Cases Of Maxillary Sinusitis Research Articles

Maxillary Sinusitis of Odontogenic Origin- A Case Report and a Short Review of Literature

Maxillary sinusitis of odontogenic origin (MSOO) presents a diagnostic challenge due to its overlapping symptoms with other forms of sinusitis. We present a case of a 17-year-old male with MSOO, emphasizing varied treatment modalities. Clinical assessment revealed facial swelling and pain, prompting a differential diagnosis. Orthopantomogram and Cone Beam Computed Tomography (CBCT) confirmed odontogenic involvement. Surgical intervention included extraction, sinus lavage, and closure of oroantral communication. Postoperative recovery was successful. Discussion highlights the prevalence, diagnosis, and management of MSOO. Contemporary reports suggest odontogenic sources contribute to over half of maxillary sinusitis cases. Radiographs and CBCT aid diagnosis, delineating odontogenic involvement. Effective management includes dental evaluation and endoscopic sinus surgery, and early diagnosis is crucial to prevent complications. However, consensus on antimicrobial therapy and drainage routes is lacking. This case underscores the importance of interdisciplinary collaboration and tailored management strategies for MSOO.

Sinus irrigation as an adjunctive therapy for odontogenic maxillary sinusitis — an in-depth analysis

BackgroundOdontogenic maxillary sinusitis (OMS) is widely acknowledged in both the dentistry and otolaryngology fields. Recently, iatrogenic odontogenic maxillary sinusitis cases can be encountered frequently. The purpose of this study was to evaluate the effect of intraoral sinus irrigation using the small lateral window approach in patients with odontogenic maxillary sinusitis by comparing pre- and postoperative volumetric measurement of CBCT and symptoms.We surveyed 21 patients who visited the Oral and Maxillofacial Surgery Department at PNUDH from 2016 to 2022. All the patients’ information was extracted from an electronic database. The patients with a follow-up period of 2 months or more were included. The three-dimensional volumetric measurement was performed using the ImageJ program (National Institute of Health, University of Wisconsin).ResultsAmong 21 patients, 16 (76.1%) were male, and 5 (23%) were female. The most common type of surgery was general anesthesia (16 cases) in which oroantral fistula was present in 7 cases. In the causes of maxillary sinusitis, there were seven implant-related patients, five patients of tooth extraction, seven patients of bone grafting, and two patients in other groups. Radiographic opacity decreased by 40.15% after sinus irrigation especially in bone graft and tooth extraction cases. Clinically, symptoms improved in 17 patients (80.9%).ConclusionBy this study, it can be concluded that maxillary sinus irrigation using the small lateral window approach is a clinically and radiologically effective treatment method for odontogenic maxillary sinusitis.

Evaluation of the efficacy of diffusion-weighted magnetic resonance imaging and apparent diffusion coefficients in the diagnosis of maxillary diseases

We investigated the efficacy of using diffusion-weighted imaging (DWI) with quantitative apparent diffusion coefficient (ADC) mapping in the diagnosis of maxillary diseases. We evaluated 146 cases of maxillary diseases (32 malignant tumors, 11 benign tumors, 28 maxillary cysts, 60 cases of maxillary sinusitis, and 15 maxillary sinus retention cysts) that had been examined using magnetic resonance imaging. The DWI sequence was obtained with b values of 0 and 800 s/mm2 and ADC values were calculated. We used one-way analysis of variance and the Tukey honestly significant difference test to identify differences within and between the types of diseases. Mean ADC values for malignant tumors (1.07 × 10-3 mm2 s-1) were significantly lower than ADCs for benign tumors (1.85 × 10-3 mm2 s-1), maxillary cysts (1.77 × 10-3 mm2 s-1), maxillary sinusitis (2.34 × 10-3 mm2 s-1), and maxillary sinus retention cysts (2.52 × 10-3 mm2 s-1), with P < 0.001. Mean ADC differed significantly between all disease types except between maxillary sinusitis and maxillary sinus retention cysts. ADC values also significantly differed between specific lesions within the malignant tumor and maxillary cyst groups. The use of ADC values can be useful in the differential diagnosis of malignant maxillary diseases, benign lesions, cysts, and inflammatory and reactive conditions.

Sinusitis Following Reduction Malarplasty.

