Bilateral Sinus Research Articles

Prognosticators of Optic Nerve Imaging in Malignant Pseudotumor Cerebri Syndrome.

Pseudotumor cerebri (PTC) syndrome is a disorder of increased intracranial pressure, most commonly affecting overweight women of childbearing age. Malignant PTC (MPTC) is a rare presentation that involves rapidly worsening vision, often necessitating surgical intervention to prevent permanent vision loss. The goal of this study was to determine whether radiographic findings of PTC are predictive of MPTC and the final visual outcome. Charts of patients diagnosed with PTC based on the modified Dandy criteria were reviewed. Snellen best-corrected visual acuity (BCVA), automated perimetry mean deviation (APMD), and papilledema grade were documented from the initial and final follow-up examinations. The MRI images were read by 2 neuroradiologists blinded to the clinical diagnosis, and consensus findings were obtained. The patients were classified into malignant and nonmalignant PTC groups. Malignant was defined as BCVA ≤ 20/200 or APMD ≤ -7 dB, and acute onset of symptoms. The sensitivity and specificity of each MRI finding for detecting MPTC was determined. Generalized linear model with random effect and backward model selection was performed to identify which radiographic findings were predictive of final BCVA, APMD, and papilledema grade. Overall, 114 eyes (57 malignant/57 nonmalignant) were included. No MRI finding has both sensitivity and specificity for MPTC reaching 60%. The highest sensitivity (86%) was flattening of the posterior globes and unilateral or bilateral transverse sinus stenosis. The highest specificities were completely empty sella (86%), enhancement (84%), and diffusion restriction (81%) of the prelaminar optic nerves. The presence of vertical tortuosity of the optic nerves was predictive of better final BCVA (P = 0.003) and better final APMD (P = 0.011). While papilledema grade was higher in MPTC, no MRI finding was predictive of papilledema grade. No single MRI finding has both high sensitivity and specificity for diagnosing MPTC. Vertical tortuosity of the optic nerves may be predictive of better final BCVA and APMD.

Management of Neglected Facial Fracture: A Case Report

Introduction: Neglected fracture occurs where there has been a delay of more than 30 days. The maxillofacial fracture complex is the most common fracture in traffic accidents. The most common maxillofacial fractures are Naso-Orbito-Etmoid (NOE), Lefort fracture, Zygomatic Complex (ZMC), Palate Fracture, and Parasymphysis Fracture. Neglected fractures lead to delayed treatment, worsening conditions, and even disability. Case: A 52-year-old male patient presents with complaints of facial bone fracture after being involved in a motor vehicle accident. CT scan examination showed: Multiple fractures of the bilateral nasal bones, interethmoidal septum, anterior walls of bilateral frontal sinuses, bilateral lamina papyracea of the ethmoid bone, anterior, medial, and lateral walls of bilateral maxillary bones all support Le Fort II. fracture, extending to bilateral dentoalveolar processes, bilateral zygomatic bones, and right mandibular parasymphysis. Case Management: The ORIF technique was used for the upper, middle, and lower face fractures in a preferred order. The palatal reduction and fixation step was frequently the first in this sequence. When proper occlusion was achieved, it was maintained by intermaxillary fixation. Conclusion: There was a significant result in correcting the functional, mastication, and aesthetic of the mid and lower face by using surgical management of facial fractures using ORIF. Keywords: Facial fracture, Neglected fracture, ORIF

Effects of Polydeoxyribonucleotide (PDRN) on Endosinus Bone Regeneration Following Sinus Floor Elevation: An Experimental InVivo Pilot Study.

To determine the effect of polydeoxyribonucleotide (PDRN) on endosinus bone regeneration in a rabbit sinus model at sequential healing time points. Eighteen New Zealand white rabbits were used. Bilateral sinus floor elevation (SFE) was performed. Two groups were randomly assigned to each sinus: (1) test group, in which SFE was performed using collagenated bone substitute material soaked with PDRN (concentration 2.0 mg/mL, dose 0.5 mL), and (2) control group, in which SFE was performed using collagenated bone substitute material only. The experimental animals were sacrificed at 2, 4, and 8 weeks (n = 6 at each healing time point). Microcomputed tomography (micro-CT), histologic, and histomorphometric analyses were performed. The micro-CT analysis revealed statistically significant increases in the mineralized tissue volume between 4 and 8 weeks (p < 0.05). Histologically, no specific intergroup difference was found in the pattern of new bone formation. Histomorphometrically, the area of newly formed bone (NB) was larger in the test group than in the control group at all healing time points (1.4 vs. 1.2 mm2 at 2 weeks, 3.4 vs. 1.9 mm2 at 4 weeks, and 5.7 vs. 4.5 mm2 at 8 weeks; median value), but the difference was statistically significant only at 4 weeks (p < 0.05). NB in set regions of interest (ROI_C, ROI_W, and ROI_M) tended to be greater in the test group than in the control group without statistical significance (p > 0.05). PDRN appeared to enhance new bone formation at all healing time points, but the improvement was statistically significant only at 4 weeks.

