Left Maxillary Sinus Research Articles

Closure of buccosinusal communication with rotation of a palatal flap: case report

An buccosinusal communication is an abnormal pathway between the oral cavity and the maxillary sinus. It is usually caused by surgical procedures such as the extraction of premolars and maxillary molars, due to the proximity of the roots to the floor of the maxillary sinus. The aim of this study is to report a surgical treatment for the closure of an buccosinusal communication with the advancement of a palatal flap. The patient was a 45-year-old female adult with no systemic comorbidities and no allergies. She reported pain in the left cheek and nasal discharge. Intraoral examination revealed an area of fistula in the region of element 26 measuring approximately 4-5mm. The CT scan showed a hyperdense image in the left maxillary sinus suggestive of sinus infection and a hypodense image in the region corresponding to the alveolus of element 26, suggestive of an buccosinusal communication. Initially, preoperative laboratory tests were requested and antibiotic therapy was prescribed. Intra- and extra-oral antisepsis, infiltration anesthesia were performed, fistulectomy, demarcation of the palatal flap, incision and full-thickness mucoperiosteal detachment, rotation of the palatal flap to obliterate the fistula and stabilization of the fistula using single-stitch sutures in the raw donor region with fibrin sponges under the suture, for later installation of surgical cement to help protect the wound. The patient is well, with complete closure of the communication and no evidence of post-operative complications.

Blast injury with foreign body in maxillary sinus: A case report

Abstract BACKGROUND. Foreign bodies of paranasal sinuses are very rare in ENT clinical practice. CASE REPORT. We will discuss the case of a 38-year-old gentleman who showed up at our Emergency Room with loss of vision in his left eye following a blast injury. The initial physical examination identified a ruptured globe in the left eye, which caused left-eye blindness. An immediate plain X-ray revealed a metallic object lodged in the left maxillary sinus, reaching up to the left sphenoid sinus. The external approach was used to manage the patient surgically, with no intra- or postoperative complications. CONCLUSION. Inadequate managing of foreign bodies in the paranasal sinuses might result in significant morbidity. They must be removed surgically, either endoscopically or via an external method.

Primary Small Cell Carcinoma of Left Maxillary Sinus: A Case Report of Rare Tumor on Rare Location

Introduction: Primary extrapulmonary small cell carcinoma (EPSCC) is a rare and aggressive tumor with diverse clinical manifestations. In the realm of head and neck pathology, EPSCC most commonly presents in the larynx or oral cavity. Sinonasal small cell neuroendocrine carcinoma represents a particularly infrequent and aggressive neoplasm affecting the nasal cavity and paranasal sinuses. Case Presentation: Here in, we are presenting a case of a 40-year-old nonsmoking male with left maxillary sinus EPSCC, demonstrating extensive local invasion and regional lymphadenopathy. The patient presented with nasal obstruction, ocular swelling, visual loss, and multiple neck swellings. Diagnosis was challenging, requiring a multidisciplinary approach and histopathological confirmation. Immunohistochemistry revealed positive cytokeratin AE1/AE3 and synaptophysin markers validating the diagnosis of small cell carcinoma. Conclusion: This case underscores the diagnostic complexities and highlights the importance of swift intervention and a multidisciplinary treatment approach for optimizing patient outcomes in rare and aggressive tumors like EPSCC. Early detection and prompt management are crucial in resource-limited settings to mitigate morbidity and mortality.

Myofibroblastic Sarcoma of the Maxillary Sinus: Very Rare Entity

Introduction: The Myofibroblastic Sarcoma is a recently discovered malignant tumor that mainly affects the face and neck region, but it occurs most often in the tongue and oral cavity. However, involvement of the maxillary sinus has only been reported a few times in the literature. It is a slowly growing neoplasm with a high recurrence and metastasis risk.  Case Presentation: 18 years old female patient, admitted for a painless mass of the left hemi palate increasing progressively in volume evolving since 5 months, associated to a left nasal obstruction and purulent rhinorrhea. Once in our department, she underwent a facial CT scan, followed by a facial MRI, which showed a tissue process centered primarily on the left maxillary sinus, causing lysis of the inferior wall and bulging of the hard palate on the left side . The surgical decision involved combining an endoscopic and external approach, and was supplemented by radiation therapy. The follow up demonstrated a successful outcome. the patient did not present any recurrence or distant metastasis.  Conclusion: The key lessons are the essential role of imaging in diagnosing and treating LGMS , as well as the crucial role of postoperative radiotherapy in preventing recurrence even though this subject is still controversial.

