Maxillary Sinus Surgery Research Articles

Experimental and numerical investigation of pressure distribution in human upper airway passage before and after maxillary sinus surgery

Sinusitis, a common disease of the maxillary sinus, is initially managed with saline solution and medication, resulting in the resolution of symptoms within a few days in most cases. However, Functional Endoscopic Sinus Surgeries are recommended if pharmacological treatments prove ineffective. This research aims to investigate the effects of maxillary sinus surgery on the airflow field, pressure distribution within the nasal cavity, and overall ventilation. This study utilized a three-dimensional realistic nasal cavity model constructed from CT images of a healthy adult. Virtual surgery including uncinectomy with Middle Meatal Antrostomy, two standard procedures performed during such surgeries, was performed on the model under the supervision of a clinical specialist. Two replicas representing pre- and post-operative cases were created using 3D printing for experimental purposes. Various breathing rates ranging from 3.8 to 42.6 L/min were examined through experimental and numerical simulations. To ensure the accuracy of the numerical simulations, the results were compared to measured pressure data, showing a reasonable agreement between the two. The findings demonstrate that uncinectomy and Middle Meatal Antrostomy significantly enhance the ventilation of the maxillary sinuses. Furthermore, increasing inspiratory rates leads to further improvements in ventilation. The static pressure distribution within the maxillary sinuses remains relatively uniform, except in regions close to the sinus ostium, even after surgical intervention.

Histomorphometric and microtomographic analysis of maxillary sinus augmentation surgeries with and without collagen membrane on the lateral window: A randomized clinical trial.

To evaluate the histomorphometric and computerized microtomographic (Micro-CT) analysis of the regenerated bone tissue from maxillary sinus augmentation surgery, with and without using the collagen membrane on the external osteotomy window. Twelve patients were selected for this prospective, controlled, and randomized study. The patients were submitted to bilateral maxillary sinus surgery in a split-mouth design. On the test side, the maxillary sinus augmentation procedure included using Geistlich Bio-Oss® and a Geistlich Bio-Gide® collagen membrane covering the lateral osteotomy window. On the control side, only Geistlich Bio-Oss® was used without the presence of the membrane. After 6 months, the surgeries for implant installation were performed. In this surgical phase, specimens of the regenerated tissue were collected for histological and Micro-CT analysis. In the histomorphometric evaluation, the mean (±SD) percentages of newly formed bone were 43.9% (±11.5) and 40.8% (±8.9) in the test and control groups, respectively. The corresponding values of the Micro-CT analysis were 36.6% (±3.4) and 37.2% (±4.7) in the test and control groups, respectively. There was no statistically significant difference between the test and control groups in the two methods. In addition, there was no statistically significant difference between the mean percentage of biomaterial remaining between the test and control groups. However, the mean percentage of newly formed bone was significantly higher and the mean percentage of remaining biomaterial was significantly lower in the histomorphometric analysis compared to the values obtained through microtomography. The additional use of collagen membranes in maxillary sinus surgery does not offer advantages in newly formed bone.

Design, Optimization, and Experimental Validation of a Handheld Nonconstant-Curvature Hybrid-Structure Robotic Instrument for Maxillary Sinus Surgery

Design, Optimization, and Experimental Validation of a Handheld Nonconstant-Curvature Hybrid-Structure Robotic Instrument for Maxillary Sinus Surgery

Model-based design optimization for motion decoupling in dual-segment flexible robots

The design of a multiple-segment notched tube is distinctively appropriate for miniature surgical robots, attributing to its superior structural compliance and the provision of a substantial lumen within a constrained diameter. However, the cable-driven mechanism commonly adopted in this design naturally leads to inter-segment motion coupling, limiting its clinical potential. This study introduces a model-based design optimization method aimed at concurrently minimizing the coupled motion of a two-segment notched flexible robot and meeting diverse design and performance criteria. In the design optimization framework, a single-segment mechanics model, a 3-dimensional (3D) coupled mechanics model, and a 3D stiffness model have been developed and integrated to simultaneously minimize the coupled bending angle and satisfy surgery-specific performance requirements. A back propagation neural network (BPNN) has also been adopted to achieve computationally efficient optimization process. A case study is conducted on two-segment notched flexible robot optimization design for maxillary sinus surgery, with the mechanics models being verified experimentally. Ultimately, the optimized robot demonstrates its ability to provide visualization of the maxillary sinus cavity, including the blind spots. The proposed robot design optimization approach offers a systematic and efficient methodology to minimize motion coupling without compromising robot performance, thus fundamentally enabling procedure-specific design of multi-segment flexible surgical robots.

