality of the stents was evaluated endoscopically. The stent-tissue blocks were analysed after 90 and 180 days using microcomputed tomography (µ-CT), histology, scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDS). Functional evaluation revealed an unobstructed stent lumen in all cases. Histological analysis showed moderate mucosal hyperplasia with a mild, nonspecific inflammatory response, and nonosteoconductive effect. Rejection reactions or necrosis did not occur. The volumetric analysis of the stents showed 51% volume loss after 180 days. The EDS analysis did not detect any neodymium (Nd) in the mucosa or bone. The Mg-2 wt % Nd stents are a promising option when treating the narrow passages following paranasal sinus surgery. In particular, its good biocompatibility and good functionality facilitate the re-epithelization of these constricted passages. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 350-365, 2017. © 2015 Wiley Periodicals, Inc.

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).

Expandable Micro-motor Bur, design of a new device for least invasive extraction of broken teeth roots

PubMed Central

2013-01-01

Background Extraction of a broken tooth root is often a traumatic experience for both the practitioner and the patient. To extract broken roots, generally invasive approaches as open window surgeries or mucoperiosteal flap and/or removal of buccal bone are performed. Presentation of the hypothesis Expandable micro-motor bur (EMB) is a hypothetical design of a dental instrument proposed for removal of broken teeth roots that cannot be extracted by the routine closed methods and in which common instrumentations cannot afford to accomplish. Implication of EMB would introduce a new technique in removal of broken teeth roots in which surgical trauma is minimized and so post-extraction disorders. It would eliminate surgical invasion to the surrounding tissues; and also it would eliminate profound hand forces by the practitioner, consequently reduces stress for both the practitioner and the patient. It would eliminate high risk aftermaths such as operative morbidity (due to bone loss), maxillary sinus exposure and probable need for additional surgery as are indicative of some conventional open access approaches. Testing the hypothesis Further studies are needed to confirm its effect in clinical cases. The effectiveness of EMB should be verified firstly by animal experiments. The likelihood of its negative influence on nearby vascular and nerve system should be well evaluated. Implications of the hypothesis Implication of EMB would be of interest to both patients and the surgeon due to the following main achievements: a) no need for mucoperiosteal flap, hence preservation of soft tissue, b) no need for osteotomy, hence retention of buccal bone, c) less risk of sinus exposure, d) minimum chance of post operative infections due to eliminated surgeries in soft tissues and bones and e) in terms of esthetics, it will have a special meaning for immediate placement of dental implants. EMB’s structural components include Bur head, Spacers and Bur base. A micro motor would power its spin. In contrast to conventional surgical approaches, EMB procedure is conservative. It is anticipated that EMB would provide less traumatic and least post-operative complications in extraction of broken teeth roots. PMID:23497515

Treatment of calvarial defects by resorbable and non-resorbable sonic activated polymer pins and mouldable titanium mesh in two dogs: a case report.

PubMed

Langer, Pierre; Black, Cameron; Egan, Padraig; Fitzpatrick, Noel

2018-06-22

To date, calvarial defects in dogs have traditionally been addressed with different types of implants including bone allograft, polymethylmethacrylate and titanium mesh secured with conventional metallic fixation methods. This report describes the use of an absorbable and non absorbable novel polymer fixation method, Bonewelding® technology, in combination with titanium mesh for the repair of calvarial defects in two dogs. The clinical outcomes and comparative complication using resorbable and non-resorbable thermoplastic pins were compared. This report of two cases documents the repair of a traumatic calvarial fracture in an adult male Greyhound and a cranioplasty following frontal bone tumor resection in an adult female Cavalier King Charles Spaniel with the use of a commercially available titanium mesh secured with an innovative thermoplastic polymer screw system (Bonewelding®). The treatment combination aimed to restore cranial structure, sinus integrity and cosmetic appearance. A mouldable titanium mesh was cut to fit the bone defect of the frontal bone and secured with either resorbable or non-resorbable polymer pins using Bonewelding® technology. Gentamycin-impregnated collagen sponge was used intraoperatively to assist with sealing of the frontal sinuses. Calvarial fracture and post-operative implant positioning were advised using computed tomography. A satisfactory restoration of skull integrity and cosmetic result was achieved, and long term clinical outcome was deemed clinically adequate with good patient quality of life. Postoperative complications including rostral mesh uplift with minor associated clinical signs were encountered when resorbable pins were used. No postoperative complications were experienced in non-resorbable pins at 7 months follow-up, by contrast mesh uplift was noted 3 weeks post-procedure in the case treated using absorbable pins. The report demonstrates the innovative use of sonic-activated polymer pins (Bonewelding® technology) alongside titanium mesh is a suitable alternative technique for skull defect repair in dogs. The use of Bonewelding® may offer advantages in reduction of surgical time. Further, ultrasonic pin application may be less invasive than alternative metallic fixation and potentially reduces bone trauma. Polymer systems may offer enhanced mesh-bone integration when compared to traditional metallic implants. The use of polymer pins demonstrates initial potential as a fixation method in cranioplasty. Initial findings in a single case comparison indicate a possible advantage in the use of non-absorbable over the absorbable systems to circumvent complications associated with variable polymer degradation, further long term studies with higher patient numbers are required before reliable conclusions can be made.

Multi-protein Delivery by Nanodiamonds Promotes Bone Formation

PubMed Central

Moore, L.; Gatica, M.; Kim, H.; Osawa, E.; Ho, D.

2013-01-01

Bone morphogenetic proteins (BMPs) are well-studied regulators of cartilage and bone development that have been Food and Drug Administration (FDA)-approved for the promotion of bone formation in certain procedures. BMPs are seeing more use in oral and maxillofacial surgeries because of recent FDA approval of InFUSE® for sinus augmentation and localized alveolar ridge augmentation. However, the utility of BMPs in medical and dental applications is limited by the delivery method. Currently, BMPs are delivered to the surgical site by the implantation of bulky collagen sponges. Here we evaluate the potential of detonation nanodiamonds (NDs) as a delivery vehicle for BMP-2 and basic fibroblast growth factor (bFGF). Nanodiamonds are biocompatible, 4- to 5-nm carbon nanoparticles that have previously been used to deliver a wide variety of molecules, including proteins and peptides. We find that both BMP-2 and bFGF are readily loaded onto NDs by physisorption, forming a stable colloidal solution, and are triggered to release in slightly acidic conditions. Simultaneous delivery of BMP-2 and bFGF by ND induces differentiation and proliferation in osteoblast progenitor cells. Overall, we find that NDs provide an effective injectable alternative for the delivery of BMP-2 and bFGF to promote bone formation. PMID:24045646

Multi-protein delivery by nanodiamonds promotes bone formation.

PubMed

Moore, L; Gatica, M; Kim, H; Osawa, E; Ho, D

2013-11-01

Bone morphogenetic proteins (BMPs) are well-studied regulators of cartilage and bone development that have been Food and Drug Administration (FDA)-approved for the promotion of bone formation in certain procedures. BMPs are seeing more use in oral and maxillofacial surgeries because of recent FDA approval of InFUSE(®) for sinus augmentation and localized alveolar ridge augmentation. However, the utility of BMPs in medical and dental applications is limited by the delivery method. Currently, BMPs are delivered to the surgical site by the implantation of bulky collagen sponges. Here we evaluate the potential of detonation nanodiamonds (NDs) as a delivery vehicle for BMP-2 and basic fibroblast growth factor (bFGF). Nanodiamonds are biocompatible, 4- to 5-nm carbon nanoparticles that have previously been used to deliver a wide variety of molecules, including proteins and peptides. We find that both BMP-2 and bFGF are readily loaded onto NDs by physisorption, forming a stable colloidal solution, and are triggered to release in slightly acidic conditions. Simultaneous delivery of BMP-2 and bFGF by ND induces differentiation and proliferation in osteoblast progenitor cells. Overall, we find that NDs provide an effective injectable alternative for the delivery of BMP-2 and bFGF to promote bone formation.

[Endoscopic sinus surgery in flowing water].

PubMed

Noda, K; Doi, K; Noiri, T; Koizuka, I; Kubo, T

2000-05-01

A balloon has been developed that completely fills the choana, preventing water from leaking into the pharynx even when the water is entering into the nasal cavity at a rate of 1000 ml per minute. The balloon enables endoscopic sinus surgery (ESS) to be safely performed in "flowing water". This surgical technique is similar to that used in transurethral resections of the prostate because the tip of the endoscope is kept clean, and blood, debris and resected tissues are continuously removed by the water flow. In addition, the water pressure helps to suppress bleeding. This technique enables ESS to be performed with greater ease and efficiency. We have performed ESS in flowing water on 38 patients with chronic sinusitis under local anaesthesia. No complications, such as water leakage into the pharynx, were encountered, and only a few patients felt discomfort from the insertion of the balloon. Even if the balloon had burst, an emergency could have been easily prevented by withdrawing the endoscope from the nasal cavity and stopping the flow of water. Ultrasonography (USG) was used to examine the water-filled nasal cavity during surgery (SSD-2000 and Micro Tip Radial (ASU-101); Aloka, Ltd., Japan). Using USG, the middle turbinate, the inferior turbinate and the nasal septum could be visualized in a single coronal image. When the sensor was in the posterior ethmoid sinus, the orbit and its optic nerve could also be visualized. Since this surgery is performed under local anesthesia, eye movements can rapidly alter the position of the optic nerve. Thus, visualization of the optic nerve's exact position is extremely important. Unfortunately, USG is not very useful for localizing structures and guiding the surgeon to distant tumors or cysts located behind thick bones, since ultrasound can not penetrate hard masses or bones. In this situation, navigation systems are more reliable than USG. Nevertheless, USG is often useful for depicting surgical sites, especially during a crisis, if the medial wall of the orbit is thin or if the skull base has been broken, exposing the dura. USG can also provide early warning of an impending complication. USG also has several practical advantages over navigation systems: the cost of USG is much lower, preparation for surgery is unnecessary, visual information can be obtained in real time, and measurement accuracy (estimated to be about 2 mm for navigation systems) is not a consideration. Thus, USG can be easily used to avoid complications in most surgeries for chronic sinusitis. Flowing water also allows the nasal eavity to be completely washed and sterilized at the end of the surgery. This not only prevents post-operative infection, but enables sinus function to be more quickly recovered. In addition, the pressure from the balloon also prevents post-operative nasal hemorrhaging. This allows patients to be safely discharged from the hospital at an earlier time. The balloon can also be used for non-surgical purposes. For example, emergent epistaxis can be easily stopped by the insertion of this balloon, even if the doctor is not an otorhinolaryngologist. In addition, the balloon's soft pressure allows it to be left in the nose for long periods without any complications. We conclude that this simple balloon, which we have named the "Noda Balloon", is extremely useful for nasal treatments.

The 360 photography: a new anatomical insight of the sphenoid bone. Interest for anatomy teaching and skull base surgery.

