Anterior Wall Of Maxillary Sinus Research Articles

Fungus Ball of the Maxillary Sinus—Modern Treatment by Osteoplastic Approach and Functional Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) is considered standard surgical therapy for fungus ball of the maxillary sinus. However, recent findings have indicated an odontogenic etiology, which requires simultaneous treatment of the dental origin. This study presents the authors' treatment results of fungus ball of the maxillary sinus using a combination of FESS and an endoscopically assisted osteoplastic approach through the anterior wall of the maxillary sinus, enabling simultaneous treatment of the dental origin. A cohort of 22 patients with histopathologically confirmed fungus ball of the maxillary sinus was retrospectively analyzed. Clinical records and medical imaging data were reviewed to evaluate the etiology, clinical and radiologic findings, and postoperative outcome. Only 15 patients presented nonspecific clinical symptoms compatible with chronic unilateral maxillary sinusitis. Computed tomography visualized complete opacity of the maxillary sinus in 11 patients and intralesional hyperdensity in 12 patients. An odontogenic association was verified in 18 patients. Twenty-one patients underwent endoscopically assisted osteoplastic surgery through the anterior maxillary sinus wall. In 12 cases, the assumed persistent odontogenic source was treated simultaneously. Depending on the patency of the ostiomeatal complex, the accompanying chronic sinusitis was treated by FESS. The present data support the assumption of an odontogenic etiology of fungus ball ofthe maxillary sinus. Hence, surgical management requires simultaneous treatment of the fungal mass, the odontogenic origin of the disease, and the accompanying chronic sinusitis. To properly treat fungus ball, the authors present a modern treatment concept, using a minimally invasive endoscopically assisted osteoplastic approach through the anterior maxillary wall, for sufficient and necessary surgical treatment.

Removal of the Residual Roots Displaced Into the Maxillary Sinus via Endoscopy.

Minimally invasive endoscopic surgery has been developed for various indications in the craniomaxillofacial area. The case report presented in this article is focused on the possibility of removing the residual roots displaced into the maxillary sinus by means of an endoscopic technique. When planning endoscopic surgery to access the residual roots displaced in the maxillary sinus, we performed 2 different approaches into the maxillary sinus, a transnasal approach through the middle or inferior turbinate and transoral approach via the anterior maxillary sinus wall. The endoscopic surgical approach described is reliable and minimally invasive for removing the residual roots displaced into the maxillary sinus. Therefore, we concluded that the application of this clinical procedure is worth promoting.

Ectopic Tooth in the Anterior Wall of Maxillary Sinus

AbstractA 16-year-old male patient reported to our department with a chief complaint of pain and swelling in the upper left cheek region. On examination, a maxillary canine was found ectopically in the anterior wall of maxillary sinus. Ectopic eruption of teeth into regions other than the oral cavity is rare. We present one such case of ectopic eruption of maxillary canine.

Depression of the maxillary sinus anterior wall and its influence on panoramic radiography appearance.

To clarify the depression aspect of the maxillary sinus anterior wall and to investigate its relationship with the panoramic image appearance of a diagonal line from the inferior part of the so-called panoramic innominate line to the medial portion of the orbital floor line. Based on CT data, panoramic images were simulated for two typical cases with and without anterior wall depression. Next, on axial CT images of 1689 subjects (3378 sinuses) stored in our image database, the wall depths were measured and analyzed for their relationships with the panoramic appearances of the diagonal line, classified into invisible, obscure and clear patterns. Based on the simulation study, visualization of the diagonal line was verified to alter depending on the morphology of the anterior wall and the position of the panoramic image layer. In 408 (12.1%) sinuses, the diagonal line (clear and obscure patterns) could be seen on the panoramic image. The incidences of the obscure and clear patterns increased with increasing age groups. The mean wall depths were 2.91, 4.80 and 7.28 mm for the invisible, obscure and clear patterns, respectively. The clear pattern showed the highest value for the wall depth, followed by the obscure pattern. The diagonal line on a panoramic image was verified to be related to depression of the maxillary sinus anterior wall, and its panoramic image appearance can be altered depending on the position of the tomographic image layer.

