Maxillary Sinus Septa Research Articles

Radiological classification of the infraorbital canal and correlation with variants of neighboring structures.

This study aims to classify the infraorbital canal according to its position related to the maxillary sinus as observed by axial CT. It is a retrospective, cross-sectional study. This study was performed in a tertiary referral center. In this study, axial and coronal CTs of 750 patients were examined and infraorbital canals and neighboring structures were evaluated. Infraorbital canals were then classified according to their positions in relation to the maxillary sinus as seen in axial sections. Morphologic variations of neighboring structures were also noted and their correlations with specific canal types were investigated. Three types of infraorbital canal configurations were identified according to the canal's relationship with the maxillary sinus: Type 1, the infraorbital canal was totally protruding into the maxillary sinus (12.3 %); Type 2, the infraorbital canal was located at the floor of the maxillary sinus or was partially protruding into the maxillary sinus (51.2 %); Type 3, the infraorbital canal was totally embedded in the maxillary corpus or was bulging on the external face of the maxillary sinus (36.4 %). Concurrence of maxillary sinus septa and infraorbital canal type-1 was found to be statistically significant on both sides (right side p = 0.00, left side p = 0.00). The study radiologically classified the infraorbital canal according to its position as related to the anterior wall of the maxillary sinus, and found that the type where the canal was totally protruding into the maxillary sinus (type-1) had a significant rate of 12.3 %. The rate of the protruded infraorbital canal was doubled with the presence of maxillary sinus septa (25 %).

Three-Dimensional Evaluation of Implant Positioning in the Maxillary Sinus Septum: A Retrospective Study.

BackgroundThe aim of this study was to simulate implant placement in the maxillary sinus septum, as a potential alternative site to avoid sinus grafting.Material/MethodsOne hundred partially or completely edentulous patients, with their maxillary sinus septum present in the edentulous region, were selected from the database of the Department of Maxillofacial Surgery, Cliniques Universitaires Saint Luc, Bruxelles, Belgium.Three-dimensional (3D) reconstructions were created using 3D planning software. 3D reconstructions were performed for each maxillary sinus. Using the software implant library, the implants that presented the best fit with the maxillary sinus septum and that followed the established inclusion criteria were selected.ResultsAll of the implants were inserted in premolar and molar regions. Most implants were inserted in the position of the second molar (21 of 55) or in the position of the first molar (17 of 55). In all sites the most frequently used implant was 4 mm in diameter and 7 mm in height.The mean coronal angle for the implant was 80.19±17.13 degrees and the mean sagittal angle was 94.83±9.94 degrees.The septal height represents 38.13% of the total available bone height (ABH). The mean percentage of the septum used to insert the implants was 47.33±2.47%. The septum increased the available bone height by a mean value of 2.18±1.47 mm.In 45 cases, the septa did not permit implant placement.ConclusionsIn completely edentulous patients, inserting implants in sinus septa does not exclude the need for sinus grafting, but in partially edentulous patients, this minimally invasive technique is an alternative to subantral augmentation.

The incidence and morphology of maxillary sinus septa in dentate and edentulous maxillae: a cadaveric study with a brief review of the literature.

ObjectivesThe aim of this study is to determine the incidence, location, and orientation of maxillary sinus septa in formalin embalmed cadavers.Materials and MethodsThe study was conducted on 210 cadaveric heads available in our department. After taking the mid-sagittal section the specimens were opened from the medial aspect and the sinus cavity was explored for the presence of maxillary sinus septa, their anatomical plane, location and dimensions.ResultsThe mean linear distance between maxillary sinus floor and its anatomical ostium was 26.76±5.21 mm and 26.91±4.96 mm on right and left side, respectively. A total of 59 maxillary sinus septa (28.1%) were observed in 210 maxillary specimens. Septae were most common, 33 septa (55.9%), in the middle region (between first and second molar tooth) of the sinus cavity. The maxillary sinus membrane (Schneiderian membrane) adhered tightly to the maxillary sinus and over the septae. Significantly more maxillary sinus septa were observed in edentulous maxillae in comparison to the dentate upper jaw.ConclusionKnowledge of location of maxillary sinus ostium is mandatory for the rhinologist for drainage of secretions in maxillary sinusitis. The morphological details of maxillary sinus septa, particularly their location and anatomical planes, will guide dentists in performance of safe implant surgeries. The maxillary antrum septa of category I and II may complicate the procedure of inversion of bone plate and elevation of sinus membrane during maxillary augmentation surgeries. The category III septa observed in the sagittal plane were embedded by one of the branches of the infraorbital nerve in it, and if accidentally cut will lead to infraorbital nerve palsy in maxillary sinus surgeries.

