Maxillary Sinus Research Articles

Relationships Between Radiomorphometric Parameters of the Maxillary Sinus and Development of Sinusitis: A Cone Beam Computed Tomography Study.

The presence of maxillary sinusitis can complicate dental procedures. This study aimed to explore the relationship between maxillary sinus radiomorphometric factors, observed in cone-beam computed tomography (CBCT) images, and inflammatory sinus diseases. In this cross-sectional study, CBCT images from patients referred to a private radiology center between January 2018-January 2020 were analyzed. Sinuses were categorized as healthy or pathologic. Sinus pathologies were further classified into subgroups; mucosal thickening, retention cyst, partial opacification, complete opacification and air-fluid level. Radiomorphometric parameters, including ostium height, drainage length, ostium opening size, and drainage angle, were measured in the coronal plane. A p value less than 0.05 was considered statistically significant. A total of 433 maxillary sinuses from 258 patients were examined. Height of the ostium and drainage path length in the groups with various sinus pathologies was significantly higher than in healthy sinuses (p < 0.05 for each subgroup) except for air-fluid level (p = 0.334 and p = 0.520, respectively). Drainage path length was significantly longer in all patient groups. Maxillary ostium openings were significantly smaller in retention cyst and partial opacification subgroups, compared to healthy patients (p = 0.000 and p = 0.006, respectively) except for mucosal thickening or air-fluid levels conditions (p = 0.094 and p = 0.62). Drainage angle did not significantly differ. This study reveals that longer drainage length is associated with a higher risk of inflammatory sinus diseases, with increased severity. Smaller ostium openings are linked to retention cysts and partial opacification, while higher ostium locations increase the likelihood of sinus inflammation and disease severity.

Analysis on the relationship between Schneiderian membrane thickening in the posterior maxillary region and periapical lesions by cone beam computed tomography.

This study aimed to evaluate the thickening of sinus membrane, which is also named Schneiderian membrane (SM), in patients and its relationship with periapical lesions (PAL) in the posterior maxillary region to provide reference for the prevention and treatment of odontogenic maxillary sinusitis. A retrospective analysis was conducted on 554 cone beam computed tomography (CBCT) imaging data of maxillary sinuses from 301 patients who met the inclusion criteria to determine the correlation between PAL and SM thickening in the posterior maxillary region. Cases of pathological SM were recorded and classified on the basis of the degree and type of SM thickening. The correlation between SM thickening and the diameter of PAL, the relationship between the upper edge of PAL and the maxillary sinus floor, and its relationship with whether affected teeth with PAL undergo root canal treatment were evaluated. The detection rate of SM thickening in patients with PAL was significantly higher than in those without PAL, so PAL was correlated with SM thickening. Analysis on the correlation between PAL detection indicators and SM thickening degree showed that SM thickening degree was positively correlated with PAL diameter (cone beam computed tomography-periapical index) and not correlated with the three spread effects between the upper edge of PAL and the maxillary sinus floor, as well as whether the teeth with PAL undergo root canal treatment. The correlation analysis between PAL detection indicators and SM thickening types showed that whether the teeth with PAL undergo root canal treatment was not correlated with SM thickening types, and the diameter of PAL, the three spread effects between the upper edge of PAL, and the maxillary sinus floor were not correlated with SM thickening types. The PAL of posterior maxillary teeth is closely related to SM thickening, and the diameter of PAL is positively correlated with the degree of SM thickening. Patients with PAL who have undergone root canal treatment often exhibit SM polyp thickening. In addition, the relationship between the upper edge of PAL and the maxillary sinus floor does not affect the possibility of SM development.

Computed tomography analysis of the infraorbital canal and adjacent anatomical structures.