Nasosinusal polyposis revealing maxillary sinus mucocele

Mucocele is a benign pseudo-cyst formation that rarely develops in the maxillary sinus. Mucocele is secondary to various conditions having in common an inflammation and an obstruction of the sinus ostium. The latter may be primary but it is often secondary to a trauma, tumor, chronic inflammation. Diagnosis is based on imaging. CT scan is essential for assessing osseous changes and for planning endonasal surgery under endoscopic control. MRI allows to specify the relations of mucocele. Therapeutic management of these mucoceles should be based on mucocele marsupialization performed at the same time as the treatment of the local factor involved. We report the case of a 21-year old man with no pathological history presenting with bilateral nasal obstruction associated with anosmia. Clinical examination showed exquisite pain in the anterior maxillary sinus wall, bilateral nasal sinus polyposis and swelling at the level of the hard palate. CT scan of the facial skeleton showed a well-defined homogeneous hypodense mass with no enhancement, involving the entire left maxillary sinus associated with regular bone lysis of its walls and a bilateral opacification of ethmoid cells and nasal cavities. The patient underwent endonasal surgery and functional ethmoidectomy associated with intranasal middle meatus antrostomy allowing the marsupialization of the mucocele. The postoperative course was uneventful and not associated with recurrence.

Intrasinus penetration of a silastic malar implant, which resulted in chronic sinusitis: A case report and literature review.

Background:Malar augmentation is a common cosmetic procedure utilizing silastic materials. We describe an uncommon complication of a silastic implant eroding into the anterior maxillary sinus wall resulting in chronic rhinosinusitis (CRS).Methods:A literature review is presented describing the presentation, surgical management and outcome of this uncommon adverse event.Results:An 80 year old female with a history of bilateral cosmetic malar implants placed approximately 25 years ago presented to our office with a 4–5 month history of left-sided symptoms consistent with chronic sinusitis, and was found to have intrasinus penetration of her left malar implant. Only one other case series of 5 cases in 4 patients is reported in the literature.Conclusions:Intrasinus malar implant migration is a rare complication of malar augmentation. The present experience suggests that removal of the offending foreign body often results in successful symptom resolution.

Clinical research on the treatment for benign lesions in maxillary sinus by endoscopic prelacrimal duct recess approach

Objective:To explore thecomplication and clinical effects of treatment for benign lesions in maxillary sinusby endoscopic prelacrimal duct recess approach. Method:A retrospective analysis of 82 patients with benign lesions in maxillary sinus.Among them there were 37 cases of inverted papilloma，45 cases of maxillary cyst. According to surgical approaches，they were divided into observation group in which 39 cases were treated by combined middle meatus and prelacrimal duct recess approachunder endoscope,contrast group1in which 22 cases were treated by combined middle meatus and inferior meatus approach and contrast group 2 in which 21 cases were treated bycombined middle meatus and Caldwell-Luc approach. Operation time, amount of bleeding during operation, length of hospitalization, postoperative complications and postoperative curative effect,were observed, recorded and compared among the three groups．Result:The 82 patiengs were successfully treated by surgery and followed up of 3 months to 24 months.There were no significant difference between observation group and contrast group1 in operation time, amount of bleeding during operation,length of hospitalization（P >0.05）, there were statistical difference in post-operative complicationand recurrence rate(P <0.05).There were statistical difference between observation group and contrast group 2 in operation time, amount of bleeding during operation,length of hospitalization andpost-operative complication(P <0.05),there were no significant difference in recurrence rate(P >0.05).Conclusion:Anterior lacrimal recess with the nasal endoscopyis is useful to the lesions of maxillary sinus anterior wall, anterior lower internal wall, anterior lacrimal recess and alveolar crypt. Theoperation time, bleeding and surgical injuries are less. Patients recover fast with less recurrence. Thus, this method is an idealoperation method to deal with benign diseasesin maxillary sinus.

The study of the effects of maxillary sinus age­specific changes on its resistance to traumatic loads using 3d­modelling

The objective of this research was to study the age­specific features of maxillary sinus anterior wall bone tissue response to the increasing traumatic load. For this purpose the authors used the data of 143 series of spiral computer-aided tomography (SCAT). The data of patients that belonged to 3 age groups: 20­40 years old, 41­60 years old and 61 years old and older were used for the study. Based on the tomographic images the authors made the corresponding 3­D models using “Rhino” web application. The obtained models were used for finite element method (FEM) calculations that allowed for age­specific mechanical properties of bone tissue. The authors calculated the stress-deformed states under the defined load equivalent to 50 and 200 kg (the impact during the operation and trauma respectively), affecting in the area of fossa canina. The modelling was made using “Solid Works 2012” software. The study result has revealed that despite the age-related bone tissue elasticity loss it retains its capacity of resisting the irreversible deformation under the load of 50 kg. This area elasticity loss is observed as early as after the age of 40, it manifests itself in the increase of the stress to the displacement ratio. With aging, the load increase to 200 kg produces fast and extensive destruction of the bone tissue of maxillary sinus anterior wall. It spreads in upper­medial direction. After the age of 60, the same load also produced destruction at the point of direct effect of the traumatic force, in the upper-medial direction from it and along the periphery. It can manifest itself in generation of micro- and macro-fracture of these areas.

