Maxillary Sinus Cavity Research Articles

Infraturbinal access to alveolar socket of maxillary sinus cavity

As of today paranasal sinuses endoscopic surgery is the method of choice in case of chronic sinusitis conservative treatment inefficacy. In a number of cases the underlying cause of sinusitis is a foreign object, which is difficult to remove through the enlarged natural junction of maxillary sinus cavity. We suggest infraturbinal access for removal of foreign objects located in alveolar socket area. The access comprises application of temporary anastomosis with the maxillary sinus in the inferior nasal meatus after preliminary separation of mucoperiosteal flap. Application of such flap allows making a bone hole large enough without the risk of generation of permanent anastomosis between the maxillary sinus cavity and the inferior nasal meatus. The article provides a detailed description of the method. We have operated on 36 patients using this method. In postoperative period the patients did not have any complaints of discomfort in cheek, gums or teeth area. No cases of intraoperative damage of nasolacrimal duct and no postoperative epiphora have been observed. In all the cases the bone defect was covered with mucoperiosteal flap. Post­operation follow up varies from 1 to 38 months. Infraturbinal approach is the optimal technique in cases when pathological process is located close to the floor of maxillary sinus.

The role of endoscopic sinus surgery in maxillary sinus foreign body removal

Extraction of impacted third molars is a common surgical procedure performed by oral surgeons and dentist. Dislodgement of the molar tooth into the maxillary sinus cavity can occur during the procedure. It comprises 0.6-3.8% of iatrogenic foreign body entrapment in the paranasal sinus. We report an unusual case of impacted maxillary third molar tooth that was accidentally displaced into the maxillary sinus during extraction and remained almost 1 year without any symptoms and removed via endoscopic sinus surgery.

“Proposed Classification for the Palatal Perforation” (Dr. Santosh Patil Classification)

The palate is an integral part of the oral cavity constituting various tissue types that give rise to different types of pathological conditions. Palatal perforation can be defined as a communication between the nasal cavities and the oral cavity. Palatal perforation is a rare condition encountered in the routine dental practice. It is well understood that the palatal perforation can pose a difficult diagnostic dilemma for the clinician. The perforation may present with the common characteristics and may be indistinguishable clinically. Emphasis is placed on the importance of obtaining a thorough and comprehensive history and collecting relevant laboratory information. Palatal perforation may be known to arise secondary congenital or acquired causes. During the sixth week of prenatal period palatal shelves may fail to fuse leading to cleft palate [1]. Acquired palatal perforations may be seen due to trauma, infectious disease, granulomatous disease, drug abuse, collagen vascular diseases and neoplastic conditions. Adenoid cystic carcinoma is reported to cause palatal perforation in many cases [2]. Tumors from maxillary sinus or nasal cavity may extend to palate leading to its perforation [3,4]. Although these neoplasms usually form a mass, but in advance cases perforation of palate may occur in course of disease or following treatment [5,6]. Various cases of palatal perforation due to narcotics abuse are reported in literature [7-9] (Table 1). Surgical procedures such as maxillectomy, septoplasty or intubation may lead to palatal perforation [10,11]. Till date there is no classification given for the palatal perforation, classification of disease makes it easier to study and understand which helps in timely diagnosis leading to the best prognosis for the patient. With this objective the following classification based on the etiological conditions has been proposed after a brief review of various causative factors for palatal perforations existing literature.

