Expansion Of Sinus Research Articles

Surgical Correction of Pneumosinus Dilatans of Maxillary Sinus

Pneumosinus dilatans is a rare disease in which 1 or more paranasal sinuses are dilated without functional alteration. The frontal sinus is the most commonly affected site, with involvement of the maxillary sinus being rare. Asymmetrical facial contour is the most common sign, and nasal obstruction and pain may also be present. We describe 6 cases of maxillary pneumosinus dilatans with histories of protrusion of the malar region. Plane radiography and computed tomography revealed abnormal expansion of the maxillary sinus without thinning of the bony wall, leading to a diagnosis of maxillary pneumosinus dilatans. Surgical decompression and maxilloplasty were achieved by electrical burring, greenstick downward fracture, or ostectomy of the anterior wall of the maxillary sinus and subsequent repositioning of the removed bony fragments with miniplates. The postoperative course was uneventful, and facial contours were improved on physical and radiologic examination. No recurrence was detected in any case, and good cosmetic results were achieved. In this article, the authors present surgical options for the treatment of pneumosinus dilatans of the maxillary sinus, including a review of the literature.

Fronto-turbinalis Sinus Expansion and Headache

Headaches of rhinogenic origin illustrate an interesting paradox. Little is known about their pathophysiology, mechanisms, and prevalence; yet, the concept that these headaches are of importance is widely accepted. This article discusses the relationship between fronto-turbinalis sinus expansion and headaches, as well as headache outcomes after surgical approach.

The Surgical Correction of Frontal Sinus Pneumoceles

Objectives: Frontal sinus pneumocele is a rare condition characterized by abnormal expansion of the air-containing sinus beyond the normal margins of the frontal bone. The etiology remains unclear but has been associated with developmental, neoplastic, inflammatory, and post-traumatic causes. Few reports in the literature describe the surgical management of frontal sinus pneumocele. We focus on describing the evaluation, work-up and surgical treatment of this condition.

Imaging of granulomatous and chronic invasive fungal sinusitis: Comparison with allergic fungal sinusitis

Objective To study the radiological features of chronic/granulomatous invasive fungal sinusitis (IFS) and identify differentiating characteristics, if any, from allergic fungal sinusitis (AFS). Study design Prospective radiological study. Setting Tertiary hospital in northern India. Subjects and methods Subjects were nonacute fungal sinusitis patients with orbital involvement presenting between January 1999 and December 2003. Seventeen IFS and 12 AFS patients with mean age 27 years (range 7-59 years) underwent computed tomographic scan (CT) and magnetic resonance imaging (MRI) of paranasal sinuses with contrast. These were operated within one month of doing the scans and had histologically confirmed fungal sinusitis. Outcome measures were characteristics of opacity produced by the diseased tissue on CT and MRI, side and number of sinuses involved, expansion of sinuses, areas of bone erosion, and extra-sinus extension. Results IFS showed homogenous opacity (isodense or hyperdense to muscle tissue) on CT and isointense and hypointense signal on T1- and T2-weighted MR images respectively. IFS showed involvement of one or two sinuses only, homogenous contrast enhancement, lack of expansion of sinuses, and bone erosion localized to the area of extra-sinus extension, and the extra-sinus component of the disease was more than the intra-sinus component. AFS showed heterogenous opacities with hyperattenuation areas on CT, isointense/hypointense to signal void on T1- and T2-weighted MR images. Expansion of sinuses, extensive bone erosion, lack of contrast enhancement, multiple sinus involvement, and major bulk of disease being intra-sinus rather than extra-sinus were other characteristics of AFS. Conclusion Radiological features of IFS are described that are different from AFS.

Paleobiogeography, biostratigraphy and systematics of the Hoplophorini (Xenarthra, Glyptodontoidea, Hoplophorinae) from the Ensenadan Stage (early Pleistocene to early-middle Pleistocene)

