Wall Of Maxillary Sinus Research Articles

Impact of beta thalassemia on maxillary sinuses and sino-nasal passages: A case control study

ObjectivesSkeletal changes among beta (β) thalassemia children are well documented, but without available data regarding sino-nasal passages alterations. The authors investigated the maxillary sinuses and sino-nasal passages changes in β-thalassemia children and correlated such changes with the amount of transfused red cells and the erythroid marrow activity. MethodsClinical analyses including otorhinolaryngical examination (ORL) were obtained in twenty β-thalassemia children and 20 matched healthy controls. Hemoglobin (Hb), serum ferritin, soluble transferrin receptor (sTfR) levels and bone mineral density of the lumbar spine (BMD ls) were assayed. The two groups were analyzed for the CT image parameters: bone thickness, anterior and posterior choanae diameters, extramedullary hematopoiesis and chronic rhinosinusitis (CRS) ResultsNasal congestion/obstruction was identified in 14 (70%) children. Eight patients (40%) had criteria of chronic rhinosinusitis. In comparison with the normal controls, the increase in the roof, floor, medial, anterior, lateral and posterior maxillary bony walls thickness was significantly higher (1.26, 2.46, 2.6, 2.9, 3.23 and 5.34-folds, respectively). The mean posterior choanae horizontal, vertical diameters and their surface area were significantly reduced in the patients compared to the controls. The mean anterior maxillary wall bone thickness directly correlated with sTfR (P=0.047) while that of the posterior wall correlated inversely with Hb level (P=0.013). The mean vertical posterior choanae diameter had positive correlation with the amount of transfused red cells (P=0.001) and negative correlation with sTfR (P=0.001). The Hounsfield unit of maxillary sinus wall had direct relation with BMDls (P=0.003) ConclusionsThalassemia children are at risk of different folds increase of maxillary sinuses walls thicknesses utmost at posterior and lateral walls. Other sino-nasal morbidities include diminished posterior choanal diameter, nasal obstruction and CRS. Certain morbidities had relations to the erythroid marrow activity and the transfusion adequacy.

Bone defect repair on the alveolar wall of the maxillary sinus using collagen membranes and temporal fascia. An experimental study in monkeys

AbstractFew studies has been done using guided bone regeneration in maxillary sinus defects. AimTo assess the bone repair process in surgical defects on the alveolar wall of the monkey maxillary sinus, which communicates with the sinus cavity, by using collagen membranes: Gen-derm - Genius Baumer, Pro-tape - Proline and autologous temporal fascia. Materials and MethodsIn this prospective and experimental study, orosinusal communications were performed in four tufted capuchin monkeys (Cebus apella) and histologic analysis was carried out 180 days after. ResultsIn the defects without a cover (control), bone proliferation predominated in two animals and fibrous connective tissue predominated in the other two. In defects repaired with a temporal fascia flap, fibrous connective tissue predominated in three animals and bone proliferation predominated in one. In the defects repaired with Gen-derm or Pro-tape collagen membranes there was complete bone proliferation in three animals and fibrous connective tissue in one. ConclusionsSurgical defect can be repaired with both bone tissue and fibrous connective tissue in all study groups; collagen membranes was more beneficial in the bone repair process than temporal fascia or absence of a barrier.

Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae.

Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical challenge, owing to their deep-seated location and complex neurovascular anatomy. This study elucidates the benefits of incremental medial maxillectomies to access this region. We compared access to the medial aspect of the infratemporal fossa provided by medial maxillectomy, anteriorly extended medial maxillectomy, endoscopic Denker approach (i.e., Sturmann-Canfield approach), contralateral transseptal approach, and the sublabial anterior maxillotomy (SAM). Methods We studied 10 cadaveric specimens (20 sides) dissecting the pterygopalatine and infratemporal fossae bilaterally. Radius of access was calculated using a navigation probe aligned with the endoscopic line of sight. Area of exposure was calculated as the area removed from the posterior wall of maxillary sinus. Surgical freedom was calculated by computing the working area at the proximal end of the instrument with the distal end fixed at a target. Results The endoscopic Denker approach offered a superior area of exposure (8.46 ± 1.56 cm(2)) and superior surgical freedom. Degree of lateral access with the SAM approach was similar to that of the Denker. Conclusion Our study suggests that an anterior extension of the medial maxillectomy or a cross-court approach increases both the area of exposure and surgical freedom. Further increases can be seen upon progression to a Denker approach.

Quantification of maxillary sinus accessibility via a middle meatal antrostomy.