Application of hemostatic adhesive compositionin complex treatment of sinus cortica defects

One of the most frequent complication of removal of the upper jaw teeth is sinus cortica perforation that may cause the development of maxillary sinusitis. The main type of sinus cortica defects treatment is the surgery aimed at elimination of oroantral connection. During the surgical treatment of sinus cortica defects, one of the common complications is suture line disruption and oroantral connection recurrence. To improve the treatment results, glue hemostatic adhesive composition is used for elimination of defects. 100 patients aged 15–74 with various sinus cortica defects were examined and operated on; 50 patients had acute maxillary sinus cavity perforation and 50 patients had chronic perforative maxillary sinusitis. It has been revealed that in most cases the perforation had been localized in the first and second molars’ alveolar sockets areas. During the operation an extensive defect of gum, walls and bottom of alveolar sockets had always been found. It indicates that the reason of sinus cortica perforation is not only the anatomic features, but also traumatizing tooth removals as well. The article describes two surgery techniques and defines indication for maxillary sinusotomy. A course of drug therapy has been performed at the pre­surgery periods and after the surgical treatment. The follow-up examination of patients was performed in 1, 3 and 6 months. No disease relapse, including suture line disruption was observed at the follow-up period. Good surgical treatment results let us recommend the use of hemostatic adhesive composition in treatment of sinus cortica defects.

Conditioned Medium From Mesenchymal Stem Cells Enhances Early Bone Regeneration After Maxillary Sinus Floor Elevation in Rabbits.

Conditioned medium from stem cells contains growth factors and has a promising prospect for use in regenerative medicine. In this study, the effects of marrow-derived stem cell-conditioned medium (MSC-CM) on bone regeneration after maxillary sinus floor elevation were examined in rabbits. Rabbit bone marrow-derived stem cells (rMSCs) were cultured with MSC-CM for 48 hours, and their mobilization and proliferation were evaluated. Beta-tricalcium phosphate scaffolds were impregnated with MSC-CM and grafted in the rabbit maxillary sinus cavities. At 2, 4, and 8 weeks after transplantation, sections of the newly formed bone were evaluated histologically and by immunohistochemical staining. MSC-CM increased the migration and proliferation of rMSCs and the early bone regeneration in rabbit sinus. Cell proliferation and vascularization were increased at 2 weeks after implantation of grafts impregnated with MSC-CM compared to controls, indicating that MSC-CM is effective at the early phase of bone regeneration. MSC-CM is a promising novel therapeutic agent to promote bone regeneration after maxillary sinus floor elevation.

The Use of Technical "Standard All-on-Four" in the Maxilla

Among the factors that should be considered for the rehabilitation of atrophic jaws is mainly the anatomy of edentulous jaw, which offers trouble installing fixtures in view of the proximity to the maxillary sinus and nasal cavity. There are several possibilities to rehabilitate atrophic arcs, autogenous grafts, distraction osteogenesis, angled and short implants have been widely used in clinical practice. Thus, advanced surgical techniques are disclosed in the literature, such as the all-on-four standard technique. This technique consists of inserting implants for a complete rehabilitation, and inclining a previously straight distal implant 45°, allowing anchorage in better bone (jaw previous zones), use of longer implants and decreasing the size of the prosthetic cantilever. The purpose of this literature review was to evaluate the scientific articles who observed the behavior of dental implants installed by the technique in the maxilla. Initially, using the key words, 62 articles were obtained. After applying the inclusion criteria, 19 articles were selected. In each study the following were evaluated parameters: success rate of angled and axial implants, bone loss, and prosthetic complications. Finally, seven studies contemplated the requirements to be in this review. The literature of the art all-on- four standard in edentulous jaws showed that both angulated and axial implants have high success rate (92.8% to 99.3%) and similar bone loss. Therefore, the all-on-four standard technique is a viable option in the medium- and long-term for immediate fixed prosthetic rehabilitation in atrophic jaws.

Differential Scaling Patterns in Maxillary Sinus Volume and Nasal Cavity Breadth Among Modern Humans.