Cerebral Arterial Inflow and Venous Outflow Assessment Using 4D Flow MRI in Adult and Pediatric Patients

Background and Purpose: The cerebral circulation is highly regulated to maintain brain perfusion, keeping an equilibrium between the brain tissue, cerebrospinal fluid (CSF) and blood of the arterial and venous systems. Cerebral venous drainage abnormalities have been implicated in multiple cerebrovascular diseases. The purpose of this study is to evaluate the relationship between the arterial inflow (AI) and the cerebral venous outflow (CVO) and their correlation with the cardiac outflow in healthy adults and children to understand the role of the emissary veins in normal venous drainage. Materials and Methods: A total of 31 healthy volunteers (24 adults (39.5 ± 16.0) and seven children (3.4 ± 2.2)) underwent intracranial 4D flow with full circle of Willis coverage and 2D PC-MRI at the level of the transverse sinus for measurement of the AI and CVO, respectively. The AI was calculated as the sum of the flow values in the bilateral internal carotid and basilar arteries. The CVO was calculated as the sum of the flow values in the bilateral transverse sinuses. The cardiac outflow was measured via 2D PC-MRI with retrospective ECG gating with images acquired at the proximal ascending aorta (AAo) and descending (DAo) aorta. The ratios of the AI/AAo flow and CVO/AI were calculated to characterize the fraction of cerebral arterial inflow in relation to cardiac outflow and venous blood draining through the transverse sinuses, respectively. Results: The AI and CVO were significantly correlated (r = 0.81, p &lt; 0.001). The CVO constituted approximately 60–70% of the AI. The CVO/AI ratio was significantly lower in children versus adults (p = 0.025). In adults, the negative correlation of the AI with age remained strong (r = −0.81, p &lt; 0.001). However, the CVO was not significantly associated with age. Conclusion: The CVO/AI ratio suggests an important role of the emissary veins, accounting for approximately 30–40% of venous drainage. The lower CVO/AI ratio in children, although partially related to decreased AI with age, suggests a greater role of the emissary veins in childhood, which strongly decreases with age.

Unilateral papilledema: illustrative case.

Idiopathic intracranial hypertension is caused by an elevation of intracranial pressure and can present with slowly progressive visual deterioration from bilateral papilledema. Unilateral papilledema is an exceedingly rare phenomenon, and the mechanisms underlying asymmetric optic nerve involvement remain unknown. A 42-year-old woman presented with acute left-eye blurred vision and extraocular pain. Examination revealed unilateral left optic disc edema with an enlarged blind spot, while the right optic disc appeared flat. Neuroimaging examination was suggestive of intracranial hypertension, characterized by flattening of the posterior globes and narrowing of bilateral distal transverse sinuses. Increased intracranial pressure was confirmed by lumbar puncture. Acetazolamide and weight loss yielded initial improvement, but recurrence prompted cerebral arteriography, revealing a transstenotic gradient in the right distal transverse sinus and hypoplastic left sigmoid and transverse sinuses with extensive collateralization to the left cavernous sinus. Stenting of the right transverse sinus successfully alleviated the optic disc swelling. This case highlights the intricate interplay between venous sinus dynamics and unilateral papilledema, underscoring the importance of tailored interventions. https://thejns.org/doi/10.3171/CASE24385.

Clinical, Radiological, and Histomorphometric Comparison of the Use of Deproteinized Bovine Bone Mineral and Titanium-Prepared Platelet-Rich Fibrin in Maxillary Sinus Augmentation: A Split-Mouth Randomized Controlled Clinical Study