PubMed

Jacquesson, Timothée; Mertens, Patrick; Berhouma, Moncef; Jouanneau, Emmanuel; Simon, Emile

2017-01-01

Skull base architecture is tough to understand because of its 3D complex shape and its numerous foramen, reliefs or joints. It is especially true for the sphenoid bone whom central location hinged with most of skull base components is unique. Recently, technological progress has led to develop new pedagogical tools. This way, we bought a new real-time three-dimensional insight of the sphenoid bone that could be useful for the teacher, the student and the surgeon. High-definition photography was taken all around an isolated dry skull base bone prepared with Beauchêne's technique. Pictures were then computed to provide an overview with rotation and magnification on demand. From anterior, posterior, lateral or oblique views and from in out looks, anatomical landmarks and subtleties were described step by step. Thus, the sella turcica, the optic canal, the superior orbital fissure, the sphenoid sinus, the vidian canal, pterygoid plates and all foramen were clearly placed relative to the others at each face of the sphenoid bone. In addition to be the first report of the 360 Photography tool, perspectives are promising as the development of a real-time interactive tridimensional space featuring the sphenoid bone. It allows to turn around the sphenoid bone and to better understand its own special shape, numerous foramen, neurovascular contents and anatomical relationships. This new technological tool may further apply for surgical planning and mostly for strengthening a basic anatomical knowledge firstly introduced.

Radiographic evaluation of anatomical variables in maxilla and mandible in relation to dental implant placement.

PubMed

Chandra, Poornima; Govindaraju, Poornima; Chowdhary, Ramesh

2016-01-01

Oral rehabilitation using implants is rapidly replacing tooth supported prostheses. The success of implants is largely dependent on the quality and quantity of alveolar bone. In this study, we assessed the location of limiting anatomical structures and the amount of alveolar bone available for implant placement. Six hundred digital panoramic radiographs (300 males and 300 females) of dentate patients aged between 15-60 years were selected from the archives. The radiographs were subdivided into 3 groups with age interval of 15 years. Then the location of mental foramen, anterior loop, mandibular canal and maxillary sinus was determined. The amount of bone available was measured in both maxilla and mandible in the premolar and molar regions. The mental foramen was most commonly located at the apex of the second premolar in both the genders. The anterior loop was more readily visible in the younger age group. The amount of bone available in the premolar and molar region of the mandible is nearly the same, while more bone is available in the premolar region of the maxilla. The location and morphology of anatomical structures of the jaws vary not only in different populations but also within the same population. The amount of bone available also showed variations in the same population and in the same individual on the right and left sides. The limiting anatomical structures govern the amount of bone available for possible implant placement.

Posttraumatic missile injuries of the orofacial region.

PubMed

Kummoona, Raja

2008-03-01

Iraq became the world's battlefield for terrorist attack to the victims by different types of weapons of missile including explosive cars, explosive belt, fragments, rifle bullets, and handgun bullets. This situation in Iraq has been present for the last 3 years. As surgeons, we cannot influence the surge of this violence, but we are surely called upon to care for its victims. Missile injuries to the orofacial region have special features that provide the surgeon with multiple medical and surgical challenges when dealing with these injuries. This study include 140 patients who were treated in the maxillofacial unit, hospital of specialized surgery, in Medical City, Baghdad, during a period of 2 years; we had 28 women and 112 men, with ages ranging from 9 to 60 years (mean, 34.5 years), suffering from posttraumatic orofacial deformities. Deformities of the face as a complication of missile injuries were classified as bone loss, soft tissue loss, combined bone and soft tissue loss, and others (sinus tracts and poor scars); 62 patients (44%) had bone loss, 45 (32%) had soft tissue loss, 9 (6.4%) had combined bone and soft tissue loss, and 22 (15.7%) had other deformities.

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.

Polypropylene Darning: A New Alternative for Reconstruction of Orbital Floor after Total Maxillectomy.

PubMed

Sharma, Prashant

2015-06-01

Removal of orbital floor is an integral part of total (radical) maxillectomy (type IIIa), which if not managed properly, may lead to some eye related distressing complications like diplopia, eyelid malposition, epiphora, dacryocystitis, enopthalmos and ectoprion. Among all, diplopia is the most distressing complication which hampers daily activity. Various options for orbital floor reconstruction are available like titanium sheet, polypropylene mesh, non-vascularized or vascularized bone graft, pedicled flaps, micro-vascular free flaps, prosthesis placement, and split skin graft followed by obturator placement. Till date no-body has tried stabilization of eye ball by 'darning' the orbital floor using non-absorbable suture. 'Polypropylene suture darning' is an easy to learn, novel method with equally good results. Five patients with potentially resectable tumors underwent total maxillectomy. I used polypropylene 3-0 round body suture and 'darning' was done at orbital floor, incorporating periosteum (if remaining) and peri-orbital fat into the sutures. Muscle flaps were done to provide bulk and palatal reconstruction. Assessment of patients was done post-operatively at day-5 i.e., before discharge and at 1 month after surgery, and also in further follow up visits. The results were very good in terms of clear vision & eye movements (directly related to 'darning'), and the aesthetic look of patients and bilateral symmetry were satisfactory (not related to darning). Darning of orbital floor by polypropylene after total maxillectomy is an easy to learn and cost-effective method of reconstruction with good results.

Distribution Characteristics of Air-Bone Gaps – Evidence of Bias in Manual Audiometry

PubMed Central

Margolis, Robert H.; Wilson, Richard H.; Popelka, Gerald R.; Eikelboom, Robert H.; Swanepoel, De Wet; Saly, George L.

2015-01-01

Objective Five databases were mined to examine distributions of air-bone gaps obtained by automated and manual audiometry. Differences in distribution characteristics were examined for evidence of influences unrelated to the audibility of test signals. Design The databases provided air- and bone-conduction thresholds that permitted examination of air-bone gap distributions that were free of ceiling and floor effects. Cases with conductive hearing loss were eliminated based on air-bone gaps, tympanometry, and otoscopy, when available. The analysis is based on 2,378,921 threshold determinations from 721,831 subjects from five databases. Results Automated audiometry produced air-bone gaps that were normally distributed suggesting that air- and bone-conduction thresholds are normally distributed. Manual audiometry produced air-bone gaps that were not normally distributed and show evidence of biasing effects of assumptions of expected results. In one database, the form of the distributions showed evidence of inclusion of conductive hearing losses. Conclusions Thresholds obtained by manual audiometry show tester bias effects from assumptions of the patient’s hearing loss characteristics. Tester bias artificially reduces the variance of bone-conduction thresholds and the resulting air-bone gaps. Because the automated method is free of bias from assumptions of expected results, these distributions are hypothesized to reflect the true variability of air- and bone-conduction thresholds and the resulting air-bone gaps. PMID:26627469

Tissue adhesives in otorhinolaryngology

PubMed Central

Schneider, Gerlind

2011-01-01

The development of medical tissue adhesives has a long history without finding an all-purpose tissue adhesive for clinical daily routine. This is caused by the specific demands which are made on a tissue adhesive, and the different areas of application. In otorhinolaryngology, on the one hand, this is the mucosal environment as well as the application on bones, cartilage and periphery nerves. On the other hand, there are stressed regions (skin, oral cavity, pharynx, oesophagus, trachea) and unstressed regions (middle ear, nose and paranasal sinuses, cranial bones). But due to the facts that adhesives can have considerable advantages in assuring surgery results, prevention of complications and so reduction of medical costs/treatment expenses, the search for new adhesives for use in otorhinolaryngology will be continued intensively. In parallel, appropriate application systems have to be developed for microscopic and endoscopic use. PMID:22073094

Diseases of the nose and paranasal sinuses in child

PubMed Central

Stenner, Markus; Rudack, Claudia

2014-01-01

Diseases of the pediatric nose and nasal sinuses as well as neighboring anatomical structures encompass a variety of pathologies, especially of inflammatory nature. Congenital disease, such as malformations and structural deviations of the nasal septum, as well as systemic metabolic pathologies affecting the nose and sinuses, rarely require medical therapy from an Otolaryngologist. The immunological function of the mucosa and genetic factors play a role in the development of disease in the pediatric upper airway tract, especially due to the constantly changing anatomy in this growth phase. Disease description of the nose and nasal sinuses due to mid-facial growth must also take developmental age differences (infant, toddler, preschool, and school age) into account. Epidemiological examinations and evidence based studies are often lacking in the pediatric population. The wide range of inflammatory diseases of the nose and paranasal sinuses, such as the acute and chronic rhinosinusitis, the allergic rhinitis, and adenoid disease, play a role in the susceptibility of a child to infection. The susceptibility to infection depends on the pediatric age structure (infant, young child) and has yet to be well defined. The acute rhinosinusitis in children develops after a viral infection of the upper airways, also referred to as the “common cold” in the literature. It usually spontaneously heals within ten days without any medical therapy. Antibiotic therapy is prudent in complicated episodes of ARS. The antibiotic therapy is reserved for children with complications or associated disease, such as bronchial asthma and/or chronic bronchitis. A chronic rhinosinusitis is defined as the inflammatory change in the nasal mucosa and nasal sinus mucosa, in which the corresponding symptoms persist for over 12 weeks. The indication for CT-imaging of the nasal sinuses is reserved for cases of chronic rhinosinusitis that have been successfully treated with medication. A staged therapeutic concept is followed in CRS based on conservative and surgical methods. Nasal sinus surgery is considered nowadays as effective and safe in children. Based on the assumption that adenoids are a reservoir for bacteria, from which recurrent infections of the nose and nasal sinus originate, the adenoidectomy is still defined as a cleansing procedure in rhinosinusitis. 69.3% of the children had benefit from adenoidectomy. Comorbidities, such as pediatric bronchial asthma, presently play an even more important role in the therapy of rhinosinusitis; therefore, it is often wise to have the support of pediatricians. In western European countries 40% of children presently suffer from allergic rhinitis, in which pronounced nasal obstruction can cause disturbed growth in facial bones. An early therapy with SIT may prevent the development of bronchial asthma and secondary sensitization to other allergens. Therefore, SIT is recommended in treatment of allergic rhinitis whenever, if possible. The assessment of diagnostic tools is for the examiner not often possible due to the lack of evidence. Rhinosurgical approaches are often described in study reports; however, they lack the standard prospective randomized long-term study design required nowadays and can only be evaluated with caution in the literature. PMID:25587370

Diseases of the nose and paranasal sinuses in child.

