Lateral Wall Of Maxillary Sinus Research Articles

A New Route for Passing a Free Flap Vascular Pedicle Using Contralateral Facial Vessels as Recipient Vessels in Skull Base Reconstruction

A New Route for Passing a Free Flap Vascular Pedicle Using Contralateral Facial Vessels as Recipient Vessels in Skull Base Reconstruction

Are panoramic images reliable in planning sinus augmentation procedures?

The inherent deformation and two-dimensional nature of panoramic radiographs jeopardise their interpretation and quantitative measurements. This study aims to estimate the degree of underestimation of available mesio-distal bone in the premolar area (comparing panoramic radiographs with multi-slice/cone-beam computer tomography [CT]) to determine the prevalence, width, length and position of the bony canal [artery] in the lateral sinus wall and to explore the prevalence, width and length of another (newly detected) bony canal at the palatal aspect of the upper canine. The distance between the distal side of the canine/first premolar and the mesial side of the first molar or the anterior wall of the maxillary sinus was measured on panoramic radiographs and corresponding multi-slice/cone-beam CT images (65 patients). Measurements were made at apical, mid-radicular and crestal regions, parallel to the occlusal plane. The presence and dimensions of the two above-mentioned intra-osseous canals were verified on multi-slice CT scans (144 patients) using reformatted cross-sectional images and/or axial slices. For all 65 patients, panoramic radiographs underscored the mesio-distal distance of available bone in the upper premolar region (mean 2.9 mm, range 0.1-7.5 mm). An intra-osseous canal in the lateral maxillary sinus wall was clearly visible in 49.5% of the cases (mean diameter 1.4 mm). In the canine region, a bony canal was obvious in 32.9% of the cases, with a mean diameter of 1.23 mm. For both canals, there was no correlation between diameter and patient's age. Based on the present data, cone-beam CT imaging can be recommended for visualising anatomical structures during planning of sinus augmentation procedures.

A Rare Case of IgG4-Related Sclerosing Disease of the Maxillary Sinus Associated With Bone Destruction

A 73-year-old man presented to the accident and casulty department with a 2-week history of increasing rightided facial swelling. This was associated with a lowrade fever. Examination confirmed a 6-cm diameter welling over the malar prominence. The overlying skin as normal and there was no paresthesia in the infraorital nerve distribution. No trismus was evident. Intraoral xamination revealed fullness in the upper buccal sulcus ith almost complete effacement. Otherwise the examiation was unremarkable. He was medically fit apart from enign prostatic hyperplasia. An orthopantomogram revealed a 22-cm “lozenge”haped radiopacity in the right maxillary sinus. Magnetic esonance imaging (Fig 1) and computed tomographic cans clearly showed opacification of the right maxillary inus and bone destruction. These demonstrated that the athology extended into the infratemporal fossa. Magnetic esonance imaging of the abdomen revealed no evidence of etroperitoneal fibrosis. Several blood investigations were taken including a full lood cell count, urea, electrolytes, creatinine, C-reactive rotein, liver function tests, immunoglobulin (Ig) G (includng subclasses 1, 2, 3, and 4), IgA and IgM levels, a urinary ample for monoclonal free light chains, and blood viscosty. All results were within normal limits with the exception f slightly raised C-reactive protein and blood viscosity evels. Examination and biopsy were carried out under general nesthesia. These revealed a thickened buccal mucosa toether with irregularity/erosion of the lateral wall of the ight maxillary sinus. A small amount of pus was present in he buccal space and maxillary antrum.

Anatomical and Surgical Findings and Complications in 100 Consecutive Maxillary Sinus Floor Elevation Procedures

