Lateral Sinus Wall Research Articles

A Comparison of Sphenoid Sinus Osteoneogenesis in Aspirin-Exacerbated Respiratory Disease.

BackgroundAspirin-exacerbated respiratory disease (AERD) is characterized by excessive leukotriene production, diffuse polyp burden and osteitic bone changes. These bony changes have not been previously characterized.ObjectiveThe aim of this radiographic study is to characterize the bony changes noted on computed tomography (CT) scans of the sphenoid sinus in patients with AERD compared to other diseased sinonasal inflammatory states and non-diseased controls.MethodsA retrospective review of 43 patients with clinically confirmed AERD were included and compared to 22 non-diseased, 9 allergic fungal sinusitis, and 43 chronic rhinosinusitis controls (23 without polyps and 18 with polyps). Comparative measurements were performed using fine-cut CT scans. Sites of comparison were the intersinus septum, the left and right lateral sphenoid wall, the roof, and left and right floor of the sphenoid sinus. Standardized measurements were averaged by two separate rhinologists.ResultsPatients with AERD had an average statistically significant increase in bone thickness compared to healthy and diseased controls in nearly every site with the most pronounced changes in the intersinus septum (p < 0.05).ConclusionPatients with AERD have significantly increased thickness of the sphenoid bone compared to control groups with the most pronounced difference in the intersinus septum. These findings may help clinicians increase suspicion for a diagnosis of AERD who clinically have diffuse nasal polyposis.

Study of factors influencing preoperative detection of alveolar antral artery by CBCT in sinus floor elevation

This study aimed at assessing the prevalence of alveolar antral artery (AAA) detection by CBCT, its related variables, and at describing explanatory models useful in surgical planning, by retrospective evaluation of CBCT explorations. The modelling of the probability for detecting AAA was undertaken using logistic generalized additive models (GAM). The capacity for discriminating detection/no detection was assessed by receiver operating characteristic curves. A total of 466 sinuses were studied. Univariate models showed detection probability was linked to sinus width and thickness of the lateral bony wall, together with the shape and height of the osseous crest. AAA detection probability increased steadily until the thickness of the bony wall reached 6 mm. Multivariate models resulted good discriminators for AAA detection, particularly for females, showing an area under the curve (AUC) of 0.85. Models considering patients altogether, and those including only males offered slightly lower values (AUC = 0.79). The probability of AAA detection by CBCT was influenced by gender (higher in males and for narrow sinuses) and increases with the thickness of the sinus lateral bony wall and the height of the residual alveolar ridge. Besides, and particularly for women, the thickness of the ridge at the basal level seems to improve the explanatory model for AAA detection.

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.

Lateral conservative approach for recurrent/persistent hypopharyngeal carcinoma: a case series.

Early persistent/recurrent hypopharyngeal tumours represent a challenge for surgeons who have to balance the need for oncological radicality and the desire to maintain a functioning larynx with preservation of the patient's quality of life. The aim of this study was primarily to understand the technical feasibility, functional outcomes, and the possibility of obtaining oncological radicality using lateral hypopharyngectomy with laryngeal preservation in early recurrent post-radio/(chemo)therapy hypopharyngeal tumours. Patients with recurrent T1 hypopharyngeal squamous cell carcinoma were retrospectively selected from our institutional database. The external lateral approach according to Spriano and a modified lateral hypopharyngectomy with laryngeal preservation were used to resect tumours of the lateral pyriform sinus wall. Reconstruction was obtained by direct approximation of the posterior border of the sectioned thyroid cartilage to the posterior hypopharyngeal wall, and this was reinforced with a second layer of vascularised and non-irradiated tissue that was provided by a microvascular fascial anterobrachial flap. Swallowing was assessed 3weeks after surgery using videoendoscopic evaluation. The surgical procedure was technically feasible, and complete resection was obtained in all patients. None of the patients experienced major post-operative complications (salivary fistula, bleeding, aspiration pneumonia). Mild dysphagia was observed in one patient who underwent swallowing rehabilitation. Tracheostomy was closed in all patients. No recurrence was recorded after a median follow-up of 20months. The reported experience shows that, in selected cases, it is possible to radically remove lateral hypopharyngeal cancer with acceptable functional results.