PubMed

Stenner, Markus; Rudack, Claudia

2014-01-01

Diseases of the pediatric nose and nasal sinuses as well as neighboring anatomical structures encompass a variety of pathologies, especially of inflammatory nature. Congenital disease, such as malformations and structural deviations of the nasal septum, as well as systemic metabolic pathologies affecting the nose and sinuses, rarely require medical therapy from an Otolaryngologist. The immunological function of the mucosa and genetic factors play a role in the development of disease in the pediatric upper airway tract, especially due to the constantly changing anatomy in this growth phase. Disease description of the nose and nasal sinuses due to mid-facial growth must also take developmental age differences (infant, toddler, preschool, and school age) into account. Epidemiological examinations and evidence based studies are often lacking in the pediatric population. The wide range of inflammatory diseases of the nose and paranasal sinuses, such as the acute and chronic rhinosinusitis, the allergic rhinitis, and adenoid disease, play a role in the susceptibility of a child to infection. The susceptibility to infection depends on the pediatric age structure (infant, young child) and has yet to be well defined. The acute rhinosinusitis in children develops after a viral infection of the upper airways, also referred to as the "common cold" in the literature. It usually spontaneously heals within ten days without any medical therapy. Antibiotic therapy is prudent in complicated episodes of ARS. The antibiotic therapy is reserved for children with complications or associated disease, such as bronchial asthma and/or chronic bronchitis. A chronic rhinosinusitis is defined as the inflammatory change in the nasal mucosa and nasal sinus mucosa, in which the corresponding symptoms persist for over 12 weeks. The indication for CT-imaging of the nasal sinuses is reserved for cases of chronic rhinosinusitis that have been successfully treated with medication. A staged therapeutic concept is followed in CRS based on conservative and surgical methods. Nasal sinus surgery is considered nowadays as effective and safe in children. Based on the assumption that adenoids are a reservoir for bacteria, from which recurrent infections of the nose and nasal sinus originate, the adenoidectomy is still defined as a cleansing procedure in rhinosinusitis. 69.3% of the children had benefit from adenoidectomy. Comorbidities, such as pediatric bronchial asthma, presently play an even more important role in the therapy of rhinosinusitis; therefore, it is often wise to have the support of pediatricians. In western European countries 40% of children presently suffer from allergic rhinitis, in which pronounced nasal obstruction can cause disturbed growth in facial bones. An early therapy with SIT may prevent the development of bronchial asthma and secondary sensitization to other allergens. Therefore, SIT is recommended in treatment of allergic rhinitis whenever, if possible. The assessment of diagnostic tools is for the examiner not often possible due to the lack of evidence. Rhinosurgical approaches are often described in study reports; however, they lack the standard prospective randomized long-term study design required nowadays and can only be evaluated with caution in the literature.

Malignant Jugular Paraganglioma: Unusual Presentation on 68Ga DOTANOC PET/CT.

PubMed

Jain, Tarun Kumar; Basher, Rajender Kumar; Shukla, Jaya; Mittal, Bhagwant Rai; Panda, Naresh K

2016-02-01

Metastatic jugular paraganglioma are rare tumors and account for less than 1% of the cases of head and neck tumors. We report a 40-year-old woman of jugular paraganglioma, presenting with right-sided neck swelling, hearing loss, and pulsatile tinnitus. Contrast-enhanced CT temporal bone revealed a mass in the right jugular foramina and extending inferiorly to internal jugular vein. Ga DOTANOC PET/CT was performed, which revealed somatostatin receptor expressing lesion in the right internal jugular vein and extension into sigmoid sinus and additional metastatic focus in the sacrum.

Temporalis myofascial repair of traumatic defects of the anterior fossa. Technical note.

PubMed

Gillespie, R P; Shagets, F W; de los Reyes, R A

1986-06-01

Bilateral temporalis myofascial flaps in continuity with frontal periosteum can be used in repairing extensive dural and bone defects of the anterior cranial fossa floor. The technique of preserving and using this flap is described and offers an alternative to the use of frontal pericranial tissue for repair of anterior dural defects.

Osedax borings in fossil marine bird bones

PubMed Central

Kahl, Wolf-Achim; Goedert, James L.

2010-01-01

The bone-eating marine annelid Osedax consumes mainly whale bones on the deep-sea floor, but recent colonization experiments with cow bones and molecular age estimates suggesting a possible Cretaceous origin of Osedax indicate that this worm might be able grow on a wider range of substrates. The suggested Cretaceous origin was thought to imply that Osedax could colonize marine reptile or fish bones, but there is currently no evidence that Osedax consumes bones other than those of mammals. We provide the first evidence that Osedax was, and most likely still is, able to consume non-mammalian bones, namely bird bones. Borings resembling those produced by living Osedax were found in bones of early Oligocene marine flightless diving birds (family Plotopteridae). The species that produced these boreholes had a branching filiform root that grew to a length of at least 3 mm, and lived in densities of up to 40 individuals per square centimeter. The inclusion of bird bones into the diet of Osedax has interesting implications for the recent suggestion of a Cretaceous origin of this worm because marine birds have existed continuously since the Cretaceous. Bird bones could have enabled this worm to survive times in the Earth’s history when large marine vertebrates other than fish were rare, specifically after the disappearance of large marine reptiles at the end-Cretaceous mass extinction event and before the rise of whales in the Eocene. PMID:21103978

Osedax borings in fossil marine bird bones.

PubMed

Kiel, Steffen; Kahl, Wolf-Achim; Goedert, James L

2011-01-01

The bone-eating marine annelid Osedax consumes mainly whale bones on the deep-sea floor, but recent colonization experiments with cow bones and molecular age estimates suggesting a possible Cretaceous origin of Osedax indicate that this worm might be able grow on a wider range of substrates. The suggested Cretaceous origin was thought to imply that Osedax could colonize marine reptile or fish bones, but there is currently no evidence that Osedax consumes bones other than those of mammals. We provide the first evidence that Osedax was, and most likely still is, able to consume non-mammalian bones, namely bird bones. Borings resembling those produced by living Osedax were found in bones of early Oligocene marine flightless diving birds (family Plotopteridae). The species that produced these boreholes had a branching filiform root that grew to a length of at least 3 mm, and lived in densities of up to 40 individuals per square centimeter. The inclusion of bird bones into the diet of Osedax has interesting implications for the recent suggestion of a Cretaceous origin of this worm because marine birds have existed continuously since the Cretaceous. Bird bones could have enabled this worm to survive times in the Earth's history when large marine vertebrates other than fish were rare, specifically after the disappearance of large marine reptiles at the end-Cretaceous mass extinction event and before the rise of whales in the Eocene.

Osedax borings in fossil marine bird bones

NASA Astrophysics Data System (ADS)

Kiel, Steffen; Kahl, Wolf-Achim; Goedert, James L.

2011-01-01

The bone-eating marine annelid Osedax consumes mainly whale bones on the deep-sea floor, but recent colonization experiments with cow bones and molecular age estimates suggesting a possible Cretaceous origin of Osedax indicate that this worm might be able grow on a wider range of substrates. The suggested Cretaceous origin was thought to imply that Osedax could colonize marine reptile or fish bones, but there is currently no evidence that Osedax consumes bones other than those of mammals. We provide the first evidence that Osedax was, and most likely still is, able to consume non-mammalian bones, namely bird bones. Borings resembling those produced by living Osedax were found in bones of early Oligocene marine flightless diving birds (family Plotopteridae). The species that produced these boreholes had a branching filiform root that grew to a length of at least 3 mm, and lived in densities of up to 40 individuals per square centimeter. The inclusion of bird bones into the diet of Osedax has interesting implications for the recent suggestion of a Cretaceous origin of this worm because marine birds have existed continuously since the Cretaceous. Bird bones could have enabled this worm to survive times in the Earth's history when large marine vertebrates other than fish were rare, specifically after the disappearance of large marine reptiles at the end-Cretaceous mass extinction event and before the rise of whales in the Eocene.

Animal Welfare and Food Safety Aspects of Confining Broiler Chickens to Cages

PubMed Central

Shields, Sara; Greger, Michael

2013-01-01

Simple Summary In commercial chicken meat production, broiler chickens are usually kept on the floor in ware-house like buildings, but the use of cages is becoming more common. Confining chickens to cages is a welfare problem, as has been thoroughly demonstrated for laying hens used for egg production. Caged broiler chickens may suffer from poor bone strength due to lack of exercise, feather loss, and restriction of natural behavior. There are also potential food safety concerns associated with the use of cages. While cages may provide an economic advantage in some geographical regions of the world, the severe, inherent disadvantages should also be considered before cages are more widely adopted in the global broiler chicken industry. Abstract In most areas of the world, broiler chickens are raised in floor systems, but cage confinement is becoming more common. The welfare of broiler chickens in cages is affected by movement restriction, poor bone strength due to lack of exercise, and prevention of key behavioral patterns such as dustbathing and ground scratching. Cages for broiler chickens also have a long history of causing skin and leg conditions that could further compromise welfare, but a lack of controlled studies makes it difficult to draw conclusions about newer cage designs. Cage environments are usually stocked at a higher density than open floor systems, and the limited studies available suggest that caging may lead to increased levels of fear and stress in the birds. Further, birds reared on the floor appear less likely to harbor and shed Salmonella, as litter may serve as a seeding agent for competitive exclusion by other microorganisms. Cages for laying hens used in egg production have met with substantial opposition due to welfare concerns and caging broiler chickens will likely be subject to the same kinds of social disapproval. PMID:26487409

Effects of two trimming methods of dairy cattle on concrete or rubber-covered slatted floors.

PubMed

Ouweltjes, W; Holzhauer, M; van der Tol, P P J; van der Werf, J

2009-03-01

This study monitored claw health, claw conformation, locomotion, activity, and step traits of cows from a single dairy herd that were trimmed according to the standard Dutch method or with an alternative "concave" trimming method. Half of the cows were kept in a stall section with concrete slatted floors in the alleys. The other cows were kept in a pen within the same housing with an identical concrete slatted floor in the alleys, but with a rubber top layer. All experimental cows were kept in the same environment for at least 3 mo before and after trimming. It was hypothesized that trimming for more-concave soles (i.e., with 3 to 5 mm of sole dug out under the claw bone) was preferred to the standard Dutch trimming with flat sole surfaces for cows kept in stalls with soft alley floors. None of the claw health or locomotion traits differed for the trimming methods. No interactions were found between flooring and trimming method. Floor effects were significant for several traits. Cows on the rubber-topped floors had significantly fewer sole hemorrhages (prevalence of 22 vs. 48% in mo 3) and larger claws (claw length 76.1 +/- 5.0 vs. 72.5 +/- 4.9 mm; heel height 49.3 +/- 6.3 vs. 46.0 +/- 6.4 mm; claw diagonal 129 +/- 6.4 vs. 125 +/- 6.9 mm), spent more time standing in the alleys (55.4 +/- 2.8 vs. 49.6 +/- 2.8%), and had higher activity (61.0 +/- 3.7 vs. 53.0 +/- 3.7 steps/h). This suggests greater claw comfort on rubber flooring compared with concrete flooring. Kinetic patterns during claw-floor contact while walking were similar for all treatments. During the double-support (stance) phase, claw-floor contact area increased to a maximum in the first 30% of double-support phase time, remained more or less stable until 80% of double-support phase time, and sharply decreased as the animal pushed off as shown by the change in center of pressure. A gradual change of center of pressure in the medial direction during double-support phase time was shown. The research hypothesis was rejected, but soft alley floors had subtle beneficial effects.