To investigate the prevalence of anatomical and surgical findings and complications in maxillary sinus floor elevation surgery, and to describe the clinical implications. One hundred consecutive patients scheduled for maxillary sinus floor elevation were included. The patients consisted of 36 men (36%) and 64 women (64%), with a mean age of 50 years (range, 17 to 73 years). In 18 patients, a bilateral procedure was performed. Patients were treated with a top hinge door in the lateral maxillary sinus wall, as described by Tatum (Dent Clin North Am 30:207, 1986). In bilateral cases, only the first site treated was evaluated. In most cases, an anatomical or surgical finding forced a deviation from Tatum's standard procedure. A thin or thick lateral maxillary sinus wall was found in 78% and 4% of patients, respectively. In 6%, a strong convexity of the lateral sinus wall called for an alternative method of releasing the trapdoor. The same method was used in 4% of cases involving a narrow sinus. The sinus floor elevation procedure was hindered by septa in 48%. In regard to complications, the most common complication, a perforation of the Schneiderian membrane, occurred in 11% of patients. In 2%, visualization of the trapdoor preparation was compromised because of hemorrhages. The initial incision design, ie, slightly palatal, was responsible for a local dehiscence in 3%. To avoid unnecessary surgical complications, detailed knowledge and timely identification of the anatomic structures inherent to the maxillary sinus are required.

Langerhans' cell histiocytosis of the temporal bone and skull base

A 22-month-old boy was referred for evaluation of a slowly enlarging right postauricular mass. The mass was first noticed by his mother 3 weeks earlier, shortly after the patient was diagnosed with a right otitis media. The patient was on a second course of antibiotics for this episode of otitis, which had been his third or fourth episode in the previous 12 months. The child had otherwise been well and was afebrile. There was no report of otorrhea or drainage from the mass. The patient stayed with a babysitter during the day, and a few declawed cats were in the household. There was no history of prior ear surgery or exposure to tuberculosis. Physical examination revealed a healthyappearing child in no apparent distress. Cerumen filled the right ear canal, which when removed revealed a retracted eardrum with a middle ear effusion. The left tympanic membrane was normal. The right postauricular mass measured approximately 3 3 cm, was soft, and was mildly tender. Additionally, the skin overlying the mass was slightly erythematous. The remainder of the head and neck exam was completely normal aside from nontender right cervical adenopathy. A computed tomography scan of the soft tissues of the temporal bones and neck with contrast was obtained and revealed a mass 2 2 3.5 cm in the right mastoid (Fig 1). The mass extended through the tegmen into the posterior cranial fossa, elevating of the overlying dura and further extending laterally through the temporal bone into the postauricular soft tissues. The mass also appeared to be eroding the lateral wall of the posterior semicircular canal. Complete opacification of the mastoid air cells and the middle ear space was seen; however, the ossicular chain appeared intact (Fig 2). A second mass was noted within the right infratemporal fossa with the epicenter located about the pterygoid muscles and measured approximately 2 2 4 cm. The mass extended into the nasopharynx where it obliterated the fossa of Rosenmuller. It also extended anteriorly into the pterygoid plates and abutted the right maxillary sinus lateral wall. Multiple deep and superficial cervical chain lymph nodes, the largest of which measured 1.5 2.5 cm in diameter, were at the level of the carotid bifurcation in the right neck. The possible diagnoses included Langerhans’ cell histiocytosis (LCH), rhabdomyosarcoma, metastatic neuroblastoma, and, less likely, multiple myeloma. The patient was taken to the operating room for incisional biopsy of the right postauricular mass. In addition, hematology and oncology departments were consulted to carry out a bone marrow biopsy, since the possibility of rhabdomyosarcoma was raised. At surgery, a postauricular incision was made and flaps were raised over a well-encapsulated lesion that protruded through a cortical mastoid defect. The mass was transected completely at the level of the bony cortex, revealing a light brown material that appeared semi-necrotic and with the consistency of fat. No purulent fluid was found. A myringotomy was also carried out and revealed dirty brown fluid in the middle ear space. A tympanostomy tube was placed. Slides of the biopsy tissue stained with hematoxylin-eosin demonstrated a connective tissue matrix containing masses of histocytic cells and numerous eosinophils (Fig 3). The histiocytes had irregular nuclear contours and From the Department of Otolaryngology–Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA. Address reprint requests to Craig S. Derkay, MD, Department of Otolaryngology–Head and Neck Surgery, 825 Fairfax Avenue, Suite 510, Norfolk, VA 23507 Copyright 2002,ElsevierScience (USA).All rights reserved. 0196-0709/02/2304-0001$35.00/0 doi:10.1053/ajot.2002.123452

Chronic bacterial rhinosinusitis: description of a mouse model.