The aim of this paper was to search for reported cases of sinus infection following reduction malarplasty and present guidelines for the prevention of sinusitis. Two cases of maxillary sinusitis that developed after reduction malarplasty has been reported, which were treated with endoscopic sinus surgery. Histologically, thickness of the mucosal lining of the maxillary sinus (Schneiderian membrane) was 0.41 mm at sinus floor, and 0.38 mm at 2 mm above the floor. In functional endoscopic sinus surgery (FESS), the uncinate process is removed, exposing the hiatus semilunaris. The anterior ethmoid air cells are opened, allowing better ventilation but leaving the bone covered with mucosa. FESS improves the function of the osteomeatal complex and therefore provides better ventilation of the sinuses. In odontogenic maxillary sinusitis, regeneration of the mucosal lining (ciliated epithelium regeneration and bone healing) was achieved in 1.4±1.2 years after modified endoscopic sinus surgery. In in zygomatic implant surgery, 12.3% patients presented maxillary sinusitis, and the most common treatment was antibiotics alone or combined with FESS. To prevent sinusitis after reduction malarplasty, accurate osteotomy and fixation are needed, especially when using only an intraoral incision. After surgery, radiological examinations (Water's view, computed tomography if needed) should be performed as part of follow-up. Prophylactic antibiotics (macrolides) are recommended for 1 week if the sinus wall is opened. If swelling or air-fluid level persists, re-exploration and drainage should be performed. In patients with risk factors such as age, comorbidities, smoking, nasal septal deviation, or other anatomical variants, simultaneous FESS is suggested.

A Case of Maxillary Sinusitis Caused by Infiltration of Agar Impression Material

A Case of Maxillary Sinusitis Caused by Infiltration of Agar Impression Material

Combined Endoscopic and Intraoral Approach or Intraoral Alone in Surgical Management of Odontogenic Sinusitis

The physiological behavior of paranasal sinuses depends on the potency of the ostiomeatal complex and on normal mucociliary function. The interruption of this delicate equilibrium can lead to pathological conditions such as sinusitis. Anywhere between 10% and over 25% of cases of maxillary sinusitis have an odontogenic origin, such as: dental infection; alveolar dental trauma; or iatrogenic causes, such as extractions, endodontic therapies, maxillary osteotomies or placement of endosseous implants. The resolution of sinus pathology is related to the resolution of odontogenic pathology. Aim: to evaluate the therapeutic efficacy of a combined oral and endoscopic approach in the treatment of chronic odontogenic sinusitis vs. oral dental management through a case control study. Materials and Methods: all patients showing signs and symptoms of odontogenic sinusitis with obliteration (appreciable radiopacity in CT) of unilateral maxillary sinus between January 2018 and September 2019 at Padua University Hospital were enrolled in this retrospective study. The exclusion criteria were: maxillary sinusitis without odontogenic origin, or resolution with a systemic antibiotic therapy; and presence of anatomical abnormalities that promote the onset of rhinosinusitis. The patients were divided into two groups: one group was treated with a combined surgical approach under general anesthesia (Functional Endoscopic Sinus Surgery-FESS and simultaneous closure of oroantral communication with Bichat’s fat pad advancement); while the other group was treated only with an intraoral approach under local anesthesia and conscious sedation (closure of oroantral communication with Bichat’s fat pad advancement). The variable “success of the surgical procedure” in the two groups was compared by a Student test (with p &lt; 0.05). Results: among the patients enrolled, 10 patients (aged between 42 and 70) made up the case group and the other 10 patients (aged between 51 and 74) constituted the control group. There was no statistically significant difference in success between the two groups (p &lt; 0.025). Conclusions: according to this case study, an exclusive annotation invasive intraoral approach seemed to be comparable to the transoral endoscopic combined method. However, during diagnosis it is necessary and fundamental to distinguish between odontogenic and rhinogenic sinusitis in order for the resolution of odontogenic sinusitis to be achieved.

Effects of Endodontic Infections on the Maxillary Sinus: A Case Series of Treatment Outcome

This article shows the follow-up of several cases of maxillary sinusitis of dental (usually endodontic) origin, with different manifestations, diagnostic challenges, and outcomes.Cases from 14 patients from 3 countries and treated by 7 different endodontists are presented, all of them with inflammatory sinus changes represented by mucositis, osteoperiostitis, and/or partial/full obstruction. All cases showed dental and/or sinus signs/symptoms that resolved after dental management. In 13 cases, the sinus condition had an endodontic origin, 4 of them concurrently with periodontal involvement. In 1 case, sinusitis was caused by trauma to the face. All cases but 1 had a satisfactory response of the periradicular tissues and maxillary sinus to treatment that consisted of root canal therapy, root amputation, extraction, or trauma management.The successful management of most cases reported in this article emphasizes the importance of endodontics as a specialty engaged in saving teeth and promoting health not only in the oral cavity but also in other areas that may be affected by infections of endodontic origin, including the maxillary sinus.

