Maxillary Pain Research Articles

Complications of standardized endonasal dacryocystorhinostomy with unciformectomy

Purpose To report the nature and frequency of complications occurring with endonasal dacryocystorhinostomy (DCR) based on routine unciformectomy. Design Prospective, noncomparative interventional consecutive case series study. Participants Endonasal DCR was performed on 300 patients with complete nasolacrimal stenosis. Methods The uncinate process was resected (unciformian endonasal DCR), except when the lacrimal fossa was anterior to its insertion (23 cases [7.7%]). Preoperative clinical assessment and computed tomography scans, intraoperative endoscopic video recording, and postoperative clinical and endoscopic follow-ups were analyzed for reported endonasal DCR failure and complications. The mean follow-up was 13±12.6 months (range, 1–57). Main outcome measures Failure rate, nature, frequency, and time of intraoperative and postoperative complications. Results Of the 300 patients treated, 39 (13%) suffered from residual epiphora and no passage upon irrigation; there was secondary canalicular stenosis in 2 cases (0.6%), sump syndrome in 4 cases (1.2%), a distal stenosis from progressive healing closure of the ostium in 21 cases (7.0%), a recurrence of lacrimal mucocele in 5 cases (1.7%), and adhesions between the ostium and septum in 2 cases (0.6%). Access to the surgical site required an anterior middle turbinectomy in 103 cases (34.3%) and a septoplasty in 1 case (0.3%). Intraoperative bleeding was minor in 183 (60.6%), moderate in 82 (27.3%), and severe in 35 cases (11.6%). Postoperative bleeding occurred in 4 cases, and was controlled by packing. Transient frontal sinusitis (n = 1), nasal mucosa burn (n = 1), cacosmia (n = 8), phlebitis (n = 1), and maxillary pain (n = 8) also occurred. Orbital fat prolapse, cerebrospinal fluid leaking, cutaneous scarring, diplopia, and loss of vision did not occur. Conclusion Complications from unciformian endonasal DCR may be less frequent or severe than with maxillary endonasal DCR, and comparable to or less frequent than those for external DCR.

Executive summary

Executive summary

Rhinosinusitis: review from a dental perspective.

Patients often present to their dental providers with reports of posterior maxillary pain. The etiology of their symptoms may be either an acute or chronic situation, and the examining dentist's primary focus is usually to rule out dental pathosis. Rhinosinusitis should be an important consideration on the list of differential diagnoses when evaluating patients with posterior maxillary pain. The American Academy of Otolaryngology standardized the terminology for paranasal sinus infections in 1996 and offered guidelines for evaluation and treatment of sinusitis. This article highlights these guidelines for diagnosing and treating patients with rhinosinusitis. It also includes a review of sinus anatomy and of the special considerations for iatrogenic sinus exposure as well. Dental providers who understand the relationship between the maxillary sinus and the oral structures are better prepared to arrive at an accurate diagnosis. The astute dental provider will ensure a rapid and positive outcome for this group of patients with rhinosinusitis.

Incidence of chronic neuropathic pain subsequent to surgical removal of impacted third molars

To determine the incidence of atypical odontalgia/chronic neuropathic pain subsequent to surgical removal of impacted third molars, a telephone survey and a clinical investigation were carried out. Patients operated on for impacted mandibular third molars during 1994-96 in the Oral Surgery Clinic, School of Dentistry, University of Bergen, Bergen, Norway, were contacted by telephone. Answers were obtained from 1035 (71%) out of a total of 1458 operated patients. Median observation time was 5 years 9 months, ranging from 4 years 5 months to 6 years 9 months. All except 23 (2.2%) patients stated that they had no long-term symptoms or problems from the surgical site, jaw, or face after the third molar removal. These 23 patients were all examined clinically and radiologically, and symptoms and findings were evaluated. Seventeen patients had TMJ dysfunction: primarily pain of muscular and joint origin. Three patients had a periodontal problem associated with the adjacent second molar, with deep bony pockets and recurrent periodontal infection while two had chronic pulpitis of a second molar. One patient reported a temporary maxillary pain after removal of an ipsilateral mandibular third molar. None of the patients met the criteria for a diagnosis of atypical odontalgia/neuropathic pain. A 95% confidence interval of 0-0.38% of incidence rate of postoperative neuropathic pain was calculated. It is concluded that atypical odontalgia/ chronic neuropathic pain subsequent to surgical third molar removal is rare.