To survey normal murine sinonasal anatomy and to create a mouse model for chronic bacterial rhinosinusitis. Anatomic, histologic, and pathophysiologic study displaying normal murine sinonasal anatomy and surgically created unilateral sinonasal inflammation. Twenty-one 6-week-old, male C57BL/6 mice. Animals that underwent unilateral maxillary sinus ostial obstruction using Merocel nasal packing, animals with unilateral Bacteroides fragilis inoculation alone, and animals with both ostial obstruction and bacterial inoculation were examined at 4 weeks for histologic evidence of chronic sinonasal inflammation. Experimental interventions were compared with contralateral control sinuses within each animal and with normal and sham-operated controls. Normal mouse paranasal sinuses include maxillary sinuses, ethmoid air cells, and respiratory-type epithelium. In experimental animals, the lateral maxillary sinus wall, nasal septum, and superior turbinelle of the maxillary sinus were examined histologically. Epithelial thickening and disarray, goblet cell hyperplasia, inflammatory infiltrates, and sinonasal fibrosis were present in the experimental sinuses of animals packed with Merocel alone or Merocel with bacterial inoculation. Changes seen with Merocel and bacteria were more dramatic than those with Merocel alone. Sham-operated controls and sinuses inoculated with bacteria alone did not differ significantly from the sinuses of normal animals. Unilateral maxillary sinus ostial obstruction using Merocel nasal packing along with B fragilis inoculation results in a persistent, localized bacterial rhinosinusitis in mice.

Anatomical aspects of sinus floor elevations.

Inadequate bone height in the lateral part of the maxilla forms a contra-indication for implant surgery. This condition can be treated with an internal augmentation of the maxillary sinus floor. This sinus floor elevation, formerly called sinus lifting, consists of a surgical procedure in which a top hinge door in the lateral maxillary sinus wall is prepared and internally rotated to a horizontal position. The new elevated sinus floor, together with the inner maxillary mucosa, will create a space that can be filled with graft material. Sinus lift procedures depend greatly on fragile structures and anatomical variations. The variety of anatomical modalities in shape of the inner aspect of the maxillary sinus defines the surgical approach. Conditions such as sinus floor convolutions, sinus septum, transient mucosa swelling and narrow sinus may form a (usually relative) contra-indication for sinus floor elevation. Absolute contra-indications are maxillary sinus diseases (tumors) and destructive former sinus surgery (like the Caldwell-Luc operation). The lateral sinus wall is usually a thin bone plate, which is easily penetrated with rotating or sharp instruments. The fragile Schneiderian membrane plays an important role for the containment of the bonegraft. The surgical procedure of preparing the trap door and luxating it, together with the preparation of the sinus mucosa, may cause a mucosa tear. Usually, when these perforations are not too large, they will fold together when turning the trap door inward and upward, or they can be glued with a fibrin sealant, or they can be covered with a resorbable membrane. If the perforation is too large, a cortico-spongious block graft can be considered. However, in most cases the sinus floor elevation will be deleted. Perforations may also occur due to irregularities in the sinus floor or even due to immediate contact of sinus mucosa with oral mucosa. Obstruction of the antro-nasal foramen is, due to its high location, not a likely complication, nor is the occurrence of severe haemorrhages since the trap door is in the periphery of the supplying vessels. Apart from these two aspects, a number of anatomical considerations are described in connection with sinus floor elevation.

Endoscopic View of Lateral Nasal Wall of Hypoplastic Maxillary Sinus

Endoscopic View of Lateral Nasal Wall of Hypoplastic Maxillary Sinus

치성상악낭종 1례

The authors have recently experienced a case of large dentigerous cyst in the maxillary sinus with destruction of lateral wall of maxillary sinus. The cyst was treated successfully by mean of Caldwell-Luc’s approach without facial disfiguration or others complications.

Pneumocele of the Maxillary Sinus

Pneumocele of the maxillary sinus is a rare condition in which the sinus cavity expands in any direction. Several authors attribute this disease to valve-like action of obstructed ostium of the maxillary sinus, resulting in air trapping.A 25 year old man had suffered from epiphora and dull pain on his left cheek since December 1975 and first visited our clinic on May 10, 1976.X-ray film showed hyperlucence of maxillary sinus areas of the left side, expanding of the left maxillary sinus cavity and thinning of the sinus wall. Dehiscence of bone was seen at the lateral wall of the left maxillary sinus. Ethmoid cells were also dilated significantly.Operation (Caldwell-Luc) was performed on June 2, 1976. The large maxillary sinus cavity contained nothing except air, and no communication with ethmoid cells was demonstrated. In the sinus cavity there were many balks or septums covered with thin mucous membrane. The postoperative course was uneventful.In this case pathogenesis was considered to be a transient hyperactivity of the pneumatization process of the maxilla. If obstruction of the ostium was the main genesis of this disease, there should have been mucous accummulation in the sinus cavity, and balks or septums are not likely to form under such circumstances.

