Lateral Wall Of Maxillary Sinus Research Articles

Assessment of neurovascular channels in lateral maxillary sinus wall using cone-beam computed tomography: An imperative clinicians guide for implant placements.

The aim of this study is to evaluate the location and radio morphometric features of the posterior superior alveolar artery (PSAA) in patients undergoing rehabilitation of posterior maxilla and other sinus augmentation surgical procedures by cone-beam computed tomography (CBCT). A total of 816 CBCT scans were included. Various radio morphometric measurements were done to assess the PSAA location, diameter, and distances to the sinus floor and alveolar crest. The PSAA was mostly intraosseous in the maximum in the age group 31-51 years (56%), in males (53.4%), and in dentate patients (57.4%). The artery tends to be wider in older patients. Distances to the sinus floor or the alveolar crest tend to be shorter in women. This study suggests that CBCT is a valuable pre-surgical tool and the evaluation of the PSAA on CBCT images could reduce the likelihood of excess bleeding during surgery in the maxillary posterior region.

The anatomical variations of paranasal sinuses may be related to the formation of antrochoanal polyp by computed tomography imaging study.

There is little investigation into the connection between anatomic variations and the development of antrochoanal polyp (ACP), and the etiology of ACP remains unclear. The study aims to explore the relationship among anatomic variations, maxillary sinus volume, nasal meatus-related parameters, and the occurrence of ACP. There were 127 patients included in this retrospective cross-sectional study with unilateral ACPs hospitalized at Shandong Provincial ENT Hospital between February 2010 and February 2020. Evaluation indicators included anatomic variations, maxillary sinus volume, and nasal meatus-related parameters in 45 children and 82 adults, which were evaluated twice by 3DSlicer software. Parameters were assessed using the Kolmogorov-Smirnov test, followed by paired t-test and Chi-squared test for multiple comparisons. Significant differences were found in the accessory maxillary ostium (AMO) and maxillary sinus retention cyst between two sides (both P<0.001). Maxillary sinus volume and sex had an association of statistical significance on adults' ACP side (P=0.026) and non-antrochoanal polyp (non-ACP) side (P=0.032). The affected side's maxillary sinus volume was significantly larger than the healthy side (P<0.001). The length from the maxillary sinus orifice to the plane of the most lateral margin of the middle turbinate of the ACP side was larger than the non-ACP side in children (P=0.044). Males' length from the maxillary sinus orifice to the plane of the most lateral margin of the middle turbinate of the ACP side was considerably greater than the healthy side (P<0.001). The length from the maxillary sinus orifice to the plane of the most lateral margin of the middle turbinate (P=0.014) and the length from the inferior turbinate to the nasal septum (P=0.013) on the non-ACP side was higher than the affected side in adults. Males' length from the inferior turbinate to the nasal septum was higher on the healthy side than the affected side (P<0.001). Males had a greater maximum length from the maxillary sinus lateral wall to the nasal septum (P=0.024) and the length from the inferior turbinate to the nasal septum (P=0.003) on the non-ACP side than females. Males had a larger maximum length from the maxillary sinus lateral wall to the nasal septum on the ACP side than females (P=0.011). In our study, the occurrence of the AMO, the maxillary sinus's expanded size, and the stenosis of the associated channels around the ostiomeatal complex and common meatus are regarded as probably connected to the formation of ACPs. In addition, the anatomic variations that involve the ostiomeatal complex and may lead to a change in maxillary sinus pressure and nasal ventilation are important factors in the formation of ACPs.

Localization of the position of vital anatomical structures in the lateral wall of maxillary sinus during different surgical intervention using cone beam computed tomography

Background: Proper information about the anatomy of the maxillary sinus is required to avoid any unexpected complications that may arise due to the close relation between the maxillary sinus and posterior superior alveolar artery. Objective: To the current study used cone beam computed tomography CBCT imaging to assess the position of the posterior superior alveolar artery (PSAA) in relationship to the alveolar ridge and the flour of maxillary sinus. Patients and Methods: A number of 95 Iraqi patients participated in this prospective study (53 females, 42 males; age range 20-49 years). From January 2021 to February 2022, attended a 2nd specialised dentistry institution in Baquba city for CBCT scanning for numerous diagnostic and management purposes. Results: According to our study, we detected the presences of artery in (83.68%) of the sample. females showed higher PSAA prevalence than men on both sides, and the difference was significant overall, Also, the existence of artery for each side and total in the intramembranous locating in females is greater than that in males, which may demonstrate that the probability of Bleeding and other side effects is higher in males, since the existence of artery in the intramembranous area in females will reduce the likelihood of traumatic injury throughout any surgical treatment. Conclusion: This research used CBCT to determine the precise location of PSAA in the Iraqi population. This data could assist in decreasing the likelihood of hemorrhage as well as other complications which may happen throughout any surgical treatment, such as dental implant placement, ridge expansion.As well as other surgical interventions in this region. Keywords: Maxillary sinus walls, posterior superior alveolar artery, cone beam computed tomography