Minimally Invasive Approaches to the Lateral Cavernous Sinus and Meckel's Cave: Comparison of Transorbital and Subtemporal Endoscopic Techniques

Transorbital and subtemporal keyhole approaches have recently been proposed to approach lesions in the lateral wall of the cavernous sinus (CS) and Meckel's cave (MC). Our goal was to compare these approaches and suggest indications for each of them. Five cadaver heads (10 sides, 40 procedures) were used. The lateral transorbital approaches were carried out without and with the removal of the lateral orbital rim, herein referred to as the lateral transorbital approach (LTOA) and the lateral orbital wall approach (LOWA). The subtemporal approaches were performed without and with the removal of the zygomatic arch, referred to as the subtemporal approach (STA) and the subtemporozygomatic approach (STZA). Five targets were chosen and 2 triangles were created representing thelateral wall of the CS and MC. Stereotactic measurements were quantified to calculate angles of attack, surgical freedom, and temporal lobe retraction for each approach. LTOA presented the smaller horizontal angles of attack. LOWA increased the angles to the same level of STA and STZA. STA and STZA presented larger vertical angles of attack. The surgical freedom presented gradual increase from LTOA to LOWA, STA, and STZA. STA and STZA needed greater temporal lobe retraction for most targets. LTOA is a good option to biopsy a lesion in the lateral wall of the CS and LOWA increased the surgical corridor to work with microsurgical techniques. STA and STZA could be better options when wide exposure is necessary, but temporal lobe retraction should be taken into consideration.

Maxillary Sinus Elevation Difficulty Score with Lateral Wall Technique

Maxillary sinus augmentation is a procedure commonly performed in patients in need of posterior maxillary implants with limited vertical ridge height and sinus pneumatization. However, minimal information has been presented to evaluate the complexity of the sinus elevation procedure via a lateral window approach based on patient examination, including extraoral findings, anatomical factors, and the possible influence from the surgeon's experience. Therefore, this article presents a new scheme of maxillary sinus floor elevation difficulty score based on comprehensive patient- and surgical-related factors. The proposed scoring tool aims to aid surgeons in performing a comprehensive presurgical evaluation prior to the lateral wall sinus augmentation surgery and also enhance communication between clinicians and patients regarding the complexity of the case.

Multidisciplinary approach to maximize angiogenesis and wound healing using piezoelectric surgery, concentrated growth factors and photobiomodulation for dental implant placement surgery involving lateral wall sinus lift: two case reports.

Background: The application of Photobiomodulation (PBM), Piezoelectric Surgery (PES) and Concentrated Growth Factors (CGF) in dental implant sinus lift procedure has gained popularity. Aim: To detail a two cases report on the use of PMB, PES, and CGF as a means of enhanced angiogenesis in tissue regeneration in dental implant lateral wall sinus lift procedure. Materials and Methods: This paper presents two cases report on the multi-disciplined approach using PBM, PES, and CGF as a method of enriched angiogenesis in tissue regeneration in dental implant sinus lift technique. In both patients, the sinus lateral windows were created using PES and the sinus membrane was raised to make a new partition. Surface modified dental implants (average 8 mm long) were inserted concurrently, packed with autologous fibrin-rich CGF, and then lastly induced PBM using Multiwave Locked System (MLS) laser. Radiographic and clinical evaluation was implemented to validate the efficacy of this multi-disciplined approach. Results and discussion: Postoperative revival was ordinary with no noteworthy postoperative complications. Wound closure/angiogenesis occurred shortly after day one. New bone formation in all augmented maxillary sinuses was detected alongside the implants on plain radiographs and on cone-beam computed tomograms. The patients were very happy with the overall treatment (>80%) and the success rate of implant was 100% after a usual 10 months loading period. PBM, PES, and CGF enhance angiogenesis/wound healing by speeding up wound approximation/healing, lessening the followings: postoperative pain, swelling, bleeding, speech impairment, analgesic use, and trismus. Conclusion: Using PBM, PES, and CGF as a method to enrich angiogenesis/wound healing in sinus lift rendered initial phase of satisfaction, simplicity, effectiveness, minimal complication, enhanced angiogenesis/wound healing with no cross infection and allergic reaction. Keywords photobiomodulation - piezoelectric surgery - concentrated growth factors - sinus augmentation - angiogenesis/wound healing