Dental implant as a potential risk factor for maxillary sinus fungus ball

Fungus ball is the most common form of non-invasive fungal sinusitis, and maxillary sinus is the most commonly involved site. Maxillary sinus fungus ball (MFB) accounts for a considerable proportion of unilateral maxillary sinusitis. The prevalence of MFB has recently increased; however, its contributing factors are unclear. This study analyzed the association between MFB and dental implants. One hundred one patients who underwent unilateral maxillary sinus surgery were divided into two groups based on surgical biopsy results: unilateral bacterial sinusitis (UBS, n = 45) and MFB (n = 56). Stratified random sampling of 30 patients from each group was performed to adjust for age. The number of dental implants on maxillary teeth and degree of penetration into the maxillary sinus was radiologically evaluated. The number of patients with dental implants was greater (P = 0.085) and the number of implants was significantly higher (P = 0.031) in the MFB group. Dental implant can be a potential risk factor for MFB development. Therefore, dental implant surgeons should take caution in penetrating the maxillary sinus floor during implant insertion and otolaryngologists should consider the possibility of fungus ball when assessing patients with sinusitis who have dental implants.

Maxillary sinus surgery and use of fibrin-rich plasma: a systematic review

Introduction: In around 25% of all maxillary sinuses, there is an accessory bone that is located in a lower portion than the main ostium, and all the mucus produced and the particles trapped in this mucus are directed through the ciliary beat to the ostium. When a dental element is lost in the posterior region of the maxilla, there is natural reabsorption of the alveolar process and at the same time, pneumatization of the maxillary sinus occurs. Objective: It was to carry out a systematic review to elucidate the main clinical approaches to the use of fibrin-rich plasma in the bone regeneration process in maxillary sinus surgeries. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October to December 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 115 articles were found, 40 articles were evaluated in full and 25 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=55.5%<50%. It was concluded that to improve osseointegration and bone anchorage, surface modifications can be chemical, such as calcium phosphate (Ca-P), or physical impregnation, being related to the microtopography of the implant. Several variables affect the biological activity of FRP preparations, such as the number of centrifuges used, centrifugation speed, and other protocols that result in preparations with various volumes, platelet numbers, amount of growth factors, and concentration of fundamental white blood cells and erythrocytes. Some researchers recommend avoiding tissue exposure to FRP-containing leukocytes, arguing that an inflammatory reaction may occur. On the other hand, other authors have described beneficial effects due to increased immunological and antibacterial resistance, although there is no clinical evidence to support its effect. FRP has gained prominence in the scientific community because it does not require the addition of an activator or anticoagulant, making the product more autologous, and featuring a fibrin network that protects growth factors, keeping them in place for longer.

Гігієна порожнини рота після проведення внутрішньоротових оперативних втручань

Purpose. Prevention of early postoperative inflammatory complications after intraoral surgical interventions. Methods. It is proposed to use modern hygiene products, 45 patients were examined after intraoral surgical interventions: 24 patients after the removal of a retained late tooth in the lower jaw and 21 patients after a sparing maxillary sinusotomy with oroantral fusion plastic surgery. Results. In the case of the recommended treatment, early inflammatory complications in the postoperative period in the form of inflammatory infiltration of soft tissues were observed in 3 of 24 patients (12.5%) after atypical tooth extraction and in 4 of 21 patients (19.1%) after sparing maxillary sinus surgery with local plastic surgery of the palate. In the control group, early postoperative complications in the form of inflammatory infiltration of soft tissues were observed in 6 out of 24 patients (25.0%) after atypical tooth extraction and in 7 patients (33.3%) after sparing maxillary sinus surgery with local palatal plastic surgery. Conclusions. Hygienic oral care using our proposed method is more effective in patients after intraoral surgical interventions compared to traditional methods of hygiene. The use of our proposed method of hygienic oral care allowed us to reduce the number of postoperative inflammatory complications by almost 2 times. We recommend using these oral hygiene products after intraoral surgical interventions. Key words: upper jaw, lower jaw, atypical tooth extraction, sparing maxillary sinusotomy, oral hygiene, Listerine, methylene blue Ligor.