Localization of the position of vital anatomical structures in the lateral wall of maxillary sinus during different surgical intervention using cone beam computed tomography

Background: Proper information about the anatomy of the maxillary sinus is required to avoid any unexpected complications that may arise due to the close relation between the maxillary sinus and posterior superior alveolar artery.&#x0D; Objective: To the current study used cone beam computed tomography CBCT imaging to assess the position of the posterior superior alveolar artery (PSAA) in relationship to the alveolar ridge and the flour of maxillary sinus.&#x0D; Patients and Methods: A number of 95 Iraqi patients participated in this prospective study (53 females, 42 males; age range 20-49 years). From January 2021 to February 2022, attended a 2nd specialised dentistry institution in Baquba city for CBCT scanning for numerous diagnostic and management purposes.&#x0D; Results: According to our study, we detected the presences of artery in (83.68%) of the sample. females showed higher PSAA prevalence than men on both sides, and the difference was significant overall, Also, the existence of artery for each side and total in the intramembranous locating in females is greater than that in males, which may demonstrate that the probability of Bleeding and other side effects is higher in males, since the existence of artery in the intramembranous area in females will reduce the likelihood of traumatic injury throughout any surgical treatment.&#x0D; Conclusion: This research used CBCT to determine the precise location of PSAA in the Iraqi population. This data could assist in decreasing the likelihood of hemorrhage as well as other complications which may happen throughout any surgical treatment, such as dental implant placement, ridge expansion.As well as other surgical interventions in this region.

Unusual Locations of Inverted Papilloma.

Inverted papilloma is a tumor found involving the nasal cavity and paranasal sinuses. They are not cancerous but can be locally aggressive. They are most commonly seen involving the lateral wall of nose and maxillary sinus. When the tumor involves the frontal sinus and sphenoid sinus or the post ethmoid cells it presents a surgical challenge. Inverted papilloma almost always occur unilateraly and affect mainly the maxillary sinus. Inverted papilloma arising from the sphenoid and frontal sinuses are rare. Here we present two cases; one involving a 60 year man, with inverted papilloma originating from the frontal sinus and another case where it originated from the sphenoid sinus anterior wall and posterior ethmoidalcell (Onodi cell) and was resected endoscopically.

Comparative diagnosis of the alveolar antral artery canal in the lateral maxillary sinus wall in corresponding panoramic radiography and cone-beam computed tomography

PurposeSinus lift operations are a tried and tested means of providing adequate implant prosthetics to patients with compromised jawbones. Knowledge of the arterial supply of the maxillary sinus region is essential for surgical treatment in this area. The aim of the present comparative study was to determine whether alveolar antral artery (AAA) canal can be diagnosed both in corresponding panoramic radiography (PR) and cone-beam computed tomography (CBCT).MethodsA total of 335 patients with 635 sites and corresponding maxillary sinus in both PR and CBCT were selected and examined for AAA canal visibility.ResultsThe visibility of the AAA canal was significantly higher in CBCT than in PR. A total of 154 (46.0%) AAA canals could be identified in the maxillary sinus on the right. However, only four (1.2%) of these were also visible in PR. The detected values of the AAA canals in the maxillary sinus on the left in the PR and CBCT images were similar to those of the right. While 164 AAA canals (49%) were observed in CBCT images, only 1 (0.3%) was identifiable in PR.ConclusionsThe results show that CBCT can be recommended for visualising the AAA canal when surgically planning sinus augmentation procedures.Graphical

Guided Lateral Window Osteotomy Using Dynamic Navigation for Maxillary Sinus Augmentation: A Novel Technique.