Choroidal Infiltration in Erdheim-Chester Disease: A Case Series

Purpose: We describe two cases of choroidal involvement in patients with Erdheim-Chester disease (ECD), a rare non-Langerhans cell histiocytosis. Methods: Short case series. Results: The first patient was a 25-year-old man with asymptomatic ECD at the level of bones, lung, and central nervous system. Fundus examination revealed bilateral yellowish choroidal infiltration in the superior macula and nasal mid-periphery. After initial mild enlargement of the choroidal lesions, treatment with weekly subcutaneous pegylated interferon α2a (PEG-IFN) was started inducing partial regression of the lesions. The second patient was a 45-year-old man with ECD involving the left orbit, maxillary sinus, heart, blood vessels, kidney, retroperitoneum, bones and testes. Fundus examination of the left eye showed choroidal folds. Macular spectral-domain optical coherence tomography confirmed the folds and revealed underlying choroidal infiltration. Final ocular diagnosis was left choroidal, scleral, and orbital involvement. The patient was initially treated with PEG-IFN, and later with cobimetinib, a MEK inhibitor, with favorable results. Neither patient developed choroidal neovascularization (CNV) during the follow-up. Conclusions: ECD is a rare multisystem disorder that can present with ocular involvement, including orbital masses, xanthelasma-like lesions, and occasionally, choroidal infiltrates. Early recognition and prompt treatment can lead to improvement of ophthalmic and systemic symptoms and prevent further complications. We recommend treating patients with choroidal ECD, regardless of the presence of symptoms, considering these patients are at increased risk of developing CNV.

Odontogenic myxoma of the maxilla: a case report

BackgroundOdontogenic myxomas are rare tumours of the mesenchymal portion of developing tooth and account for 3–6% of all odontogenic tumours. Microscopically, odontogenic myxomas have a characteristic histologic appearance, which distinguishes it from other odontogenic tumours. However, it can mimic normal dental follicles of a developing tooth, from which it can be differentiated histologically by the nature of connective tissue and also by clinical and radiological appearances.Case presentationWe present a case of a 30-year-old female with a large mass involving the left maxillary sinus. Histopathology showed features of odontogenic myxoma.DiscussionEarly diagnosis of such lesions is critical for avoiding extensive surgical procedures and the subsequent impact on the patient’s quality of life.ConclusionComplete surgical excision is the treatment choice, which can be difficult owing to the tumour’s invasive borders. Hence, the patients should benefit from regular follow-ups.

Development of maxillary sinuses in relation to the development of cranium in children on computed tomography imaging

There are available studies assessing the development of maxillary sinuses in relation to the viscerocranium. However, there are no publications analyzing the development of maxillary sinuses in relation to the development of the cranium, i.e. both the viscerocranium and the neurocranium. The aim of the study was to analyze the correlation between the dimensions of maxillary sinuses and anthropometric measurements of the cranium in children. The study was retrospective and was conducted at the based on the results of head computed tomography investigation. The study group included 180 girls and 180 boys, aged from birth to 18 years. To assess the correlation between the degree of development of the paranasal sinuses and the growth of the cranium, standard anthropometric points on the skull and strictly defined dimensions of the height, length, width, and volume of right and left maxillary sinuses were used. In the study group, both in girls and boys, a statistically significant positive correlation was found at the significance level of p < 0.0001 between: the height, length, width and volume of right and left maxillary sinuses, and cranial maximum length (glabella-opisthocranion), its maximum width (euryon-euryon), height (basion-bregma) and the length of the cranial base (basion-nasion) and the dimension of the subspinale-opisthocranion in children. Our study showed a statistically significant positive correlation between the development of maxillary sinuses and the growth of the cranium in children.