BackgroundMaxillary sinus augmentation (MSA) is a standard and predictable procedure to increase bone height in the atrophic posterior maxilla. Many biomaterials are employed in this technique; however, autologous platelet concentrates have been found to reduce clinical recovery time and improve bone gain in MSA. PurposeThis study aimed to compare the radiographic, histomorphometric, and implant stability outcomes of titanium-prepared platelet-rich fibrin (T-PRF) and deproteinized bovine bone mineral (DBBM) in a two-stage MSA technique. Study design, setting, sampleThis randomized controlled split-mouth study included patients requiring bilateral two-stage MSA at the Periodontology Department of Kutahya Health Sciences University between March 2022 and April 2023. Patients with systemic comorbidities and residual bone height >5 mm in the bilateral posterior maxilla were excluded. Predictor variableThe predictor variable was the two-stage MSA technique. Each surgical site was randomly assigned to the T-PRF or DBBM group for two-stage MSA. Main outcome variablesThe primary outcome was the histomorphometric evaluation of the percentage of new bone (PoNB) between the two groups. Secondary outcomes included radiographic evaluation of total bone height (ToBH), bone gain (BG), bone density (BD), and graft volume (GV) on CBCT 6 months post-MSA, clinical assessment of primary implant stability at implant placement and secondary stability 3 months postplacement, and histomorphometric evaluation of the percentage of residual particles, percentage of connective tissue, and percentage of blood vessels from bone biopsy samples collected 6 months after MSA. CovariatesAge, sex, periodontitis susceptibility, and smoking status were treated as covariates. AnalysesThe Wilcoxon signed-rank test was used for bivariate comparisons between two groups, and the Pearson or Spearman test was used to analyze correlations of variables within groups. A p value ≤0.05 was considered statistically significant. ResultsThe sample was composed 10 patients with bilateral maxillary sinuses, 20 MSA regions, 8 (80%) male and 2 (20%) female with a mean age of 51.30 (9.06) yr. The PoNB was 19.48 ± 14.60 μm2 in the T-PRF group and 8.31 ± 5.47 μm2 in the DBBM group, and there was no statistically significant difference between the groups (p = 0.074). Radiographic measurements showed ToBH, GV, and BD values of 10.64 ± 3.96 mm, 989.89 ± 523.07 mm3, and 192.09 ± 127.90 HU in the T-PRF group and 14.25 ± 1.65 mm, 1519.39 ± 432.61 mm3, and 492.77 ± 117.35 HU in the DBBM group, respectively. ToBH, GV, and BD values were statistically significant between the groups (p = 0.01 and p = 0.00). Primary and secondary implant stability in the T-PRF group were 71.11 ± 12.48 ISQ and 68.03 ± 6.81 ISQ, respectively, compared with 67.94 ± 19.84 ISQ and 72.46 ± 11.21 ISQ in the DBBM group. The difference was not statistically significant between the groups (p = 0.41 and p = 0.33).” Conclusion and relevanceAlthough T-PRF demonstrated inferior radiographic outcomes compared with DBBM during the initial 6-month healing phase, both techniques yielded comparable results regarding new bone formation and implant stability. Further research is warranted to explore the efficacy of different T-PRF applications in MSA. This trial is registered at ClinicalTrials.gov (NCT05596084).

Automatic maxillary sinus segmentation and pathology classification on cone-beam computed tomographic images using deep learning

BackgroundMaxillofacial complex automated segmentation could alternative traditional segmentation methods to increase the effectiveness of virtual workloads. The use of DL systems in the detection of maxillary sinus and pathologies will both facilitate the work of physicians and be a support mechanism before the planned surgeries.ObjectiveThe aim was to use a modified You Only Look Oncev5x (YOLOv5x) architecture with transfer learning capabilities to segment both maxillary sinuses and maxillary sinus diseases on Cone-Beam Computed Tomographic (CBCT) images.MethodsData set consists of 307 anonymised CBCT images of patients (173 women and 134 males) obtained from the radiology archive of the Department of Oral and Maxillofacial Radiology. Bilateral maxillary sinuses CBCT scans were used to identify mucous retention cysts (MRC), mucosal thickenings (MT), total and partial opacifications, and healthy maxillary sinuses without any radiological features.ResultsRecall, precision and F1 score values for total maxillary sinus segmentation were 1, 0.985 and 0.992, respectively; 1, 0.931 and 0.964 for healthy maxillary sinus segmentation; 0.858, 0.923 and 0.889 for MT segmentation; 0.977, 0.877 and 0.924 for MRC segmentation; 1, 0.942 and 0.970 for sinusitis segmentation.ConclusionThis study demonstrates that maxillary sinuses can be segmented, and maxillary sinus diseases can be accurately detected using the AI model.

"A Unique Case of Branchio-Oto-Renal Spectrum Disorder".

A 17 year old male patient presented with bilateral preauricular sinus, right sided second branchial cleft sinus and bilateral hearing deficit. He has previous history of right congenital cataract surgery and right dacryocystorhinostomy at the age of 8 year. He was operated for branchial sinus. No family history with similar complaint was observed. According to all these features this case was the variant of branchio-oto-renal spectrum disorder with de novo mutation. According to literature search this will be a unique and rare case report of BORSD published till date in India.