This study aimed to investigate the incidence of infraorbital canal (IOC) protrusion into the maxillary sinus via computed tomography (CT) and classify its variations. Additionally, it sought to identify nearby sinonasal variations that might elevate the risk of iatrogenic injury. Paranasal sinus CT of 500 patients was evaluated retrospectively. The IOC types were categorized. The length of the IOC, septum, the distance between the maxillary ostium and IOC (dOI), the presence of Haller cells, IOC-related intra-sinus opacity, and IOC dehiscence were investigated. The prevalence of type 3 IOC was 12%, of which 9.2% were type 3c. The maximum length of the IOC was positively correlated with type 3 IOC. A significant difference was found between IOC types in terms of dOI only on the left side. On both sides, the incidence of Haller cells was greater in patients with type 2 IOC than in those with type 1 and in patients with type 3 IOC than in those with type 2. IOC-related opacity and IOC dehiscence were more common in types 2 and 3 IOCs. The assessment of preoperative IOC types and neighboring anatomical structures by CT imaging is of great significance in preventing iatrogenic damage.

Osseodensification technique in crestal maxillary sinus elevation-A narrative review.

Osseodensification is a novel approach that has significantly advanced the field of implant dentistry, particularly in the context of transcrestal maxillary sinus floor elevation. This technique involves the use of specially designed burs that compact and densify bone along the osteotomy walls, thereby enhancing implant primary stability and facilitating osseointegration in low-density bone. This article reviews the historical evolution of implant site preparation, and the biomechanical, histological, and clinical evidence of osseodensification with a special focus on its application in sinus floor augmentation. The integration of this technique into contemporary practice represents a paradigm shift, offering a minimally invasive and efficient solution for addressing the challenges of posterior maxilla, with improved patient-reported outcomes and low complication rate. Three different protocols for sinus lift and implant placement using osseodensification burs are proposed based on available literature, and risk factors for Schneiderian membrane perforation based on residual bone height are discussed, along with implant-related outcomes and patient-reported outcome measures. The potential for osseodensification to become a standard practice in sinus floor augmentation is emphasized, highlighting key aspects such as surgical protocol and patient selection.

Central Giant Cell Granuloma Associated with the Maxillary Sinus

Central Giant Cell Granuloma Associated with the Maxillary Sinus

Anatomy and function of the canalis sinuosus and its injury prevention and treatment strategies in implant surgery

The canalis sinuosus, a canal containing the anterior superior alveolar nerve bundle, originates from the infraorbital canal and extends along the maxillary sinus and nasal cavity edges to the anterior maxilla. It was once regarded as an anatomical variation. However, with the widespread application of cone beam computed tomography (CBCT), the detection rate of canalis sinuosus in the population has increased. The canalis sinuosus exhibits diverse courses, branching into multiple accessory canals and terminating at the nasal floor or the anterior tooth region, with the majority traversing the palatal side of the central incisor. The anterior superior alveolar nerve bundle within the canalis sinuosus not only innervates and nourishes the maxillary anterior teeth and the corresponding soft tissues, and the maxillary sinus mucosa, but also relates to the nasal septum, lateral nasal wall, and parts of the palatal mucosa. To minimize surgical complications, strategies for preventing and treating canalis sinuosus injuries need to be investigated. Preoperatively, CBCT is used to identify the canalis sinuosus and to virtually design implant placement at a distance of more than 2 mm from the canalis sinuosus. Intraoperatively, assessing bleeding and patient comfort, complemented by precision surgical techniques such as the use of implant surgical guide plates. Postoperatively, CBCT is used to examine the relationship between the implant and the canalis sinuosus, and treatment of canalis sinuosus injuries can be tailored based on the patient's symptoms. This review summarizes the detection of canalis sinuosus in the population, its anatomical characteristics, and the physiological functions in the anterior maxilla, and discusses strategies for avoiding canalis sinuosus injuries during implant surgery, thereby enhancing clinical awareness and providing references for clinical decision-making.

Xenograft with advanced platelet rich fibrin compared to xenograft for maxillary sinus floor augmentation: Randomized clinical trial

Xenograft with advanced platelet rich fibrin compared to xenograft for maxillary sinus floor augmentation: Randomized clinical trial

Correction: Bilateral pararhinotomy with middle meatal antrostomy of the maxillary sinus in a rabbit (Oryctolagus cuniculus) with chronic rhinitis

Correction: Bilateral pararhinotomy with middle meatal antrostomy of the maxillary sinus in a rabbit (Oryctolagus cuniculus) with chronic rhinitis

The Impact of COVID-19 on the peri-operative complications rate of maxillary sinus floor augmentation.