Anatomical relationship between roots of maxillary posterior teeth and maxillary sinus using cone-beam computed tomography

Aim: Maxillary sinusitis of odontogenic origin accounts for approximately 10%–12% of maxillary sinusitis cases. The primary objective of the present study was to analyze the vertical relationship between the maxillary posterior roots and the adjacent maxillary sinus floor (MSF) in the Indian population using cone-beam computed tomography. The secondary objective was to correlate the data with age and gender.Materials and Methods: The shortest distance between 452 maxillary posterior teeth and the adjacent border of MSF was measured. The data were divided into three groups. Group IS included maxillary posterior teeth roots protruding into the sinus, Group CO included root apices contacting the MSF, and Group OS included root apices not contacting the MSF. The data obtained were correlated with age and gender.Results: The vertical distance of the root apices of second premolars from the MSF was significantly lesser compared to the root apices of first premolars (P < 0.05). The difference between the vertical distance of buccal roots and palatal roots (PRs) of first molar from the MSF was significantly more (P < 0.05). Majority of the roots of posterior teeth were located below the MSF border (Type OS). Type IS was most frequently seen for PRs of maxillary first molars (29.12%). The frequency of Type IS decreased with increasing age. The distance between the posterior root apices and the adjacent border of the MSF was found to be more in males compared to females.Conclusion: The PRs of maxillary first molars were found to be closest to the MSF. Variation in the vertical relationship was found by age and gender.

Facial abscess revealing maxillary sinusitis of dental origin

Maxillary sinusitis is exceptionally externalized. We report an unusual case of maxillary sinusitis externalized through the average meatus by following the intersinusonasal bulkhead toward the anterior angle of the maxilla and the nasogenian sulcus. The study involved a patient aged 17 years, with no previous medical history, presenting with facial swelling associated with right nasal obstruction occurred two days before. Clinical examination revealed febrile patient with abscess in the right nasogenian sulcus (A), with total filling of the right nasal fossa by a renitent submucosal bulge. Contrast-enhanced CT scan of the facial bones showed right maxillary sinusitis enlarging the average meatus (B) with collections in the intersinusonasal bulkhead and in the nasogenian sulcus. Furthermore, it showed intrasinusal migration of the 17th tooth root (C). The diagnosis of maxillary sinusitis of dental origin exteriorized to the face was made. Under general anesthesia, drainage of the different purulent collections through an incision in the nasal vestibule, middle meatotomy for drainage of the maxillary sinus and extraction of the 17th tooth were performed. Patient's evolution was favorable with regression of fever and of inflammatory signs.

Aerobic bacteria and fungal isolates in maxillary sinusitis of adults in a resource poor environment

Background: Infective rhinosinusitis is a common clinical condition which if left unattended to could result in various degrees of both morbidity and mortality. We aimed to identify aerobic and fungal organisms implicated in acute and chronic maxillary sinusitis and determine their antibiotic sensitivity patterns among adults in South Western Nigeria.Materials and methods: This was a cross sectional study of adults with clinical and radiological diagnosis of maxillary sinusitis treated at the University College Hospital, Ibadan over a period of one-year. Semi- structured questionnaire was administered to each consented adult to obtain relevant demographic and clinical data. Maxillary antral proof puncture was done to obtain specimen for microscopy, culture and sensitivity for aerobic bacterial and fungal isolates. Descriptive statistics was used in the data analysis.Results: Seventy-nine patients (49.4% males and 50.6% females) with acute maxillary sinusitis (17.7%), and chronic maxillary sinusitis (82.3%) were recruited into the study. The mean age of the patients was 32.9 years (SD=12.78; Range: 19- 59). All patients presented with rhinorrhea while 92.8% had nasal obstruction. Fifty eight (73.4%) patients had history of antibiotic usage before presentation. Eight (57.1%) of the specimens from acute maxillary sinusitis cases and 40 (61.5%) of the specimens from chronic maxillary sinusitis yielded significant growth of bacteria and fungi respectively while 2 (3.5%) yielded mixed bacterial growth. Organisms commonly isolated from these specimens were Streptococcus pneumonia, Staphylococcus aureus, Pseudomonas aeruginosa, Haemophilus influenzae, and Aspergillus spp. The bacteria isolates were sensitive to Amoxicillin, Ciprofloxacin, Perfloxacin, Sparfloxacin and Ceftriaxone.Conclusion: The leading aerobic bacterial isolates from acute and chronic maxillary sinusitis were Streptococcus pneumonia and Staphylococcus aureus respectively. Fungal infections are seen only in chronic cases. It is recommended that where there are no microbiologic laboratory facilities, any of Ciprofloxacin, Perfloxacin, Sparfloxacin, and Amoxicillin can be administered empirically to treat infective maxillary sinusitis.Keywords: Aerobic bacteria, Fungus, Maxillary sinus, Rhinosinusitis