Cone-Beam Computed Tomography: An Accurate Diagnostic Tool in Dental Practice for Evaluation of Anatomic Variations in Maxillary Bone Septa

Background: Advanced knowledge of the shape and length of the maxillary sinus and its internal septa is useful for treatment planning of extraction, implant and sinus lift procedures. Purpose: This study evaluates the prevalence, morphology, orientation, location, height, and length of bone septa in the maxillary sinus using cone-beam computed tomography (CBCT) images, for completely dentate versus partially or fully edentulous patients. Also, since dental extractions may induce formation of sinus septa, this study assesses the correlation between edentulism and prevalence of the maxillary sinus septa. Material and methods: Four hundred forty-three CBCT images were selected to evaluate the prevalence of a septum in the maxillary sinus to perform an anatomic study of septum morphology. All images were evaluated by one an expert in oral radiology. The χ2 test was used to verify the relationship between the presence of septa and sex, age, and edentulism status. Variance analysis and the Tukey test showed a relationship between partial or full edentulism and the height and length of the maxillary sinus septum. Results: A maxillary sinus septum was found in 50.1% of the study sample size. 69.8% of patients with a septum were partially edentulous. Gender did not correlation with septum prevalence. The length of the septum in the transverse orientation, and the location of the septum in the medial aspect of the sinus, both correlated with tooth loss. Conclusions: Maxillary sinus bone septa are more prevalent in partly or fully edentulous populations. Given the diversity of septa morphology among patients, a detailed evaluation of each patient’s septa using CBCT is useful for customizing bone graft and implant placement treatment planning for each patient.

Cross-sectional study estimating prevalence of maxillary sinus septum in South Indian population

Maxillary sinus septum is an anatomical variation in the maxillary sinus. Sinus septum is also an important anatomical structure that complicates sinus lift procedure. Aim of the Study : This study evaluated the prevalence of maxillary sinus septa in the edentulous and dentate maxilla using digital orthopantomogram. Materials and Method: This study was based on the analysis of digital orthopantomogram images for posterior maxilla that were obtained from patients who visited a Private Hospital. A retrospective analysis of 921 pairs of nonpathological maxillary sinuses was done. Patients who had pathological findings were excluded from the study. Results: Sinus septum was present in 217 (23.6%) of the 921 pair of maxillary sinuses. Totally, 704 (76.4%) patients did not have maxillary sinus septum. Also, out of 527 male patients, 125 patients had the septum and out of 394 female patients, 92 patients had sinus septum. Conclusion: This study gives an idea about the prevalence of sinus septum that would help a surgeon prevent a few possible complications during sinus lifting

Accuracy of spiral computed tomography in evaluation of maxillary sinus septa among dentate and edentulous Iraqi subjects (Comparative study)

Background: Presence of maxillary sinus septa has been known to be a complicating factor for sinus elevation procedure and implant placement in posterior maxilla. The maxillary sinuses septa are thin walls of cortical bone inside the sinus. They vary in number, location, and height. This study aimed to discover the accuracy of Spiral Computed Tomographic Scan in evaluation the maxillary sinus septa (prevalence, location, height) in subjects with dentate, partially edentulous and completely edentulous maxilla. Material and method: This study included (267) subjects ranged from (20-70 years), (132) male and (135) female divided into three groups, (97) fully dentate group, (102) partially edentulous group and (68) completely edentulous group who admitted to Spiral Computed Tomography Scan in Al-Karkh General Hospital in Baghdad to have Computed Tomography Scan of the brain and paranasal sinuses for different diagnostic purposes from November 2012 to April 2013. The maxillary sinus septa were evaluated in the axial and sagittal views and the data were subjected to statistical analysis using Statistical Package for Social Sciences version 20. Result: The prevalence rate of septa was 77.3% among fully dentate maxilla sample. Almost the same prevalence rate was obtained in the other two study sample (partially edentulous maxilla 77.5% and completely edentulous maxilla 76.5%).No important or statistically significant difference in prevalence was observed between the three study groups. Age and gender showed no important or statistically significant difference in prevalence rate in each study group, the mean septal height was slightly higher in fully dentate group (7mm) compared to partially edentulous maxilla group (6.2 mm) and completely edentulous maxilla group (6.5 mm). The difference in mean between the 3 groups however was not significant statistically. The rate of septa at floor position was significantly lowest in fully dentate maxilla group (36.1%) compared to partially edentulous maxilla group (52.1%) and completely edentulous maxilla group (53.3%). Conclusion: Spiral Computed Tomography is a precise diagnostic tool for the examination of this zone capable for investigating their location and height during different maxillary sinus surgical procedures. In the posterior maxilla, regardless of type of ridge (atrophy/edentulous or non-atrophy/dentate), the anatomical variation of sinus septa is diverse in its prevalence and location.