7392 Unilateral Adrenal Embolization In Cushing Disease-A Lifesaving Emergent Procedure

Abstract Disclosure: M. Sadiq: None. B. Irshad: None. A. Haider: None. Case presentation: A 59-year-old female was diagnosed with Cushing Disease (CD) thirteen years ago with symptomatic hypercortisolism. Hypokalemia and elevated 24-hour urine cortisol (392 ug/24 hr, n 0-50 ug/24 hr) were noted at the time of diagnosis. Following LDDST, morning cortisol was 30.5 ug/dl, and HDDST showed greater than 50% suppression. A pituitary macroadenoma with bilateral cavernous sinus extension was noted on MRI Sella. Due to cavernous sinus invasion, she was not considered a surgical candidate and underwent Gamma knife radiation. 24-hour urine cortisol decreased significantly (20 ug/24 hours). Two years follow-up MRI brain showed an empty Sella and AM cortisol was noted to be normal at 12.2 ug/ dl with no evidence of AI. She was lost to follow-up and reestablished almost ten years after her initial gamma knife and was symptomatic from hypercortisolism. 24-hour urine cortisol at 85.4 mcg/24 hr, abnormal salivary cortisol x 2 (0.24 and 0.20 mcg/dl n &amp;lt; 0.09 mcg/dl) confirming hypercortisolism. MRI of Sella showed recurrent adenoma with bilateral sellar masses. She was referred to Neurosurgery and was started on Ketoconazole and Paseriotide once-monthly injections. She developed new onset diastolic heart failure &amp; upper GI bleeding, requiring hospitalization. High ACTH level of 668 pg/ml (n. 6.6- 65 pg/ ml). 8 am cortisol was 107.6 ug/dl which was suppressed to 16.1 after 8 mg overnight Decadron. Repeat Gamma knife was planned but due to her decline, it was decided to do unilateral adrenal artery embolization to reduce hypercortisolism. IR-guided adrenal artery embolization of the left middle &amp; inferior adrenal arteries was performed. She required stress dosing of HC post-embolization which was tapered off while monitoring 8 am cortisol which started to rise &amp; 24-hour cortisol levels were noted to be normal (51.2 mcg/24 H) on post-embolization day eight. Gamma knife radiation treatment was performed a month later after which she was noted to have GWS and required Hydrocortisone 15/10 mg twice daily, which she has been taking to date. 24-hour urine cortisol remains normal at 11.8 mcg/24 h. Discussion: Treatment for CD is primarily surgical. Radiotherapy is a second-line alternative in tumors that are non-amenable to surgery. Radiotherapy takes time to achieve its full effect. Cushing Disease patients with significant hypercortisolism and resultant complications require urgent treatment. Unilateral Adrenalectomy is described in literature to curb the cortisol burden . Similarly Unilateral Adrenal artery embolization offers less invasive approach to treat patients considered unfit for surgery. Conclusion: Unilateral adrenal artery embolization can be considered a bridging treatment in CD to reduce cortisol burden and improve the metabolic profile following which a more definitive treatment such as repeat surgery or radiotherapy can lead to long-term remission. Presentation: 6/1/2024

7295 Giant Pituitary Adenoma with Rapid Symptomatic Progression and Postoperative Mortality

Abstract Disclosure: R.D. Kennedy: None. M. Nicholson: None. Introduction: Giant pituitary adenomas, defined as pituitary adenomas measuring greater than 4 cm, present a therapeutic challenge because of their size, clinical features, and increased potential for complications following surgical intervention. Early detection and intervention to prevent growth and progression is paramount. We present a case of a patient with a giant 6.3 cm pituitary adenoma who had significant neurologic compromise, requiring surgical intervention, with resultant postoperative complications and death. Case:Patient is a 41 year old male with known history of pituitary adenoma who presented on 11/1/2023, from outside hospital, to the Neuroendocrine clinic with complaints of excessive truncal obesity, impotence, fatigue, and apathy. Vital signs were within normal limits. Physical exam revealed clouding of consciousness, grossly intact cranial nerve function, truncal obesity, and diminished power, tone, and bulk of the extremities. Formal visual field testing revealed bitemporal hemianopsia. A head CT scan revealed a 6.3 cm sellar mass with expansion of the sella, invasion of soft tissue into the sphenoid sinus, and extension of soft tissue cranially to the level of the third ventricle eccentric to the left. There was no evidence of apoplexy. Lab results revealed Prolactin of 924 ng/mL. The patient had been taking Bromocriptine, 2.5 mg daily, for at least three weeks. Less than three weeks after his initial evaluation, he returned to the hospital with complaint of acute ataxia. Pituitary MRI revealed 6.3 cm sellar mass with evidence of acute and subacute blood products, stretching of the optic chiasm from mass effect, extension into the bilateral cavernous sinuses, superior left MCA displacement, posterior left PCA displacement, 5 mm midline shift, uncal herniation and descending transtentorial herniation. The patient underwent endoscopic transsphenoidal resection with subsequent craniotomy for debulking. Postoperatively, he developed new right sided hemiplegia with aphasia with subsequent MRI finding of watershed infarct at the left MCA/PCA lateral posterior border zone territories with increasing mass effect over a 30 day hospital stay. He developed progressive global edema with worsening uncal and tonsillar herniations. Brain death was pronounced on 11/30/23. Discussion:This case highlights the importance of early intervention in patients with giant pituitary adenomas. Our patient had been experiencing right sided weakness for at least one year prior to his admission to our facility. In this case, earlier treatment with a dopamine agonist may have decreased the size of the adenoma or prevented rapid growth. This may have precluded the need for surgical intervention on an adenoma of this size, which carries increased risk for postoperative complications. Presentation: 6/2/2024