Principles of appropriate antibiotic use for acute rhinosinusitis in adults: Background

The following principles of appropriate antibiotic use for adults with acute rhinosinusitis apply to the diagnosis and treatment of acute maxillary and ethmoid rhinosinusitis in adults who are not immunocompromised.1.Most cases of acute rhinosinusitis diagnosed in ambulatory care are caused by uncomplicated viral upper respiratory tract infections.2.Bacterial and viral rhinosinusitis are difficult to differentiate on clinical grounds. The clinical diagnosis of acute bacterial rhinosinusitis should be reserved for patients with rhinosinusitis symptoms lasting 7 days or more who have maxillary pain or tenderness in the face or teeth (especially when unilateral) and purulent nasal secretions. Patients with rhinosinusitis symptoms that last less than 7 days are unlikely to have bacterial infection, although rarely some patients with acute bacterial rhinosinusitis present with dramatic symptoms of severe unilateral maxillary pain, swelling, and fever.3.Sinus radiography is not recommended for diagnosis in routine cases.4.Acute rhinosinusitis resolves without antibiotic treatment in most cases. Symptomatic treatment and reassurance is the preferred initial management strategy for patients with mild symptoms. Antibiotic therapy should be reserved for patients with moderately severe symptoms who meet the criteria for the clinical diagnosis of acute bacterial rhinosinusitis and for those with severe rhinosinusitis symptoms—especially those with unilateral facial pain—regardless of duration of illness. For initial treatment, the most narrow-spectrum agent active against the likely pathogens, Streptococcus pneumoniae and Haemophilus influenzae, should be used.[Hickner JM, Bartlett JG, Besser RE, Gonzales R, Hoffman JR, Sande A. Principles of appropriate antibiotic use for acute rhinosinusitis in adults: background. Ann Emerg Med. June 2001;37:703-710.]

Sinonasal Tract Eosinophilic Angiocentric Fibrosis

Eosinophilic angiocentric fibrosis (EAF) is a rare submucosal fibrosis without a well-developed differential diagnosis. Three cases of sinonasal tract EAF were identified in 2 women and 1 man, aged 49, 64, and 28 years, respectively. The patients experienced a nasal cavity mass, maxillary pain, or nasal obstructive symptoms of long duration. The process involved the nasal septum (n = 2), nasal cavity (n = 1), and/or the maxillary sinus (n = 1). There was no evidence for Wegener granulomatosis, Churg-Strauss syndrome, Kimura disease, granuloma faciale, or erythema elevatum diutinum. Histologically, the lesions demonstrated a characteristic perivascular "onion-skin" fibrosis and a full spectrum of inflammatory cells, although eosinophils predominated. Necrosis and foreign body-type giant cells were not identified. Surgical excision was used for all patients, who are all alive but with disease at last follow-up. Sinonasal tract EAF is a unique fibroproliferative disorder that does not seem to have systemic associations with known diseases. The characteristic histomorphologic features permit accurate diagnosis.

Randomised, double blind, placebo controlled trial of penicillin V in the treatment of acute maxillary sinusitis in adults in general practice

Objective - To compare the effectiveness of penicillin V with placebo in the treatment of adult patients with acute maxillary sinusitis in general practice. Design - Randomised, double blind, placebo controlled trial. Setting - 26 Danish general practices. Patients - 133 adult patients with a clinical diagnosis of acute maxillary sinusitis based on maxillary pain and raised values of either C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). Main outcome measures - Pain score and illness score as well as measurement of CRP and ESR values after initiation of treatment. Results - Penicillin V led to a better recovery than did placebo. The difference was statistically significant 3 days after the initiation of treatment with regard to pain reduction, whereas no significant difference was found with regard to the reduction in the sense of illness. At the end of the study, significantly more patients in the penicillin group were completely free of pain compared to the placebo group. This difference was only found in patients with an initial pain score of more than three. The cure rate was 71% in the penicillin group and 37% in the placebo group. Significantly more patients achieved normal CRP values when treated with penicillin (88%) as opposed to placebo (75%). Conclusion - Penicillin V is more effective than placebo in the treatment of acute maxillary sinusitis in adults in general practice, but only in patients with pronounced pain.

Functional Endoscopic Sinus Surgery in Chronic Sinusitis - a Series of 237 Consecutively Operated Patients

From 1989 to 1999, 237 consecutive patients with chronic sinusitis and/or nasal polyposis entered a prospective study on the effect of functional endoscopic sinus surgery (FES). Nasal stenosis associated with massive nasal polyposis was the most frequent problem found in 61% of the patients. The rest had long-lasting symptoms of chronic sinusitis. Duration of symptoms averaged 9.3 years. Most frequent symptoms preoperatively were: nasal stenosis, chronic secretion, anosmia, frontal pain, headache and maxillary pain. All patients had the operation performed under general anaesthesia. 86% of the patients have been operated bilaterally. In 72% the posterior ethmoid was opened, and in 54% the sphenoid was opened. The maxillary ostium has been enlarged in 82% of the patients and the frontal recess opened in 51% of the cases. No serious complications were registered. Annoying bleeding was experienced in 21%, hampering the intended procedure. In three patients rhinoliquore was observed. One case was treated during the procedure; the last two patients were in no need of surgical treatment. At the 1-year follow-up study, 45% of the patients were totally satisfied with the results and without symptoms, and 44% were definitely feeling better.