HISTOPATHOLOGICAL STUDY ON CARCINOMA OF MAXILLARY SINUS

The author attempted observations on 20 cases with upper jaw cancer clinically and histopath-ologically. Following results were obtained:1. Most patients were 40-60 years old. In the numbers of affected side there was no big differe-nce between right and left.2. All tumors were squamous cell carcinomas except one undifferenciated carcinoma.3. In the center parts of tumor the growth of carcinoma cells was rather expansive and in the peripheral parts it was infiltrative. Extent of the infiltration of carcinoma was different in the parts of tumor.4. The hone destructions were most frequently found at the orbital wall of maxillary sinus, and besides they were found at the ethomoidal sinus and the lateral wall, the anterior wall and the inferior wall of maxillary sinus. And after bone destruction by tumor, the formation of fibrous capsule against tumor was observed at the orbital, the posterior and the lateral wall of maxillary sinus.5. We could notice that in spite of large bone destraction of the orbital wall the infiltration of carcinoma cells into the orbita was prevented by the formation of fibrous capsule.6. In the most cases carcinoma cells did not infiltrate through the orbital wall, but they destro- yed the lateral wall of maxillary sinus and invaded the soft tissue and infiltrated into the orbita through the inferior orbital fissure.

Traumatic Pneumocephalus

Prior to the advent of radiologic diagnosis, only one case of traumatic pneumocephalus had been reported. Extracranial pneumatocele, characterized by the dissection of air through the subaponeurotic tissues of the scalp, has long been recognized, but its intracranial counterpart, following fracture of the paranasal sinuses or mastoids, was not so accessible to the usual methods of diagnosis. Since the report of Luckett in 1913, many cases of pneumocephalus have been recorded, and major contributions such as those of Dandy and Lewis have appeared. The following case presents evidence of the immediate development of pneumocephalus following skull fracture, a somewhat unusual finding. A well developed white male was attacked by thieves as he stopped to change a tire early in the morning of April 10, 1948. He evidently was struck about the head and face by some blunt object. He was found unconscious on the street shortly after the beating and was brought immediately to Wesley Memorial Hospital. Films of the skull and facial bones taken probably four or five hours after injury were not entirely satisfactory because of the patient's disoriented condition. They revealed, however, various linear fractures in the vault, chiefly on the left, with multiple fracture lines entering the base of the skull in the region of the sphenoid yoke and the cribriform plate. Fracture of the lateral wall of the right maxillary sinus, with dense clouding of this sinus, was also observed. A large amount of air was seen within the subarachnoid space, both in the basal cisterns and surrounding the cerebral convexities. The lateral ventricles were well delineated by air (Fig. 1). Air was also present in the subdural space about the falx (Fig. 2). Physical examination on entry to the hospital showed edema and ecchymosis of the periorbital tissues. The left pupil was larger than the right, and there was no evidence of light perception by the left eye. A large hematoma was present over the left temporal bone, and there were a few small lacerations, the largest involving the left ear. Dry blood was seen in the nasal cavity, but no cerebrospinal fluid rhinorrhea or otorrhea was observed at this time. There were no cranial nerve motor changes, and generally the reflexes were normal; no signs of meningeal irritation were present. Blood pressure was 130/78. Laboratory findings were not significant. By April 11 the patient was fully conscious. He received penicillin and sulfonamides from the time of admission to April 18. Parenteral fluids were discontinued after the first two days, after which time he took nourishment by mouth. The blood pressure ranged from 120 to 140 systolic and from 68 to 90 diastolic. The temperature, which rose to 103° F. on April 12, subsided rapidly and remained under 99.4° to the time of discharge. Ophthalmologic examination on April 14 revealed complete blindness of the left eye, and it was concluded that the left optic nerve had been severed.