One-stage combined ENT and dental surgical treatment of odontogenic sinusitis: a prospective study

PurposeThe study analyses outcomes of the surgical treatment of odontogenic sinusitis that concurrently address sinusitis and its dental source.MethodsA total of 364 adult patients were included, representing 13% of all patients we have operated on for any rhinosinusitis over the past 18 years. The diagnosis was based on both ENT and dental examinations including CT imaging. Patients were divided into three groups: (1) FESS with dental surgery without antrotomy, (2) FESS with intraoral antrotomy, and (3) intraoral surgery without FESS. The mean postoperative follow-up was 15 months.ResultsFirst group involved 64%, second group 31%, and third group 6% of the cases. The one-stage combined ENT and dental approach was used in 94% of cases (group 1 and 2) with a success rate of 97%. Concerning FESS, maxillary sinus surgery with middle meatal antrostomy only was performed in 54% of patients. Oroantral communication flap closure was performed in 56% of patients (success rate 98%). Healing was achieved within 3 months. The majority (87%) of patients were operated on unilaterally for unilateral findings. Over the past 18 years, a 6% increase of implant-related odontogenic sinusitis was observed.ConclusionOdontogenic sinusitis is common, tending to be unilateral and chronic. Its dental source needs to be uncovered and treated and should not be underestimated. Close cooperation between ENT and dental specialists has a crucial role in achieving optimal outcomes. The one-stage combined surgical approach proves to be a reliable, safe, fast and effective treatment.

Surgical ciliated cysts of the mandible: A systematic review of case reports.

Surgical ciliated cysts occur mainly in the maxillae after radical maxillary sinus surgery; they rarely develop in the mandible. This study aims to gather information on all the characteristics of patients suffering from mandibular surgical ciliated cysts. This article also reports two new cases. PubMed, Google Scholar and the International Clinical Trials Registry Platform were explored until 13 December 2022 for articles regarding mandibular surgical ciliated cysts. Maxillary ciliated cysts were excluded. Fourteen original articles were included in a total of 16 cases. Maxillofacial surgeries are the first aetiology (94.4%). Surgical ciliated cysts of the mandibular region show a 1.25:1 male-to-female ratio with a protracted time to diagnosis (range: 2-56 years). Most patients are symptomatic (77.8%). Typically, radiology shows a radiolucency lesion (88.9%) and histology describes pseudostratified ciliated columnar epithelium. Enucleation has always been described as the treatment. All results were case reports, thus a low level of evidence studies. Mandibular surgical ciliated cysts should be considered in patients presenting a mandibular swelling or radiolucency lesion with a maxillofacial surgery history. Meticulous surgical techniques can aid in the prevention of this lesion.

A Novel Miniature Spring-Based Continuum Manipulator for Minimally Invasive Surgery: Design and Evaluation

Minimally invasive surgery is gaining wide-spread attention in the laboratory and the clinic due to its advantages of less trauma, less pain, and faster recovery. Miniature continuum instruments with a large central channel are needed for reducing damage to healthy tissue and delivering multiple surgical tools in microsurgery such as fetal surgery and maxillary sinus surgery. In this article, we proposed a novel miniature spring-based cable-driven continuum manipulator characterized by its offset neutral bending plane and its simple and clever structure. These features enable the manipulator to have several advantages such as easy miniaturization, bending stability and uniformity, a large central channel, smaller cable tension required, and low cost. A piecewise constant curvature model, with the offset neutral bending plane taken into account, is presented for the kinematic control of the proposed manipulator. To explore the relationship between the cable tension and manipulator bending angle, the statics model based on the equivalent model principle, is exhaustively discussed. The accuracy of kinematics and statics models, as well as the design superiority, was verified experimentally. Furthermore, teleoperation experiments of peg-transfer tasks and porcine tissue laser ablation are conducted to verify the feasibility and effectiveness of the proposed manipulator in different forms. Final, design variations are showcased to enrich manipulator design and functionality.