Neosclerocalyptus Paula Couto (= Hoplophorus = Sclerocalyptus) is a Pleistocene genus of Glyptodontidae Hoplophorini (=Sclerocalyptini) that includes several (ca. twelve) species, many of which have been recognized by typological/morphological taxonomic criteria. Four species have been described for the Ensenadan Stage (early Pleistocene to early-middle Pleistocene) of the Pampean region, Argentina. However, this study shows only two of them to be valid: Neosclerocalyptus pseudornatus and Neosclerocalyptus ornatus. An evident synapomorphy of Neosclerocalyptus is the notable pneumatization and lateral expansion of the fronto-nasal sinuses, which becomes evident in N. pseudornatus (ca. 1.07–0.98 Ma) and even more so in N. ornatus (ca. 0.98–0.40 Ma). This character, interpreted here as a probable response to the cold and arid/semiarid Pleistocene climate, is maximally manifested in the taxa from the middle Pleistocene (Bonaerian Stage) and late Pleistocene (Lujanian Stage). Neosclerocalyptus is very common in the Pampean region and north-central Argentina, but very scarce or absent in the Argentinian Mesopotamia, Uruguay and southern Brazil, areas that were subject to relatively more humid and warmer climates during most of the Pleistocene. From a biogeographical perspective, both Ensenadan species are restricted to the current Pampean region. N. pseudornatus is recorded in the “Toscas” (caliche duricrusts) of Río de La Plata (Buenos Aires City and Olivos) and Mar del Plata (Buenos Aires province), while N. ornatus is recorded in Mar del Plata and San Pedro (Buenos Aires province), and Granadero Baigorria (Santa Fe province).

Hidden unilateral agenesis of the frontal sinus: human cadaver study of a potential surgical pitfall

Purpose The aim of the study was to attract attention to the surgical significance of unilateral agenesis of the frontal sinus hidden by the overlapping expansion of the contralateral sinus toward the agenetic side. Materials and methods Retrospective review of endoscopic transnasal sinus dissections of 55 human cadavers (42, formalin fixated; 13, fresh frozen) was done in a tertiary care academic medical center. Surgical and radiologic findings were noted. Results Absence of right frontal sinus ostium in the presence of a connection between the right and left frontal sinuses was demonstrated in 2 (3.6%) cadavers. An absent and an incomplete septum between the frontal sinuses were also noted in these cadavers. No accompanying abnormality of other sinuses was found, and no evidence of previous sinus surgery was noted in these 2 cadavers. Conclusions If one of the frontal sinus ostia cannot be found during sinus surgery, although this sinus and its recess can be seen on the thick-sliced coronal computed tomographic (CT) scans, keep in mind that it may be (3.6%) an agenetic frontal sinus hidden by the extensive pneumatization of the contralateral sinus that is crossing the midline. It may not be possible to foresee this variant preoperatively by endoscopic examinations or thick-sliced CT scans. If there is suspicion, thin-sliced CT scans with reconstruction will be ideal to confirm the agenesis of the frontal sinus and to avoid complications. In the presence of such variant of frontal sinus, 1-sided successful frontal sinusotomy is adequate because this sinus or cell will already be drained through the treated frontal recess.

Cricopharyngeal dysfunction with significant piriform sinus expansion: case report

This report describes the case of a patient with cricopharyngeal dysfunction with significant piriform sinus expansion. An 80-year-old man presented with a three-year history of dysphagia. Palsy of the cricopharyngeal chalasis was identified by electromyography under both videofluorography and manofluorography. Although a widening procedure was performed in the cricopharyngeal region using a bougie, the patient gained only minor relief from his dysphagia. After the patient had had adequate time to recover spontaneously (six months), a cricopharyngeal myotomy was performed. As a result, his dysphagia resolved and the post-operative course was uneventful. The clinical and histopathological findings in this case suggested that significant piriform sinus expansion had resulted from the cricopharyngeal dysfunction, due to cricopharyngeal myopathy.

Dental precocity and secondary pneumatization

Paranasal sinus expansion integrates skeletal elements of the nasal capsule, orbit, and dentition. Computer modeling suggests that sinus cavities appear in spatial "gaps" within the craniofacial complex. Anthropoid primates provide excellent natural experiments for testing this model, since not all possess a full complement of paranasal sinuses. Using histological and microCT methods, we studied an ontogenetic sample of Saguinus spp., which possesses maxillary sinuses (MS), and Saimiri sciureus, which does not form a MS. In Saguinus, secondary pneumatization begins perinatally. From infant to juvenile stages, the MS cavity progressively overlaps all of the deciduous molars (dm). The MS overlays all permanent molars in the adult. In Saimiri, the primordial space of the MS (maxillary recess) extends no farther posteriorly than dm2 at birth and no farther than the last premolar in the adult. Three‐dimensional reconstructions of newborns reveal critical differences that may account for these differences, including relatively larger dm teeth in Saimiri. Radiographic density of dm teeth is more than 20% greater in Saimiri compared to Saguinus, indicating more precocious development. These findings support the hypothesis that secondary pneumatization is a novel, opportunistic growth mechanism that may be constrained by adjacent elements such as the maxillary dentition. Grant support: NSF BCS‐0820751.