The size and the position of the sinus antrostomy play a key role in making sinus grafting surgery more predictable and effective with less complications. A cone beam computed tomography and intraoral scan of the maxilla were taken for a patient who is missing maxillary first molar tooth with limited residual bone. Data were exported to the dynamic navigation (DN) system software. Sinus lateral window osteotomy position and dimensions were determined and planned using four 1.5 mm diameter implants placed on the maxillary sinus lateral wall. The osteotomy was initiated following the planned four 1.5 mm implants in a parallel motion to the bone surface using dynamic navigation guidance; thus, creating an outline for the lateral sinus window. Afterword's, the lateral sinus window was greenstick fractured and the membrane was lifted; first molar implant osteotomy done, implant placed, and bone graft material was placed. The flap was sutured, and post-operative instructions and medications were given. No post-operative complications noticed. The outline of the lateral window osteotomy along with implant osteotomy can be accurately planned and executed using DN technology, which may potentially reduce complications and insure accurate placement of the implant and the graft.

Radiographic assessment of maxillary sinus lateral wall and anatomy of posterior superior alveolar artery: A Cone-Beam Computed Tomographic

hickness of maxillary sinus (MS) lateral wall and to assess the prevalence, distance from maxillary sinus floor, diameter and course of posterior superior alveolar artery (PSAA) based on age, gender and dental status using conebeam computed tomography (CBCT) that might be relevant to accomplish complication free surgeries in posterior maxilla. CBCT images of maxillary sinus (right and left) were obtained for 40 patients, which included 20 males and 20 females. Maxillary sinus lateral wall and PSAA parameters were measured and evaluated. The data obtained were then subjected to descriptive statistical analysis; independent t-test and oneway Anova test were performed and compared based on age, gender and dental status. The results showed that the average thickness of the lateral wall of the maxillary sinus was determined to be approximately around 2.50 mm. PSAA was observed in 25% of subjects with a maximum distance of 8.83 mm from the maxillary sinus floor and a minimum distance of 6.90 mm. PSAA had a diameter of 1-2 mm with the intraosseous course in most individuals. Comparison between CBCT images of the selected individuals among age groups, gender and dental status were not statistically significant on measuring the above mentioned parameters. This study concluded that CBCT provides valuable diagnostic information pertaining to sinus and related landmarks that assist during surgical procedures.

Risk factors for sinus membrane perforation during lateral window maxillary sinus floor elevation surgery: A retrospective study.

To analyze the sinus membrane perforation (SMP) rate and its potential risk factors during lateral window maxillary sinus floor elevation (LSFE). For patients with LSFEs at Department of Implantology, Stomatology Hospital, School of Medicine, Zhejiang Universitiy during January 2014 to December 2020, patient-related risk factors (age/sex/smoking habit), surgery-related risk factors (operator experiment/number of tooth units/technique of osteotomy/surgical approach), and maxillary sinus-related risk factors (residual bone height/sinus membrane thickness/lateral wall thickness/maxillary sinus contours/presence of septa/blood vessels at the lateral maxillary sinus wall) were compared between perforated and nonperforated sites and were evaluated for their influence affecting SMP. The study sample comprised 278 LSFE procedures in 278 patients; a total of 47 LSFE procedures (16.91%) presented SMP. Four significant factors were identified: smoking habit (p < 0.001), thin (≤1.5 mm) sinus membrane (p=0.027), maxillary sinus contours (p < 0.001), and presence of septa (p=0.001). The SMP rate of irregular, narrow tapered, and tapering sinus contours was significantly higher than that of ovoid and square one (p < 0.05). In general, smoking habit, thin sinus membrane, irregular, narrow tapered, and tapering sinus contours, and presence of septa may increase the risk of SMP during LSFE.

Evaluation of Sexual Dimorphism in Schneider Membrane Thickness Using Cone-Beam Computed Tomography (CBCT) for its Clinical and Forensic Implications

Sinus augmentation requires careful manipulation of the Schneider membrane. Perforation of the membrane can be a challenging complication. The objective of this study is to evaluate the sexual dimorphism of Schneider membrane (sinus membrane) using cone-beam computed tomography (CBCT) imaging modality and discuss its clinical applications vis-a-vis the sinus lift procedure for dental implants and also its forensic implications. One hundred CBCT scans in the maxillary first molar region of fifty men and fifty women in the age group of 25–50 years were examined at two standardized points on the floor and lateral wall of maxillary sinus, and its mean was obtained. Measurements were taken for thickness of sinus membrane at most prominent antero-posterior and mesio-distal dimensions. The mean sinus membrane thickness and correlation in age groups (25–35 and 36–50 years) of both the genders were evaluated statistically. The results showed a thicker sinus membrane in women, especially in 36–50 age group than that of men. This study correlates the thickness of the sinus membrane with gender dimorphism and delves on its association with the risk of perforation during sinus lift procedures and also its forensic implications.