8403 A Rare Presentation: Mucosal Melanoma with Pituitary Gland Involvement

Abstract Disclosure: L.R. Sepulveda-Garcia: None. L. El Musa Penna: None. W. Medina-Torres: None. J. Segarra-Villafane: None. Z. Maisonet-Feliciano: None. I. Arroyo-Gomez: None. L.A. Gonzalez-Rodriguez: None. M. Alvarado-Santiago: None. M. Ramirez-Vick: None. Introduction: Sinonasal mucosal melanoma (SNMM) is a rare form of aggressive melanoma with poor prognosis, compromising less than 1% of all melanoma. The most frequently reported symptoms include nasal obstruction and epistaxis, but the manifestation of symptoms may occur late and be nonspecific, causing delays in diagnosis and resulting in a less favorable prognosis. Here we report a rare case of mucosal melanoma with pituitary gland involvement initially thought to be a pituitary adenoma. Clinical Case Description: A 22-year-old male with no previous medical history was found with a biopsy proven pigmented epithelioid melanocytoma (PEM) in the palate. Three weeks after the biopsy, the patient presented with a severe headache, prompting the performance of a CT scan that revealed a pituitary macroadenoma. Several days later he developed acute right eye ptosis requiring emergency evaluation. The patient reported mild epistaxis, headaches, and nausea of 2 weeks duration associated with lack of erections and diminished libido. Physical exam was remarkable for sinus bradycardia, right eye ptosis, and a palate bluish pigmentation. Hormonal work up revealed a prolactin of 23 ng/mL (3.46-19.40), TSH of 2.22 uIU/mL (0.27-4.20), fT4 of 0.37 ng/dL (0.93-1.70), total testosterone &amp;lt;0.007 ng/mL (1.88-6.84), free testosterone of 0.001 ng/mL (0.032-0.168), FSH of 0.41 mIU/mL (2.6-11.0), and LH of 0.27 mIU/mL (0.4-7). Serum cortisol and ACTH levels were found to be low at &amp;lt;1.00 µg/dL (3.7-19.40) and 5.98 pg/mL (0.00-46.00), respectively, but these were taken while patient was given dexamethasone by neurosurgery for headaches. Brain MRI was remarkable for 3.4 cm x 3.3 cm x 3.5 cm sellar mass extending inferior into the sphenoid sinus, posteriorly into the right ethmoid air cells, superiorly into the suprasellar cistern with upward displacement of the optic chiasm, as well as bilateral cavernous sinus invasion. Case outcomes: A diagnosis of hypopituitarism was made. Physiologic doses of hydrocortisone were started after being found with central adrenal insufficiency. This replacement unmasked an arginine vasopressin deficiency also requiring desmopressin therapy. Central hypothyroidism was treated with levothyroxine and treatment for the hypogonadotropic hypogonadism was deferred in the meantime. Biopsy of right sphenoid sinus revealed a mucosal melanoma. Revised pathology slides led to the conclusion that palate PEM was an independent entity to the mucosal melanoma Case discussion: Prognosis is poor in patients with SNMM since this tumor is usually diagnosed at advanced stages. In this case, the sellar mass was initially thought to be a pituitary adenoma that later was found to be an extension of a mucosal melanoma. This case serves as a reminder of the critical role that differential diagnosis plays in evaluating sellar masses. Presentation: 6/1/2024

On The Use of a Sticky Bone Substitute in the Presence of a Ruptured Schneider Membrane During Sinus Lift Procedures - An Experimental Within-Rabbit Study.