The Impact of COVID-19 on the peri-operative complications rate of maxillary sinus floor augmentation.

The Modified Caldwell-Luc Approach for Treating Odontogenic Maxillary Sinusitis Without Need for Functional Endoscopic Sinus Surgery: A Retrospective Study

BackgroundOdontogenic maxillary sinusitis is a common inflammatory condition resulting from the violation of the Schneiderian membrane by conditions arising from the dentoalveolar unit, which includes teeth, their supporting structures, and adjacent tissues. This study aims to evaluate a modified surgical approach for treating this condition. PurposeThe purpose of this study is to measure the frequency of re-treatment of maxillary sinusitis of odontogenic origin following treatment with a modified Caldwell-Luc approach, which involves accessing the maxillary sinus through the canine fossa without creating a counter-opening in the inferior nasal meatus. Study DesignThis retrospective cohort study included 82 cases (83 sinuses) with odontogenic sinusitis treated surgically with the modified Caldwell-Luc technique at the Department of Oral and Maxillofacial Surgery, Poriya Medical Center, between 2014 and 2021. Patients with non-odontogenic sinusitis were excluded. Predictor VariablesAnatomic findings defined as the presence or absence of ostiomeatal complex abnormalities and oroantral communication, as identified through clinical examination and CT imaging. Main Outcome VariablesThe need for retreatment, defined as the requirement for functional endoscopic sinus surgery (FESS) due to persistent signs and symptoms of maxillary sinusitis after the modified Caldwell-Luc procedure, including facial pain/pressure, nasal congestion, purulent nasal discharge, or radiographic evidence of persistent sinus opacification on CT scan, lasting more than 4 weeks despite appropriate medical management. CovariatesCovariates included demographic data (age, sex [male/female as identified at birth]), smoking status, etiologies of odontogenic sinusitis, and surgical conditions. AnalysesDescriptive statistics, Cox proportional hazards regression was used to compute hazard ratios. Kaplan-Meier survival analysis was performed to estimate the probability of remaining FESS-free over time. The level of statistical significance was set at p < 0.05. ResultsThe sample was composed of 82 patients (83 sinuses) with a mean age of 52.3 years (SD 13.5), and 47 (56.6%) were male. Dental implantation and sinus augmentation procedures were the most common etiologies of odontogenic sinusitis (50.6%). The median follow-up time was 6.03 months (IQR: 2.57 - 10.93 months). The incidence rate of FESS requirement was 2.64 per 100 person-months of follow-up. The FESS-free frequency was 89.2% (95% CI: 80.4% - 94.4%). The Kaplan-Meier analysis estimated the probability of remaining FESS-free at 12 months to be 89.1% (95% CI: 79.8% - 94.4%). Patients with OMC abnormalities had a hazard ratio of 2.25 (95% CI: 0.47-10.84, p = 0.31) for requiring FESS, while those with OAC had a hazard ratio of 1.85 (95% CI: 0.46-7.39, p = 0.38). Conclusions and RelevanceThe modified Caldwell-Luc procedure was effective in treating the majority of odontogenic sinusitis cases. FESS may be necessary in a small percentage of cases with persistent symptoms. Further research is needed to identify predictors for FESS requirement. Of note, we recommend that oral and maxillofacial surgery surgeons review sinusitis cases with a FESS surgeon before performing the modified Caldwell-Luc procedure creating the opportunity for simultaneous or closely timed procedures when necessary

Reamer-scraping and implant-pushing technique for transcrestal sinus floor elevation.