Surgical alternative for maxillary sinus approach in the post maxilla. Case Report

The present case is about a 25-year-old male patient, with no relevant medical history, who attended the SERODU dental clinic. On clinical examination, it is observed that the patient presents sensitivity when making a light tapping of the lateral wall of the left maxillary sinus externally on the cheekbones and intraoral palpation on the lateral surface of the maxilla between the canine and zygomatic fossa. In the tomographic study, a hypodense image compatible with an infectious process and a hyperdense image related to a root remnant belonging to a dental organ No. 2.6 is observed. The objective of this study is to describe the clinical case of a patient with sinusitis of odontogenic origin due to displacement of a radicular remainder towards the left maxillary sinus, in which clinical and surgical procedures were performed through trepanation in the post maxilla, which obtained greater precision. for foreign body removal compared to the classic Caldwell Luc approach. 8 days after the surgical procedure, the stitches were removed and optimal soft tissue healing, absence of pain, edema, and infection was observed clinically. Tomographic control was carried out three months after the intervention to assess the results of the treatment and to follow up the case. The surgical approach carried out constitutes an invasive and effective treatment for the removal of root remains.

Gingival Biotype and Its Relationship With the Maxillary Membrane and Lateral Wall Thickness.

The purpose of this study was to analyze the risk of the maxillary sinus lift technique and the correlation between the thickness of the gingiva, maxillary sinus membrane, and the maxillary sinus lateral wall. Cone-beam computerized tomograhy (CBCT) records of 32 adult dentate patients (10 male/22 female) were analyzed. The gingival thickness records of the dental units were compared with the thickness measurements of the membrane and lateral wall of the maxillary sinus. The gingival biotypes varied between 1.1 mm (thin) and 1.6 mm (thick), with a small association with sex. The thickness of the sinus membrane presented a small association between sexes (0.2 mm, female/0.3 mm, male) and gingival biotypes (Cohen d = .52). The lateral wall presented a weak association between the biotypes (1.3 mm, thin/1.1 mm, thick). There was also no correlation between the membrane and lateral wall (r = -.22). The volume dimension related to the graft area of the sinus was 4 mm3 for men and 5 mm3 for women. There was a weak correlation of gingival thickness compared with membrane thickness and lateral wall of the sinus (r = .304/r = -.31). Gingival thickness does not appear to be a reliable thickness predictor of the membrane or lateral wall of the maxillary sinus. The analysis of maxillary sinus anatomical structures through CBCT is the most reliable technique to identify the thickness of the membrane and lateral wall of the maxillary sinus before surgery. We believe that new studies are necessary to confirm our findings.

Prevalence and morphometric analysis of the alveolar antral artery in a group of Thai population by cone beam computed tomography.

To investigate the prevalence, diameter, and position of the alveolar antral artery (AAA) canals and measure the distances from the canal to the maxillary sinus floor and to the edentulous alveolar crest in each posterior maxillary tooth locations by cone beam computed tomography (CBCT). CBCT images of the posterior maxillary region from 280 patients were investigated. The prevalence and diameter of the AAA canal were evaluated. The perpendicular distances from the canal to the maxillary sinus floor and to the edentulous alveolar crest of each tooth locations were measured. The mediolateral positions and routes of the canals were observed with novel classification. Statistical analyses were carried out to determine any significant differences in mean distances between the tooth locations along with mean distances of tooth location by age, gender, and dentate status. The AAA canal was found in 94.6% with a mean diameter ± SD of 1.05 ± 0.34mm. The mean ± SD perpendicular distance from AAA canal to the edentulous alveolar crest at the first (16.02 ± 3.94mm) and the second molars (16.74 ± 3.51mm) were significantly shorter than the second premolar region. The intrasinus mediolateral position of the canal (72.5%) was the most common in concordance with the all-in type mediolateral route (50.9%). The intrasinus mediolateral position of the AAA canal is a common structure in the lateral wall of maxillary sinus, which could be detected with CBCT images. The all-in type is the most prevalent mediolateral route among a novel 7-type classification system of AAA routes. Owing to the short distance between the AAA canal and the alveolar crest in the first and second molar locations, CBCT images should be taken to investigate the AAA position and route before sinus lift procedure to prevent the risk of hemorrhage.