To assess the efficacy and safety of a sticky dual-phase porcine-derived bone substitute, compared to a similar non-adhesive graft, in addressing induced perforations of the Schneider membrane during sinus lift using a within-subject design rabbit model. Bilateral sinus floor elevations were performed in 12 rabbits. The sinus mucosa was intentionally perforated using a blade on both sides and randomly filled with either a cortico-cancellous bone embedded in a 20% thermosensitive gel (GTO sticky bone test) or a cortical cancellous bone and 10% collagen (mp3 control). Healing progress was evaluated after 2 and 10 weeks in 6 animals at each time-point, with cone-beam computed tomography (CBCT), micro-computed tomography (microCT) and histological assessments. One animal of the 2-week group died but was substituted. No other complications were observed. At 2-week, on CBCTs, biomaterials particles were observed in the vicinity of the Schneider membrane in two out of six sinuses of each group, but never dispersed into the sinus. MicroCT and histology consistently revealed few granules beyond the elevated region. Histologically, five sinuses in the mp3 group and two sinuses in the GTO group exhibited granules outside the elevated region but in the vicinity of the perforations. In the 10-week groups, the number of affected sinuses decreased to one in the mp3 group and two in the GTO group. Throughout all observations, the graft granules consistently resided proximate to the elevated region. Micro-CT demonstrated a reduction in the volume of the elevated region by approximately 12% after 2 weeks and 50-54% after 10 weeks. The use of both sticky and non-sticky bone substitutes seems to prevent a substantial amount of particles from extruding through an induced perforation of the Schneiderian membrane. This suggests that it could be possible to use a sticky bone as an alternative to a barrier membrane to avoid the extrusion of bone granules in the presence of accidental perforation of the sinus membrane in clinical practice. After 10 weeks of healing, the volume of the elevated region decreased by approximately 50%, possibly due to biomaterial resorption and loss through the surgically created perforation.

Low-intensity focused ultrasound combined with microbubbles for non-invasive downregulation of rabbit carotid body activity in the treatment of hypertension.

Targeting the carotid body (CB) is a new approach in treating hypertension. This study investigates the efficacy and safety of ultrasound combined with microbubbles in targeting CB to treat hypertension. Twenty-seven hypertensive rabbits were randomly assigned to three groups: microbubbles only (sham group, n = 11), ultrasound plus microbubbles (LIFU group, n = 11), and bilateral carotid sinus nerve denervation (CSND group, n = 5). Four weeks post-intervention, blood pressure, hypoxic ventilatory response (HVR), blood pressure variability (BPV), heart rate variability (HRV), biochemical indicators, neurohormones, and histopathology were assessed in all groups. The results indicated significant reductions in systolic and diastolic blood pressure in the LIFU and CSND groups post-intervention, along with decreases in BPV, HRV, and catecholamines. HVR results showed a 35.10% reduction in CB activity in the LIFU group compared to the sham group, which was significantly lower than the reduction in the CSND group compared to the sham group (73.85%). Histopathology and transmission electron microscopy confirmed CB damage and cell apoptosis, with immunofluorescence showing a reduction in type I and II cells. In conclusion, LIFU combined with microbubbles can reduce blood pressure by lowering CB and sympathetic nerve activity.

Experience in the diagnosis and treatment of non-invasive bilateral carotid cavernous sinus fistula based on CT image examination

Carotid cavernous fistula is a rare but clinically important vascular abnormality that is challenging to diagnose and treat. The clinical data of a patient with bilateral carotid cavernous fistula diagnosed by CT images were retrospectively analyzed. Through the analysis of CT images, the patient was accurately located and the diagnosis was confirmed. CT images can provide detailed anatomical information and accurately show the location, morphology and hemodynamic characteristics of carotid cavernous fistula. Through CT image examination, we successfully diagnosed bilateral carotid cavernous fistula patients, and can provide an important reference for surgical treatment. Therefore, CT image examination can provide accurate diagnosis and surgical planning information, and provide support for the formulation of individual treatment plans for patients. The application of this method is helpful to improve the early diagnosis rate and treatment effect of carotid cavernous fistula.

Maxilla reconstruction with 100% BioOss: A clinical and tomographic follow-up study.