Lack of Torsion in the Type-III Duane Retraction Syndrome (DRS-III) Affected Left Eye During Dix -Hallpike Test

Abstract Background Duane retraction syndrome (DRS) is a congenital cranial dysinnervation disorder (CCDD) of ocular movements, characterized by deficits in horizontal duction associated with narrowing of palpebral fissure, retraction of eye globe on attempted adduction and occasionally accompanied by upshoot or downshoot of the eye globe. It is caused by congenital absence of sixth cranial nerve, which results in fibrotic changes in the extraocular muscles leading to an abnormal ocular motility--a concept known as CCDD. Depending on whether only abduction/adduction or both are affected, DRS has been classified into three types designated as type-I, type-II and type-III. The torsional movements of the affected eye in DRS have not been reported to be deficient hitherto, which could be due to difficulties in the routine bedside evaluation of such movements. Case Presentation An unusual case of a patient of left unilateral type-III DRS is reported, who presented with a short history of vertigo on getting up from supine to sitting position and on assuming right lateral recumbent position. The diagnostic right Dix-Hallpike test (DHT) revealed upbeating torsional geotropic positioning nystagmus in the normal right eye and upbeating positioning nystagmus without torsional component in the abnormal left eye and this clinical finding was video recorded. Conclusion The observed lack of incyclotorsion of the left eye, affected with DRS-III during right Dix-Hallpike positioning, is primarily due to the absence of initial slow-phase excyclotorsional component. If the slow phase of VOR does not occur, then the fast-phase VOR, which is a refixation saccade, will be lacking too. An anastomosis, either in the lateral wall of the cavernous sinus or within the orbit, between the trochlear nerve and fibers of the oculomotor nerve can lead to simultaneous co-contraction of the inferior and superior oblique muscles. This is the most probable explanation for such finding of asymmetrical absence of torsional component in the left eye affected by DRS-III, during right Dix -Hallpike positioning. Thus, the recording of eye movements (voluntary and involuntary) opened a window into the brain to conceptualize neural and mechanical factors influencing the human eye movements.

Scrub Typhus with Partial Superior Orbital Fissure Syndrome

We report a case of a 33 year old woman suffering from scrub typhus who presented with binocular horizontal diplopia. Magnatic Resonance Imaging of Brain showed thickening and enhancement of the lateral wall of cavernous sinus, extending to involve orbital apex. She improved after treatment with doxycycline. Various ophthalmological manifestations of scrub typhus have also been reviewed.

Endovascular treatment of a small ruptured non-traumatic internal carotid artery aneurysm presenting with repeated massive epistaxis

ObjectiveWe encountered a rare case of massive epistaxis resulting from a small ruptured non-traumatic cavernous internal carotid artery aneurysm associated a bony defect in the wall of the posterior lateral wall of the sphenoid sinus. We presented successful diagnosis and treatment with a balloon-assisted neck-plasty coil embolization. Case PresentationA 74-year-old Japanese man was admitted following recurrent massive epistaxis. There was no history of trauma, surgery, radiotherapy, infection, or tumor. Radiographic imaging demonstrated a bony defect in the wall of the posterior lateral wall of the sphenoid sinus that allowed the aneurysm to ruptured into the nasal cavity rather than intracranially. After rupture, the patient presented with epistaxis that resulted in systemic hypotension. This aneurysm can be managed rapidly using endovascular techniques of a balloon-assisted neck-plasty coil embolization. ConclusionThe present case report highlights the rarity of a small non-traumatic cavernous ICA aneurysm causing massive epistaxis. Clinicians should be aware of this possibility, as a high index of suspicion is required for proper diagnosis. Internal carotid angiography should be performed, particularly in patients with refractory epistaxis. Aneurysms in this location are usually amenable to endovascular treatment. Coil embolization using a microballoon-assisted neck-plasty technique can result in immediate hemostasis, parent artery preservation, and successful long-term aneurysm occlusion.