Delayed-Onset Methicillin-Resistant Staphylococcus aureus Infection at 18 Months after Absorbable Plate Fixation for Zygomaticomaxillary Complex Fracture.

None of the reports of delayed infection mentioned a latent period exceeding 13 months. we report an infection that developed 18 months after implantation of an absorbable plate. A 16-year-old adolescent girl had undergone reduction and fixation with an absorbable plate for Lefort I and zygomaticomaxillary complex fractures 18 months prior at our hospital. In her most recent hospital visit as an outpatient, abscess was observed in periocular area. Computed tomography revealed sinusitis with an abscess above the infraorbital rim. Wound culture yielded methicillin-resistant Staphylococcus aureus . Despite conservative treatments, wound state did not improve. Therefore, our department decided to perform surgery. Absorbable plate had been mostly absorbed but remained a bit. Bony depression of infraorbital rim and mucosal exposure of maxillary sinus anterior wall were observed. After the surgery, the patient recovered. We believe that the reason the wound infection and sinusitis manifested at the same time is because of several factor such as alcohol abuse, smoking, and mucosal exposure of maxillary sinus anterior wall. Absorbable plate takes 9 months to 3 years to be completely absorbed, thus we suggest studies with a follow-up of at least 3 years be undertaken to determine the outcomes of patients with many risk factors.

Analysis of effect of three under nasal endoscope surgery in the treatment of maxillary sinus cyst

Objective To explore three under nasal endoscope surgery treatment the clinical curative effect of maxillary sinus cyst. Methods 95 cases of maxillary sinus cyst patients were chosen, the maxillary sinus were used respectively to open to expand, the nasal passages of maxillary sinus fenestration and maxillary sinus anterior wall fenestration three types of surgical treatment, postoperative follow-up of 1 year, the clinical curative effect of three kinds of operation method were analyzed. Results The maxillary sinus mouth open expansion of 39 cases during operation, 37 cases were cured,2 cases of recurrence; The nasal passages under the maxillary sinus fenestration 27 cases,26 cases cured,1 case of recurrence; The maxillary sinus anterior wall fenestration 29 cases,29 cases healed; Three kinds of operation cure rate difference had no statistical significance(P>0.05). Conclusion The treatment of maxillary sinus cyst operation should be selected according to the location and size of cysts and whether the various associated withnasal sinuses diseases and other factors determine the. Maxillary sinus cyst neararound the maxillary sinus, sinus cavity lateral wall or with sinus disease can use theostium of maxillary sinus extending open surgery path;near the sinus cavity innerwall and the bottom wall can use windowing of the inferior nasal meatus approach; near the front wall of sinus cavity and large cysts or recurrence can be choice ofmaxillary sinus by fenestration operation path; the purpose is to remove the cystoccurs completely, reduce tissue injury and complications. Key words: Maxillary sinus; Cyst; Fenestration

Reconstruction of Orbital Floor Fractures with Autogenous Bone Graft Application from Anterior Wall of Maxillary Sinus: A Retrospective Study.

Orbital wall fracture implies a situation where disruptions of the walls or floor have occurred. It is a blowout type fracture where bone fragments with torn periosteum are pushed outside of the original bony orbit. There is no intact bone even near the defect area except the thin bone rim surrounding the blowout fracture. The purpose of this defect repair is to support orbital contents, free entrapped tissue, and, especially, restore the original orbital volume. Ten patients (seven males and three females) who underwent repair of orbital floor factures with maxillary sinus bone grafts were included in this study. Surgical procedure for harvesting graft and its fixation was almost same in all operated cases. The collection in the maxillary sinus due to fracture of floor of orbit, blood and bony fragments collected in the maxillary sinus can be easily drained and removed after removal of anterior wall of maxillary sinus and through the same approach you can reduce the floor of orbit manually to the proper position which helps to decease the orbital floor defect.