Tooth loss and use of a complete denture is still a reality and results in bone loss. Adequate reconstruction of an extremely atrophic edentulous maxilla is a challenge, and different treatment methods have been described for its resolution. Patients seeking implant placement in edentulous upper jaw with atrophic maxilla were selected in a private clinic in Porto Alegre, Brazil. The bone graft was performed with bilateral sinus lift and horizontal bone graft in anterior region with 0,25-1mm particles of Bio-Oss (Geistlich) covered with a collagen membrane (Bio-Gide, Geistlich). CBCTs were evaluated to verify the need for bone graft, and 6-8 months after bone graft follow-up, to plan implant placement and assess horizontal bone gain. 124 implants were placed in 19 patients, 76 of those in the sinus region. The survival rate was 95.2%, with six implants lost over a mean implants follow-up time of 47.68 months. The horizontal bone gain ranged from 0.00 to 6.86 mm, a mean gain of 2.85mm. An average of 5.5g of Bio-Oss was used per patient, and in 73.7 % of the cases, a flapless surgery was possible for implant placement, and in 92 implants an immediate loading was possible. Final rehabilitation was accomplished with fixed prosthodontics in 16 patients with a mean follow-up of 38.4 months. Within the limitations of this study, it is possible to affirm that bone graft with 100% Bio-Oss in atrophic maxilla is a reliable treatment and allow rehabilitation with implants with a high survival rate and the higher the initial bone height, the greater the gain in bone width. Key words:Bone Regeneration, Dental Implants, Prosthodontics, Dentistry.

Tumor versus bland thrombus: diffuse large B-cell lymphoma presenting as cavernous sinus and left superior ophthalmic vein thrombosis.

A 66-year-old female with a history of sinusitis presented with persistent diplopia and worsening eyelid swelling. Examination revealed bilateral vision loss, cranial nerve palsies, left-sided chemosis, proptosis, and edema. Initial imaging showed sphenoid sinus opacification, bilateral ethmoid disease, lack of filling of bilateral cavernous sinuses, and partial thrombosis of the left superior ophthalmic vein. The sinus findings were evaluated with endoscopic sinus surgery, which was unremarkable. Subsequent orbital imaging suggested the lesions were in keeping with tumor thrombus as opposed to bland thrombus. CT scans revealed a large mass in the right axilla, which was biopsied and confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL). The patient was treated with anticoagulation, steroids, and chemotherapy resulting in marked improvement. Our report highlights a rare case of tumor thrombus from DLBCL causing bilateral cavernous sinus thrombosis and, to the best of our knowledge, the first documented case of superior ophthalmic vein thrombosis from tumor thrombus.

The effect of nasal septal deviation on maxillary sinus volume in patients undergoing septoplasty surgery

Background: In this sudy, we aimed to determine the association between nasal septal deviation and maxillary sinus volume in patients undergoing septoplasty. Materials and Methods: 164 paranasal sinus computed tomography (PNS CT) of the patients(80 female, 84 male) undergoing septoplasty surgery were retrospective evaluated between September 2022 and September 2023. Bilateral maxillary sinuses volüme (MSV) and septal deviation angle(SDA) were calculated using the computed program. SDA was divided into right and left, also was described as mild, moderate, or severe. Results: The mean of right MSV was measured as 14.34 ± 3.91 (7.45-23) and the mean of left MSV was 15.11 ± 4.29 (6.34-24.3). The average SDA of all patients was 15.51 ± 5.22 (6.7-34). The difference between right and left MSV was measured lower in patients with mild septal deviation than in patients with moderate or severe septal deviation (p=0.016, p=0.024, respectively). In the evaluation made according to MSV, the difference values between ipsilateral MSV, contralateral MSV, total MSV and right-left MSV according to the side of septal deviation were found to be higher in men than in women (p=0.011, p=0.001, p=0.004, p

Histomorphometric and microtomographic analysis of maxillary sinus augmentation surgeries with and without collagen membrane on the lateral window: A randomized clinical trial.

To evaluate the histomorphometric and computerized microtomographic (Micro-CT) analysis of the regenerated bone tissue from maxillary sinus augmentation surgery, with and without using the collagen membrane on the external osteotomy window. Twelve patients were selected for this prospective, controlled, and randomized study. The patients were submitted to bilateral maxillary sinus surgery in a split-mouth design. On the test side, the maxillary sinus augmentation procedure included using Geistlich Bio-Oss® and a Geistlich Bio-Gide® collagen membrane covering the lateral osteotomy window. On the control side, only Geistlich Bio-Oss® was used without the presence of the membrane. After 6 months, the surgeries for implant installation were performed. In this surgical phase, specimens of the regenerated tissue were collected for histological and Micro-CT analysis. In the histomorphometric evaluation, the mean (±SD) percentages of newly formed bone were 43.9% (±11.5) and 40.8% (±8.9) in the test and control groups, respectively. The corresponding values of the Micro-CT analysis were 36.6% (±3.4) and 37.2% (±4.7) in the test and control groups, respectively. There was no statistically significant difference between the test and control groups in the two methods. In addition, there was no statistically significant difference between the mean percentage of biomaterial remaining between the test and control groups. However, the mean percentage of newly formed bone was significantly higher and the mean percentage of remaining biomaterial was significantly lower in the histomorphometric analysis compared to the values obtained through microtomography. The additional use of collagen membranes in maxillary sinus surgery does not offer advantages in newly formed bone.