Large Foreign Body in the Nasal Cavity, Maxillary Sinus and Infratemporal Fossa—Atypical Presentation

A 59-year-old male presented with complaints of trismus and discharge of altered blood from nose for 1 year. Patient had a history of facial trauma one year back. Nasal endoscopy and CT scan revealed a foreign body lodged in posterior half of both nasal cavity, left maxillary sinus and left infratemporal fossa penetrating the walls of maxillary sinus and nasal septum. Foreign body was removed by infratemporal fossa approach. This case has a rare location of a forgotten foreign body with atypical presentation.

Anatomical Variation of the Maxillary Sinus in Cone Beam Computed Tomography

Purpose. The aim of this paper is to report a case in which the cone beam computed tomography (CBCT) was important for the confirmation of the presence of maxillary sinus septum and, therefore, the absence of a suspected pathologic process. Case Description. A 27-year-old male patient was referred for the assessment of a panoramic radiograph displaying a radiolucent area with radiopaque border located in the apical region of the left upper premolars. The provisional diagnosis was either anatomical variation of the maxillary sinuses or a bony lesion. Conclusion. The CBCT was important for an accurate assessment and further confirmation of the presence of maxillary septum, avoiding unnecessary surgical explorations.

Sinus lifting procedures in the presence of the maxillary sinus septa: Case report

Sinus lifting procedures in the presence of the maxillary sinus septa: Case report

Maksiller sinüs septumunun konumu ve yaygınlığının dental volümetrik tomografik değerlendirilmesi

Purpose: The aim of this study was to determine the prevalence and location of maxillary sinus septa with the help of dental volumetric tomography. Methods: 760 patients 1520 maxillary sinus were evaluated by dental volumetric tomography for detecting maxillary sinus septa. Maxillary sinus was divided into 3 zones (anterior, middle and posterior zones) while location of the maxillary sinus septa. Results: 47 of maxillary sinus septa existed in the anterior zone (24.7%), 35 of them in the middle zone (18.4%) and 108 of them in the posterior region (56.8%). Conclusion: The formation of the maxillary sinus septa was affected by the existence or lack of the teeth. Correct detection of the presence of maxillary sinus septa was important prior to sinus lifting and dental implant surgery. Dental volumetric tomographical evaluation of maxillary sinus septa was more useful for a correct diagnosis and treatment planning.

Cone Beam CT Evaluation of Maxillary Sinus Septa Prevalence, Height, Location and Morphology in Children and an Adult Population

Objective: The purpose of this study was to determine the prevalence, height, location and morphology of maxillary sinus septa in dentate, partially dentate and edentulous adults as well as in mixed dentition children using cone beam computed tomography (CBCT) for maxillary sinus surgical interventions. Subjects and Methods: Five hundred and fifty-four sides in the CBCT scans of 272 patients (30 children and 242 adults) were retrospectively analyzed. The prevalence, location and morphology were assessed in axial, sagittal, cross-sectional and panoramic 3-dimensional images. The height of septa was measured with the angle between the direction of the septum and median palatine suture. The differences among age, localization and measurements were statistically analyzed. Results: The prevalence of maxillary sinus segments with septa was 58%. There were a total of 13 (3.2%) septa of completely edentulous (CE), 198 (53.9%) septa of edentate and 14 (3.8%) septa of the mixed dentition maxillary segments. The location of septa observed in all study groups demonstrated a greater prevalence (69.1%) in the middle region than in the anterior and posterior regions. No statistically significant differences were observed with regard to gender or age, for septum height (p > 0.05). However, maxillary sinus septa are higher in partially edentulous patients than edentate and CE ones (p < 0.05). Conclusion: Septa of various heights and courses developed in all parts of the maxillary sinus, therefore to prevent possible complications during sinus surgery, extensive evaluation with an appropriate radiographic technique was indispensable.