Among modern humans, nasal cavity size and shape reflect its vital role in air conditioning processes. The ability for the nasal cavity to augment its shape, particularly in inferior breadth, likely relates to the surrounding maxillary sinuses acting as zones of accommodation. However, much is still unknown regarding how nasal and sinus morphology relate to each other and to overall craniofacial form, particularly across diverse populations with varying respiratory demands. As such, this study uses computed tomographic (CT) scans of modern human crania (N = 171) from nine different localities to investigate ecogeographic differences in (1) the interaction between maxillary sinus volume (MSV) and nasal cavity breadth (NCB) and (2) scaling patterns of MSV and NCB in relation to craniofacial size. Reduced major axis (RMA) regression reveals that all samples exhibit an inverse relationship between MSV and NCB, but statistical significance and the strength of that relationship is sample dependent. Individuals from cold-dry climates have larger MSVs with narrower NCBs, while smaller MSVs are associated with wider NCBs in hot-humid climates. MSV and NCB each scale with positive allometry relative to overall craniofacial size. However, sample differences are evident in the both the interaction between MSV and NCB, as well as their correlation with craniofacial size. While these results provide further support that the maxillary sinus and nasal cavity are integrated among populations from opposite ends of the climatic spectrum, additional epigenetic factors are needed to explain variation of these structures among populations from more intermediate climates.

Influence of Maxillary Sinus Width on Transcrestal Sinus Augmentation Outcomes: Radiographic Evaluation Based on Cone Beam CT.

Maxillary sinus elevation is a predictable procedure to vertically enhance bone volume in the posterior maxilla for successful implant placement. It is speculated that graft bone resorption and remodeling which require angiogenesis may be affected by the dimensions of maxillary sinus cavity. The aim of this study is to investigate the effect of sinus width (SW) on the outcomes of transcrestal sinus lift with simultaneous implant placement based on cone beam CT (CBCT). A total of 57 elevated sites in 33 patients were included in this study. All the patients were treated with transcrestal sinus lift procedure associated with simultaneous implant placement using a composite graft material of autogenous bone and Bio-Oss. For each patient, CBCT scans were performed preoperatively, immediately after surgery and 6 months after surgery. Measurements of the linear parameters were conducted on the preoperative and postoperative CBCT images. The correlation of SW with graft resorption (GR) was analyzed using Pearson's correlation test with or without the classification of residual bone height. The average width of maxillary sinus was 13.68 ± 2.66 mm. The mean height of apical graft bone decreased from 2.85 mm immediately after surgery to 1.38 mm after 6 months. A positive association between SW and GR (r = 0.323, p = .014) was found in general. The findings show that graft bone resorption in elevated sinus has a positive correlation with the SW.

What is the optimal maxillary antrostomy size during sinus surgery?

To review all the journal articles relevant to chronic maxillary sinusitis in order to discuss the optimal size of maxillary antrostomy during endoscopic sinus surgery. Although endoscopic maxillary antrostomy is a longstanding and frequently performed procedure, there is limited evidence about the optimal size of the antrostomy. Commonly employed surgical options include dilation via balloon sinuplasty, traditional antrostomy with uncinectomy using forceps and powered microdebriders, enlargement of the natural ostium, and the mega-antrostomy or modified medial maxillectomy. Historically, inferior antrostomies or nasal-antral windows were commonly utilized in the preendoscopic era, although this procedure is less commonly used today. Balloon sinuplasty can be effective in dilating the ethmoid infundibulum and natural ostium for select patients with isolated maxillary sinusitis or mild disease. A standard antrostomy using biting forceps and powered instrumentation is more appropriate for advanced disease such as severe mucosal hyperplasia or nasal polyps, as it allows for visualization of the maxillary sinus cavity and more effective topical delivery of saline irrigations and medications. For recalcitrant maxillary sinusitis, the mega-antrostomy allows for gravity-dependent drainage and is most appropriate for patients with inherent mucociliary defects.

An Inflammatory Pseudotumor Arising from Pterygopalatine Fossa with Invasion to the Maxillary Sinus and Orbital Cavity.