Transcrestal maxillary sinus floor elevation is an effective method to solve the problem of insufficient bone height in the posterior maxillary region. However, current methods, such as osteotome sinus floor elevation, cushioned grind-out technique, Smart Drill technique, etc., require specialized surgical tool boxes. In this article, we introduce a new method of transcrestal maxillary sinus elevation that uses built-in reamers of various implant systems to scrap residual bone at the sinus floor and uses the implant to push the sinus membrane during implant placement. This technique is easy to operate and time saving and has a low rate of sinus membrane perforation. After a one-year follow-up observation of 146 people and 175 implants, the endo-sinus bone gains were 5.00 (4.70, 5.30) mm and 2.10 (1.40, 2.70) mm in the group of 3 mm≤residual bone height (RBH)<5 mm and the group of 5 mm≤RBH<8 mm, respectively, which can meet the clinical requirements of implant stability. This technique is suitable in generalizing dental implantation.

Sustained co-release of ciprofloxacin and dexamethasone in rabbit maxillary sinus using polyvinyl alcohol-based hydrogel microparticle

Topical delivery to paranasal sinuses through sustained-release stents is one of the new horizons in treating chronic rhinosinusitis (CRS). This study aims to introduce and evaluate sustained co-release of encapsulated ciprofloxacin (CIP) and dexamethasone (DEX) in polyvinyl alcohol-based carriers within the maxillary sinus of rabbit animals. DEX and CIP were loaded in a tyramine-substituted polyvinyl alcohol microparticle (PVATyr MP). The mechanical stability, degradability, and sustained-release patterns of both drugs as well as cellular cytocompatibility were assessed in vitro. The PVATyr MPs were then injected into the maxillary sinus of rabbits and they were monitored weekly for 21 days. Nasal endoscopy, MRI imaging, and tissue microscopy were used to follow the changes and compared them with the control condition. Also, the concentrations of drugs were evaluated in the maxillary sinus and blood samples over the study period. Produced PVA-based MPs possessed a relatively narrow particle size distribution (CV 7.7%) with proper physical stability until 30 days of incubation. The uniform-sized PVATyr MPs and their surrounding hydrogel showed sustained-release profiles for DEX and CIP for up to 32 days in vitro. The injected drugs-loaded hydrogel showed complete clearance from the maxillary sinus of rabbits within 28 days. The concentrations of DEX and CIP in mucosal remained within the therapeutic window when measured on days 7, 14, and 21, which were well above the plasma concentrations without any pathological changes in endoscopy, MRI imaging, and histological examinations. DEX/CIP loaded PVATyr MPs provided an effective, controlled, and safe sustained-drug delivery in both in vitro and in vivo analyses at therapeutic concentrations with minimal systemic absorption, suggesting a promising treatment approach for CRS.Graphical

Retro-maxillary nasal recess: a case report with a new finding

BackgroundRetro-maxillary recess of the nasal cavity is an area that has not yet described in the literature.ObjectiveTo report, present, and describe a previously non-reported case which has bilateral retro-maxillary nasal recess by multi-slices computed tomography (MSCT).Case presentationA CT of a 22-year-old male showed bilateral retro-maxillary nasal recess extends beyond the posterior maxillary sinus wall and anterior to the pterygopalatine fossa as an extension of the middle meatus laterally and bounded by the maxillary sinus anterior, the orbital floor superior, the inferior turbinates lateral attachment inferior, and the pterygopalatine fossa anterior. The retro-maxillary nasal recess anteroposterior, lateral, and vertical dimensions were 11.53, 8.24, and 11.6 mm respectively at the left side and 5.6, 4.61, and 6.16 mm respectively at the right side.ConclusionThis study reports and describes a new retro-maxillary nasal recess that could represent a new hidden challenging area for ESS.

Diagnostic Challenges and Management of Non-Odontogenic Toothache: A Case of Unilateral Pansinusitis Mimicking Dental Pain