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 of the study: To describe the management of orosinusal pathology by combined transnasal endoscopy and oral combined. 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. To the ENT evaluation in videorinoscopy with rigid optics, complex deviation of the nasal septum was relevated with not any evident formations or pathological secretions. While on inspection of the oral cavity the mucous membranes appeared unscathed. Alveolus of 1.6 previosuly extracted 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 has 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 ostio-meatal 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 adipose bolla and closure by first intention. In the same session, the ENT moment is carried out trans nasally 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 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 therefore mycotic and actinomycotic super infection. 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 to resolve the pathology without any sign of recurrence.

Sphenoid sinus meningoencephalocele in an adult patient

The incidence of sphenoid sinus meningoencephalocele is very low. It is estimated one person out of 700 000 live births. This clinical entity is rarer in adults. We here report the case of a 51-year old woman presenting with feeling of intranasal heaviness that had progressed since the young age without rhinorrhea or nasal obstruction. She had no dysosmia or headache. She did not have a history of recurrent meningitis, skull base surgery or head trauma. Both nasal fossae were free. Computed tomography (CT) scan of the facial skeleton showed subtotal filling of the right sphenoid sinus, with spontaneously hyperdense content at places, without significant contrast enhancement associated with lysis of the lateral wall of the right sphenoid sinus. Brain and facial skeleton magnetic resonance imaging (MRI) showed dehiscence of the lateral wall of the right sphenoid sinus with herniation of the cerebrospinal fluid presenting hyposinal on T1, hypersignal on T2, cerebral parenchyma in T1 and T2 isosignal. We opted for therapeutic abstention because the patient was asymptomatic.

Anatomic Study of Endoscopic Transnasal Approach to Petrous Apex

With the development of Neurosurgery technology, there has been a qualitative leap forward with the appearance of microanatomy, which makes the deep brain tumors which were hard to be achieved in the past, and effectively reduces the mortality of patients. Petrous apex is a cone-shaped part of the anteromedial part of the temporal bone, which is deep. It has been a challenging area for surgical anatomy for a long time. In this paper, fresh adult perfused cadaveric head specimens and dry adult cadaveric head specimens were taken as the experimental objects. The anterior wall of sphenoid sinus and the internal septum of sphenoid sinus were excised under neuroendoscope. The structures of the lateral wall of sphenoid sinus were identified and dissected. The lateral wall of sphenoid sinus and the bone of skull base were opened with micro drill, The meninges were exposed and cut open, and the related structures were dissected, observed and photographed. The experimental results show that it is relatively safe to operate in the range of less than 8mm, and the rock tip can be found accurately. The measurement of the bony structure of the skull base is helpful for the surgeon to judge the course of the internal carotid artery and its adjacent structure.

Evaluation of the alveolar antral artery position in the lateral sinus wall using cone-beam computed tomography

Evaluation of the alveolar antral artery position in the lateral sinus wall using cone-beam computed tomography

Chapter 6 - Middle fossa meningiomas

The middle cranial fossa is bounded anteriorly by the sphenoid ridge, medially by the lateral wall of the cavernous sinus and Meckel's cave, posteriorly by the sphenoid wing and petrous bone, and laterally by the greater wing of sphenoid and squamous temporal bone. In normal individuals, unnamed venous channels within the dura and arachnoid granulations can be seen on the floor of this fossa by the operating surgeon. Meningiomas arising mainly from the dura of the floor are uncommon, and middle fossa meningiomas have been arbitrarily named so based on an attachment of more than 75% to this location. They tend to present clinically at a large size and require special considerations for surgical treatment.