Silent Sinus Syndrome: A Paediatric Condition Diagnosed in the Orthodontic Department

Silent sinus syndrome (SSS) is defined as unilateral maxillary sinus hypoplasia and orbital floor resorption. This case report highlights a rare paediatric diagnosis of SSS during an orthodontic clinic. The diagnostic orthopantogram (OPG) and cone-beam computed tomography showed complete opacification of the left maxillary sinus. Following referral to the ear, nose and throat (ENT) department, a CT sinus confirmed SSS. Owing to the risk of facial asymmetry in a growing adolescent patient without surgical intervention, functional endoscopic sinus surgery will be used to manage this. This case highlights the importance of a thorough investigation of incidental findings. CPD/Clinical Relevance: The clinical relevance of early diagnosis of silent sinus syndrome and its implications on facial symmetry is discussed.

Prevalence of Incidental Findings and Assessment of Maxillary Sinus Pathologies and Dental Diseases Using Cone-Beam Computed Tomography (CBCT) in the Tamil Nadu Population: A Retrospective Study.

Background Cone-beam computed tomography (CBCT), a cross-sectional imaging technique, is valuable for clinical diagnosis and creating effective treatment plans. CBCT can precisely examine the connection between the maxillary sinuses and the maxillary root apices. Oral radiologists must be aware of all potential incidental findings and should be diligent in thoroughly identifying and assessing possible underlying diseases. Aim To determine the prevalence of incidental maxillary sinus pathologies and their relationship to dental diseases. Materials and methods In the present retrospective study, CBCT scans from 300 subjects (encompassing 600 right and left maxillary sinuses), aged 18 to 70, were gathered from various CBCT centers to represent the Tamil Nadu population. The CBCT images were analyzed using proprietary software, which provided both a panoramic reconstruction view and multiplanar reformation modules, including axial, sagittal, and coronal slices. The entire sample size was classified as follows: Group 1, age groups of 18 to 25 years; Group 2, age groups of 26 to 35 years; Group 3, age groups of 36 to 45 years; Group 4, age groups of 46 to 55 years; Group 5, age groups of 56 to 65 years; Group 6, age groups of 66 to 70 years. The prevalence of incidental maxillary sinus findings was analyzed, and their relationship with periapical abscess, periapical granuloma, periapical cyst, and breach was assessed. Results There was a prevalence of 52.05% of cases that had incidental maxillary sinus findings. Among them, 53.43% were males and 50.65% were females. Maxillary sinus pathologies were more common in individuals between 46 and 55 years, i.e., Group 4. In 300 datasets, the frequency of incidental maxillary sinus findings on the right is 21.33%, on the left is 24%, in both is 6.67%, and absent in 48% of the cases. Mucosal thickening was observed in 30% of cases with a periapical abscess, 19.52% with a periapical granuloma, 25% with a periapical cyst, and 51.79% with a breach. Polypoidal mucosal thickening was present in 32.50% of cases with a periapical abscess, 13.79% with a periapical granuloma, 50% with a periapical cyst, and 23.21% with a breach. Opacification occurred in 37.50% of cases with a periapical abscess, 20.69% with a periapical granuloma, 25% with a periapical cyst, and 25% with a breach. Conclusion Dental professionals should have a bird's-eye view in treating chronic odontogenic infections close to the maxillary sinus. Early diagnosis and prompt treatment of odontogenic infections help prevent maxillary sinus pathologies.

Evaluation of maxillary sinus volume by cone beam computed tomography in asthma patients

ObjectiveThe study aims to evaluate maxillary sinus volume in asthmatic patients. MethodsPatients who applied to the faculty of dentistry between January 2014 and December 2023 were retrospectively screened. Cone beam computed tomography images of 312 maxillary sinuses (156 people) consisting of asthmatic patients and controls were included in the study. Radiographic images in the study were obtained with a Newtom 5 G (FP, Quantitative Radiology, Verona, Italy) cone beam computed tomography device. SimPlant Pro 16 program (Materialise NV, Leuven, Belgium) measured maxillary sinus volumes. SPSS 25.0 software (IBM SPSS, Inc.) was used to analyze statistical data. ResultsAs a result of the tests, the right and left maxillary sinus volumes of asthmatic patients were significantly smaller than the control group.No significant relationship was found between age and maxillary sinus in both the study and control groups. Gender distribution was equal between the groups.There was no significant difference between the groups in terms of age. No significant difference was found between the right and left maxillary sinus volumes. ConclusionConsidering that there is no other study in the literature measuring maxillary sinus volume in asthmatic patients, this study may guide future research.