This case report details the diagnostic challenge and subsequent management of a 38-year-old male patient who presented with severe, sharp, and non-localized pain in the right maxillary distal area. Initial¬ly unresponsive to non-steroidal anti-inflammatory drugs and antibiotics, the patient’s symptoms deviat¬ed from typical odontogenic pain characteristics. Comprehensive dental examinations revealed minimal pathologies, challenging initial assumptions of dental-origin pain. Advanced diagnostic imaging, including Orthopantomography and Cone Beam Computed Tomography (CBCT), was pivotal in identifying unilat¬eral pansinusitis, with notable obstruction in the maxillary, ethmoid, and frontal sinuses. Further microbi¬ological analysis confirmed a Staphylococcus aureus and anaerobic infection, refocusing the diagnosis to a non-odontogenic source. The patient underwent a targeted 14-day complex antibiotic regimen, supple¬mented with local treatments including Nasonex nasal spray and saline nasal irrigations. This integrative approach resulted in marked symptom improvement and was instrumental in the patient’s recovery. This case highlights the critical need for thorough evaluation in distinguishing between odontogenic and non-od¬ontogenic sources of orofacial pain, ensuring accurate diagnosis and effective treatment.

Clinical and radiographic changes following transcrestal sinus augmentation: A scoping review of the last 25 years.

Maxillary sinus floor elevation is a surgical procedure intended to increase the volume of the bone vertically to accommodate dental implant placement. This intervention is frequently required for implant installation in the posterior maxilla, where the bone may be insufficient for securing implants of necessary length and stability. Sinus floor elevation can be completed either through a direct approach with a "window" through the lateral wall of the alveolar ridge or an indirect "transcrestal/transalveolar" sinus floor elevation (TSFE), which accesses the sinus floor through the crest of the edentulous ridge. Our study aims to provide a comprehensive scoping review of research conducted over the past 25 years on TSFE, specifically. A literature search aimed at identifying pertinent literature for the purpose of this PRISMA-ScR-compliant scoping review was conducted. Only randomized controlled trials, non-randomized controlled trials, prospective cohort studies, and case series that met the eligibility criteria were selected. Relevant data from these studies were extracted. Primary outcome measures included radiographic bone levels and implant failure >5 years. Secondary outcome measures included implant stability at time of placement and complications. Interventions reported in the selected studies were grouped based on treatment modality, which were then compared with the control therapy (traditional osteotome technique) after a minimum of 12 months healing period. Our search yielded 633 records, and after deduplication, 574 of these were screened. Application of the eligibility criteria led to the inclusion of 37 articles in the final selection. Case selection for included studies enrolling subjects: Four different transcrestal sinus elevation treatment modalities were identified: (a) osteotome, (b) piezoelectric surgery, (c) osseodensification, and (d) hydraulic techniques. Due to the heterogeneity of the studies, no superior approach for TSFE could be identified. Overall, all techniques demonstrated high implant survival rates. Comprehensive understanding of the patient's medical history, available armamentarium, and post-operative complications/management strategies are all essential to the completion of a successful TSFE approach for implant placement in the posterior maxilla, regardless of the treatment modality used.

Risk analysis for acute oroantral communication: a retrospective study

Aims: The purpose of this study was to evaluate the relationship to type of sinus pneumatization with the relationship between extracted tooth and maxillary sinus in patients who developed oroantral communication (OAC). Methods: The patients who developed OAC after maxillary extraction and underwent OAC treatment were included in the study. The predictor variable was the type of maxillary sinus pneumatization (MSP). The primary outcome was relationship between extracted tooth and maxillary sinus. The covariates were age and sex. A Kruskal-Wallis and Pearson chi-square tests were used for the statistically analysis. Results: The study completed with 429 patients who met inclusion criteria. There was a statistically significant difference in the mean age between the relationship type between the extracted teeth and the maxillary sinus groups in this study (p

Orofacial Migraine-A Narrative Review.

The diagnosis of migraine is based on clear criteria outlined in the International Classification of Headache Disorders version 3 (ICHD-3). Notably, the criteria in ICHD-3 omit the location of the migraine. There are increasing reports of migraine in the facial region. Facial presentations of migraine are not easy to diagnose as they appear in the lower two-thirds of the face, often in the maxillary sinus region, around the ear, the upper/lower jaws, and the teeth. Additionally, a similar but distinct entity, neurovascular orofacial pain, has been established. The symptomatology of facial presentations of these headaches often resembles sinusitis and dental pathology. We will review these presentations, their diagnosis, and possible pathophysiology.