To quantify maxillary sinus volume and mucosal surface area (SA) that is accessible endoscopically via a middle meatal antrostomy and to explore the financial implications of using multiple disposable instruments for this procedure. Eight cadaver maxillary sinuses configured with image guidance software were evaluated. In each sinus, a standard middle meatal antrostomy was created, through which curved microdebriders of 15, 40, 70, and 120° were placed. The SA and volume of the region accessible by each microdebrider tip was calculated. Mean maxillary sinus volume was 16.5 ± 2.5 cm(3) and mean SA was 31.0 ± 2.3 cm(2). The 15, 40, 70 and 120° microdebriders accessed an average of 10, 25, 41, and 66%, respectively, of the SA, and of 2, 9, 17, and 36%, respectively, of the volume. There was a trend toward improved accessibility of the superior half versus the inferior half of the maxillary sinus. When instruments of different degrees were combined to maximize accessibility, 81% of the SA of the sinus could be accessed. Microdebriders with increasing curvatures allowed for greater access of the maxillary sinus mucosa through an middle meatal antrostomy. No single microdebrider curvature or combination of curvatures reached the entirety of the maxillary sinus wall. Knowledge about the area of reach for these blades can lead to lower per procedure costs.

Ewing’s sarcoma of the maxillary sinus

Ewing’s sarcoma is typically an aggressive, poorly differentiated tumor affecting children and young adults, it accounts for 4–6% of all primary bone tumors and facial primary localizations occur in only 1–4% of all cases, mostly in the mandible and calvaria. Paranasal sinus involvement is rare. A 22-year-old female was reviewed in Oral & Cranio Maxillofacial Surgery Department. She complained of swelling of the right paranasal area, of one-month duration, progressively increasing in size and associated with pain. The medical history was unremarkable, Contrast Enhanced Computed Tomography scan showed a destructive lesion of the anterior wall of the right maxillary sinus reaching up to the medial wall of the maxillary sinus, other paranasal sinus appearance was normal. Incisional biopsy proved it to be Ewing’s Sarcoma. She was treated by chemotherapy using Vincristine, Adriamycin, and Cyclophosphamide alternating with Etoposide & Ifosfamide and Radiotherapy, and this resulted in complete regression of the tumor. Repeated PET scans every 6months did not suggest any recurrence of the right maxillary sinus tumor. We concluded that treatment by induction chemotherapy followed by radiation therapy leads to a favorable outcome in the above described case, avoiding the morbidity that can result from surgical options.

Maxillary sinusitis diagnosed by ultrasound

A 65-year-old male patient with history of alcohol dependence was admitted to the ICU twenty-five days before suffering from aspiration pneumonia and severe acute respiratory distress syndrome. He had an orotracheal tube in place and was nourished through an enteral feeding tube inserted through his left nostril. The patient presented new febrile episodes and an abundant postnasal purulent discharge. Due to the raising suspicion of sinusitis, an ultrasound of both maxillary sinuses was performed and revealed a well-defined hyperechoic walls of the right maxillary sinus

Transnasal Endoscopic Medial Maxillary Sinus Wall Transposition with Preservation of the Inferior Turbinate and Nasolacrimal Duct

Transnasal Endoscopic Medial Maxillary Sinus Wall Transposition with Preservation of the Inferior Turbinate and Nasolacrimal Duct

Pediatric Facial Arteriovenous Malformations: Case Report and Overview of the Basics

Aims: Describe the multimodality imaging of a large facial AVM in a child and discuss the treatment options of pediatric facial AVMs Case Presentation: An 11 year old girl developed spontaneous (no prior trauma) enlargement of her left cheek with bleeding from her mouth when eating hard foods. The bleeding was described as pulsatile red bleeding that stopped spontaneously. On physical exam, she had a palpable pulsatile left buccal AVM; auscultation revealing high-flow through it. MRI demonstrated a 2.7 cm heterogeneous vascular mass arising in the soft tissues of the left cheek with involvement of the anterior wall of the left maxillary sinus with a large tortuous ectatic draining vein. CTA demonstrated a large AVM involving the left face with the nidus along the posterior wall of the left maxillary sinus, markedly enlarged draining veins throughout the left face/cheek and prominence of the pterygoid venous plexus. Left common carotid artery angiogram demonstrated an extensive AVM centered in the left maxilla. Left external carotid artery angiogram demonstrates the AVM receiving supply from the distal left internal maxillary, left facial, and left internal maxillary arteries. Angiography of the left internal maxillary demonstrated a high flow AVM with drainage to the left facial vein. The left internal maxillary artery was embolized using Onyx. The left facial, transverse facial, and internal

Bone suture and lateral sinus lift surgery.

Bone suture in lateral sinus lift has four indications. Three of them depend on creating a hole in the lateral maxillary sinus wall above the antrostomy window for securing the elevated medial maxillary sinus membrane to manage perforated Schneiderian membrane. Covering the buccal antrostomy window with the buccal fat pad (BFP) for better nourishment of the inserted graft and as an alternative for bone tags in fixation of collagen membrane has been reported previously. A new indication for firmly anchoring the BFP to the medial maxillary sinus wall as the last resort for the management of perforated Schneiderian membrane is explained in this article.