The CBCT Retrospective Study on Underwood Septa and Their Related Factors in Maxillary Sinuses-A Proposal of Classification.

Introduction. The presence of bone septum in the maxillary sinus is one of the most common anatomical findings. So-called Underwood septa (US) are an atypical bone formation in the maxillary sinuses. Mostly they are quite easily found in CBCT studies and have major importance in sinus lift procedures in dental surgery. Furthermore, the shape, location, and size of the bony septa are important in each maxillary sinus surgery. Material and methods. A retrospective study of 120CBCT scans from the authors' own database was conducted. Results. Approximately 37.5% of each CBCT was associated with the occurrence of US, while just 25% had a full septum, and a total of only 14 patients had a half septa. More females have US, while healthy pneumatized maxillary sinus is most commonly found (82.22%). There is no correlation between the occurrence of silent sinus syndrome (p = 0.174), mucosal thickening (p = 0.325), or retention cyst formation (p = 0.272). Most sinuses are without any opacification in CBCT evaluation (91.11%), while other syndromes are not statistically relevant. Conclusions. It seems that the occurrence of Underwood septa is not statistically related to any clinical, radiological, or pathological condition within the sinus (p > 0.05). Furthermore, a more full or partial appearance of US was found in female patients.

Transoral Marsupialization of an Isolated Surgical Ciliated Cyst of the Infratemporal Fossa.

Surgical ciliated cysts occur primarily in the maxilla after radical maxillary sinus surgery. We report the first case of a surgical ciliated cyst that developed in the infratemporal fossa 25 years after the patient sustained severe facial trauma. The patient complained of mandibular pain and limited mouth opening. The patient's condition was completely resolved 5 months after marsupialization via Le Fort I osteotomy. Surgical morbidities can be minimized by proper diagnosis and less invasive surgery.

Spatial Shape Sensing of a Multisection Continuum Robot With Integrated DTG Sensor for Maxillary Sinus Surgery

Owing to the curved and narrow pathway of the maxillary sinus, reaching blind regions using rigid instruments in the traditional method of treatment is difficult. In this article, a novel multisection continuum robot (CR) integrated with essential instruments and sensors is developed for the maxillary sinus surgery. Moreover, shape sensing is important for the control of the CR, but this is still a challenge due to the confined operating space. To track the spatial shape of the developed CR, a draw tower grating (DTG) sensor is integrated. A shape sensing algorithm is proposed to reconstruct the shape of the CR based on the relation between the DTG sensor and the CR centerline. Simulations and experiments on a maxillary sinus phantom are conducted to test the ability of the CR to reach the blind regions. Different groups of experiments are performed to evaluate the performance of the shape reconstructions, including DTG sensor shape tests and CR shape tests in planar and spatial space. Experiments show a mean planar error of 0.23 mm (0.51%) and a mean spatial error of 0.61 mm (1.36%). The results demonstrate the effectiveness of the multisection CR shape sensing method suggested in this study.

Maxillary sinus surgery with autologous or allogenic graft with platelet-rich plasma/fibrin for dental implants: a systematic review