We report a patient who had an inflammatory pseudotumor (IPT) that invaded to the maxillary sinus and orbital cavity, with the left pterygopalatine fossa as the principal site; this is a very rare case. The patient was an 83-year-old woman who suddenly became aware of impairment in the eyesight and visual field of the left eye. CT images showed a neoplastic lesion that invaded to the maxillary sinus and orbital cavity, with the left pterygopalatine fossa as the principal site, and also showed contrast effects. To obtain a definitive diagnosis from histopathological analysis, the lesion was biopsied, and she was diagnosed as the inflammatory pseudotumor with the immunohistochemical study and multiplex polymerase chain reaction-based clonality assays. The patient had a lymphoid-predominant lesion that responded to radiotherapy but corticosteroids were not effective. It is important to scrutinize the pathology to avoid unnecessary and mutilating surgery.

The mechanical properties of the bone tissue from the middle facial region

The objective of the present work was to study age-related features of the reaction of the maxillary sinus cavity walls to a variety of impacts associated with the surgical interventions. To this effect, a variety of stress-strain conditions were simulated that are known to arise in the maxillary sinus cavity walls under the action of different force vectors taking into consideration the age-specific peculiarities of the mechanical structure of the bone tissue. The 3D model of the maxillary sinus cavity was built up based on the results of spiral computed tomography with the use of the Solid Works 2012 software package (USA). The finite element method (FEM) was employed to construct the grid. Three variants of force application were simulated, one to the canine fossa region, another to the upper portion of the alveolar process at the border between the upper and lower walls of the sinus, and the third to the anterior part of the inferior nasal passage. The study has demonstrated that the bone wall of the maxillary sinus differently responds to the impacts of similar magnitude depending on the application point and age-related physical and mechanical properties of the bone tissue. This finding should be taken into account in the choice of the optimal surgical approach to the maxillary sinus. It was calculated that endonasal interventions should be preferred for the treatment of patients above 60 years of age as the minimally injurious ones to the bone tissue. Moreover, special caution is needed when the intervention is performed beneath the canine fossa, where the bone is extremely fragile and the risk of injury extension to the floor of the maxillary sinus is especially high.

Prosthetic rehabilitation of acquired maxillary defect

This case report describes the rehabilitation of a patient with acquired maxillary defect using heat polymerizing acrylic resin hollow bulb obturator. The aim of the prosthesis is to improve the retention of the prosthesis and the esthetics. Acquired maxillary defects caused by surgical correction of tumors or trauma can lead to various functional, esthetic and psychologic disturbances to the patient. The defect results in liquid and food escaping into the maxillary sinus and nasal cavities, causing severe speech and swallowing dysfunction with significant reduction in quality of life. The maxillofacial prosthodontist has a challenging role in the rehabilitation of the acquired defects. This clinical report describes rehabilitation of an acquired maxillary defect of a 45-year-old male patient using single piece closed hollow bulb obturator made with heat polymerizing acrylic resin. The bulb portion with the tissue surface of the denture was formed first followed by lid fabrication separately. The lid was attached appropriately using auto polymerising resin. The hollow bulb design improves the retention of the prosthesis when the clinical situation prevents adequate retention of the prosthesis. Furthermore for patients with financial constraints, heat polymerizing acrylic resin prosthesis provides a cost-effective treatment. A hollow bulb obturator allows fabrication of light weight prosthesis. The weight of the prosthesis contributes significantly to the retention of the prosthesis. In cases where the defect is large or if anatomy of the defect does not contribute to the retention and stability of the prosthesis, closed hollow obturators are a good treatment option. The hollow obturator makes the prosthesis lighter in weight and thereby improves the retention of the prosthesis and improves speech.

Asymptomatic chronic rhinosinusitis and osteitis in patients treated with multiple zygomatic implants: a long-term radiographic follow-up.