Three-dimensional morphometric and volumetric analysis of maxillary sinuses.

The maxillary sinus is a pyramid-shaped cavity with varying shapes, sizes, and capacities. Its dimensions grow gradually and develop until early adulthood. Anatomical knowledge of the maxillary sinus is essential to understanding sinonasal disorders, planning surgical procedures and preventing complications. Awareness of the sinus's proximity to critical structures helps avoid injuries during surgery. The European, Korean, and Sri Lankan population study parameters show varying results and do not necessarily apply to the Indian population. The standard morphometric data of the maxillary sinus is scanty in the Indian population. The study aimed to determine the volume and morphometry of the maxillary sinus along with gender differences in the Eastern population of the Indian. A retrospective cross-sectional study was conducted using cone beam computed tomography data of maxillary sinuses of 100 normal individuals. The data were analysed after the three-dimensional reconstruction of digital imaging and communications in medicine (DICOM) images with the help of DICOM to print and Geomagic freeform software in the Anatomy department. The different linear morphometric variables and volume of the maxillary sinus were studied. SPSS version 27.0. was utilised for statistical analyses. The mean values of Antero-posterior diameter, Transverse diameter, Craniocaudal diameters, the height of ostium from the floor and volume of the maxillary sinus in males on the right side are 36.61 mm, 20.7 mm, 40.31 mm, 26.02 mm and 16055.24 mm³ and on the left side are 37.17 mm, 20.17 mm, 40.73 mm, 26.91 mm and 15712.66 mm³ whereas in females the values on the right side are 38.10 mm, 21.56 mm, 38.96 mm, 25.81 mm and 14687.78 mm³ and on left side are 38.23 mm, 21.53 mm, 38.48 mm, 25.28 mm and 14203.13 mm3 respectively. The side-to-side parameter differences were non-significant within the male and female groups, respectively. The females had significantly (p < 0.05) larger transverse diameters than males in both the right and left maxillary sinuses. The males tend to have a slightly larger mean craniocaudal diameter than females, but the difference was found statistically significant (p < 0.05) only in the left maxillary sinus. The gender differentiation based on the measured parameters of bilateral maxillary sinus accuracy rate was 89.4% in males and 61.8% in females. These parameters serve as a standard or reference point, allowing radiologists and surgeons to compare individual patient scans to population averages and aid in better clinical outcomes. The mean values of different parameters of the maxillary sinus may be utilised to differentiate various suspected sinus pathologies, which is helpful for functional endoscopic sinus surgery. Gender differentiation can be done more accurately by forensic experts using Maxillary sinus transverse diameter bilaterally, followed by craniocaudal diameter of the left side sinus for predicting the gender of an unknown maxilla.

Utility of Itraconazole in Combination with Liposomal Amphotericin B in Rhizopus oryzae Associated Mucormycosis-An Exploratory Study.

During the COVID-19 pandemic-associated mucor epidemic, acute antifungal drug shortage necessitated the exploration of other antifungals based on culture sensitivity. Itraconazole is a cheap, safe, and effective antifungal in sensitive cases. We enrolled itraconazole-sensitive COVID-19-associated mucormycosis during the mucormycosis pandemic. After the intensive phase course of liposomal amphotericin B, Itraconazole was offered in susceptible cases during the maintenance phase along with standard of care. These patients were clinically and radiologically followed for 6 months. We enrolled 14 patients (Male: Female-11:3) of Rhino-orbito-cerebral mucormycosis (ROCM) which included 12 diabetics. All patients had facial swelling, orbital swelling, visual impairment, and headache. MRI showed involvement of bilateral sinus (10/14), orbital extension (13/14), cavernous sinus (5/14), cerebral part of the internal carotid artery (3/14), and brain infarcts (4/14). All 14 patients showed sensitivity to Itraconazole with 12 having minimum inhibitory concentration (MIC) ≤ 1 μg/ml and 2 having MIC ≤ 2μg/ml. Follow-up at 6 months showed clinical improvement in the majority (11/14) and radiological improvement in six out of seven scanned patients. Our study shows the potential therapeutic role of oral Itraconazole in ROCM.