Investigation of dental maxillary sinusitis cases treated with endoscopic endonasal sinus surgery

Investigation of dental maxillary sinusitis cases treated with endoscopic endonasal sinus surgery

Study of anatomical variants at osteomeatal complex in cases of chronic maxillary sinusitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; To study the contribution of anatomical variations at osteomeatal complex area in development of chronic maxillary sinusitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 60 patients with chronic maxillary sinusitis, clinically diagnosed on the criteria layed by Lanza and Kennedy and radiologically supported by X-ray PNS, were included in the study. Nasal endoscopy with different angled endoscopes done under local anaesthesia to recognize the anatomical variants at osteomeatal complex area. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In 41.09% of cases anatomical variants like concha bullosa, paradoxical middle turbinate, large bulla ethmoidalis or medially bent uncinate process were detected, but in rest 59.91% of cases of maxillary sinusitis there was no anatomical abnormality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Among the causative factors for development of chronic maxillary sinusitis different anatomical variants at osteomeatal area causes narrowing of the drainage pathway of maxillary sinus leading to development of chronic inflammation of the maxillary sinus. &lt;/p&gt;

When Maxillary Sinusitis Does Not Heal: Findings on CBCT Scans of the Sinuses With a Particular Focus on the Occurrence of Odontogenic Causes of Maxillary Sinusitis.

ObjectivesThis study sought to investigate the proportion of patients with suspected sinusitis referred for radiological examination who have radiologically verified sinusitis of odontogenic origin and to describe this type of sinusitis.Study DesignThis investigation is a retrospective study.MethodsA total of 303 sinus examinations involving cone beam computed tomography (CBCT) performed at Sunderby Hospital, Luleå, Sweden in 2012 were independently reviewed by two radiologists. The number of cases of maxillary sinusitis and the correlation between maxillary sinusitis and odontogenic infections were determined.ResultsOverall, 24% of the verified cases of sinusitis were odontogenic. An odontogenic origin was identified in 40% of unilateral maxillary sinusitis cases but only 6% of bilateral maxillary sinusitis cases (p = 0.0015). Forty‐nine out of 54 patients with periapical destruction had adjacent mucosal swelling in the maxillary sinus, but only 15 of these patients satisfied the criteria for sinusitis.ConclusionThe present study confirms the close relationship between odontogenic infections and unilateral maxillary sinusitis. Level of Evidence 4

Odontogenic Fungal Maxillary Sinusitis: A Case Report of a Displaced Dental Foreign Body.

Odontogenic etiology accounts for 10-12% of cases of maxillary sinusitis. Although uncommon, direct spread of dental infections into the maxillary sinus is possible due to the close relationship of the maxillary posterior teeth to the maxillary sinus. An odontogenic infection is a polymicrobial aerobic-anaerobic infection, with anaerobes out numbering the aerobes. Diagnosis requires a thorough dental and clinical evaluation, including radiographs. Management of sinus disease of odontogenic origin often requires medical treatment with appropriate antibiotics, surgical drainage when indicated, and treatment to remove the offending dental etiology. A 35-year-old, non-smoking woman visited our clinic, with a history of 6months of facial pain, purulent nose discharge, and a foul taste in her mouth. The patient was otherwise healthy. Nasal endoscopy showed purulent discharge coming from the left middle meatus with a congested nasal mucosaand with a past history of dental treatments. CT PNS showed fractured free floating and an impacted foreign body through the premolar tooth and a right maxillary polyp with evidence of similar dental procedure done bilaterally. Functional endoscopic sinus surgery with extraction of the affected tooth and closure of oroantral fistula was done. The association between an odontogenic condition and maxillary sinusitis requires a thorough dental examination of patients with sinusitis. Concomitant management of the dental origin and the associated sinusitis will ensure complete resolution of the infection and may prevent recurrences and complications. A combination of a medical and surgical approach is generally required for the treatment of odontogenic sinusitis. An endoscopic shaver-assisted approach to is a reliable, minimally invasive method associated with less morbidity and lower incidence of complications.