Cemento-ossifying fibroma: an extensive fibro-osseous lesion involving paranasal sinuses

Cemento-ossifying fibroma (COF) is a fibro-osseous lesion arising from cells of the periodontal ligament. This tumor typically occurs in individuals during their third and fourth decades of life, with a predilection for women. COF primarily affects the maxillofacial region, most commonly the mandible. Its localization in the paranasal sinuses and skull base is unusual. However, we present a rare case of COF involving the right paranasal areas of the maxillofacial region in an 18-year-old female. Computed tomography (CT) revealed an expansile lesion measuring 52.45×32×74.29 mm involving the right maxillary sinus, expanding into both the anterior and posterior choanae. The patient underwent endoscopic sinus surgery (ESS) with preservation of adjoining vascular structures. Clinical, radiographic, and histologic features are presented, and differential diagnosis is discussed.

Computed tomographic findings of nasal and paranasal disease in domestic rabbits highlight maxillary sinusitis and close association with dental disease: 100 studies (2004-2024).

To describe CT findings and epidemiologic features of nasal and paranasal disease of rabbits (Oryctolagus cuniculus). An electronic search was performed for rabbits that underwent skull CT from 2004 to 2024 and had findings consistent with nasal/paranasal or maxillary dental disease. History, signalment, and physical examination findings were recorded and reevaluated retrospectively for evidence of changes to the nasal passages, paranasal sinuses, and nearby associated anatomy. Data were analyzed with descriptive statistics, ordinal mixed logistic regression, and correlation analysis. 100 studies from 69 rabbits were reviewed. Lop-eared rabbits represented 30 of 69 cases. Upper respiratory signs (48 of 69 [69.6%]) and dental-related disorders (21 of 69 [31.9%]) were primary complaints. Rhinitis (49 of 69 [71.0%]), sinusitis (50 of 69 [72.5%]), and both (40 of 69 [60.0%]) were most diagnosed, with turbinate destruction (48 of 69 [69.6%]) and alveolar bone loss of adjacent teeth (51 of 69 [73.9%]) being common findings. Sinusitis was most common in the ventral (48 of 50 [96.0%]) and dorsal (33 of 50 [66.0%]) recesses of the maxillary sinus. Multiple CT variables were significantly correlated (P < .05); of those, maxillary alveolar bone loss of the incisor teeth and the second premolar tooth were, respectively, correlated with rhinitis grade and with sinusitis and sinusitis grade within the ventral recess of the maxillary sinus (P < .001). Computed tomographic evaluation allowed characterization of nasal and paranasal disease in rabbits and the association of rhinitis, sinusitis, and dental disease. The correlation between the maxillary dentition, rhinitis, and sinusitis highlights the need for thorough evaluation in CT of the teeth in rabbits with upper respiratory signs.

Treatment outcome of modified endoscopic assisted sinus surgery for treating maxillary sinus diseases with three dimensional volumetric analysis

This retrospective study aimed to analyze volumetric changes of the maxillary sinus after modified endoscopic-assisted sinus surgery (MESS) and to assess short-term treatment outcomes. The volumes of the total maxillary sinus, aeration, and sinus pathology were calculated using computed tomography data obtained prior to surgery and six months after surgery. Postoperative radiological improvement was assessed using the Lund–Mackay score. Bone regeneration around the bony window was evaluated during plate removal. A total of 32 patients were evaluated. Compared with before surgery, air and sinus pathology volumes improved significantly (air, increase by 6.0 cm3, p < 0.001; sinus pathology, decrease by 6.4 cm3, p < 0.001). However, there was no statistically significant change in the total maxillary sinus volume after surgery. The preoperative Lund–Mackay score was 2.9, decreasing to 0.4 six months after surgery (p < 0.001). The only predictors of postoperative aeration rate and Lund–Mackay score were preoperative sinus pathology volume (p = 0.049) and Lund–Mackay score (p = 0.015), respectively. The continuity between the bony window and surrounding sinus wall was restored in all patients. The results of this study suggest that MESS can be a successful, effective, and minimally invasive surgical treatment option for treating maxillary sinus diseases.