Fixation of Fractured Anterior Wall of Maxillary Sinus Using Fibrin Glue in a Zygomaticomaxillary Complex Fracture

Zygomaticomaxillary complex (ZMC) fracture occurs commonly, and restorations of facial shape and symmetry by 3-dimensional reduction and ridged fixation are important. A severe ZMC fracture is accompanied by fractures to the anterior wall of maxillary sinus; thus, various complications can occur without appropriate restoration by surgery. Of the patients with ZMC fracture from January 2008 to December 2012, 328 patients underwent surgery. Among them, 234 patients with severe fractures to the anterior wall of the maxillary sinus underwent restoration using fibrin glue (Tisseel; Baxter Healthcare, Norfolk, UK). There were no major side effects in any of the 234 patients in whom Tisseel was used, and the bone fragments were fixed well in their original places according to postoperative CT findings. Grafted bone fragments can be maintained in their original places by fibrin clot layers with Tisseel. Using Tisseel, operation time is reduced, and the bleeding tendency is decreased by reduced shearing force with surrounding tissues and the hemostatic reaction of fibrin. Therefore, it can be concluded that using Tisseel is one effective method for the restoration of fractures on the anterior wall of the maxillary sinus.

Minimal Invasive and Cost-effective Method in Reduction of Maxillofacial Fracture by Using a Foley Catheter Ballooning Technique

The purpose of this study was to introduce 2 successful cases of orbital inferior wall fracture and maxillary sinus anterior wall fracture using the Foley catheter ballooning technique. One patient is a 43-year-old man with left orbital inferior wall fracture. A window on the sinus was made for visualization, and a Foley catheter was accessed through the natural ostium. The ballooned catheter was inflated to lift the inferior orbital wall rim and stationed for 2 weeks. The window was closed using metal plates and screws. Another patient is a 64-year-old woman with right maxillary sinus anterior wall fracture, nasal fracture, and orbital blow-out fracture. A Foley catheter was accessed through the fractured maxillary sinus and reduced into place and fixed with absorbable plates screws. The technique of stabilization of reduced maxillofacial fractures using a Foley balloon catheter with restorable plates and titanium plates showed stable results. This technique is relatively easy to undergo with minimal or no complications because of reduced operation time. Also, it is cost-effective compared with other materials providing similar results and heightens patient satisfaction.

Reduction and Fixation Methods for Fractured Anterior Maxillary Sinus Wall Using Suture Tie

Copyright © 2013 The Korean Cleft Palate-Craniofacial Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. www.e-acfs.org pISSN 2287-1152 eISSN 2287-5603 111 Correspondence: Byung Min Yun Department of Plastic and Reconstructive Surgery, Jeju National University College of Medicine, 102 Jejudaehang-ro, Jeju 690-756, Korea Tel: +82-64-717-1742 / Fax: +82-64-755-6130 / E-mail: almostfree@hanmail.net Received August 26, 2013 / Revised September 24, 2013 / Accepted October 7, 2013 Arch Craniofac Surg Vol.14 No.2, 111-114 http://dx.doi.org/10.7181/acfs.2013.14.2.111

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

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

Transzygomatic Kirschner wire fixation for the treatment of blowout fracture

Total orbital floor reconstruction with sheet-shape materials is available for the treatment of extensive and crushed-type blowout fractures. Simple blowout fractures, on the other hand, require only manual reduction without fixation. Although several types of blowout fractures do not require total reconstruction, some fixation is usually necessary. Eighteen cases of blowout fracture were treated with transzygomatic Kirschner wire fixation between 2002 and 2009. This technique was applied to simple fracture cases in which periorbital soft tissue re-herniated through the floor defect into the maxillary sinus after manual reduction, despite improvement of the extra-ocular muscle entrapment. The wire was used to directly support the fracture segment in five cases and used together with a maxillary sinus anterior wall bone graft in 13 cases. Mean follow-up was 12.5 months. Mild diplopia remained as a subjective symptom in one case. None of the cases developed major complications or conspicuous scars on the cheek. Transzygomatic Kirschner wire fixation for blowout fracture has the advantages of precise and rigid fixation of all parts of the inferior floor, minimal morbidity without requiring an orbital approach and long-term safety without artificial remnants. This technique can be applied for the treatment of simple blowout fractures.