Prevalence, location and morphology of maxillary sinus septa: systematic review and meta‐analysis

To gain further insights and resolve conflicting results in the literature regarding prevalence, predominant location and morphologic variability of maxillary sinus septa. Electronic and hand searching of English literature identified 33 investigations published from 1995 to 2011. Septa were defined as at least 2-4 mm in height. Septa were present in 28.4% of 8923 sinuses investigated (95% confidence interval: 24.3-32.5%). Prevalence was significantly higher in atrophic sinuses compared with dentate maxillae (p < 0.001). Septa were located in premolar, molar and retromolar regions in 24.4%, 54.6% and 21.0% respectively. Orientation of septa was transverse in 87.6%, sagittal in 11.1% and horizontal in 1.3% of cases. Septa height measured 7.5 mm on average. Complete septa (dividing the sinus into two separate cavities) were found in only 0.3%. Other rare conditions included multiple septa in one sinus (4.2%) and bilateral septa (17.2%). Septa diagnosis using panoramic radiographs yielded incorrect results in 29% of cases. In view of their high overall prevalence and significant morphologic variability, 3D radiographic imaging prior to sinus floor augmentation may help to reduce complication rates in the presence of maxillary sinus septa.

Les septums du sinus maxillaire. Prévalence et anatomie au travers d’une revue de la littérature de 1980 à 2009

Maxillary sinus septa may complicate sinus elevation procedures, especially when they are not diagnosed prior to surgery. The authors had for aim to review published data, to analyze the etiology, the prevalence, the localization, and the size of maxillary sinus septa, and to determine what were the best preoperative radiological examinations. The Medline search was made with keywords such as "maxillary sinus anatomy, maxillary sinus augmentation, maxillary sinus septa, sinus graft/complications, dental implants". The search was limited to studies published in English from 1980 to January 2009. Twenty-two articles were analyzed. The prevalence of maxillary sinus septa ranged between 14.3% and 33.3%. There was no specific geographic distribution within the sinuses. The mean heights of septa ranged between 2.8 and 8.1 mm. It is recommended to systematically use preoperative CT or CBCT scan imaging because of the prevalence, the variable anatomy, and the bad contribution of conventional X-rays.

Prevalence and location of maxillary sinus septa in the Taiwanese population and relationship to the absence of molars

Understanding the septum structure of the sinus is necessary for correct implant placement in the maxilla if sinus encroachment is required. The exact mechanism that controls septum development is unclear, although a role for the irregular pneumatization of the sinus floor following tooth loss has been suggested. The aims of this study were to examine the prevalence and location of sinus septa in the Taiwanese population and to determine whether there is a relationship between the presence of septa and the absence of molars. Using computed tomography (CT) scans of sinuses obtained from 423 subjects (216 women and 207 men, mean age 53.65 years), septum morphology and its correlation with the presence of molars was examined. About 30% of subjects (124/423) had sinus septa, corresponding to 20.45% of all sinus segments detected (173/846). Fifty-nine patients had multiple septa, giving a prevalence of septa of 22.93%. Septa were located most frequently in the regions of the first and second molars. The prevalence was not related to tooth loss (edentulous, partially edentulous, or dentate maxillary segments). Logistic regression analysis showed that men were significantly more likely to have septa than were women (OR=1.67; P=0.019). In the 423 Taiwanese subjects tested, the prevalence of septum was 29.31% according to the subjects and 22.93% according to the sinus segments. The most frequent location of septa was in the region of the first and secondary molars. No correlation was observed between the presence of septa and the absence of molars.