Cystic Shape Cemento-Ossifying Fibroma of Ethmoid Sinus

PubMed Central

Shejbal, Dražen; Vonsović, Gabrijela; Baudoin, Tomislav; Vagic, Davor

2015-01-01

Cemento-ossifying fibromas are a group of rarely occurring benign tumours, developing from the periodontal membrane and varying considerably in appearance and in the progress of the disease. Their common feature is higher or lower production of cemental tissue. In most cases the tumours are small because their cementoma mature quickly and become inactive, which causes the tumour to stop growing. They develop most frequently in the mandible and also in the maxilla. Other sites, such as paranasal cavities, soft tissues and bones of the head, are extremely rare. The case of a cemento-fibrosing tumour with psammoma infiltrations, developing from the ethmoid sinus in a nine-year-old girl is reported. Due to frontal headaches and sight defects as well as impaired vision on the right side, NMR was done, which showed a mucocele of the front and rear ethmoid with destruction of the orbital wall and a breakthrough into the orbit. The right maxillary sinus showed a visible retention and a thickened mucous membrane. A rhinoscopy revealed a ball-shaped spherical mass in the medial nasal meatus, which was defined as concha bullosa. An endoscopic examination showed that the tumour protruded in front of the medium nasal concha into the right nasal cavity, softened the ethmoid roof, penetrated toward the base of the skull, adhered and pushed the orbit. It was removed by FESS technique, and PHD revealed subsequently that it was not a mucocele but a cemento-ossifying fibroma. PMID:27688399

Cystic Shape Cemento-Ossifying Fibroma of Ethmoid Sinus.

PubMed

Shejbal, Dražen; Vonsović, Gabrijela; Baudoin, Tomislav; Vagic, Davor

2015-06-01

Cemento-ossifying fibromas are a group of rarely occurring benign tumours, developing from the periodontal membrane and varying considerably in appearance and in the progress of the disease. Their common feature is higher or lower production of cemental tissue. In most cases the tumours are small because their cementoma mature quickly and become inactive, which causes the tumour to stop growing. They develop most frequently in the mandible and also in the maxilla. Other sites, such as paranasal cavities, soft tissues and bones of the head, are extremely rare. The case of a cemento-fibrosing tumour with psammoma infiltrations, developing from the ethmoid sinus in a nine-year-old girl is reported. Due to frontal headaches and sight defects as well as impaired vision on the right side, NMR was done, which showed a mucocele of the front and rear ethmoid with destruction of the orbital wall and a breakthrough into the orbit. The right maxillary sinus showed a visible retention and a thickened mucous membrane. A rhinoscopy revealed a ball-shaped spherical mass in the medial nasal meatus, which was defined as concha bullosa. An endoscopic examination showed that the tumour protruded in front of the medium nasal concha into the right nasal cavity, softened the ethmoid roof, penetrated toward the base of the skull, adhered and pushed the orbit. It was removed by FESS technique, and PHD revealed subsequently that it was not a mucocele but a cemento-ossifying fibroma.

Development of the jugular bulb: a radiologic study.

PubMed

Friedmann, David R; Eubig, Jan; McGill, Megan; Babb, James S; Pramanik, Bidyut K; Lalwani, Anil K

2011-10-01

Jugular bulb (JB) abnormalities such as JB diverticulum and high-riding JBs of the temporal bone can erode into the inner ear and present with hearing loss, vestibular disturbance, and pulsatile tinnitus. Their cause and potential to progress remain to be studied. This comprehensive radiologic study investigates the postnatal development of the venous system from transverse sinus to internal jugular vein (IJV). Academic medical center. PATIENTS, INTERVENTION, MAIN OUTCOME MEASURE: Measurements of the transverse and sigmoid sinus, the JB, IJV, and carotid artery were made from computed tomographic scans of the neck with intravenous contrast in infants (n = 5), children (n = 13), adults (n = 35), and the elderly (n = 15). Jugular bulbs were not detected in patients younger than 2 years, enlarged in adulthood, and remained stable in the elderly. The venous system was larger in men than in women. From transverse sinus to IJV, the greatest variation in size was just proximal and distal to the JB with greater symmetry observed as blood returned to the heart. Right-sided venous dominance was most common occurring in 70% to 80% of cases. The JB is a dynamic structure that forms after 2 years, and its size stabilizes in adulthood. The determinants in its exact position and size are multifactorial and may be related to blood flow. Improved understanding of this structure's development may help to better understand the cause of the high-riding JB and JB diverticulum, both of which may cause clinical symptoms.

[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.

Cervicofacial tissue infarction in patients with acute invasive fungal sinusitis: prevalence and characteristic MR imaging findings.

PubMed

Seo, Jungmin; Kim, Hyung-Jin; Chung, Seung-Kyu; Kim, Eunhee; Lee, Hanbee; Choi, Jin Wook; Cha, Ji Hoon; Kim, Hye Jung; Kim, Sung Tae

2013-03-01

Tissue infarction is known as one of the characteristic features of invasive fungal sinusitis (IFS). The purpose of this study was to investigate the prevalence and characteristic MR imaging findings of cervicofacial tissue infarction (CFTI) associated with acute IFS. We retrospectively reviewed MR images in 23 patients with histologically or microbiologically proven acute IFS. CFTI was defined as an area of lack of enhancement in and around the sinonasal tract on contrast-enhanced T1-weighted images. We divided CFTI into two groups, i.e., intrasinonasal and extrasinonasal. Particular attention was paid to the location of extrasinonasal CFTI and the signal intensity of CFTI on T1- and T2-weighted images. The presence of bone destruction on CT scans was also recorded. CFTI was found in 17 (74%) of 23 patients. All of these 17 patients had intrasinonasal CFTI, and 13 patients also had extrasinonasal CFTI. All 13 patients with extrasinonasal CFTI died of disease directly related to IFS. Various locations were involved in the 13 patients with extrasinonasal CFTI, including the orbit (n = 8), infratemporal fossa (n = 7), intracranial cavity (n = 3), and oral cavity and/or facial soft tissue (n = 4). Various signal intensities were noted at the area of CFTI on T1- and T2-weighted images. Bone destruction was found on CT scans in only 3 of 17 patients with CFTI. CFTI with preservation of the bony wall of the involved sinonasal tract may be a characteristic MR imaging finding of acute IFS. The mortality is very high once the lesion extends beyond the sinonasal tract.

Full dose reduction potential of statistical iterative reconstruction for head CT protocols in a predominantly pediatric population

PubMed Central

Mirro, Amy E.; Brady, Samuel L.; Kaufman, Robert. A.

2016-01-01

Purpose To implement the maximum level of statistical iterative reconstruction that can be used to establish dose-reduced head CT protocols in a primarily pediatric population. Methods Select head examinations (brain, orbits, sinus, maxilla and temporal bones) were investigated. Dose-reduced head protocols using an adaptive statistical iterative reconstruction (ASiR) were compared for image quality with the original filtered back projection (FBP) reconstructed protocols in phantom using the following metrics: image noise frequency (change in perceived appearance of noise texture), image noise magnitude, contrast-to-noise ratio (CNR), and spatial resolution. Dose reduction estimates were based on computed tomography dose index (CTDIvol) values. Patient CTDIvol and image noise magnitude were assessed in 737 pre and post dose reduced examinations. Results Image noise texture was acceptable up to 60% ASiR for Soft reconstruction kernel (at both 100 and 120 kVp), and up to 40% ASiR for Standard reconstruction kernel. Implementation of 40% and 60% ASiR led to an average reduction in CTDIvol of 43% for brain, 41% for orbits, 30% maxilla, 43% for sinus, and 42% for temporal bone protocols for patients between 1 month and 26 years, while maintaining an average noise magnitude difference of 0.1% (range: −3% to 5%), improving CNR of low contrast soft tissue targets, and improving spatial resolution of high contrast bony anatomy, as compared to FBP. Conclusion The methodology in this study demonstrates a methodology for maximizing patient dose reduction and maintaining image quality using statistical iterative reconstruction for a primarily pediatric population undergoing head CT examination. PMID:27056425

Transparent model of temporal bone and vestibulocochlear organ made by 3D printing.

PubMed

Suzuki, Ryoji; Taniguchi, Naoto; Uchida, Fujio; Ishizawa, Akimitsu; Kanatsu, Yoshinori; Zhou, Ming; Funakoshi, Kodai; Akashi, Hideo; Abe, Hiroshi

2018-01-01

The vestibulocochlear organ is composed of tiny complex structures embedded in the petrous part of the temporal bone. Landmarks on the temporal bone surface provide the only orientation guide for dissection, but these need to be removed during the course of dissection, making it difficult to grasp the underlying three-dimensional structures, especially for beginners during gross anatomy classes. We report herein an attempt to produce a transparent three-dimensional-printed model of the human ear. En bloc samples of the temporal bone from donated cadavers were subjected to computed tomography (CT) scanning, and on the basis of the data, the surface temporal bone was reconstructed with transparent resin and the vestibulocochlear organ with white resin to create a 1:1.5 scale model. The carotid canal was stuffed with red cotton, and the sigmoid sinus and internal jugular vein were filled with blue clay. In the inner ear, the internal acoustic meatus, cochlea, and semicircular canals were well reconstructed in detail with white resin. The three-dimensional relationships of the semicircular canals, spiral turns of the cochlea, and internal acoustic meatus were well recognizable from every direction through the transparent surface resin. The anterior semicircular canal was obvious immediately beneath the arcuate eminence, and the topographical relationships of the vestibulocochlear organ and adjacent great vessels were easily discernible. We consider that this transparent temporal bone model will be a very useful aid for better understanding of the gross anatomy of the vestibulocochlear organ.

Determination of pre-cecal phosphorus digestibility of inorganic phosphates and bone meal products in broilers.

PubMed

van Harn, J; Spek, J W; van Vuure, C A; van Krimpen, M M

2017-05-01

A broiler study was performed to determine the pre-cecal phosphorus (P) digestibility of 5 P sources, 3 from animal (Delfos, Calfos, and porcine bone meal) and 2 of inorganic (monocalcium phosphate [MCP] and dicalcium phosphate [DCP]) origin. Delfos is processed from bones resulting in a dicalcium phosphate product, and Calfos is processed from bones in which part of the gelatin is removed but in which the hydroxy-apatite matrix is preserved. During the first 14 d, birds were housed in floor pens bedded with wood shavings and received a commercial starter diet. At d 14, broilers were randomly assigned to pens (0.9 m2, 10 birds/pen) with a slatted floor. From d 14 onwards, one of the 6 experimental diets (a basal diet, and 5 diets containing the P sources) was provided. Test diets were replicated 6 times, and the basal diet 8 times. Electron microscopy images of test products were made in order to verify whether the spatial structure of the test products could be related to the pre-cecal P digestibility of the same products. Diets met or exceeded CVB (2011) requirements for all nutrients except for P and were formulated to contain a calcium to total P ratio of between 1.4 and 1.6 and a minimal amount of phytate P. Diets contained 5 g/kg titanium oxide as a marker to determine digestibility of P. At d 24 all birds were euthanized, after which the content of the terminal part of the ileum was sampled. The P digestibility was calculated by linear regression according to World's Poultry Science Association (WPSA) protocol for determination of pre-cecal P digestibility. Pre-cecal P digestibility of MCP, DCP, Delfos, Calfos, and porcine bone meal was 88.5, 82.4, 94.5, 86.9, and 78.2%, respectively. Based on visual inspection of electron microscopy images of test products, the spatial structure of the test products might be related to P digestibility. It is concluded that processing of bone meal increases the pre-cecal P digestibility in broilers. © The Author 2017. Published by Oxford University Press on behalf of Poultry Science Association.