Orbital floor reconstruction in zygomatic-orbital-maxillary fracture with a fractured maxillary sinus wall segment as useful bone graft material

The anterior maxillary sinus wall is a suitable and useful bone donor site for reconstructive bone graft material for blowout fractures in zygomatic-orbital-maxillary complex fracture surgery. A 51-year-old male patient was referred to the Division of Oral and Maxillofacial Surgery of Kagawa Prefectural Central Hospital after slipping down and bumping the right cheek against a rock at a hot spring on the previous night. The patient presented with complaints of diplopia and acute throbbing pain, and had a right midfacial concave deformity. Computed tomography revealed that the right midfacial deformity was due to comminuted fractures of the maxillo-zygomatico-orbital floor, a large orbital bone defect measuring 25mm×28mm, and blowout of the orbital contents, which appeared to be the cause of the diplopia and ophthalmic dysfunction. Clinical examination by an ophthalmologist resulted in diagnoses of diplopia and enophthalmos. Open reduction and internal fixation of the maxillary-zygomatic segment, together with an orbital floor reconstruction with a bone graft taken from the fractured one-piece segment of anterior maxillary sinus wall at the intraoral reduction of the zygomatic-orbital-maxillary segment, were performed via a transconjunctival approach. The postoperative clinical course was successful with good bony reduction of the midface and full recovery of ophthalmological function. Use of the anterior maxillary sinus wall in the operative series of zygomatic-orbital-maxillary complex fracture open reduction surgery may be recommended as an effective and simple reconstruction material, shortening the surgery time for orbital reconstruction.

Transnasal Endoscopic Medial Maxillectomy for Sinonasal Inverted Papilloma

Sinonasal inverted papilloma, an uncommon benign neoplasm, tends to recur and is associated with malignancy. As endoscopic visualization has improved, inverted papilloma has been managed endoscopically through a transnasal approach, with recurrence rate similar to that in extranasal surgery. Transnasal endoscopic medial maxillectomy (TEMM) enables tumors to be removed completely, and lets the nasal cavity be better visualized postoperatively without skin or sublabial incision. Thus preserving the unaffected sinonasal framework, such as the anterior maxillary sinus wall, helps keep recurrent tumors from finding a preformed gateway for invading extranasal tissue. Our analysis of 5 such cases surgically resected with TEMM showed that. All tumors had been extirpated endoscopically and no recurrence was observed in follow-up. We find TEMM to be efficacious in treating inverted papilloma. Avoiding possible complications requires appropriate experience in endoscopic sinus surgery, and long-term follow-up is crucial to reporting long-term results.

Central Giant Cell Granuloma of the Jaws

Central giant cell granuloma was classified by the World Health Organization in 2005 as a rarely aggressive idiopathic benign intraosseous lesion that occurs almost exclusively in the jaws. It occurs most frequently in young women (aged <30 y). This osteolytic lesion histologically consists of proliferation of fibrous tissue, hemorrhagic focuses, hemosiderin deposits, osteoclast-like giant cells, and reactive bone formation. Differential diagnosis has to be made with other osteolytic neoformations of the jaws, both unicystic and multicystic (odontogenic tumors, fibrous dysplasia, cysts, etc). From 2002 to 2008, we surgically treated 8 cases of giant cell granuloma. Our article focuses on a 59-year-old woman who came to our department with a swelling on the right side of the face. Computed tomography examination showed an osteolytic and expansive neoformation spreading up from the lateral wall of the nose to the anterior wall of maxillary sinus and above up to the inferior margin of the eye socket. Besides, it was contiguous to the canine root apex, the first and second bicuspids. Intraoral incisional biopsy confirmed the histologic picture of central giant cell granuloma. After a few days, she underwent surgical excision of the neoformation, preserving the lateral wall of the nose, the anterior wall of maxillary sinus, the eye socket, and the dental elements, respectively. Results of the histopathologic examination confirmed the previous biopsy. A follow-up at 30 months excluded any relapse.

Endoscopic transantral repair of orbital floor fractures

Objective To review our technique of endoscopic transantral repair of orbital floor fractures. Study Design Case series with chart review. Methods All orbital floor fractures treated with the outlined technique from 1998 to 2007 were reviewed in a retrospective fashion. Demographic data, surgical outcomes, and complications were gathered from available patient charts. Results A total of 63 patients were treated with the described technique (44 male, 19 female). Thirty-nine patients underwent autograft placement from the anterior maxillary sinus wall harvest/exposure. Fourteen patients underwent placement of various alloplasts, and the remaining 10 patients underwent reduction of the contents and floor repositioning. Two patients underwent repeat repair due to inadequacy of initial repair. Both of these complications occurred in the subgroup of patients who underwent simple repositioning. There were no cases of blindness, permanent new diplopia, ectropion, entropion, or new infraorbital anesthesia. Conclusions The described technique of endoscopic repair of orbital floor fractures represents a precise method of fracture repair that results in excellent outcomes with minimal morbidity in the majority of patients. It allows for immediate fracture repair without the need to wait for periorbital edema to settle. It also allows for clear visualization of the entire fracture for precise graft placement.