Analysis of the Anatomy of the Maxillary Sinus Septum Using 3-Dimensional Computed Tomography

Maxillary posterior teeth exhibit a high incidence of periodontal bone and tooth loss. After tooth loss, the edentulous alveolar process of the posterior maxilla is often affected by resorption, which results in loss of vertical bone volume. Moreover, progressive sinus pneumatization leads to a decrease in the alveolar process from the cranial side. The sinus elevation and augmentation surgical technique opened a new way of anchoring endosseous implants despite discernible bone reduction. However, the surgical interventions require in-depth knowledge of maxillary sinus anatomy such as sinus septum and potential variations. The purpose of this study was to investigate the prevalence, location, height, morphology, and orientation of maxillary sinus septa by use of computed tomography (CT) and 3-dimensional imaging. Two hundred patients undergoing implant treatment at the Yonsei University College of Dentistry, Seoul, South Korea, were randomly selected for analysis of maxillary sinus septa. CT and DentaScan (GE Medical Systems, Milwaukee, WI)-reformatted data from 400 sinuses were analyzed with the Preview program (Infinitt, Seoul, South Korea). Three-dimensional images were rendered for measurement by use of the Accurex program (CyberMed, Seoul, South Korea). We found 111 septa in 400 maxillary sinuses (27.7%). This corresponded to 37% of the patients. Among total septa, 25 sinus septa (22.5%) were located in the anterior, 51 (45.9%) in the middle, and 35 (31.5%) in the posterior regions. The directional orientation analyses showed that 106 septa were buccopalatal, 4 were sagittal, and 1 was transverse type. The mean septal heights were 7.78 ± 2.99 and 7.89 ± 3.09 mm in the right and left sinuses, respectively. Three-dimensional CT image analyses may provide useful information that can avoid unnecessary complications during sinus augmentation procedures by facilitating adequate, timely identification of the anatomic structures inherent to the maxillary sinus.

Prevalence, Location, and Size of Maxillary Sinus Septa: Panoramic Radiograph Versus Computed Tomography Scan

To determine the prevalence, location, and size of maxillary sinus septa, and to compare the results of panoramic radiographs and computed tomography (CT) scans. This study included 30 patients, 17 women and 13 men, with a mean age of 50.9 years (range, 28-73 years), undergoing treatment planning for implant-supported restorations in the maxilla. Three observers analyzed the panoramic radiographs, the conventional CT scans in acetate, and the Implametric 3-dimensional CT (3Dent, Valencia, Spain). The maxillary sinus septa of each patient and the type of septa, as well as its location and size, were recorded. In 60 maxillary sinuses, panoramic radiographs showed 32 septa (53.3%); CT in acetate showed 42 septa (70%); and Implametric 3-dimensional CT showed 40 septa (66.7%). Most septa (60%) were located in the middle region of the maxillary sinus, 22.5% in the posterior region, and 17.5% in the anterior region. The mean height of the septa was 4.78 ± 1.76 mm. Panoramic radiographs led to an erroneous diagnosis in 46.5% of the cases. Maxillary sinus septa are a frequent anatomic variation. They can be found in any of the maxillary sinus regions independently of patient edentulism. The panoramic radiograph can lead to false-positive and false-negative findings in the visualization of septa in almost half of cases. Therefore, whenever a maxillary sinus lift is planned, a thorough study of the affected sinus should be made using CT.

Morphological analysis of maxillary sinus septum using computed tomography

Introduction: The current study examined the morphological characteristics of maxillary sinus septum by computed tomography (CT). Materials and Methods: Two hundred and four patients (408 maxillary sinuses) who visited dental clinic were evaluated. CT were examined. The height of the septum measured from the sinus floor to the apex of the septum more than 3 mm was defined as “sinus septum” . Results: The prevalence of sinus septa was 21.3% (87/408), and 31.4% (64/204) of patients had more than 1 sinus septum. Females showed h igher and thinner sinus septa than males. The anatomic location of the septa were distributed in the 2nd molar region (43.7%), 1st mo lar region (31.0%), 2nd premolar region (21.8%) and 1st premolar region (3.5%). In 57 patients with chronic disease, there was no significant differenc e between sinus disease and the presence of sinus septa. The loss of remaining teeth and teeth adjacent to the sinus septum area was not related to the presence of sinus septa. Older subjects showed a reduced height and length of the septum, and a thicker septum. Conclusion: These results show that the maxillary sinus septum undergoes atrophy with age.