Schwannoma (Neurilemmoma). Ectopic Position in Maxillary Sinus

A Schwannoma (Neurilemmoma) is a benign nerve tumor arising from a myelinated nerve fibers sheath, that can appear in any part of the body. Forty-five percent of the cases occur in the head and neck region. Intraoral Schwannomas are rather uncommon, intranasal and intrasinus Schwannomas are even rarer (less than 1%). The clinical case reports a young, man 14-years-old male with a Neurilemmoma the left maxillary sinus, involving the left third molar. The reports include case information, radiological findings, the surgery treatment, the histological characteristics of this particular tumor, a differential diagnosis, the post-operation process, and a review of the available literature.

Three-dimensional morphometric and volumetric analysis of maxillary sinuses.

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

Clinical course and vascular endothelial growth factor signaling system expression in maxillary angiosarcoma: A case report.

Maxillary angiosarcoma, an aggressive tumor derived from vascular endothelial cells, is very rare. Recently, antivascular endothelial growth factor (VEGF) therapies have attracted considerable attention. We describe the clinical course of a patient with maxillary angiosarcoma and discuss the expression of VEGF signaling molecules assessed via immunohistological analysis. An 81-year-old man presented with an aggressive tumor in the left maxillary sinus. Biopsy revealed atypical nuclear cell proliferation, and the tumor was suspected to be a sarcoma. The maxillary malignancy was treated using a multidisciplinary approach with a combination of surgery, radiotherapy, and regional chemotherapy. Examination of the specimen obtained in the first surgery revealed maxillary angiosarcoma, found to be positive for CD31, while negative for CD34, D2-40, and factor Ⅷ. Although no pathological residual tumor was observed after the planned wide surgery, cervical lymph node and distant metastases occurred. The patient died 24 months after the first surgery. Staining revealed VEGF receptor (VEGFR) 1, VEGFR2, phosphorylated Ak strain transforming, mitogen-activated protein kinase, and signal transducer and activator of transcription 3 positivity. Although our findings do not indicate that anti-VEGF therapy is beneficial for treating maxillary angiosarcomas, we found that VEGFR signaling pathways were activated in maxillary angiosarcomas similar to angiosarcomas originating at other sites. Herein, we report a case of maxillary angiosarcoma, focused on VEGFR and signaling pathway activation. To our knowledge, this is the first report to describe VEGFR system immunostaining findings in maxillary angiosarcoma.

Effects of volume ratios of tongue and oral cavity on upper airway in skeletal Class II cases

Abstract Background The relationship between tongue volume and oral cavity volume (TV/OCV) ratio and upper airway volume is of great interest especially in skeletal Class II cases because they are commonly associated with retruded mandible as seen in Class II div. 1. It results in backward displacement of the tongue and hyoid bone causing reduction in the upper airway volume. This reduction in the upper airway volume is a causative factor for some common respiratory disorders such as obstructive sleep apnea syndrome. Aim The present study was carried out to find the effect of tongue size and oral cavity size and their ratio on the upper airway volume in skeletal Class II cases. Methods A cross-section study was performed on cone beam computed tomography images of 40 skeletal Class II patients whose age ranges from 17 to 22 years old. The volume of the nasopharyngeal airway, oropharyngeal airway, hypopharyngeal airway, nasoethmoid cavity (nasal cavity and ethmoid sinus), right and left maxillary sinus and oral cavity airway were calculated by using materialize Mimics Medical, Version 21.0. Correlation of each segment with TV/OCV ratio was detected. Results It was found that TV/OCV ratio had a significant positive correlation with TV (P &lt; 0.05). TV/OCV ratio had a highly significant negative correlation with oral cavity airway volume (P &lt; 0.001). Conclusions These findings reflect the relationship of TV/OCV and their ratio on the upper airway especially in skeletal Class II malocclusions.

Ewing's Sarcoma of Maxillary Sinus.