Gallium-67 Scintigraphy in Differential Diagnosis of Malignant Tumours from Non-Tumorous Lesions of the Maxilla.

To assess the gallium-67 (67Ga) scintigraphy in differential diagnosis of malignant tumours from non-tumorous lesions of the maxilla. Nineteen patients with malignant tumours (six cases of squamous cell carcinoma and one case of malignant melanoma) and non-tumorous lesions (seven cases of maxillary sinusitis and five cases of postoperative maxillary changes) in the maxilla underwent 67Ga and bone scintigraphy with CT and MRI. The statistical analysis with respect to comparison between imaging features of 67Ga and bone scintigraphy and maxillary lesions was performed with the Pearson's chi-squared test. 67Ga scintigraphy for six of the seven patients with malignant tumours in the maxilla was positive (85.7%), 0 of 12 patients with non-tumorous lesions were positive (0%) (P = 0.000). Bone scintigraphy for six out of seven patients with malignant tumours was positive (85.7%), 10 of 12 patients with non-tumorous lesions were positive (83.3%) (P = 0.891). 67Ga scintigraphy was useful for detection of malignant tumours in the maxilla. However, bone scintigraphy was not an effective technique for interpretation of malignant tumours, maxillary sinusitis and postoperative change in the maxilla.

Differential protein expression in the secretory fluids of maxillary sinusitis and maxillary retention cyst.

Both maxillary sinusitis (MS) and maxillary retention cyst (MRC) involve the maxillary sinus and show similar clinical features. Clinically, differentiating between MS and MRC is sometimes difficult in asymptomatic patients, despite their quite different pathogenic behaviors. To identify differential protein expressions in the secretory fluids of MS and MRC, 25 cases of asymptomatic MS and 15 cases of asymptomatic MRC were examined pathologically in this study. All patients underwent routine endoscopic sinus surgery or modified Caldwell-Luc procedure and the sinus mucosal specimens obtained during these procedures with the approval of the Institutional Review Board. Their secretory fluids were analyzed via immunoprecipitation-based high-performance liquid chromatography (IP-HPLC) using 25 types of antiserum, including inflammatory cytokines, antimicrobial proteins, and mucosal protective proteins. In the histological examinations, MS and MRC showed similar features in the secretory columnar epithelial lining and thick submucosal connective tissue, both of which contained few inflammatory cells infiltrates. The IP-HPLC analysis revealed that TNFα, IL-1, -8, MMP-3, -10, α1-antitrypsin, cathepsin C, lysozyme, lactoferrin, β-defensin-1, -3, LL-37, mucocidin, and mucin-1 were more intensely expressed in MS than in MRC; whereas IgA, cystatin A, and proline-rich proteins were more strongly expressed in MRC than in MS. These data indicate that the secretory fluid of MS is indicative of a more robust inflammatory reaction to certain bacteria compared to that of MRC, while the secretory fluid of MRC contains more abundant mucosal protective proteins compared to that of MS. Taken together, the IP-HPLC analysis of MS and MRC secretory fluid revealed that MRC showed a weaker inflammatory reaction but a stronger mucosal protective function than MS.

Relationship between dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor and paranasal sinusitis.

To determine the clinical features of the dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor and its relationship with paranasal sinusitis. A retrospective analysis of 46 patients who received surgical treatment at the Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University for the dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor from October 2010 to December 2012. Each patient underwent magnetic resonance imaging (MRI) of the orbits and the 4 paranasal sinuses. Disease status and the level of serum immunoglobulin G4 (IgG4) was measured before and 6mo after surgery. The initial clinical feature of the idiopathic dacryoadenitis type of orbital inflammatory pseudotumor was redness or swelling of the eyelids. Masses were palpated in the area of the lacrimal gland in some patients. Of the 46 patients, 16 also suffered from sinusitis (34.8%), with 14 cases of ethmoid sinusitis, 8 cases of maxillary sinusitis, 9 cases of sphenoid sinusitis, and 8 cases of frontal sinusitis. Of the 16 patients with sinusitis, 4 patients had a medical history of rhinitis (range: 10mo to 15y previously), 10 patients had occasional nasal congestion, and 2 patients had no nasal congestion. Thirteen of the 46 patients had elevated serum IgG4 levels. Nine of these 13 patients had MRI signs of sinusitis. All patients (n=46) received oral glucocorticoid treatment for approximately 3mo after surgery. No sign of recurrence was found in the orbital MRI 6mo after surgery. Of the 16 patients with sinusitis, 9 cases of elevated serum IgG4 levels improved after treatment with decreased serum IgG4 level and 7 cases of normal serum IgG4 levels remained unchanged. Some patients with the dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor may also suffer from paranasal sinusitis. The incidence of paranasal sinusitis was much higher in patients with IgG4-elevated dacryoadenitis subtype orbital inflammatory pseudotumor than in those with normal IgG4 levels. Dacryoadenitis subtype orbital inflammatory pseudotumor and paranasal sinusitis may both the clinical manifestations of IgG4-related disease involved in different locations.