Combined application of latissimus dorsi myocutaneous flap and iliac bone flap in the treatment of chronic osteomyelitis of the lower extremity.

PubMed

Ju, Jihui; Li, Lei; Zhou, Rong; Hou, Ruixing

2018-05-18

To evaluate the clinical efficacy and safety of latissimus dorsi myocutaneous flap (stage I) combined with iliac bone flap (stage II) in the treatment of chronic osteomyelitis of the lower extremity. Clinical data of 18 patients undergoing latissimus dorsi myocutaneous flap in combination with iliac bone flap grafting were retrospectively analyzed. Among them, 2 patients developed chronic osteomyelitis of the lower segment of the femur, 4 were diagnosed with chronic osteomyelitis of the tibial plateau, and 12 with chronic osteomyelitis of the lower segment of the tibia. All the latissimus dorsi myocutaneous flaps survived in 18 patients. After the corresponding surgery, primary wound healing was achieved in 11 patients, and delayed wound healing was obtained in 7 cases. All wounds were completely healed with postoperative 2 months. Following the iliac bone flap grafting, primary would healing was accomplished in all cases. All dorsal window chambers survived. The bone defects were properly restored within 4-12 postoperative months. Functional training was performed after removal of the internal and external fixators. Postoperative follow-up was endured from 6 months to 10 years. All patients were satisfied with the bone healing and flap texture without the incidence of osteomyelitis and sinus tract. No contraction was observed in the grafting area of 2 patients receiving latissimus dorsi myocutaneous flap grafting. Residual linear scars were noted in the dorsal and iliac donor sites. Combined usage of stage I latissimus dorsi myocutaneous flap and stage II iliac bone flap grafting is an efficacious and safe surgical technique in clinical practice.

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.

Radiological assessment of the sinus tympani: temporal bone HRCT analyses and surgically related findings.

PubMed

Marchioni, Daniele; Valerini, Sara; Mattioli, Francesco; Alicandri-Ciufelli, Matteo; Presutti, Livio

2015-05-01

To evaluate the morphology of the sinus tympani (ST) based on computed tomography (CT) scans (axial view), describing the findings in a cohort of 148 patients (296 ears), and classifying the prevalence according to our ST classification. To evaluate the surgical prevalence based on the type of ST. To calculate the sensibility and positive predictive value (PPV) of high-resolution computed tomography (HRCT) scans for ST involvement by cholesteatoma. Retrospective review of the radiologic database and surgical reports. In total, 98/296 (33.1%) middle ears presented a radiologic morphology Type A; 185/296 (62.5%) middle ears presented a radiologic morphology Type B; 13/296 (4.4%) middle ears presented a radiologic morphology Type C; HRCT showed a sensibility of 91%, specificity of 65%, PPV of 68% and negative predictive value (NPV) of 90%. ST shape and depth can influence surgical preference in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; whereas in the case of a deeper ST, a retrofacial approach is usually preferred. HRCT scans demonstrated high sensibility and NPV for ST involvement by cholesteatoma.

Trauma of the midface

PubMed Central

Kühnel, Thomas S.; Reichert, Torsten E.

2015-01-01

Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair. PMID:26770280

Combined endodontic therapy and periapical surgery with MTA and bone graft in treating palatogingival groove.

PubMed

Mittal, Mudit; Vashisth, Pallavi; Arora, Rachita; Dwivedi, Swati

2013-04-18

A 37-year-old male patient reported to our department with chief complaint of pain and pus discharge from the labial marginal gingiva in the maxillary right lateral incisor region since last 4 months. Clinically, the tooth was hypersensitive to percussion and palpation but failed to respond to pulp sensitivity testing. After periodontal probing, a palatal groove was observed which started at the cingulum and travelled apically and laterally, associated with a pocket depth of 8 mm. Occlusal radiograph showed circumscribed radiolucency measuring 5 mm×7 mm in diameter at the apex of the tooth. A clinical diagnosis of chronic apical abscess was established. The case was treated with a combination of mineral trioxide aggregate and bone graft. At the 6-month follow-up visit, the tooth showed progressive healing without sinus track and sulcular bleeding.

Transplantation of bone marrow-derived mesenchymal stem cells expressing elastin alleviates pelvic floor dysfunction.

PubMed

Jin, Minfei; Chen, Ying; Zhou, Yun; Mei, Yan; Liu, Wei; Pan, Chenhao; Hua, Xiaolin

2016-04-05

Pelvic floor dysfunction (PFD) is a group of clinical conditions including stress urinary incontinence (SUI) and pelvic organ prolapse (POP). The abnormality of collagen and elastin metabolism in pelvic connective tissues is implicated in SUI and POP. To reconstitute the connective tissues with normal distribution of collagen and elastin, we transduced elastin to bone marrow-derived mesenchymal stem cells (BMSC). Elastin-expressing BMSCs were then differentiated to fibroblasts using bFGF, which produced collagen and elastin. To achieve the sustained release of bFGF, we formulated bFGF in poly (lactic-co-glycolic acid) (PLGA) nanoparticles (NP). In an in vitro cell culture system of 7 days, when no additional bFGF was administrated, the initial PLGA-loaded bFGF NP induced prolonged production of collagen and elastin from elastin-expressing BMSCs. In vivo, co-injection of PLGA-loaded bFGF NP and elastin-expressing BMSCs into the PFD rats significantly improved the outcome of urodynamic tests. Together, these results provided an efficient model of connective tissue engineering using BMSC and injectable PLGA-loaded growth factors. Our results provided the first instance of a multidisciplinary approach, combining both stem cell and nanoparticle technologies, for the treatment of PFD.

Reconstruction of Midface and Orbital Wall Defects After Maxillectomy and Orbital Content Preservation With Titanium Mesh and Fascia Lata: 3-Year Follow-Up.

PubMed

Motiee-Langroudi, Maziar; Harirchi, Iraj; Amali, Amin; Jafari, Mehrdad

2015-12-01

To describe the authors' experience in the reconstruction of patients after total maxillectomy with preservation of orbital contents for maxillary tumors using titanium mesh and autogenous fascia lata, where no setting for free flap reconstruction is available. Twelve consecutive patients with paranasal sinus tumors underwent total maxillectomy without orbital exenterations and primary reconstruction. The defects were reconstructed by titanium mesh in combination with autogenous fascia lata in the orbital floor performed by 1 surgical team. Titanium mesh (0.2 mm thick) was contoured and fixed to reconstruct the orbital floor and obtain midface projection. Fascia lata was used to cover the titanium mesh along the orbital floor to prevent fat entrapment in the mesh holes. The most common pathology was squamous cell carcinoma (50%). Patients' mean age was 45.66 years (33 to 74 yr). The mean follow-up period was 35.2 months (30 to 49 months). During follow-up, no infection or foreign body reaction was encountered. Extrusion of titanium mesh occurred in 4 patients who underwent postoperative radiotherapy. Two cases of mild diplopia at extreme gaze occurred early during the postoperative period that resolved after a few months. Placing fascia lata between the titanium mesh surface of the orbital implant and the orbital contents was successful in preventing long-term diplopia or dystopia. Nevertheless, exposure of the titanium implant through the skin surface represented a complication of this technique in 25% of patients. Further studies are required with head-to-head comparisons of artificial materials and free flaps for reconstruction of maxillectomy defects. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Management of Dropped Skull Flaps.

PubMed

Abdelfatah, Mohamed AbdelRahman

2017-01-01

Dropping a skull flap on the floor is an uncommon and avoidable mistake in the neurosurgical operating theater. This study retrospectively reviewed all incidents of dropped skull flaps in Ain-Shams University hospitals during a 10-year period to show how to manage this problem and its outcome. Thirty-one incidents of dropped skull flaps occurred from January 2004 to January 2014 out of more than 10,000 craniotomies. Follow-up period varied from 20 to 44 months. The bone flap was dropped while elevating the bone (n = 16), while drilling the bone on the operating table (n = 5), and during insertion of the bone flap (n = 10). Treatment included re-insertion of the skull flap after soaking it in povidone iodine and antibiotic solution (n = 17) or after autoclaving (n = 11), or discarding the skull flap and replacing it with a mesh cranioplasty in the same operation (n = 3). No bone or wound infection was noted during the follow-up period. Management of dropped skull flap is its prevention. Replacement of the skull flap, after decontamination, is an option that avoids the expense and time of cranioplasty.

Visualisation of the Bonebridge by means of CT and CBCT

PubMed Central

2013-01-01

Background With the Bonebridge, a new bone-anchored hearing aid has been available since March 2012. The objective of the study was to analyse the visualisation of the implant itself as well as its impact on the representation of the bony structures of the petrosal bone in CT, MRI and cone beam CT (CBCT). Methods The Bonebridge was implanted unilaterally in two completely prepared human heads. The radiological imaging by means of CBCT, 64-slice CT, 1.5-T and 3.0-T MRI was conducted both preoperatively and postoperatively. The images were subsequently evaluated from both the ENT medical and nd radiological perspectives. Results As anticipated, no visualisation of the implant or of the petrosal bones could be realised on MRI because of the interactive technology and the magnet artefact. In contrast, an excellent evaluability of the implant itself as well as of the surrounding neurovascular structures (sinus sigmoideus, skull base, middle ear, inner ear, inner auditory canal) was exhibited in both the CT and in the CBCT. Conclusion The Bonebridge can be excellently imaged with the radiological imaging technologies of CT and CBCT. In the process, CBCT shows discrete advantages in comparison with CT. No relevant restrictions in image quality in the evaluation of the bony structures of the petrosal bones could be seen. PMID:24004903

The role of multislice spiral computed tomography in the diagnosis and management of acute facial trauma in patients with multiple injuries.

PubMed

Nemsadze, G; Urushadze, O

2011-11-01

Using of mutislice spiral CT as first line examination for the diagnosis of Acute Facial trauma in the setting of Polytrauma reduces both: valuable time and cost of patient treatment. After a brief clinical examination, MDCT was performed depending on the area of injury, using a slice thickness of 0.65 mm. The obtained data were analyzed using 3D, MIP and Standard axial with Bone reconstruction protocols. 64 polytrauma patients were evaluated with both Anterior and Lateral craniography (plain skull X ray: AP and Lateral) and Multi Slice CT. Craniography detected only 18 cases of traumatic injuries of facial bones, but exact range of dislocation and accurate management plan could not be established. In the same 64 cases, Multislice CT revealed localization of all existed fractures, range of fragment dislocation, soft tissue damage and status of Paranasal sinus in 62 cases (96.8%). In two cases MS CT missed the facial fracture, in one case the examination was complicated because of bone thinness and numerous fracture fragments, in another multiple foreign body artifacts complicated the investigation. The study results show that, CT investigation based on our MDCT polytrauma protocol, detects all more or less serious facial bone injuries.