Ewing's sarcoma is a small round cell tumor commonly involving long bones. Head and neck involvement is seen less frequently with maxillary sinus being the rarest site. Here we report a case of a12-year-old female patient presented with left side facial swelling for 3 weeks duration which was diffuse and hard on palpation. CT and MRI of Nose & para nasal sinus revealed a mass lesion in the left maxillary sinus infiltrating and eroding the orbital wall and extending intracranially. Biopsy from the lesion revealed Ewing's sarcoma with strong positivity for CD-99 marker. Patient was referred to radiotherapy due to extensive disease at younger age. The CT and MRI along with HPE and IHC markers enables early diagnosis and prompt treatment that leads to better survival and prognosis, as unlike Ewing's sarcoma of long bones, that metastasize early. The combined chemoradiotherapy is now the standard line of treatment along with close follow up for at least 2 years.

Prosthetic Rehabilitation of a Maxillectomy Patient with Restricted Mouth Opening Using an Altered Cast Technique: A Case Report

Deformity in the maxillofacial region caused by surgical resection of a tumor have an adverse effect on the patient's ability to swallow, masticate, phonate, and psychological state. These patients may have restricted mouth opening capacity due to several surgical procedures and scar contracture resulting from radiation therapy. Therefore due to restricted access to the oral cavity prosthetic rehabilitation of these patients becomes a challenging task. A precise impression of the resection defect is necessary for accurate obturation. This is not practical for patients who have restricted mouth opening, hence this crucial first step in the making of a good prosthesis is frequently accomplished by altering the conventional impression method. This clinical report details the prosthetic rehabilitation of a patient who was diagnosed with Adenoid cystic carcinoma of the left maxillary sinus. Patient underwent maxillectomy for tumor removal, which was worsened by trismus as a result of the procedure and radiation therapy. For orofacial rehabilitation and defect obturation, the patient was restored with a removable dental prosthesis with a hollow bulb obturator. An altered cast technique was used in the final impression making. This rehabilitation approach was successful in restoring lost function and appearance of the patient. Keywords: Maxillectomy, Hollow Obturator, Altered cast technique

Effects of rapid maxillary expansion on upper airway parameters in OSA children with maxillary restriction: A CBCT study.

Rapid maxillary expansion (RME) has been proposed as an effective treatment for pediatric obstructive sleep apnea (OSA) and maxillary restriction in children. This study aimed to evaluate the effect of RME appliances on the nasomaxillary complex dimensions in children with OSA and maxillary constriction. This prospective longitudinal study included 34 children aged 8-12 years with maxillary restriction and OSA confirmed by polysomnography who had completed RME therapy. The nasomaxillary complex is segmented into the nasal cavity, maxillary sinuses, and nasopharynx. The effect of RME on nasomaxillary complex dimensions was assessed pre and posttreatment using cone-beam computed tomography, analysis, while a second standard overnight polysomnography (PSG) was performed to assess changes in respiratory parameters. Significant improvements were observed, including inferior maxillary dislocation (S-S1 distance and N-ANS), increased anterior and posterior facial height, and a 5.43 events/h reduction in Apnea-Hypopnea Index (p < .001). The nasal cavity volume increased by 2439 (±584) mm3 (p < .001), nasopharynx size increased by 883 (±479) mm3 (p = .008), mid cross-sectional area increased by 31.74 (±14.50) mm2 (p < .001), and the distance between the right and left maxillary sinuses increased by 8.37 (±3.67) mm (p < .001) all exhibited positive changes, with some insignificant variations in volume change (p = .254). RME treatment was found to be effective in improving nasal cavity and nasopharyngeal dimensions, leading to improved respiratory parameters in children with OSA and maxillary constriction. While these results are promising, considerations about the potential long-term benefits of RME on future growth are important. The study provides valuable insights into the efficacy of RME as a treatment option for this pediatric population.

Nasal Polyposis Showing Aggressive Behaviour – Inflammatory or Inverted Papilloma?