Cavernous Hemangioma of the Nasal Cavity

A 22 year old six month pregnant female presented with right eye tearing, proptosis and nasal congestion. CT revealed a large right nasal cavity mass with involvement of the ethmoids, right maxillary sinus, lamina papyracea, cribriform plate and nasal septum. There was significant remodeling of the right cribriform plate with mild extra-axial intracranial and mild intraorbital extension. Transnasal endoscopic excision confirming the diagnosis of cavernous hemangioma of the nasal cavity. Hemangiomas are benign slow-growing vascular neoplasms classified as capillary, cavernous or mixed. Hemangiomas of the nasal cavity and paranasal sinuses are very rare with only a few reported cases. The occurrence and growth of these lesions during pregnancy may be related to increased blood volume or hormonal factors. The most common therapeutic option is complete surgical resection via transnasal endoscopic approach. Pre-operative embolization may be utilized in some cases to decrease the risk of intraoperative bleeding.

Spiral Computed Tomography Based Maxillary Sinus Imaging in Relation to Tooth Loss, Implant Placement and Potential Grafting Procedure

ABSTRACTObjectivesThe purpose of the present study was to explore the maxillary sinus anatomy, its variations and volume in patients with a need for maxillary implant placement.Material and MethodsMaxillary sinus data of 101 consecutive patients who underwent spiral computed tomography (CT) scans for preoperative implant planning in the maxilla at the Department of Periodontology, University Hospital, Catholic University of Leuven, Leuven, Belgium were retrospectively evaluated. The alveolar bone height was measured on serial cross-sectional images between alveolar crest and sinus floor, parallel to the tooth axis. In order to describe the size of the maxillary sinus anteroposterior (AP) and mediolateral (ML) diameters of the sinus were measured.ResultsThe results indicated that the alveolar bone height was significantly higher in the premolar regions in comparison to the molar region (n = 46, P < 0.01). The age showed negative relation to bone dimension (r = - 0.32, P = 0.04).Anterior and posterior border of the maxillary sinuses were mostly located in the first premolar (49%) and second molar (84%) regions, respectively. Maxillary sinus septa were indentified in 47% of the maxillary antra. Almost 2/3 (66%) of the patients showed major (> 4 mm) mucosal thickening mostly at the level of the sinus floor. The present sample did not allow revealing any significant difference (P > 0.05) in maxillary sinus dimensions for partially dentate and edentulous subjects.ConclusionsCross-sectional imaging can be used in order to obtain more accurate information on the morphology, variation, and the amount of maxillary bone adjacent to the maxillary sinus.

Analysis of location and prevalence of maxillary sinus septa

PurposeThe sinus lift procedure requires detailed knowledge of maxillary sinus anatomy and the possible anatomical variations. This study evaluated the location and prevalence of maxillary sinus septa using computed tomography (CT).MethodsThis study was based on the analysis of CT images for posterior maxilla which were obtained from patients who visited Chonbuk National University Dental Hospital during the period of June 2007 to December 2008. With the exclusion of cases presenting any pathological changes, 236 maxillary sinuses in 204 patients were retrospectively analyzed. The average age of the patients was 50.9. The cases were divided into two groups, an atrophy/edentulous segment and a non-atrophy/dentate segment, and maxillary sinus septa of less than 2.5 mm were not taken in-to consideration. The location of septa was also divided for analysis into 3 regions: the anterior (1st and 2nd premolar), middle (1st and 2nd molar) and posterior (behind 2nd molar) regions.ResultsIn 54 (20.9%) of the 204 patients there were pathologic findings, and those patients were excluded from the analysis. Sinus septa were present in 58 (24.6%) of the 236 maxillary sinuses and in 55 (27%) of the 204 total patients. In the atrophy/edentulous ridge group (148 maxillary sinuses), 41 cases (27.7%) were found, and 17 cases (19.3%) were found in the non-atrophy/dentulous ridge group (88 maxillary sinuses). In terms of location, septa were found in 18 cases (27.3%) in the anterior, in 33 cases (50%) in the middle and in 15 cases (22.7%) in the posterior regions.ConclusionsIn the posterior maxilla, regardless of type of ridge (atrophy/edentulous or non-atrophy/dentate), the anatomical variation of sinus septa is diverse in its prevalence and location. Thus, accurate information on the maxillary sinus of the patient is essential and should be clearly understood by the surgeon to prevent possible complications during sinus lifting.