Frontal recess cells: a rare cause of frontal sinus pneumocoele

A pneumocoele is a pathologically expanding, air-containing paranasal sinus. Pneumocoeles are uncommon entities, with very few cases reported in the literature. The most plausible aetiological theory is that of a one-way valve effect allowing air into the sinus under increased pressure without pressure equilibration. Review of a frontal sinus pneumocoele caused by a type III frontal cell and intersinus septal cell. We present a patient with chronic sinusitis who developed a pneumocoele of her left frontal sinus with erosion into her orbit. This patient was a habitual, chronic nose-blower with a large type III frontal cell adjacent to an intersinus septal cell. We propose the new theory that, in our patient, such cells formed a one-way valve, causing air-trapping and pathological expansion of the frontal sinus. To our knowledge, there are no previously published cases that establish an association between large frontal cells and expansion of a pneumocoele.

Early Implant Placement in Bilateral Sinus Floor Augmentation Using Iliac Bone Block Grafts in Severe Maxillary Atrophy: A Clinical, Histological, and Radiographic Case Report

Effectively restoring a grossly atrophic maxilla can be difficult for the implant surgeon. The placement of dental implants in patients who are edentulous in the posterior maxilla can present difficulties because of deficient posterior alveolar ridge and increased pneumatization of the maxillary sinus, resulting in a minimal hard tissue bed. Implant placement requires adequate quality and quantity of bone, especially in the posterior maxilla. Insufficient bone height and width in this area of the maxilla, because of expansion of the maxillary sinus and atrophic reduction of the alveolar ridge, represents a contraindication for conventional insertion of dental implants. The reconstruction of edentulous patients with adequate bone volume and density by the use of bone graft and, subsequently, the placement of dental implants has become a viable treatment option with high predictability. It is commonly shared that autologous bone graft is the gold standard grafting method in the augmentation of Higmoro antrum and in any kinds of guided bone regeneration. In this article, the authors report a case of severe maxillary atrophy that is augmented by block bone graft harvested from iliac crest. An early placement of implants is possible due to the quick healing of the site, as proven by histologic examinations.

Simultaneous Implant Placement in Sinus Floor Augmentation Using Iliac Bone Block Grafts in Severe Maxillary Atrophies: Case Report

The placement of implants requires adequate basic conditions. Insufficient bone height and width in the area of the maxilla, because of expansion of the maxillary sinus and atrophic resorption of the alveolar ridge, represent a common anatomical complication, which can be solved by augmentation of the floor of the maxillary sinus. It is commonly shared that autologous bone graft is the gold standard method in the augmentation of the Higmoro antrum. The reconstruction of atrophies with adequate bone volume and density has become a viable treatment option with high predictability and success rates. The purpose of this study was to present the results obtained with a surgical procedure aimed at reconstructing (rehabilitating) advanced maxillary atrophies. This method includes the use of intramembranous, corticocancellous bone grafts harvested from the iliac crest. These are then fixed to the residual bone by endosseous implants.

Fate of the Nasal Capsular Cartilages in Prenatal and Perinatal Tamarins (Saguinus geoffroyi) and Extent of Secondary Pneumatization of Maxillary and Frontal Sinuses