Introduction: In the context of bone grafts and regenerative processes, the maxillary sinus acts in the equalization of barometric pressures in the nasal cavity, which is lined by a membrane called Schneider's membrane. When grafting procedures are needed, our focus is often on the type of biomaterial to be used, and the success and predictability of our results do not depend only on the biomaterial. Objective: It was to perform a systematic review of the main clinical approaches of maxillary sinus surgery with autologous and/or allogeneic graft, using platelet-rich plasma or fibrin. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from December 2022 to January 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 2005 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 125 articles were found, 55 articles were evaluated in full and 27 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 20 studies that did not meet GRADE. It can be concluded from the present study that there is no statistical superiority observed between platelet-rich plasma, PerioGlas, or Bio-Oss in terms of their use as a grafting material along with the immediate implant placement procedure. Furthermore, the combination of autograft/xenograft and plasma rich in growth factors in the periosteal pocket flap technique is a simpler, cheaper, and faster technique than the guide bone regeneration technique to achieve moderate lateral bone augmentation in implant treatment. Tricalcium β-phosphate is a promising biomaterial for clinical situations that require bone augmentation. However, the addition of platelet-rich plasma results in decreased bone loss around dental implants.

The Influence of Environmental Exposure to Heavy Metals on the Occurrence of Selected Elements in the Maxillary Bone.

The elemental composition of the body's calcified tissues may reflect the environmental exposure of the population to heavy metals. The aim of the study was to assess whether the elemental composition of the maxillary bone from individuals belonging to a given population reflects the environmental exposure of this population to lead and cadmium. The research material consisted of cortical bone from the anterolateral walls of the maxilla collected from 126 patients during Caldwell-Luc maxillary sinus surgery on residents of two cities differing in terms of the lead and cadmium pollution of the natural environment. The content levels of lead, cadmium, iron, manganese, chromium, copper, and iron were determined by using atomic absorption spectrophotometry. The content levels of lead and cadmium in the samples of the maxillary bones of residents of Bielsko-Biala were 3.26 ± 2.42 µg/g and 0.74 ± 0.38 µg/g, respectively, whereas in the samples from the residents of Katowice, they were 7.66 ± 2.79 µg/g and 1.12 ± 0.08 µg/g, respectively. It was found that the lead and cadmium levels in the maxillary bone corresponded to the environmental exposure to these heavy metals in the place of residence, which was proven here via the example of the residents of two cities with different concentrations of these heavy metals in the air over long time periods. Additionally, higher content levels of essential metals such as manganese, chromium, copper, and iron are characteristic of the maxillary bone samples of residents of the area that is more polluted with heavy metals.

Design and path tracking control of a continuum robot for maxillary sinus surgery.

Continuum robots (CRs) have been developed for maxillary sinus surgery (MSS) in recent years. However, due to the anatomically curved and narrow pathway of the maxillary sinus and the deformable characteristics of the CR, it is still a challenge to accurately approach the target in the sinus. Thus, the CR-assisted MSS demands further research, whether in robotic system design or in reliable motion control. A continuum robotic system integrated with essential instruments and sensors for MSS is developed, and the path tracking control of the designed CR is studied. The differential kinematic model of the CR is constructed. By analyzing the potential problem of the traditional Jacobian-based control, an iterative Jacobian transpose-based closed-loop control method is proposed to improve the path tracking performance. To validate the design of the CR and the effectiveness of the proposed control scheme, different groups of experiments are performed. With the proposed method, the path tracking performance of the CR is improved. Compared with the open-loop Jacobian transpose-based control method, the path tracking error of the proposed method is much less. The maxillary sinus phantom tests are conducted to verify the reachability of the designed CR. Given the reference path from the nostril to the target in the maxillary sinus phantom, experiments show a mean error of 0.96mm. The designed CR is slender, flexible, and able to smoothly approach the target in a tortuous and constrained environment without colliding with or damaging the surrounding tissue. The designed continuum robotic system and the proposed iterative Jacobian transpose-based closed-loop control strategy have great potential for MSS. The limitations of the proposed method are also discussed.

A Postoperative Cheek Cyst Originating from the Maxillary Sinus with Orbital Involvement

Purpose: Here we report a case of a postoperative cheek cyst arising from the maxillary sinus with orbital involvement.Case summary: A 56-year-old male presented to our clinic with right periorbital edema and visual impairment. Upon examination, he had a visual field defect and a best corrected visual acuity of 0.6 in the right eye. The patient was diagnosed with a postoperative cheek cyst originating from the maxillary sinus. The cyst developed because of radical maxillary sinus surgery. Computed tomography showed a mass originating from the maxillary sinus. After endoscopic sinus surgery, the best corrected visual acuity of the right eye improved to 1.0 and the periorbital edema was reduced.Conclusion: In patients with orbital involvement of a maxillary sinus cyst, radiographic examination and surgical history of the postoperative cheek cyst can be diagnostic.