[Sinus tarsi approach combined with medial distraction technique for treatment of intra-articular calcaneus fractures].

PubMed

Zhou, Haichao; Ren, Haoyang; Li, Bing; Yu, Tao; Yang, Yunfeng

2016-07-08

?To discuss the effectiveness of limited open reduction via sinus tarsi approach using medial distraction technique in the treatment of intra-articular calcaneus fractures by comparing with open reduction and internal fixation via extensile L-shaped incision. ?A retrospective analysis was made on the clinical data of 21 patients with intra-articular calcaneus fractures treated by sinus tarsi approach combined with medial distraction technique between April 2013 and November 2014 (minimally invasive group), and 32 patients treated by extensile L-shaped incision approach between June 2012 and September 2014 (extensile incision group). No significant difference was found in gender, age, injury pattern, fracture classification, time from injury to operation, preoperative Böhler angle, Gissane angle, calcaneal varus angle, the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and visual analogue scale (VAS) score between 2 groups (P>0.05), which was comparable. The operation time, wound complications, and bone healing time were recorded. The postoperative function was also evaluated by AOFAS score and VAS score. The pre-and post-operative Böhler angle, Gissane angle, and calcaneal varus angle were measured on the X-ray films, and the corrective angle was calculated. ?Sixteen patients were followed up 6-18 months (mean, 11.5 months) in the minimally invasive group, and 23 patients for 6-24 months (mean, 13.5 months) in the extensile incision group. Difference was not significant in operation time between 2 groups (t=0.929, P=0.796). No complication occurred in the minimally invasive group; partial skin flap necrosis occurred in 3 cases of the extensile incision group, was cured after dressing change. There was no loosening of implants or reduction loss in 2 groups at last follow-up. Subtalar joint stiffness occurred in 1 case of the minimally invasive group and 4 cases of the extensile incision group, and 1 patient had discomfort for the implants in the extensile incision group. The bone healing time was (9.9±0.8) weeks in the minimally invasive group, and was (10.1±0.7) weeks in the extensile incision group, showing no significant difference (t=0.613, P=0.845 ). Böhler angle, Gissane angle, calcaneal varus angle, AOFAS score, and VAS score were significantly improved at last follow-up when compared with preoperative values in 2 groups (P<0.05), but there was no significant difference between 2 groups (P>0.05), and the corrective value of angle showed no significant difference between 2 groups (P>0.05). ?Limited open reduction via sinus tarsi approach for intra-articular calcaneus fractures could reduce the incidence of wound complications effectively. Meanwhile, the medial distraction technique is helpful to correct the heel varus deformity.

Gorham-Stout syndrome of the facial bones: a review of pathogenesis and treatment modalities and report of a case with a rare cutaneous manifestations.

PubMed

Al-Jamali, Jamil; Glaum, Ricarda; Kassem, Ahmed; Voss, Pit Jacob; Schmelzeisen, Rainer; Schön, Ralf

2012-12-01

Gorham disease is a very rare condition associated with spontaneous destruction and resorption of 1 or more bones anywhere in the body. Many authors have suggested and/or implicated trauma as the initiating factor in the majority of the reported cases. It can affect almost all bones, and a combination of bones has been reported. In the maxillofacial skeleton, the first facial case was reported by Romer in 1928. Until now, only a few cases of Gorham disease affecting the maxillofacial bones, including this case report, have been reported. We present a brief review of the pathogenesis and treatment modalities of the disease and report a very rare clinical picture of the disease affecting a young and otherwise healthy patient with massive osteolysis of the mandibular bone and extensive involvement of the mouth floor and skin of the chin, which to our knowledge, is the only case report with skin manifestation affecting the maxillofacial region. Such skin manifestations play an important role for the diagnosis and add a clue for management of such condition. Copyright © 2012 Elsevier Inc. All rights reserved.

One-stage tooth-borne distraction versus two stage bone-borne distraction in surgically assisted maxillary expansion (SARME).

PubMed

Seeberger, Robin; Abe-Nickler, Dorothee; Hoffmann, Jürgen; Kunzmann, Kevin; Zingler, Sebastian

2015-12-01

To evaluate and compare the effects of tooth-borne and bone-borne distraction devices in surgically assisted maxillary expansion (SARME) on dental and skeletal structures. A sample of 33 skeletally mature patients with transverse maxillary deficiencies was examined with cone beam computed tomography (CBCT) before and 3 months after surgery. Fourteen patients were treated with tooth-borne devices and 19 patients with bone-borne devices. Dental crown expansion in the first premolars did not differ significantly between the two groups, and median expansion was 5.55 mm (interquartile range [IQR] 5.23) in the tooth-borne device group and 4.6 mm (IQR 3.4) in the bone-borne device group. In the first molars, crown expansion and lateral tipping were significantly greater in the tooth-borne device group (P ≤ .02). The median skeletal nasal isthmus increase was significantly more in the bone-borne device group at 3.0 mm than in the tooth-borne device group at 0.98 mm (P ≤ .02). Both tooth-borne and bone-borne devices are effective treatment modalities to correct maxillary transverse deficiencies. Bone-borne devices produced greater widening of the skeletal nasal floor and fewer dental side effects in the first molars. Copyright © 2015 Elsevier Inc. All rights reserved.

Gel-Sinuplasty for Chronic Rhinosinusitis With and Without Nasal Polyposis

ClinicalTrials.gov

2018-03-13

Chronic Sinusitis, Ethmoidal; Chronic Sinusitis - Ethmoidal Anterior; Chronic Sinusitis; Chronic Sinusitis - Ethmoidal, Posterior; Chronic Sinusitis, Sphenoidal; Chronic Sinusitis - Frontoethmoidal; Nasal Polyps; Nasal Polyp - Posterior

Clinical outcomes of an osteotome technique and simultaneous placement of Neoss implants in the posterior maxilla.

PubMed

Volpe, Stefano; Lanza, Massimiliano; Verrocchi, Damiano; Sennerby, Lars

2013-02-01

Insufficient bone volume often hamper placement of dental implants in the posterior maxilla. The aim of the present clinical study was to evaluate retrospectively the clinical outcome of implant placement in the resorbed posterior maxilla using an osteotome technique without adding any grafting material. Twenty patients with 5 to 9 mm of residual alveolar bone height in the posterior maxilla received twenty-nine implants (Neoss Ltd., Harrogate, UK) using an osteotomy technique without bone grafts. Intraoral radiographs were taken before and after implant placement, at the time of loading and after 11 to 32 months of loading (mean 16.4 months), to evaluate bone formation below the sinus membrane and marginal bone loss. Implant stability measurements (Osstell(TM) , Gothenburg, Sweden) were performed after implant installation and at abutment connection 5 months later. All implants were installed with the prosthetic platform level with the bone crest. No implant was lost giving a survival rate of 100% after a mean follow-up time of 16.4 months. The average vertical bone height was 7.2 ± 1.5 mm at placement and 10.0 ± 1.0 mm after 11 to 32 months. The average increase of 2.8 ± 1.1 mm was statistically significant. There was a statistically significant improvement in implant stability from 70.7 ± 9.2 implant stability quotient (ISQ) at placement to 76.7 ± 5.7 ISQ at abutment connection, 5 months later. The mean marginal bone loss amounted to 0.7 ± 0.3 mm after 11 to 32 months of loading. It is concluded that the osteotome technique evaluated resulted in predictable intrasinus bone formation, firm implant stability, and good clinical outcomes as no implants were lost and minimal marginal bone loss was observed. © 2011 Wiley Periodicals, Inc.

Haziness in X-Ray Paranasal Sinus Water's View in Sinusitis: A Fact or Fiction.

PubMed

Gujrathi, Aatish; Wakode, P T

2013-08-01

It is a clinical dilemma whether patients having no symptoms of sinusitis but sinus haziness in X-ray should be considered as sinusitis or not and patients clinically having sinusitis and do not have radiological evidence should be considered as case of sinusitis or not. This study is an attempt to discuss this issue in details. To study diagnostic efficacy of conventional X-ray para nasal sinus water's view in sinusitis. To study the proportion of asymptomatic individuals showing haziness in conventional X-ray para nasal sinus water's view. Sensitivity and specificity of sinus X-ray in combination (conventional + digital) is 95 and 44%, respectively. Proportion of asymptomatic individuals showing haziness in conventional X-ray and digital X-ray paranasal sinus water's view are 52.4 and 75%, respectively. X-ray paranasal sinus water's view undoubtedly yields valuable information regarding sinus pathology. However it should not be accepted as a diagnosis in itself, but considered in the light of patient's history and clinical findings.

Cardiac Iodine-123-Meta-Iodo-Benzylguanidine Uptake in Carotid Sinus Hypersensitivity.

PubMed

Tan, Maw Pin; Murray, Alan; Hawkins, Terry; Chadwick, Thomas J; Kerr, Simon R J; Parry, Steve W

2015-01-01

Carotid sinus syndrome is the association of carotid sinus hypersensitivity with syncope, unexplained falls and drop attacks in generally older people. We evaluated cardiac sympathetic innervation in this disorder in individuals with carotid sinus syndrome, asymptomatic carotid sinus hypersensitivity and controls without carotid sinus hypersensitivity. Consecutive patients diagnosed with carotid sinus syndrome at a specialist falls and syncope unit were recruited. Asymptomatic carotid sinus hypersensitivity and non-carotid sinus hypersensitivity control participants recruited from a community-dwelling cohort. Cardiac sympathetic innervation was determined using Iodine-123-metaiodobenzylguanidine (123-I-MIBG) scanning. Heart to mediastinal uptake ratio (H:M) were determined for early and late uptake on planar scintigraphy at 20 minutes and 3 hours following intravenous injection of 123-I-MIBG. Forty-two subjects: carotid sinus syndrome (n = 21), asymptomatic carotid sinus hypersensitivity (n = 12) and no carotid sinus hypersensitivity (n = 9) were included. Compared to the non- carotid sinus hypersensitivity control group, the carotid sinus syndrome group had significantly higher early H:M (estimated mean difference, B = 0.40; 95% confidence interval, CI = 0.13 to 0.67, p = 0.005) and late H:M (B = 0.32; 95%CI = 0.03 to 0.62, p = 0.032). There was, however, no significant difference in early H:M (p = 0.326) or late H:M (p = 0.351) between the asymptomatic carotid sinus hypersensitivity group and non- carotid sinus hypersensitivity controls. Cardiac sympathetic neuronal activity is increased relative to age-matched controls in individuals with carotid sinus syndrome but not those with asymptomatic carotid sinus hypersensitivity. Blood pressure and heart rate measurements alone may therefore represent an over simplification in the assessment for carotid sinus syndrome and the relative increase in cardiac sympathetic innervation provides additional clues to understanding the mechanisms behind the symptomatic presentation of carotid sinus hypersensitivity.

How to get into bones: proton pump and carbonic anhydrase in Osedax boneworms

PubMed Central

Tresguerres, Martin; Katz, Sigrid; Rouse, Greg W.