Синдром Толоса — Ханта в педиатрической практике

Tolosa-Hunt syndrome (THS) is a rare disease manifested with one or more cranial nerve disorders and orbital pain. In children, THS is diagnosed very rarely due to the lack of vigilance among physicians. Careful examination including MRI or helical CT help diagnose this disease. This paper discusses case history of THS in a child in the first ten years of life who has previously experienced similar episodes of ptosis and right-sided orbital pain; however, the cause of these symptoms has remained elusive. Disease anamnesis, clinical signs, neurological status, and additional diagnostic data are described in detail. Clinical course of THS with its relapses and remissions, rapid symptom regress after corticosteroid pulse therapy, and no specific granulomatous inflammation of the lateral wall of the cavernous sinus as demonstrated by MRI suggest idiopathic THS. The importance of in-depth neurological and general examination of patients with clinical signs of THS due to a variety of the causes of this syndrome is highlighted. KEYWORDS: pediatrics, Tolosa-Hunt syndrome, ophthalmoplegia, superior orbital fissure, cavernous sinus, corticosteroids. FOR CITATION: Shishkina E.V., Bazilevskaya T.N., Izokhvatova R.F. et al. Tolosa-Hunt syndrome in pediatric practice. Russian Journal of Woman and Child Health. 2020;3(4):336–339. DOI: 10.32364/2618-8430-2020-3-4-336-339.

Short implants (

Background One of the greatest challenges that dentists face today is to rehabilitate severe atrophied alveolar ridges in partially and completely edentulous patients with implants. Despite the high survival rate of implants placed next to sinus elevation, this technique presents complications that can be avoided by placing short implants, an option that also presents high survival rates. For this reason, the aim of this study is to compare the survival rate, marginal bone loss and complications associated with short implants (<8 mm) versus longer implants (≥8mm) placed with lateral sinus floor elevation in posterior atrophic maxillae. Material and Methods A literature search was conducted by two independent reviewers in the PubMed/Medline (National Library of Medicine, Washington, DC) electronic database for articles published from January 2007 to July 2018. Seven qualified articles were selected for the meta-analysis. Results The test for overall effect did not find statistical significance in the survival rates, overall complications, intra-operative complications, post-operative complications and prosthetic complications. However, the test showed statistically significant differences in biological complications in favor of standard implants, and marginal bone loss between control and test groups in favor of short implants (<8mm) was found. Conclusions Within the limitations of the present study, prosthetic rehabilitations with short implants (<8mm) in posterior maxilla is a reliable treatment option as an alternative to lateral wall sinus floor augmentation. Key words:Short implant, lateral sinus floor augmentation, Randomized controlled trial, Survival rate, Complications, Marginal bone loss.

Paranasal Sinus Wall Erosion and Expansion in Allergic Fungal Rhinosinusitis: An Image Scoring System

BackgroundBone erosions are common in allergic fungal rhinosinusitis (AFRS). This study aimed at developing an image-based grading and scoring system for paranasal sinus (PNS) wall erosion in AFRS.MethodsA retrospective review of all confirmed AFRS cases based on the Bent and Kuhn criteria was conducted. Preoperative computed tomography (CT) images were studied to detect PNS wall erosion with expansion. Based on our observation, we described a grading system based on the proportion of PNS wall erosion, with 1 if less thanone-third, 2 if between one-third and two-thirds, and 3 if more than two-thirds of the wall is eroded. This method provides a new scoring system ranging from 0 to 72. The inter-observer reliability of this scoring system was tested and the percent of agreement was found to be 90%.ResultsAmong 142 AFRS cases, 82 patients (57.7%) had bone erosion. Orbital extension via lamina papyracea erosion occurred in 28.2% and 17.6% of the anterior and posterior ethmoid sinuses respectively, via floor erosion in 8.3% of the frontal sinuses, and via roof erosion in 2.1% of the maxillary sinuses. Intracranial extension caused by the anterior skull base erosion occurred in 19.4%, 10.9%, and 6% of the posterior ethmoid, anterior ethmoid, and frontal sinuses, respectively. The middle and posterior cranial fossa skull base was eroded in 14.4% and 9.2% of the sphenoid sinuses, respectively. Infratemporal extension occurred via erosion of the sphenoid sinus lateral wall in 17.3% of the sphenoid sinuses and via erosion of the maxillary sinus posterior wall in 6.7% of the maxillary sinuses. The mean of bone erosion score was 9.52, and the highest score was 34/72.ConclusionThe orbit is the most common extra-sinus extension site via the lamina papyracea erosion. We propose a new grading and scoring system to assess disease severity and progress.

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.