Idiopathic maxillary painPrevalence of maxillary sinus hyperreactivity in relation to allergy, chronic mucosal inflammation, and eosinophilia

Objective. In patients with chronic orofacial pain, an underlying sinus hyperreactivity may contribute to the clinical symptoms of a diagnosis of atypical odontalgia, trigeminal neuralgia, or temporomandibular disorders. The purpose of this study was to assess the prevalence of histamine-related maxillary sinus hyperreactivity in patients manifesting signs and symptoms of idiopathic maxillary pain and to correlate the respective findings with the presence or absence of chronic maxillary sinusitis–related diagnoses such as allergy, chronic mucosal inflammation, and eosinophilia. Study Design. Fifty patients who had been assigned a diagnosis of idiopathic maxillary pain underwent skin allergy tests, maxillary sinus histamine provocation tests, and maxillary sinus mucosa biopsy. Histamine challenge to a selected area was performed during transoral sinuscopy of the maxillary sinus; a positive test result was defined as the development of a significant local mucosa response such as reddening and swelling. Results. Comparison of the data showed most patients (38%) to have an absence of chronic maxillary sinusitis–related diagnoses, whereas the most common multiple diagnosis was found to be chronic mucosal inflammation in combination with eosinophilia (22%). Regarding the prevalence rates of positive histamine provocation test outcomes, a significant difference was found between the diagnostic subgroup “absence of chronic maxillary sinusitis–related diagnoses” (36.9%) and the diagnostic subgroups “chronic mucosal inflammation” (20%; P < .05), “chronic mucosal inflammation in combination with eosinophilia” (18.2%; P < .05), and “chronic mucosal inflammation in combination with eosinophilia and allergy” (14.3%; P < .01). An analysis of the distribution of chronic maxillary sinusitis–related diagnoses revealed absence of chronic mucosal inflammation–related diagnoses to be significantly more frequently associated with positive histamine provocation test outcomes than with negative histamine provocation test outcomes (41.2% vs 19.7%; P < .01), whereas chronic maxillary sinusitis (41.0% vs 29.4%), eosinophilia (26.2% vs 17.6%), and allergy (13.1% vs 11.8%) were found to be more prevalent in patients with negative histamine provocation test outcomes. Conclusions. The findings of this study suggest patients with idiopathic maxillary pain to be associated with a low rate of sinus hyperreactivity, whereas a positive test outcome with histamine provocation may not be linked to the presence of chronic maxillary sinusitis–related diagnoses such as allergy, chronic mucosal inflammation, and eosinophilia. Further investigations using a larger sample size of patients with idiopathic maxillary pain and nonidiopathic maxillary pain are necessary to demonstrate the presence or absence of an idiopathic maxillary pain–specific prevalence of maxillary sinus hyperreactivity. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:685–90)

Facial canal decompression leads to recovery of combined facial nerve paresis and trigeminal sensory neuropathy: Case report

BACKGROUND Trigeminal sensory neuropathy is often associated with facial idiopathic nerve paralysis (Bell’s palsy). Although a cranial nerve viral polyneuropathy has been proposed as the usual cause, in many instances the etiology remains unclear. This case report of recovery of both trigeminal and facial neuropathy after surgical decompression of the facial nerve suggests an anatomic link. METHODS A case of a 39-year-old woman presenting with recurrent unilateral facial paralysis is summarized. Her fifth episode, which did not spontaneously recover, was associated with retroorbital and maxillary pain as well as sensory loss in the trigeminal distribution. RESULTS A middle cranial fossa approach for decompression of the lateral internal auditory canal, labyrinthine segment of the facial nerve and the geniculate ganglion was performed. The patient’s pain and numbness resolved immediately postoperatively, and the facial paralysis improved markedly. CONCLUSION This result implicates a trigeminal-facial reflex as hypothesized by others. It suggests that decompression of the facial nerve can lead to improvement in motor and sensory function as well as relief of pain in some patients with combined trigeminal and facial nerve dysfunction.