The aim of this study was to investigate implant survival and the reactions of the bone and mucosa of the maxillary sinuses in patients treated with fixed dental prostheses supported by multiple zygomatic implants. Between 2001 and 2007, patients with extensive resorption of the basal bone of the maxilla received multiple zygomatic implants without grafts. In 2012, the maxillary sinuses were examined with cone beam computed tomography. Neo-osteogenesis at the posterior wall of the sinus was considered to be a sign of osteitis and classified as mild (3 to 4 mm), moderate (4 to 5 mm), or severe (> 5 mm). The maxillary ostium was examined and accessory ostia were registered. The sinus mucosa was evaluated according to the Lund-Mackay staging system, and the sinus was checked for fluid level and atelectasis. Patients reported any nasal- and sinus-related symptoms. Fourteen patients who had received 58 zygomatic implants and 13 standard implants were examined. The mean follow-up was 9.3 years, and the implant survival rates were 97% and 92% for zygomatic and standard implants, respectively. Osteitis was found in all but one patient and classified as severe in 17 of the 27 investigated sinuses. The infundibulum was obstructed in nine sinuses, and an accessory ostium was present in seven. The mucosa of the maxillary sinus showed signs of chronic rhinosinusitis in all but one patient. No fluid levels were observed. Atelectasis occurred in 15 sinuses. Twelve patients reported unaltered nasal and sinus status. Patients with extensive bone resorption in combination with voluminous maxillary sinuses and nasal cavities can experience long-term success with prostheses supported by multiple zygomatic implants. Asymptomatic chronic rhinosinusitis with osteitis and gradual collapse of the maxillary sinus cavity can be anticipated.

Immediate function of partial fixed rehabilitation with axial and tilted implants having intrasinus insertion.

Implant-supported rehabilitation of the posterior maxilla could be challenging because hyperpneumatization of the maxillary sinus might reduce the bone height. In this study, the authors report preliminary results of a new treatment modality for the partial fixed rehabilitation of posterior maxilla with immediate function by using 1 anterior axial implant and 1 posterior tilted implant with intrasinus mesial insertion. From 2009 to 2011, 10 patients (6 women and 4 men) with missing upper premolars and molars were recruited and treated according to this protocol. Each patient received a partial fixed bridge supported by 1 axial anterior implant and 1 posterior implant placed with a 30-degree mesial inclination and intrasinus insertion. Autologous bone was positioned to fill the maxillary sinus cavity and to cover the exposed implant surface after elevation of the anterior sinus membrane. A prosthesis with immediate function was positioned within 3 hours, whereas a CAD/CAM final restoration was delivered 6 months later. Follow-ups at 6 and 12 months, and then annually, were scheduled. At each follow-up, plaque level and bleeding scores were assessed, and radiographic evaluation of marginal bone level change was performed at 1 year. The patients were followed up for a mean of 50 months (range, 42-57 mo). No implants were lost, and all prostheses were stable and functional, reporting 100% of implant and prosthetic success rates. After 1 year, bone loss had a mean (SD) of 1.0 (0.4) and 0.9 (0.5) mm for axial and tilted implants, respectively, with no statistically significant differences between them (P > 0.05). The preliminary results suggest that this approach could allow the rehabilitation of posterior maxilla with immediate function in case of reduced bone volume, representing an alternative technique to bone grafting, short implants, and zygomatic or pterygoid implants.

On the Early Mechanisms of Bone Formation after Maxillary Sinus Membrane Elevation: An Experimental Histological and Immunohistochemical Study