2013-01-01

Osedax are gutless siboglinid worms that thrive on vertebrate bones lying on the ocean floor, mainly those of whales. The posterior body of female Osedax penetrates into the bone forming extensions known as ‘roots’, which host heterotrophic symbiotic bacteria in bacteriocytes beneath the epidermis. The Osedax root epithelium presumably absorbs bone collagen and/or lipids, which are metabolized by the symbiotic bacteria that in turn serve for Osedax's nutrition. Here, we show that Osedax roots express extremely high amounts of vacuolar-H+-ATPase (VHA), which is located in the apical membrane and in cytoplasmic vesicles of root and ovisac epithelial cells. The enzyme carbonic anhydrase (CA), which catalyses the hydration of CO2 into H+ and HCO3−, is also expressed in roots and throughout Osedax body. These results suggest Osedax roots have massive acid-secreting capacity via VHA, fuelled by H+ derived from the CA-catalysed hydration of CO2 produced by aerobic metabolism. We propose the secreted acid dissolves the bone carbonate matrix to then allow the absorption of bone-derived nutrients across the skin. In an exciting example of convergent evolution, this model for acid secretion is remarkably similar to mammalian osteoclast cells. However, while osteoclasts dissolve bone for repairing and remodelling, the Osedax root epithelium secretes acid to dissolve foreign bone to access nutrients. PMID:23760644

Sinuses / Sinusitis / Rhinosinusitis

MedlinePlus

... Primary Immunodeficiency Disease Related Conditions Drug Guide Conditions Dictionary Just for Kids Library School Tools Videos Virtual ... Search AAAAI Breadcrumb navigation Home ▸ Conditions & Treatments ▸ Conditions Dictionary ▸ Sinuses|Sinusitis|Rhinosinusitis Share | Sinuses | Sinusitis | Rhinosinusitis « Back ...

Intraoperative cone-beam computed tomography and multi-slice computed tomography in temporal bone imaging for surgical treatment.

PubMed

Erovic, Boban M; Chan, Harley H L; Daly, Michael J; Pothier, David D; Yu, Eugene; Coulson, Chris; Lai, Philip; Irish, Jonathan C

2014-01-01

Conventional computed tomography (CT) imaging is the standard imaging technique for temporal bone diseases, whereas cone-beam CT (CBCT) imaging is a very fast imaging tool with a significant less radiation dose compared with conventional CT. We hypothesize that a system for intraoperative cone-beam CT provides comparable image quality to diagnostic CT for identifying temporal bone anatomical landmarks in cadaveric specimens. Cross-sectional study. University tertiary care facility. Twenty cadaveric temporal bones were affixed into a head phantom and scanned with both a prototype cone-beam CT C-arm and multislice helical CT. Imaging performance was evaluated by 3 otologic surgeons and 1 head and neck radiologist. Participants were presented images in a randomized order and completed landmark identification questionnaires covering 21 structures. CBCT and multislice CT have comparable performance in identifying temporal structures. Three otologic surgeons indicated that CBCT provided statistically equivalent performance for 19 of 21 landmarks, with CBCT superior to CT for the chorda tympani and inferior for the crura of the stapes. Subgroup analysis showed that CBCT performed superiorly for temporal bone structures compared with CT. The radiologist rated CBCT and CT as statistically equivalent for 18 of 21 landmarks, with CT superior to CBCT for the crura of stapes, chorda tympani, and sigmoid sinus. CBCT provides comparable image quality to conventional CT for temporal bone anatomical sites in cadaveric specimens. Clinical applications of low-dose CBCT imaging in surgical planning, intraoperative guidance, and postoperative assessment are promising but require further investigation.

Analysis of complications following augmentation with cancellous block allografts.

PubMed

Chaushu, Gavriel; Mardinger, Ofer; Peleg, Michael; Ghelfan, Oded; Nissan, Joseph

2010-12-01

Bone grafting may be associated with soft and hard tissue complications. Recipient site complications encountered using cancellous block allografts for ridge augmentation are analyzed. A total of 101 consecutive patients (62 females and 39 males; mean age 44 ± 17 years) were treated with implant-supported restoration of 137 severe atrophic alveolar ridges augmented with cancellous bone-block allografts. Alveolar ridge deficiency locations were classified as anterior maxilla (n = 58); posterior maxilla (n = 32 sinuses); posterior mandible (n = 32); and anterior mandible (n = 15). A total of 271 rough-surface implants were placed. Recipient site complications associated with block grafting (infection, membrane exposure, incision line opening, perforation of mucosa over the grafted bone, partial graft failure, total graft failure, and implant failure) were recorded. Partial and total bone-block graft failure occurred in 10 (7%) and 11 (8%) of 137 augmented sites, respectively. Implant failure rate was 12 (4.4%) of 271. Soft tissue complications included membrane exposure (42 [30.7%] of 137); incision line opening (41 [30%] of 137); and perforation of the mucosa over the grafted bone (19 [14%] of 137). Infection of the grafted site occurred in 18 (13%) of 137 bone blocks. Alveolar ridge deficiency location had a statistically significant effect on the outcome of recipient site complications. More complications were noted in the mandible compared to the maxilla. Age and gender had no statistically significant effect. Failures caused by complications were rarely noted in association with cancellous block grafting. The incidence of complications in the mandible was significantly higher. Soft tissue complications do not necessarily result in total loss of cancellous block allograft.

Automatic partitioning of head CTA for enabling segmentation

NASA Astrophysics Data System (ADS)

Suryanarayanan, Srikanth; Mullick, Rakesh; Mallya, Yogish; Kamath, Vidya; Nagaraj, Nithin

2004-05-01

Radiologists perform a CT Angiography procedure to examine vascular structures and associated pathologies such as aneurysms. Volume rendering is used to exploit volumetric capabilities of CT that provides complete interactive 3-D visualization. However, bone forms an occluding structure and must be segmented out. The anatomical complexity of the head creates a major challenge in the segmentation of bone and vessel. An analysis of the head volume reveals varying spatial relationships between vessel and bone that can be separated into three sub-volumes: "proximal", "middle", and "distal". The "proximal" and "distal" sub-volumes contain good spatial separation between bone and vessel (carotid referenced here). Bone and vessel appear contiguous in the "middle" partition that remains the most challenging region for segmentation. The partition algorithm is used to automatically identify these partition locations so that different segmentation methods can be developed for each sub-volume. The partition locations are computed using bone, image entropy, and sinus profiles along with a rule-based method. The algorithm is validated on 21 cases (varying volume sizes, resolution, clinical sites, pathologies) using ground truth identified visually. The algorithm is also computationally efficient, processing a 500+ slice volume in 6 seconds (an impressive 0.01 seconds / slice) that makes it an attractive algorithm for pre-processing large volumes. The partition algorithm is integrated into the segmentation workflow. Fast and simple algorithms are implemented for processing the "proximal" and "distal" partitions. Complex methods are restricted to only the "middle" partition. The partitionenabled segmentation has been successfully tested and results are shown from multiple cases.

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.

[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.

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.

Management and treatment of sinonasal inverted papilloma

PubMed Central

Ungari, Claudio; Riccardi, Emiliano; Reale, Gabriele; Agrillo, Alessandro; Rinna, Claudio; Mitro, Valeria; Filiaci, Fabio

2015-01-01

Summary Aims The aim of this paper is to describe the surgical experience of 35 patients with Inverted Papilloma (IP) of paranasal sinuses and its recurrence rate after a year of follow-up. Materials A retrospective chart review was performed on patients presenting with IP of paranasal sinuses. Thirty-five patients comprised the focus of this study. For all patients was performed a pre-surgery TC, and for more 5 patients it was necessary to perform a Magnetic Resonance (MR) with gadolinium. Results Among 35 patients selected, 18 patients underwent to open surgery, 4 patients had a combined approach with endoscopy and open surgery, while 13 patients were managed only with an endoscopic approach, with a minimum of 1 year of follow-up. Our results highlighted that the global percentage of success 12 months after the treatment was 93% and it not vary according to the tipology of the approach used if a radical excision of the lesion is achieved. More in depth, among 35 cases, only 2 patients were found to have recurrences and were treated with coronal and endoscopic approach. Conclusion It is fundamental to underline that surgery must be carried on in a radical manner to treat these tend to recur. A complete removal of the lesion and bone peripheral border filing are essential to perform a correct and definitive treatment. Also, endoscopic approach can be taken into account when tumors are localized median to a sagittal plan crossing the orbit median wall and when they did not massively compromised paranasal sinus walls. PMID:26941894

Plain Language Summary: Adult Sinusitis (Sinus Infection).

PubMed

Caspersen, Leslie A; Walter, Lindsey M; Walsh, Sandra A; Rosenfeld, Richard M; Piccirillo, Jay F

2015-08-01

This plain language summary serves as an overview in explaining sinusitis (pronounced sign-you-side-tis). The purpose of this plain language summary is to provide patients with standard language explaining their condition in an easy-to-read format. This summary applies to those 18 years of age or older with sinusitis. The summary is featured as an FAQ (frequently asked question) format. The summary addresses how to manage and treat sinusitis symptoms. Adult sinusitis is often called a sinus infection. A healthcare provider may refer to a sinus infection as rhinosinusitis (pronounced rhi-no-sign-you-side-tis). This includes the nose as well as the sinuses in the name. A sinus infection is the swelling of the sinuses and nasal cavity.The summary is based on the published 2015 "Clinical Practice Guideline: Adult Sinusitis." The evidence-based guideline includes research to support more effective diagnosis and treatment of adult sinus infections. The guideline was developed as a quality improvement opportunity for managing sinus infections by creating clear recommendations to use in medical practice. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Olfactory Training in Improving Sense of Smell After Radiation Therapy in Patients With Paranasal Sinus or Nasopharyngeal Cancer

ClinicalTrials.gov

2017-07-11

Stage 0 Nasopharyngeal Carcinoma; Stage 0 Paranasal Sinus Cancer; Stage I Nasopharyngeal Carcinoma; Stage I Paranasal Sinus Cancer; Stage II Nasopharyngeal Carcinoma; Stage II Paranasal Sinus Cancer; Stage IIA Nasopharyngeal Carcinoma; Stage IIB Nasopharyngeal Carcinoma; Stage III Nasopharyngeal Carcinoma; Stage III Paranasal Sinus Cancer; Stage IV Nasopharyngeal Carcinoma; Stage IV Paranasal Sinus Cancer; Stage IVA Nasopharyngeal Carcinoma; Stage IVA Paranasal Sinus Cancer; Stage IVB Nasopharyngeal Carcinoma; Stage IVB Paranasal Sinus Cancer; Stage IVC Nasopharyngeal Carcinoma; Stage IVC Paranasal Sinus Cancer

Temporal lobe sulcal pattern and the bony impressions in the middle cranial fossa: the case of the el Sidrón (Spain) neandertal sample.