Evaluation of the Posterior Superior Alveolar Artery Prior to Sinus Floor Elevation via Lateral Window Technique: A Cone-Beam Computed Tomography Study

Aim:To evaluate the prevalence, diameter, localization of the posterior superior alveolar artery (PSAA) and the relationship between PSAA and the floor of the maxillary sinus and the thickness of the maxillary sinus lateral wall using cone-beam computed tomography (CBCT).Material and Methods:In this retrospective study, more than 500 CBCT images were retrieved. Out of them 156 CBCT images were related to the sinus floor elevation, among which 120 CBCT images were enrolled in the study based on the inclusion criteria, and 36 CBCT images were excluded. A total of 120 CBCT images of the PSSA from 60 patients comprising 32 (53.3%) men and 28 (46.7%) women were analyzed. Statistical data were analyzed using SPSS for Windows version 22. Descriptive statistics (mean, standard deviation, frequency) were used for the analyses.Results:The ages of the participants ranged between 26 and 76 years and the mean age was 54.48 ± 10.92 years. The PSAA was detected on the right side in 95% of the CBCT scans and on the left side in 85% of the maxillary sinuses. At the first detection point (FDP) and last detection point (LDP), the mean values of the distance between the inferior border of the PSAA and the floor of the maxillary sinus were 9.54 ± 4.27 mm and 7.91 ± 4.75 mm, respectively. The mean diameters of the PSAA at the FDP and LDP were 1.36 ± 0.46 mm and 1.12 ± 0.35 mm, respectively.Conclusion:Detection of the characteristics of the PSAA by using CBCT is crucial for handling the sinus floor elevation procedures uneventfully.

Modification of Septal Window to Improve Angled Endoscopic View for Beyond Maxillary Sinus.

Many endoscopic surgeons have showed various techniques on septal window using endoscopic tools. However, each technique has its own merits and faults. In this study, the authors introduce simple and time saving endoscopic window technique by avoiding intranasal suture resulting from simple incision line. The procedure to make septal window is to improve an angled endoscopic view for beyond lateral wall of maxillary sinus with septum preservation. To date, this approach has shown no major or concerning complications and has also showed favorable disease control outcomes while maintaining nasal airway patency and functionality through our experience.

Maxillary Sinusitis of Odontogenic Origin in Relation to Ectopic 2.8 Associated with Follicular Dentigerous Cyst – Combined Transnasal and Oral Endoscopic Approach: A Case Report

Purpose: To describe the management of orosinusal pathology by combined transnasal and oral endoscopy. Methods: The 54-year-old patient underwent a dental and otolaryngological evaluation for left odontogenic maxillary sinusitis in relation to plausible dental follicular cyst of ectopic element 2.8. The symptoms reported at the time of access to the hospital were nasal obstruction and nocturnal rhonchopathy. In the ENT evaluation by videorhinoscopy with rigid optics, complex deviation of the nasal septum was revealed, without any evident formation or pathological secretion. On inspection of the oral cavity, the mucous membranes appeared unscathed. The previously extracted aleveolus of 1.6 was evident. The radiological examination, facial CT, revealed the left maxillary sinus almost completely occupied by a cystic appearance, with thin calcified walls and homogeneous content that had a dental element, probably the 2.8, which fenestrates the vestibular cortex of the lateral wall of the maxillary sinus. This lesion erodes the medial wall of the sinus, obliterating the ostiomeatal complex and imprinting the ipsilateral ethmoidal cells. Biohumoral tests showed normal coagulation parameters, indices of renal function, liver and ionemia. The patient under general anesthesia and oral intubation with a combined intervention of the left anterior FESS, intrasulcular flap from dental elements 2.7 to 2.3 with mesial releasing incision, moderate osteotomy, ectopic 2.8 extraction and enucleation of the cystic lesion with simultaneous closure of the orosinusal communication with advancement of the Bichat fat pad and closure by first intention. In the same session, the ENT moment is carried out transnasally for total left uncinectomy, medium antrostomy with the union of the natural ostium and the accessory ostium. Bilateral lower turbinoplasty with bipolar forceps. The patient was then controlled after 15 days and then six months, showing good healing and no signs of recurrence at the rhinoscopic check on the physical examination of the oral cavity. Results: Based on the clinical and radiological aspect, the diagnosis of a follicular dentigerous cyst (WHO 2017) covered by a multi-layered non-keratinized paving epithelium, with moderate chronic inflammation, including gigantocellular and cholesteric crystals, is reached from the microbiological and histological examination. Necrotic amorphous material coexists including rare hyphae and fungal spores, with mycotic and actinomycotic superinfection. Conclusions: The combined oral and nasal intervention, allowed by the collaboration between the oral surgeon and ENT, has made it possible to shorten the healing time and resolve the pathology without recurrence.