A Two-Segment Continuum Robot With Piecewise Stiffness for Maxillary Sinus Surgery and Its Decoupling Method

With the use of tendon-driven continuum manipulators, it is possible to reach deep-seated small lesions in a constrained anatomical space. This circumvents the difficulties encountered by existing straight endoscopes and surgical instruments, which require direct line of sight access during inspection and operation. However, maintaining adequate stiffness while ensuring smoothness and flexibility during operation for a continuum robot with a small diameter is difficult. In this article, we present the design, modeling, and validation of a new two-segment continuum robot for maxillary sinus surgery. It addresses the coupling effects that can affect the safety and precise operation within the maxillary sinus. To overcome potential distal-to-proximal deviations, a piecewise stiffness structure for the continuum manipulator is proposed. Modified kinematics, based on variable curvature continuum kinematics, is used to resolve motion coupling, and a model of the continuum manipulator with varying stiffness is proposed, with due consideration of tension coupling. Experiments are carried out to validate the proposed design, modeling, and compensation schemes. Results show that the proposed manipulator can flexibly and accurately reach the target positions in the maxillary sinus model. Comparisons of continuum robots with and without the proposed compensation schemes demonstrate the practical value and potential clinical use of the proposed method.

Outcome of Open Surgery in Disease Progression of Post-COVID Rhinomaxillary Mucormycosis Treated by Functional Endoscopic Sinus Surgery and Proposed Evaluation Scale for Maxillary Sinus Disease and Osteomyelitis.

IntroductionRhinomaxillary Mucormycosis (RMM) is a condition peculiarly seen as post-COVID-19 opportunistic infections with Maxillary Sinus Disease and Osteomyelitis (MSDO). The open method of debridement and closed method are two types of surgical modalities available. There is no scoring method for this infection in maxilla. This paper aims to study the clinical and CT-based outcome of open versus closed surgery of MSDO in post-COVID-19 RMM and propose a new scoring method to evaluate the disease severity, progression as well as recovery.Material and MethodsSymptomatic cases of RMM (n = 17) with a history of closed surgical treatment were enrolled for this prospective clinical study. These cases were then treated by medicinal and open surgical method. The clinical and CT scan outcomes were compared by proposed new scoring method.The CT-based score for Maxillary Sinus Disease (MSD) and Maxillary Osteomyelitis (MO) from pre-FESS (CT1), Post-FESS (Preoperative, CT2), and Post-operative (CT3) were compared for both right and left sides. One-way ANOVA test and post HOC tests were used for statistical evaluation.ConclusionThe open method of maxillary sinus surgery has given significant improvement in the treatment of RMM already treated by a closed endoscopic approach.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12663-022-01803-5.

Surgical ciliated cyst of the mandible after orthognathic surgery: a case report with review of the literature

BackgroundSurgical ciliated cysts, also known as postoperative maxillary cysts or implantation cysts, occur mainly in the posterior maxilla after radical maxillary sinus surgery; they rarely develop in the mandible. They are thought to occur when the sinonasal epithelium is infiltrated by a surgical instrument during surgery or as a result of transplantation of bone or cartilage with respiratory epithelium attached.Case presentationWe report a case in which a surgical ciliated cyst developed in the anterior part of the mandible, presumably as a result of bimaxillary orthognathic surgery and genioplasty performed 24 years earlier. We then review the few similar cases reported in the literature.ConclusionSurgical ciliated cysts in the mandible are extremely rare, but they could occur after simultaneous surgery on the maxilla and mandible, even decades later. To prevent surgical ciliated cysts in the mandible, we recommend that the surgical instruments, especially the saw blade used during bimaxillary surgery, be new or cleaned and that previously placed plates and screws be removed at an appropriate time.