양측 안와를 침범한 술후성 상악낭종 1례

Postoperative maxillary sinus cyst develops 10-30 years after Caldwell-Luc surgery. It is also called postoperative maxillary sinus mucocele or postoperative maxillary cyst. The etiology of the cystic lesion may be derived from the infected sinus mucosa left after a sinus operation. The most consistent symptom is dull maxillary facial pain. Enlarged cysts infrequently protrude into the orbit and elevate the eyeball on the affected side. On that occasion, proptosis, enophthalmos, diplopia, ptosis, and epiphora can develop. In most cases, the location of cyst is unilateral. However, bilaterality is rare. We report a case of bilateral postoperative maxillary sinus cyst affecting the orbits, which were managed via revision Caldwell-Luc’s operation with good result.

Sickle cell disorder and orofacial pain in Jamaican patients.

The aim of this study was to investigate the prevalence of orofacial pain in a large group of sickle cell disorder (SCD) sufferers. In 1996, 51 Jamaican adults and teenagers with SCD and 51 matched subjects (non-SCD) without any sickle cell problems were questioned about their experience of pain in the maxilla or mandible, and pain in their teeth. The subjects, aged 13 to 45 years, had oral examinations and the state of the teeth was recorded together with the presence or absence of deep periodontal pockets, vertical or horizontal mobility, sepsis, trauma and severe erosion. Mandibular or maxillary pain during the previous 12 months was reported by 49% of those with SCD and only 8% of the non-SCD subjects. Among the SCD group reporting this pain, 68% were found to have no dental problems which could have caused the pain. Dental disease accounted for the facial pain in all non-SCD subjects. Headaches were experienced by 77% of the SCD group and only 47% of the non-SCD group. Experience of toothache during the previous year was reported by 67% of the SCD group and 57% of the non-SCD. In half of these SCD subjects there was no obvious dental pathology to account for the dental pain but none of the controls had dental pain in the absence of dental pathology. People who suffer from sickle cell disorders are likely to suffer orofacial and dental pain in the absence of dental pathology and this is probably because of sickling crises within the microcirculation of the facial bones and dental pulps and small areas of necrosis in the bone marrow.

Difficulties in diagnosing acute sinusitis in a Dutch group practice: Relative value of history, radiography and ultrasound

Objectives: To determine the degree of agreement between (1) history, ultrasound and radiographic examinations, and (2) between two ultrasound and two radiographie examinations in the diagnosis of acute sinusitis in a local situation.Methods: This cross-sectional pilot study was undertaken among patients on the list of a Dutch group practice (six GPs), in cooperation with the ENT and radiography departments of a local hospital. Included were patients aged 15 to 65 years with one or more of the following symptoms: purulent nasal discharge; pain in the sinuses on bending forward; predominantly unilateral maxillary pain and pain in teeth or on mastication; the above symtoms after a common cold or influenza. The main outcome measure was agreement, calculated by Kappa statistics, between the results of diagnosing acute sinusitis from the history, following the guidelines of the Dutch College of General Practitioners (DCGP), and by ultrasound and radiography.Results: Of 60 evaluated patients, acute sinusitis was assessed from the history in 80%. The diagnosis was confirmed in 13% and 18% of the cases by two assessors reading the ultrasound scans, and in 55% and 60% by two radiographs reading the X-rays.Agreement was poor between history and ultrasound (Kappa. 03 and. 11), between history and radiograph) (.11 and. 24), and between ultrasound and radiography (.19 and. 31), but between the two ultrasound assessments (.56) and the two radiography assessment (.63) it was fair. The combination of clinical criteria as presented in the guidelines of the DCGP was better than any other combination of criteria formulated by the GPs in the group practice.Conclusions: The group practice decided that in this pilotstudy agreement between clinical history and ultrasound and radiography was too poor for these two investigations to add greater diagnostic certainty to their situation.

Pterygoid hamulus bursitis: One cause of craniofacial pain

Craniofacial pain disorders are frustrating to the doctor and the patient. Diagnosis is often difficult because the anatomy of the head and neck region is complex, grossly and neurologically. Frequently, several pain syndromes exhibit similar symptoms. One such disorder is bursitis of the pterygoid hamulus. This type of bursitis may produce symptoms of soft palatal, ear, and throat pain, maxillary pain, and difficulty and pain on swallowing. This disorder is often misdiagnosed as otitis media. Treatment may be conservative or surgical. This article discusses the anatomy, symptoms, diagnosis, and treatment of bursitis of the hamular process.