Maxillary sinusitis as a complication of infected dens invaginatus in maxillary lateral incisor: A case report

Introduction: Maxillary sinusitis can have various origins, including odontogenic origin. Case Report: We describe a case of maxillary sinusitis in a 25-year-old female patient who experienced pain and swelling in the right maxillary region as a complication of infected maxillary lateral incisor. Clinical and radiographic examinations revealed dens invaginatus (DI; Oehler's type III) associated with apical pathosis in the maxillary right lateral incisor, with a large periapical lesion involving the adjacent four teeth. Nonsurgical root canal treatment using calcium hydroxide medicament was carried out for all five teeth, which resulted in gradual diminution of sinusitis, and the patient remained asymptomatic. Discussion: This paper emphasizes the following: (i) the challenges posed by DI for root canal treatment because of its anatomical complexity; (ii) a nonsurgical approach in the management of a large periapical lesion, using calcium hydroxide medicament; and (iii) the interdisciplinary management of conditions of common clinical concern for medical and dental practitioners, for successful outcome.

A Case of Nasal Inverted Papilloma Accompanied with Odontogenic Maxillary Sinusitis Caused by an Oral Implant

A 67-year-old man presented with left nasal obstruction and mucopurulent discharge. CT showed shadows at his left sinuses, and implant extension into the left maxillary sinus cavity with an osteolytic lesion around that equivalent to the left side maxillary second molar. Our diagnosis in this case was left maxillary sinusitis related to a dental implant, and we performed endoscopic sinus surgery with implant extraction. Postoperatively, a concomitant sinonasal inverted papilloma (IP) was diagnosed with a histopathological examination. Residual lesion or recurrence has not occurred so far and all patient symptoms disappeared during the follow-up period. Dental implants are widely used and their use is increasing rapidly. On the other hand, cases of maxillary sinusitis caused by inadequate dental implant treatment have been reported. IP is one of the most frequent sinonasal benign tumors, and there are various differential diagnoses, including antrochoanal polyp, and odontogenic maxillary sinusitis. We should keep in mind that IP may occur in unilateral nasal polypoid cases, including cases suspected as being odontogenic maxillary sinusitis. Such masked lesions might not be detected if the treatment is performed by a dentist alone; therefore, we think it is important that dentists and otolaryngologists should make the diagnosis and perform the treatment together.

Fifteen years of experience with the midfacial distraction without maxillary osteotomy protocol

Midfacial distraction for facial stenosis is minimizing the communication between cranial fossa and nasal fossa caused by the Le Fort III osteotomy during frontofacial advancement procedures. There are different types of distractors, such as internal and external devices. The aim of our study is to present a series of 22 consecutive distraction cases operated without any Le Fort osteotomy with external distraction frames. We completely avoid the gap between the skull and nose, thus avoiding related complications. Between 1997 and 2012, we operated on 22 patients presenting syndromes associating midfacial retrusion, maxillomandibular class III malocclusion and upper airway obstruction. We perform a fronto-orbital advancement. We do not perform any maxillary osteotomy. A vertical cut in the lateral orbital wall is done towards the inferior orbital fissure and another cut on the zygomatic arch. We realise the fixation of the frame posteriorly with a folded K-wire and anteriorly with a transmaxillary pin. Aiming overcorrection, we distract on average 1 mm a day for a mean period of 26 days and with a horizontal distraction vector. No deaths or life-threatening complications were reported. All midfacial retrusions were corrected without relapse. The advancement ranged between 6 and 20 mm. Several complications were notified: one sphenopetrous dislocation, one ethmoidonasal dislocation, two device disassemblages and two cases of maxillary sinusitis. Some of these complications caused an incomplete distraction result. Compared to other techniques, this method is safe, simple and efficient. By sparing major osteotomies, it avoids severe complications.