PubMed

Rosas, Antonio; Peña-Melián, Angel; García-Tabernero, Antonio; Bastir, Markus; De La Rasilla, Marco

2014-12-01

Correspondence between temporal lobe sulcal pattern and bony impressions on the middle cranial fossae (MCF) was analyzed. MCF bone remains (SD-359, SD-315, and SD-1219) from the El Sidrón (Spain) neandertal site are analyzed in this context. Direct comparison of the soft and hard tissues from the same individual was studied by means of: 1) dissection of two human heads; 2) optic (white light) surface scans; 3) computed tomography and magnetic resonance of the same head. The inferior temporal sulcus and gyrus are the features most strongly influencing MCF bone surface. The Superior temporal sulcus and middle temporal and fusiform gyri also leave imprints. Temporal lobe form differs between Homo sapiens and neandertals. A wider and larger post-arcuate fossa (posterior limit of Brodmann area 20 and the anterior portion of area 37) is present in modern humans as compared to neandertals. However other traits of the MCF surface are similar in these two large-brained human groups. A conspicuous variation is appreciated in the more vertical location of the inferior temporal gyrus in H. sapiens. In parallel, structures of the lower surface of the temporal lobe are more sagittally orientated. Grooves accommodating the fusiform and the lower temporal sulci become grossly parallel to the temporal squama. These differences can be understood within the context of a supero-lateral deployment of the lobe in H. sapiens, a pattern previously identified (Bastir et al., Nat Commun 2 (2011) 588-595). Regarding dural sinus pattern, a higher incidence of petrosquamous sinus is detected in neandertal samples. © 2014 Wiley Periodicals, Inc.

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.

The influence of diet consistence, drinking water and bedding on periodontal disease in Sprague-Dawley rats.

PubMed

Björnsson, Magnús Jón; Velschow, Sten; Stoltze, Kaj; Havemose-Poulsen, Anne; Schou, Søren; Holmstrup, Palle

2003-12-01

Although rats have been extensively used in periodontal research, pre-experimental periodontal inspection has not been given high priority in previous studies of experimental periodontal disease in rats. An inspection of 50 Sprague-Dawley rats, which were to be used in a model of experimental periodontal disease, revealed signs of periodontal disease in a considerable proportion of the animals. The objectives of the present study were to describe disease progression, identify factors responsible for induction of periodontal disease and test a method for breeding of healthy rats. A longitudinal study revealed that 33% of rats, bred under the same conditions, showed signs of periodontal disease during, or shortly after, eruption of the molars. Regular diet caused significantly more horizontal bone loss (P = 0.0001) and significantly less periodontal bone support (P < 0.0001) than the same kind of diet with a smaller grain size. Wood chip bedding in the rats' cages significantly reduced periodontal bone support (P < 0.0001) compared to a wire mesh floor and a simultaneous use of regular diet and bedding decreased it even further (P = 0.0023). Finally, by using finely milled diet, a wire mesh floor and tap water, instead of conventional breeding methods of regular diet, bedding and acidic water, it was possible to breed rats with minimal signs of periodontal disease. The results of the present study emphasize the need for pre- experimental examination of rats. They also show that diet and bedding conditions have the potential of seriously influencing outcomes of studies of periodontal disease in rats.

Modified Graded Repair of Cerebrospinal Fluid Leaks in Endoscopic Endonasal Transsphenoidal Surgery

PubMed Central

Park, Jae-Hyun; Choi, Jai Ho; Kim, Young-Il; Kim, Sung Won

2015-01-01

Objective Complete sellar floor reconstruction is critical to avoid postoperative cerebrospinal fluid (CSF) leakage during transsphenoidal surgery. Recently, the pedicled nasoseptal flap has undergone many modifications and eventually proved to be valuable and efficient. However, using these nasoseptal flaps in all patients who undergo transsphenoidal surgery, including those who had none or only minor CSF leakage, appears to be overly invasive and time-consuming. Methods Patients undergoing endoscopic endonasal transsphenoidal tumor surgery within a 5 year-period were reviewed. Since 2009, we classified the intraoperative CSF leakage into grades from 0 to 3. Sellar floor reconstruction was tailored to each leak grade. We did not use any tissue grafts such as abdominal fat and did not include any procedures of CSF diversions such as lumbar drainage. Results Among 200 cases in 188 patients (147 pituitary adenoma and 41 other pathologies), intraoperative CSF leakage was observed in 27.4% of 197 cases : 14.7% Grade 1, 4.6% Grade 2a, 3.0% Grade 2b, and 5.1% Grade 3. Postoperative CSF leakage was observed in none of the cases. Septal bone buttress was used for Grade 1 to 3 leakages instead of any other foreign materials. Pedicled nasoseptal flap was used for Grades 2b and 3 leakages. Unused septal bones and nasoseptal flaps were repositioned. Conclusion Modified classification of intraoperative CSF leaks and tailored repair technique in a multilayered fashion using an en-bloc harvested septal bone and vascularized nasoseptal flaps is an effective and reliable method for the prevention of postoperative CSF leaks. PMID:26279811

Blast effect on the lower extremities and its mitigation: a computational study.

PubMed

Dong, Liqiang; Zhu, Feng; Jin, Xin; Suresh, Mahi; Jiang, Binhui; Sevagan, Gopinath; Cai, Yun; Li, Guangyao; Yang, King H

2013-12-01

A series of computational studies were performed to investigate the response of the lower extremities of mounted soldiers under landmine detonation. A numerical human body model newly developed at Wayne State University was used to simulate two types of experimental studies and the model predictions were validated against test data in terms of the tibia axial force as well as bone fracture pattern. Based on the validated model, the minimum axial force causing tibia facture was found. Then a series of parametric studies was conducted to determine the critical velocity (peak velocity of the floor plate) causing tibia fracture at different upper/lower leg angles. In addition, to limit the load transmission through the vehicular floor, two types of energy absorbing materials, namely IMPAXX(®) foam and aluminum alloy honeycomb, were selected for floor matting. Their performances in terms of blast effect mitigation were compared using the validated numerical model, and it has been found that honeycomb is a more efficient material for blast injury prevention under the loading conditions studied. © 2013 Elsevier Ltd. All rights reserved.

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.

The reverse sural artery fasciomusculocutaneous flap for small lower-limb defects: the use of the gastrocnemius muscle cuff as a plug for small bony defects following debridement of infected/necrotic bone.

PubMed

Al-Qattan, M M

2007-09-01

The reverse sural artery fasciomusculocutaneous flap is a modification of the original fasciocutaneous flap in which a midline gastrocnemius muscle cuff around the buried sural pedicle is included in the flap. This modification was done to improve the blood supply of the distal part of the flap, which is harvested from the upper leg. The aim of this paper is to demonstrate that there is another important advantage of the modified flap: the use of the muscle cuff as a "plug" for small lower limb defects following debridement of infected/necrotic bone. A total of 10 male adult patients with small complex lower-limb defects with underlying bone pathology were treated with the modified flap using the muscle component to fill up the small bony defects. The bony pathology included necrotic exposed bone without evidence of osteomyelitis or wound infection (n = 1), an underlying neglected tibial fracture with wound infection (n = 4), and a sinus at the heel with underlying calcaneal osteomyelitis (n = 5). Primary wound healing of the flap into the defect was noted in all patients. No recurrence of calcaneal osteomyelitis was seen and all tibial fractures united following appropriate orthopedic fixation. It was concluded that the reverse sural artery fasciomusculocutaneous flap is well suited for small complex lower-limb defects with underlying bone pathology.

Intra-temporal facial nerve centerline segmentation for navigated temporal bone surgery

NASA Astrophysics Data System (ADS)

Voormolen, Eduard H. J.; van Stralen, Marijn; Woerdeman, Peter A.; Pluim, Josien P. W.; Noordmans, Herke J.; Regli, Luca; Berkelbach van der Sprenkel, Jan W.; Viergever, Max A.

2011-03-01

Approaches through the temporal bone require surgeons to drill away bone to expose a target skull base lesion while evading vital structures contained within it, such as the sigmoid sinus, jugular bulb, and facial nerve. We hypothesize that an augmented neuronavigation system that continuously calculates the distance to these structures and warns if the surgeon drills too close, will aid in making safe surgical approaches. Contemporary image guidance systems are lacking an automated method to segment the inhomogeneous and complexly curved facial nerve. Therefore, we developed a segmentation method to delineate the intra-temporal facial nerve centerline from clinically available temporal bone CT images semi-automatically. Our method requires the user to provide the start- and end-point of the facial nerve in a patient's CT scan, after which it iteratively matches an active appearance model based on the shape and texture of forty facial nerves. Its performance was evaluated on 20 patients by comparison to our gold standard: manually segmented facial nerve centerlines. Our segmentation method delineates facial nerve centerlines with a maximum error along its whole trajectory of 0.40+/-0.20 mm (mean+/-standard deviation). These results demonstrate that our model-based segmentation method can robustly segment facial nerve centerlines. Next, we can investigate whether integration of this automated facial nerve delineation with a distance calculating neuronavigation interface results in a system that can adequately warn surgeons during temporal bone drilling, and effectively diminishes risks of iatrogenic facial nerve palsy.

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

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.

Cushing's disease due to mixed pituitary adenoma-gangliocytoma of the posterior pituitary gland presenting with Aspergillus sp. sinus infection.

PubMed

Bridenstine, Mark; Kerr, Janice M; Lillehei, Kevin O; Kleinschmidt-DeMasters, Bette K

2013-01-01

Gangliocytic lesions of the pituitary gland producing Cushing's disease are extremely rare entities that may exist with or without a pituitary adenoma. The latter have been designated mixed pituitary adenoma-gangliocytomas, the majority of which produce growth hormone, not adrenocorticotropin (ACTH), and are localized to the anterior gland. We now report an immunocompetent woman with hypercortisolism who presented with an intranasal aspergilloma eroding the bony sellar floor. The fungal ball was contiguous with, and extended into, a large neurohypophyseal-centered mass. Transsphenoidal resection revealed a gangliocytic lesion of the posterior gland with small clusters of intimately admixed ACTH-immunoreactive adenoma cells as the cause of her Cushing's disease. Rare transitional sizes and shapes of cells coupled with immunohistochemical findings supported interpretation as advanced neuronal metaplasia within an ACTH adenoma. This mixed ACTH adenoma-gangliocytoma is the first example to present clinically with an opportunistic infection.

An unusual case of orbito-frontal rod fence stab injury with a good outcome.

PubMed

Miscusi, Massimo; Arangio, Paolo; De Martino, Luca; De-Giorgio, Fabio; Cascone, Piero; Raco, Antonino

2013-08-13

High-energy non-missile penetrating injuries (stab injuries) account for a small percentage of penetrating head injuries and they present a series of special features. A 35-year-old man suffered orbito-frontal? and trans-cranial injuries after falling five meters from a terrace onto a rod iron fence. The removal of the metal rod was performed outside the operating room. The orbital roof was exposed and repaired through a bifrontal craniotomy and the frontal sinuses were cranialised. The orbital floor and zygoma were plated with micro-screws. The patient recovered without significant complications, apart from a slight paresis of the right superior rectus; the ocular globe remained intact.The positive outcome obtained in this very challenging case is attributable to the competency of the Neurotrauma Unit and to the use of a synergistic approach which involved the contribution of neurosurgeons, maxillo-facial surgeons, radiologists and anaesthesiologists.