Previous studies have shown predictable bone formation in the maxillary sinus after membrane elevation. However, how and where the bone is formed is not well understood. The aim of the study was to histologically and immunohistochemically study the early bone formation events in primates after membrane elevation in the maxillary sinus. Nine adult male tufted capuchin primates (Cebus apella) were included in the study. Eight animals were subjected to bilateral maxillary sinus membrane elevation using a lateral replaceable bone window technique. One oxidized dental implant was placed into the maxillary sinus cavity on both sides. In four animals, one sinus was left without any additional treatment, whereas the contralateral sinus was filled with autologous bone grafts from the tibia. In two animals, the implants were inserted under the elevated sinus membrane on both sides. In two animals, the sinus membrane was totally removed. The animals were euthanized after 10 or 45 days. One nonoperated animal representing pristine tissue conditions served as control. The maxillary sinuses with implants were retrieved and further processed for light microscopic ground sections or decalcified sections for immune-histochemical analyses. Bone formation started from the bottom of the sinus floor, sprouting into the granulation tissue along the implant surface under the elevated membrane irrespective of time and surgical technique. Bone formation was not seen in direct conjunction with the sinus membrane. A distinct expression of osteopontin was observed in the serous glands of the lamina propria close to the implant within all groups. Bone formation after sinus membrane elevation with or without additional bone grafts starts at the sinus floor and sprouts into the elevated space along the implant surface. The sinus membrane does not seem to present osteoinductive potential in sinus membrane elevation procedures in this study.

Use of Temporalis Myofascial Flap in Maxillary Reconstruction

ABSTRACT Maxillary ameloblastoma is a benign odontogenic neoplasm. Excision should involve wide margins because of its high recurrence rate and ideally be followed by reconstruction. A 23 year-old female patient presented with recurrent ameloblastoma. One year previously, she had undergone a curettage excision. The recurrent lesion was managed by a total maxillectomy preserving the inferior orbital rim. Simultaneous reconstruction was performed with an temporalis myofascial flap for obliteration of the maxillary sinus and nasal cavities. Reconstruction of mid facial defects after tumor resection or trauma has evolved from skin graft to pedicled flaps and more recently, to free tissue transfer. Each of these reconstructive modalities has its specific indications, advantages and drawbacks. Temporalis muscle is one of the regional flaps that can be used to reconstruct midfacial defects. The muscle is available close to the surgical field and has a constant vascular supply. However, the flap has a limited arc of rotation and most of the muscle bulk is used in the pedicle. Therefore, various modifications of the surgical procedure were attempted in order to increase the arc of rotation of the flap. The temporalis muscle flap can provide a reliable, one-stage reconstructive alternative for more complicated surgical procedures for moderate-sized midfacial defects. Dimensions and arc of rotation of the flap may be increased by using temporalis muscle and deep temporal fascia as a myofascial unit. How to cite this article Nayak C, Swain SK. Use of Temporalis Myofascial Flap in Maxillary Reconstruction. Clin Rhinol An Int J 2014;7(2):73-75.

Rehabilitation of maxillectomy defect with obturator prosthesis

The acquired defects of the palate are created commonly surgical intervention of benign or malignant neoplasms. The size and location of the defect influence the level of difficulty in prosthetic rehabilitation. Surgical intervention creates anatomic defect which forms communication among the oral cavity, nasal cavity and maxillary sinus. The goal of prosthodontist is to rehabilitate missing oral and extra oral structures with restoration of normal anatomic and physiologic function. Prosthetic rehabilitation with obturator restores the oral structures and also acts as barriers between communications among the cavities. Acquired maxillary defects of the palate are seen in patients suffering from benign and malignant neoplasms, trauma, pathologic changes, radiation therapy and surgical intervention. Ablative surgical therapy is frequently adopted for the control of malignancies and other abnormal growths. This results in anatomic defect that allows the oral cavity maxillary sinus and nasal cavity to become one compartment, abrupt alteration of physiologic functions such as speech, mastication, deglutition and salivary control. Prosthodontics rehabilitation for an acquired maxillary defect begins immediately at the time of surgical resection. Prosthetic rehabilitation begins with a surgical obturator, which is inserted at the time of surgery to help retain the packing, prevent oral contamination of the surgical wound and skin graft, and to allow the patient to speak and swallow during the initial post operative period. The surgical obturator is commonly converted into an interim obturator with the addition of resilient lining material to adapt to the defect. Definitive obturator is initiated approximately 3 to 4 months after surgery when healing is complete. The impression for definitive obturator prosthesis should include the skin graft mucosal junction, lateral aspect of the orbital floor, and the dynamic physiology of the velopharyngeal mechanism during speech and swallowing. The obturator bulb must also be contoured to prevent obstruction of nasal breathing and to maintain nasal resonance during speech. The degree of extension into the defect varies depending upon the configuration of the defect, character of its lining tissue, and functional requirement for retention, stability and support of the prosthesis. This article describes a case report of a patient who had undergone partial maxillectomy secondary to squamous cell carcinoma and rehabilitated with definitive obturator.