Nasal polyposis affects 0.2-1% of the general population. Inflammatory nasal polyp rarely behaves aggressively causing expansion to the surrounding structures without evidence of invasion. We report a case of an aggressive nasal polyp which was mistaken for inverted papilloma. A 48-year-old gentleman with underlying ischemic heart disease on aspirin presented with one month history of progressive left nasal block. He started to have frequent sneezing triggered by exposure to cold and dust. He had unilateral left straw-coloured rhinorrhea which was copious, and he was treated with oral antibiotics by the emergency department. He then developed recurrent left epistaxis which stopped after Trotter’s method. Nasal endoscopy revealed left grade three nasal polyp arising from the osteometal complex (OMC) with greenish discharge and ulcerated area. Initial biopsy showed inflammatory polyps.Computed tomography showed an expansion filling left maxillary sinus extending to nasal cavity, with no medial wall and thinning of the other maxillary walls. The lesion expands to left OMC, left sphenoethmoidal and the frontoethmoidal recess, obliterating the superior and inferior turbinates with hyperdensity in the maxillary sinus. He underwent functional endoscopic sinus surgery with left medial maxillectomy. Intraoperatively there were polypoidal mass grade 4 with epicentre in the left maxillary sinus causing erosion of the medial wall, extended around the nasolacrimal duct, the anterior and posterior ethmoids, the frontal recess, and sinus. There were dehiscence of the lamina papyracea and bone covering the anterior ethmoidal artery. The left superior and middle turbinate were unidentifiable. The histopathology findings of multiple pieces from the areas of operation were all reported as inflammatory polyps. His postoperative healing was uneventful with no nasal symptoms. In conclusion, nasal polyp with aggressive tendencies must be promptly managed surgically with close monitoring postoperatively to not miss any sinister pathology.International Journal of Human and Health Sciences Supplementary Issue 01: 2024 Page: S56

Different machine learning methods based on maxillary sinus in sex estimation for northwestern Chinese Han population.

Sex estimation is a critical aspect of forensic expertise. Some special anatomical structures, such as the maxillary sinus, can still maintain integrity in harsh environmental conditions and may be served as a basis for sex estimation. Due to the complex nature of sex estimation, several studies have been conducted using different machine learning algorithms to improve the accuracy of sex prediction from anatomical measurements. In this study, linear data of the maxillary sinus in the population of northwest China by using Cone-Beam Computed Tomography (CBCT) were collected and utilized to develop logistic, K-Nearest Neighbor (KNN), Support Vector Machine (SVM) and random forest (RF) models for sex estimation with R 4.3.1. CBCT images from 477 samples of Han population (75 males and 81 females, aged 5-17 years; 162 males and 159 females, aged 18-72) were used to establish and verify the model. Length (MSL), width (MSW), height (MSH) of both the left and right maxillary sinuses and distance of lateral wall between two maxillary sinuses (distance) were measured. 80% of the data were randomly picked as the training set and others were testing set. Besides, these samples were grouped by age bracket and fitted models as an attempt. Overall, the accuracy of the sex estimation for individuals over 18 years old on the testing set was 77.78%, with a slightly higher accuracy rate for males at 78.12% compared to females at 77.42%. However, accuracy of sex estimation for individuals under 18 was challenging. In comparison to logistic, KNN and SVM, RF exhibited higher accuracy rates. Moreover, incorporating age as a variable improved the accuracy of sex estimation, particularly in the 18-27 age group, where the accuracy rate increased to 88.46%. Meanwhile, all variables showed a linear correlation with age. The linear measurements of the maxillary sinus could be a valuable tool for sex estimation in individuals aged 18 and over. A robust RF model has been developed for sex estimation within the Han population residing in the northwestern region of China. The accuracy of sex estimation could be higher when age is used as a predictive variable.

Maxillary Sinus NUT Carcinoma: A Case Report.

Nuclear protein in testis (NUT) carcinoma is extremely rare, occurs in the midline of the body, progresses rapidly and is refractory to treatment; most patients die within a year. Here, we describe a case of maxillary sinus NUT carcinoma presenting with epistaxis and nasal obstruction that was treated as a standard head and neck carcinoma. The patient was a 41-year-old male with a left buccal swelling; the diagnosis was made of primary NUT carcinoma of the left maxillary sinus and bone metastasis in the cervical spine. After induction chemotherapy with docetaxel plus cisplatin and 5-fluorouracil, the tumor decreased in size, and the patient was further treated with cisplatin and radiation therapy. One month after that, the tumor remained small, however, lung metastasis was observed. Therefore, nivolumab was administered. Cetuximab and paclitaxel were administered after the lung metastasis worsened, but the patient developed progressive disease and died 11 months after diagnosis. Effective treatments for NUT carcinoma have not yet been established. However, early testing to establish the diagnosis may provide useful insights to guide clinical decisions to improve patient outcomes.