Quantitative and qualitative assessments of intraosseous neurovascular canals in dentate and posteriorly edentulous individuals in lateral maxillary sinus wall

ObjectiveKnowledge and evaluation of the blood supply within the maxillary sinus before sinus augmentation are vital to avoid surgical complications. The lateral maxilla is supplied by branches of the posterior superior alveolar artery and infraorbital artery forming intraosseous anastomoses (IA) within the bony lateral antral wall. This study was undertaken to (i) measure mean diameter of IA and its distance from the alveolar ridge within dentate and posteriorly edentulous subjects and, (ii) qualitatively display the relationship of IA throughout its course within the lateral maxillary sinus in cone beam computed tomography (CBCT). MethodMaxillary CBCT images of two-hundred-and-fifty-seven consecutive patients (163 men, 94 women, mean age 42 years) were analyzed. Samples were later divided into dentate (n = 142) and posteriorly edentulous (n = 115) jaws. Using both alveolar ridge and tooth location as reference points, the distance and diameter of IA were assessed. ResultThe IA was seen in 63.7% of all sinuses with 68.2% in dentate and 62.4% in edentulous. Mean distance and diameter of IA across the posterior tooth locations were 17.9 ± 3.0 mm and 1.4 ± 0.5 mm (dentate) and 15.1 ± 3.0 mm and 1.0 ± 0.5 mm (posteriorly edentulous), respectively. In each sample, there were no significant differences in distance-alveolar ridge and no significant correlations in diameter-tooth location. A statistically significant Pearson coefficient correlation between diameter and distance in dentate state was observed (r = −0.6). ConclusionThis study reveals that dentate maxillary jaws present larger diameters as compared to posteriorly edentulous jaws, although the IA course remains the same. As these canal structures contain neurovascular bundles with diameters that may be large enough to cause clinically substantial complications, a thorough pre-surgical planning is therefore highly advisable.

Proximity of Vascular Bone Channel in the Lateral Sinus Wall to Root Apices of Maxillary First Molars: A Cone-beam Computed Tomographic Analysis

IntroductionApical surgery is frequently indicated in maxillary first molars. Occasionally, a vascular anastomosis in the lateral maxillary sinus wall can be observed during surgery. The aim of this study was to examine the distance between the vascular bone channel (VBC) and the root apices of maxillary first molars using cone-beam computed tomographic imaging. MethodsCone-beam computed tomographic images of 104 maxillary first molars were oriented in the coronal plane to evaluate the distance between the roots and the VBC. The measurements were only recorded in relation to the buccal roots. In addition, demographic parameters and further measurements such as the diameter of the VBC and the proximity to the periapical pathology were evaluated. ResultsA total of 210 VBCs were assessed. The mean distance from the VBC to the apices of the buccal roots of the maxillary first molars was 6.18 mm ± 3.84 mm. The VBC was mostly located intrasinusally (74.3%) and only rarely superficially (0.5%). The diameter of the VBC was on average 0.88 ± 0.32 mm. ConclusionsIn this study, the VBC was usually found closer to the mesiobuccal than to the distobuccal root apex. During preparation of the access window, the existence of the VBC should be kept in mind because the mesiobuccal roots of maxillary first molars undergo apical surgery to the buccally positioned roots only.