Treatment of an extensive maxillary cyst using nasal airway and balloon catheter devices.

Introduction. Large maxillary cysts occasionally expand into the maxilla and erode the maxillary sinus and nasal cavity. The Caldwell-Luc procedure is the recommended treatment for large maxillary sinus cysts. However, it is hard to preserve the nasal space in the case of large maxillary sinus cysts that penetrate into the nasal cavity. Methods. A 22-year-old man who had large maxillary sinus cysts was referred to our department for a surgical treatment. After removing the cyst from the maxillary sinus using the Caldwell-Luc procedure, we used nasal airway and balloon catheter devices to preserve the space of the inferior nasal meatus and maxillary sinus. These devices were removed 10 days postoperatively. Insertion and removal of both devices were simple and painless. Findings. The nasal airway and balloon catheter devices were useful for performing maxillary sinus surgery to remove large cysts. Our method was satisfactorily safe and was an effective minimally invasive treatment that preserved the space of the inferior nasal meatus and maxillary sinus.

上顎洞を広範に占拠した内反乳頭腫の1例

Inverted papilloma of the nasal cavity and paranasal sinuses is a relatively uncommon benign tumor. Because of the aggressive nature and risk of recurrence of the tumor, complete resection is essential.We report a patient with a massive inverted papilloma of the maxillary sinus who was surgically treated by a collaborative medical team approach, including otorhinolaryngology specialists and oral surgeons. The patient was a 50-year-old woman who consulted an otorhinolaryngologist at a primary care center in early June 2010 because of left nasal obstruction. A left nasal polyp was resected. The histopathological diagnosis was an inverted papilloma.In early July 2010, she was referred to the Division of Otolaryngology at Ebina General Hospital. Computed tomography revealed a mass of different density in the left maxillary sinus and nasal cavity. The clinical diagnosis was a suspected massive inverted papilloma of the left maxillary sinus.In mid-July 2010, otorhinolaryngology specialists were consulted and resection of the tumor was considered difficult by endoscopic sinus surgery （ESS） alone. In September 2010, the patient underwent tumor resection combined with the Caldwell-Luc operation under general anesthesia in collaboration with our department. The histopathological diagnosis was an inverted papilloma.No recurrence has occurred as of 36 months after the operation.

硬口蓋原発の悪性筋上皮腫例

Malignant myoepithelioma is a rare tumor that occurs in about 0.2% of the salivary gland tumors. We report herein on a case of malignant myoepithelioma which presented in the hard palate.The patient was a 54-year-old woman, who visited our outpatient clinic with a complaining of nasal obstruction. Rhinology showed an elevation of the nasal cavity floor, and a 15 mm mass lesion was observed in hard palate.The presence of tumor was confirmed by CT imaging on which a large solid mass occupying part of right maxillary sinus, hard palate, and nasal cavity were observed. There were no palpable neck lymph nodes. The pathological diagnosis of a biopsy taken from the nasal cavity floor was malignant myoepithelioma. Immunohistochemical studies showed positive staining for keratin and p63, and partial positivity for S-100 and GFAP.The patient underwent subtotal maxillectomy of the right maxilla and partial maxillectomy of the left maxilla.In a 2-year follow up after the surgery, there has been no evidence of recurrence.