悪性腫よう像を呈した上顎洞血りゅう腫例 本邦報告例の検討

An 81-year-old woman was admitted to our hospital because of right maxillary swelling, pain and nasal obstruction. The medial wall of the right maxillary sinus protruded to the nasal septum. Plain X-ray films showed destruction of the lateral bony wall, and plain CT scans showed destruction of the posterior bony wall of the right maxillary sinus. The tumor was invading the parapharyngeal space. These findings suggested a malignant tumor of the right maxillary sinus.When needle biopsy was attempted intranasally, the needle could be inserted into the right maxillary sinus without any resistance. The pathological report was no malignancy, only coagulation.The right cheeck and gingiva showed swelling abruptly. Emergency CT showed an osteolytic lesion of the alveolar bone. Right maxillary sinectomy was done. The pathological report was fibrosis, hyalinization and capillary dilatation, these finding are compatible with hemangioma of the right maxillary sinus. The authors review the Japanese literature and discuss the ethiology of hemangiomas of the nose and paranasal sinuses.

Experience of a Permanent Ventilation and Drainage System in the Management of Purulent Maxillary Sinusitis

Fifty patients with purulent maxillary sinusitis, 11 patients with pressure-induced maxillary pain, and 14 patients undergoing maxillary sinus surgery were treated with a new type of permanent ventilation and drainage tube. With use of local anesthesia and as an office procedure, an inferior meatus antrostomy was performed with a circular-bore trephine, and a medical-grade, x-ray-dense silicone tube was inserted to secure the ventilation and drainage. Experience of 14 months of clinical use demonstrated a high success rate (92%) in cases of recurrent and chronic purulent sinusitis. All patients with pressure-induced pain were free from symptoms throughout the observation time. Only a few minor complications were observed. Among the advantages of the method is a more aggressive and early treatment in cases of purulent maxillary infections, possibly prior to the development of irreversible mucosal damage.

Maxillary sinus lymphoma: A consideration in the diagnosis of odontogenic pain

A patient with a known history of diffuse large cell histiocytic non-Hodgkin's lymphoma in the neck and left parotid gland presented with acute right maxillary odontogenic pain and swelling. Following endodontic treatment of the nonvital maxillary right second molar, minor masticatory discomfort persisted in the sextant but a dental etiology could not be established. Two months after the onset of symptoms, the right maxilla expanded uncontrollably and biopsy confirmed an antral lymphoma. The patient succumbed to the lymphoma and secondary complications 2 months later.

Temporomandibular joint dysfunction and orofacial pain caused by parotid gland malignancy: report of case

A 41-year-old female with 2 years of mandibular and maxillary facial pain sought multiple medical evaluations. Symptoms were similar to those accompanying many benign temporomandibular, salivary gland, and neurological disorders. Through manual palpation, a slight swelling in the salivary gland was discovered; a malignant carcinoma was removed by parotidectomy.

The spatial distribution, intensity and unpleasantness of acute dental pain

The distribution, intensity and unpleasantness of acute dental pain were studied in 196 patients. Dental pain was classified by source according to 7 anatomical sites: dentinal, pulpal, pulpal and periapical, periapical, pericoronal, papular and periodontal. The distribution of dental pain was classified by the frequency of pain spread throughout the sample, by the extent of pain spread for a particular pain source, that is, the number of vectors of spread and by the pain reference locations in the face and head. Pain-intensity and pain-unpleasantness were assessed on Visual Analogue Scales. The frequency and extent of pain spread varied as a function of source. However, specific patterns of pain spread were not associated with particular pain sources. There was considerable overlap in patterns of spread between maxillary and mandibular pain sources. The frequency and extent of pain spread was correlated positively with both pain intensity and pain unpleasantness. The correlation between pain ratings and pain spread may be attributed to central mechanisms and interactions between trigeminothalamic neurons. Spatial overlap of pain from maxillary and mandibular pain sources may be due to the large receptive fields of wide dynamic range neurons, that can extend beyond one trigeminal division. These observations indicate that the spatial distribution of acute dental pain is not sufficient as a diagnostic tool for indentifying pain source.

Fibrous histiocytoma of the paranasal sinus: Report of a case

The patient was a 57-year-old woman. About three years before she had been struck on the right zygomatic region. Two years later she noticed the right maxillary swelling, pain, nasal obstruction, and occasional right nasal bleeding. Symptoms became gradually severe, and on Feb. 14, 1983, she was referred to our clinic by a dentist.A maxillary cyst was suspected from the x-rays of panoramic tomography and Waters'view. But on admission, CT scan demonstrated a soft tissue mass which filled out the right maxillary antrum.Tumorectomy was done on 16, March, and after that histopathological diagnosis of benign fibrous histiocytoma was made.The postoperative course was uneventful and during 16-month interval since surgery, there has been no evidence of recurrence.