Application of curved needling technique in the treatment of trigeminal neuralgia by radiofrequency ablation through foramen rotundum with inward opening

Objective To observe the application effect of radiofrequency puncture needle with individualized and on-demand plastic curved needle technique in the treatment of second-branch trigeminal neuralgia by radiofrequency ablation through foramen rotundum with inward opening. Methods From November 2012 to May 2018, a total of 263 cases of second-branch trigeminal neuralgia were admitted to Department of Anesthesiology, the First Hospital of Jiaxing and underwent foramen rotundum puncture for radiofrequency ablation. All those cases were enrolled into this retrospective analysis. The paranasal sinus model of CT was used to scan the pterygoid fossa with a thickness of 3 mm, and the CT images, including the midpoint of the foramen rotundum tube, the internal and external hole, were selected and the puncture path was designed. The length of the line (puncture depth) and the angle between the straight line and the sagittal plane (the angle of puncture) were measured by using the ruler tool of CT software from the external hole of the foramen rotundum along the lateral wall of the maxillary sinus to the surface of the skin (puncturing point). If the external hole of foramen rotundum demonstrated an inward opening, the angle between the line and the direction of the foramen rotundum tube(the angle of the needle needed to bend) should be measured. The radiofrequency needle was inserted 5 mm into the self-made needle-bender, the corresponding bending angle was pulled out slightly to the side of the needle at the tip of the needle, and the individual radiofrequency needle for the patient was made. Then, puncturing under the guidance of CT followed by designed trajectory. The arc of the needle was turned to the top of the front when the needle reached the external hole of the foramen rotundum. Whereafter, the arc of the needle was turned to the bottom when the needle crossed the external hole. Subsequently, the needle was pushed into the foramen rotundum. Then, electrophysiological test was conducted for radiofrequency treatment. Results Of 263 patients undergoing radiofrequency ablation of the second branch of trigeminal nerve, 71 (27.0%) had an inward opening of the external hole of foramen rotundum, which needed the patient's individually designed radiofrequency puncture needle. The average bending angle was 21.3 °±3.6 °(14°-31 °). When using the individual puncture needle, the needle tip could always reach the puncture target. Using 0.1-0.5 mA current could induce obvious muscle tremor or numbness in the region innervated by the second branch of trigeminal nerve in electrophysiological test. Following radiofrequency ablation, the second-branch trigeminal neuralgia disappeared completely. Ipsilateral palate muscosal numbness and the skin numbness involving the side of the nose, upper lip and zygomatic facial region were reported. None of the patients developed numbness involving the first or third branch of trigeminal nerve. A total of 242 patients were followed up for an average of 3.2±0.6 years. The total recurrence rates at 6 months, 1 year, 2 years, 3 years and 4 years were 2.5% (6/242), 7.9% (19/242), 16.1% (39/242), 24.4% (59/242) and 33.9% (82/242), respectively. Conclusions CT-guided individually made curved needle technology allows the radiofrequency needle tip to bypass the sphenoid bone which obstructs the outer opening of foramen rotundum and enter the middle of foramen rotundum tube with inward opening, so as to improve the radiofrequency effect and reduce the recurrence rate. Key words: Trigeminal neuralgia; Radiofrequency coagulation; Foramen rotundum; Treatment effect

The Relationship between Maxillary Sinus Lateral Wall Thickness, Alveolar Bone Loss, and Demographic Variables: A Cross-Sectional Cone-Beam Computerized Tomography Study

Objectives: Sinus floor elevation and augmentation surgery is widely used as a reliable procedure to increase insufficient bone height in the posterior maxillary area. The purpose of the present clinical study was to determine the associations between periodontal bone loss (PBL), maxillary sinus lateral bone wall thickness, age, and gender using cone-beam computerized tomography (CBCT). Materials and Methods: The current retrospective study consists of 716 maxillary sinus CBCT images of 358 patients. The CBCT scans were assessed to detect the relationship between lateral wall thickness and PBL. ANOVA and Student t test analysis were used to determine the influence of PBL on sinus lateral wall thickness. Results: Sinus lateral wall thickness was significantly associated with PBL (p < 0.05) at 3, 13, and 15 mm height. There was no significant association between lateral wall thickness and gender (p > 0.05). However, there was a significant association between lateral wall thickness at 3 and 13 mm and age (p < 0.05). There were significant associations between PBL and age (p < 0.001), and PBL and gender (p < 0.05). Conclusions: PBL might have an association with maxillary sinus lateral bone wall thickness. Further studies are needed to confirm this possible relationship.