Development of the nasal capsule cartilages was studied in seven Geoffroy's tamarins (Saguinus geoffroyi), including one fetus, five neonates and one infant. Four additional postnatal specimens of the genus were studied (one 5-month-old and three adults) to determine the magnitude of postnatal expansion of the paranasal sinuses. Alcian blue histochemistry and osteopontin immunohistochemistry were employed in selected subadult specimens to characterize cartilage matrix. The fetal S. geoffroyi possesses a continuous nasal capsule, including a zona anularis; the primordial maxillary sinuses are surrounded by cartilage. Secondary pneumatization is in progress in all older specimens, which have sinuses that are more than twofold larger compared to that of the fetus. Results indicate that extensive ossification of the middle part of the nasal capsule (pars intermedia) is occurring in the perinatal timeframe, forming portions of the ethmoid bone. Anteriorly, the nasal capsule comprises isolated fragments in perinatal specimens, which are fewer and smaller in the infant and in a 5-month-old S. midas, and nearby multinucleate cells suggest that osteoclasts break apart these initially continuous elements. Fragments of the pars intermedia and the tectum nasi are found transiently between mucosa and the sites of secondary pneumatization. The maxillary sinus mucosa is highly vascular in most perinatal specimens. Histochemical and immunohistochemical findings show that cartilage of endochondral bones and non-ossifying parts are distinct in the perinatal time period. These results indicate that breakdown of the capsular cartilage precedes secondary pneumatization as previously suggested. There are portions of the cartilage of the recessus maxillaris and tectum nasi that transiently block mucosa from interfacing directly with bone. Vascularization may play a role in the breakdown of cartilages as well as the onset of secondary pneumatization. Since cartilage has the capacity to produce substances that trigger angiogenesis and bone resorption, further detailed characterization of the cartilage bordering sites of secondary pneumatization is merited.

Pneumosinus Dilatans: A Rare Cause of Frontal Sinus Expansion—Case Report and Review of Literature

Pneumosinus Dilatans: A Rare Cause of Frontal Sinus Expansion—Case Report and Review of Literature

Allergic fungal sinusitis with extensive bone erosion of the clivus presenting with diplopia

We report a case of allergic fungal sinusitis causing bone erosion and diplopia. A 43-year-old man presented with a four-month history of increased nasal congestion and progressive diplopia. Clinical examination revealed bilateral nasal polyposis and a right lateral gaze deficit, consistent with a VIth cranial nerve palsy. Computed tomography of the paranasal sinuses demonstrated a large sellar mass with extensive bony erosion and both supra- and infra-sellar extension. An endoscopic approach to the sphenoid sinus, clivus and posterior cranial fossa with image guidance was performed, enabling surgical treatment involving nasal polypectomy, wide marsupialisation of the sphenoid sinus and removal of the extensive allergic fungal mucin. The patient awoke from anaesthesia with complete resolution of his diplopia. Otolaryngologists should be aware that approximately 20 per cent of patients with allergic fungal sinusitis demonstrate paranasal sinus expansion and bone erosion involving surrounding anatomical structures. Such patients may have clinical findings involving the orbit and cranial vault.

Tumor-Induced Sentinel Lymph Node Lymphangiogenesis and Increased Lymph Flow Precede Melanoma Metastasis

Lymphangiogenesis is associated with human and murine cancer metastasis, suggesting that lymphatic vessels are important for tumor dissemination. Lymphatic vessel alterations were examined using B16-F10 melanoma cells implanted in syngeneic C57Bl/6 mice, which form tumors metastasizing to draining lymph nodes and subsequently to the lungs. Footpad tumors showed no lymphatic or blood vessel growth; however, the tumor-draining popliteal lymph node featured greatly increased lymphatic sinuses. Lymph node lymphangiogenesis began before melanoma cells reached draining lymph nodes, indicating that primary tumors induce these alterations at a distance. Lymph flow imaging revealed that nanoparticle transit was greatly increased through tumor-draining relative to nondraining lymph nodes. Lymph node lymphatic sinuses and lymph flow were increased in mice implanted with unmarked or with foreign antigen-expressing melanomas, indicating that these effects are not due to foreign antigen expression. However, tumor-derived immune signaling could promote lymph node alterations, as macrophages infiltrated footpad tumors, whereas lymphocytes accumulated in tumor-draining lymph nodes. B lymphocytes are required for lymphangiogenesis and increased lymph flow through tumor-draining lymph nodes, as these alterations were not observed in mice deficient for B cells. Lymph node lymphangiogenesis and increased lymph flow through tumor-draining lymph nodes may actively promote metastasis via the lymphatics.

Pneumosinus dilatans of the ethmoid sinus presenting with exophthalmus: a case report and review of the literature

Pneumosinus dilatans (PSD) is a rare condition of unknown aetiology in which there is enlargement of the paranasal sinuses by air, where the affected sinus expands beyond the normal boundaries of bone without thinning of its bony walls. The case of a 28 year old male with PSD, who had gradually increasing exophthalmus and diplopia, is presented and characteristics of this condition are reviewed with literature data.

Mucocoele of the maxillary sinus

Mucocoele is histopathologically benign, cystic change of paranasal sinuses filled with mucoid contents, which with its growth is pressuring and destroying local bone walls. In only 3% of the cases it can be localized in maxillary sinuses. Etiology is unknown. Pyocoele develops by secondary infection. The male patient was 21 years old. His symptoms were runny nose with thick contents and heavy breathing on the right side of the nose, headaches, as well as the swelling of the right cheek. During clinical examination, the expansive change was found. It was completely closing the right side of the nose cavity. Computerized tomography (CT) of paranasal cavities showed excessive expansion of the right maxillary sinus, with very thinned walls, while the cavity was filled with liquid. After antibiotics therapy, the radical operation of the right maxillary sinus was performed, based on Caldwell Luc method. The frontal wall was found to be extremely convex and thinned, while the medial wall was with dehiscention. The cystic change was extirpated. Mucocoele was proved by pathohistologic findings. Its wall was about 2 mm thick and it showed squamous metaplasia in the large part of the mucocoela epithel. In the submucosa fibrosis and inflammatory infiltrate was present. Postoperative follow-up was under control. Clinicaly and radiographycaly, six months after therapy, the patient does not have troubles. The rare localization of the mucocoeles in maxillary sinus can be explained with the width of the maxillary ostia. Infected mucocoeles, expanded to the local anatomical structures, should be operated on with classic radical surgical operation.

Preparing the “Soil”: The Primary Tumor Induces Vasculature Reorganization in the Sentinel Lymph Node before the Arrival of Metastatic Cancer Cells

Sentinel lymph node (SLN) metastasis is the first step in the spreading of cancer in many malignancies. Tumor-reactive lymphadenopathy in SLNs has been observed for decades, but alterations of the lymphatic channels and vasculature in these nodes before the arrival of metastatic tumor cells remain unexplored. Using animal models, we show here that, before the establishment of metastasis in the SLN, there are reorganizations of the lymphatic channels and the vasculature. The node becomes a functional blood vessel-enriched and lymph vessel/sinus-enriched organ before metastasis. The enlargement of the lymph sinuses is correlated with the primary tumor weight. The newly emerged functional blood vessels develop from high endothelial venules (HEV), in which the proliferation rate of the endothelial cells is also significantly increased. Similar alterations of the HEVs are also characterized in the axillary lymph nodes from human breast cancer patients without the evidence of metastasis. These findings support the hypothesis that modification of the microenvironment for a secondary tumor (i.e., vasculature reorganization in the SLN) can be initiated by a primary tumor before and independent of the physical presence of metastatic cancer cells.

Twin–twin transfusion syndrome: cerebral ischemia is not the only fetal MR imaging finding

Twin-twin transfusion syndrome (TTTS) is a complication of monochorionic/diamniotic twin pregnancies. An imbalance of blood flow occurs through placental anastomoses, causing potentially significant morbidity and mortality in both twins. Although the sonographic findings of TTTS are well documented, we believe that MR imaging is a valuable adjunct. We describe the fetal MR imaging findings associated with TTTS. From 2003 to 2005, 37 consecutive MR imaging studies were performed on multiple-gestation pregnancies. Of the 37, 25 were consistent with TTTS, correlated and confirmed by sonographic criteria. MR fetal abnormalities were documented. Cerebral ischemia, which could not be demonstrated by sonography, was delineated well by MR imaging. New findings noted on fetal MR imaging were enlargement of cerebral venous sinuses in both twins, dilatation of the renal collecting system in the recipient, lung lesions in the recipient and cerebral malformations in the donor. MR imaging is an important adjunct in TTTS imaging. Its benefit over sonography is its clear definition of cerebral pathology, which is important for intervention and counseling. The new findings, particularly in the urinary tract and cerebral venous sinuses, also help support the diagnosis of TTTS and might reveal additional consequences of the altered hemodynamics that occur in TTTS.

Pneumosinus dilatans: demonstrated by sinus expansion on serial sinus X-rays with discussion of possible aetiology

A case of pneumosinus dilatans of the frontal sinus is presented. The findings on serial skull X-rays, performed on three occasions over a 10-year period, seem to support a developmental aetiology for this rare condition.