A Case of Maxillary Sinus Cholesteatoma Originating from the Retromaxillary Sinus Wall

Cholesteatomas are often observed in the middle ear or mastoid cavity. However, cholesteatomas in areas other than the middle ear or mastoid are extremely rare and thus are not often reported in the literature. We recently treated an 18-year-old female patient with an incidentally detected maxillary sinus mass. A paranasal sinus computed tomography examination revealed a cystic lesion in the left maxillary sinus infiltrating the posterolateral walls of the left maxillary sinus. An endoscopic operation was performed for definitive diagnosis. Histopathological examination of the mass confirmed the diagnosis of cholesteatoma. Despite the rarity of paranasal cholesteatoma in comparison with cholesteatomas in the tympanum, a few cases involving the frontal sinus have been reported. However, retromaxillary cholesteatoma is even less common than sinus cholesteatoma and is reported rarely. To our knowledge, this is the first reported case of a maxillary cholesteatoma originating from the retromaxillary area. For this reason, we present this case along with a literature review.

"All-On-4/DIEM 2" A concept to rehabilitate completely resorbed edentulous arches

Although a number of approaches to implant-supported restoration of severely atrophic maxillae and mandibles have been developed, most of these treatments are costly and protracted. An exception is the all-on-four concept, which uses only four implants to support an acrylic, screw-retained provisional prosthesis delivered on the day of implant placement, followed by a definitive prosthesis later on. The present article describes about full-arch rehabilitations using implants supported prosthesis by DIEM 2/all on 4 technique. This is an innovative technique that allows for immediate function, full arch implant-supported prosthesis without the need for any bone grafting procedures even in atrophic situations. In this technique, four implants are placed in the anterior region of the jaw between the two mental foramina in the mandible and between the mesial walls of maxillary sinus in the maxilla. The two anterior implants follow the jaw anatomy and the two distal implants are tilted at 45° angulation posteriorly, this arrangement allowed for good implant anchorage, short cantilever length, and large inter implant distance thus favoring fruitful outcome of the treatment.

An Unusual Case of a Large Orbital Wooden Foreign Body

Results: An 11 years old child with history of fall and referred for suturing, presented within 6 hours of the injury with an external wound about 1.5 × 1 cm along the medial 1/3rd of the inferior orbital rim below the lower eyelid margin of left eye, with normal ocular examination. An axial CT reported as a linear hypodense tract of 5.8 cm. The tract was extending medially to pierce and enter the medial wall of the right maxillary sinus. The patient was immediately taken to emergency OT for exploration and wound repair. A trans-orbital wooden FB with paranasal sinus extent was removed successfully without any visual or ocular damage.

Reconstruction of Orbital Floor Fractures with Autogenous Bone Graft Application from Anterior Wall of Maxillary Sinus: A Retrospective Study.

Orbital wall fracture implies a situation where disruptions of the walls or floor have occurred. It is a blowout type fracture where bone fragments with torn periosteum are pushed outside of the original bony orbit. There is no intact bone even near the defect area except the thin bone rim surrounding the blowout fracture. The purpose of this defect repair is to support orbital contents, free entrapped tissue, and, especially, restore the original orbital volume. Ten patients (seven males and three females) who underwent repair of orbital floor factures with maxillary sinus bone grafts were included in this study. Surgical procedure for harvesting graft and its fixation was almost same in all operated cases. The collection in the maxillary sinus due to fracture of floor of orbit, blood and bony fragments collected in the maxillary sinus can be easily drained and removed after removal of anterior wall of maxillary sinus and through the same approach you can reduce the floor of orbit manually to the proper position which helps to decease the orbital floor defect.

Unusual difficult airway due to the presence of a large facial foreign body

The anesthetic management of patients with facial trauma that directly or indirectly involves the airway can be challenging. We present this image that represents a 22-yrold female patient who suffered a penetrating stiletto shoe injury to the left eye incurred during an altercation. She arrived at the emergency department with the heel still embedded in the eye and the sole covering most of the facial structures and oronasal openings. A computed tomography scan indicated possible fractures of the left infraorbital canal/ orbital floor and the posterior wall of the left maxillary sinus along with the left maxillary hemosinus (Figure). Airway management was complicated by alcohol intoxication, recent food ingestion, agitation, and most importantly, significant elevation of intraocular pressure (33 mmHg). Emergent surgical removal was scheduled, and although cricothyrotomy and awake tracheostomy were considered, after the administration of an antisialagogue (glycopyrrolate 0.2 mg iv), dexmedetomidine (1 lgkg -1 hr -1 iv infusion), and 4% lidocaine airway toplicalization, an awake flexible fibreoptic intubation was performed through the very limited access to the patient’s mouth. Following induction of general anesthesia, the stiletto heel was extracted manually from the orbit, necessitating a significant amount of force. Afterward, the intraocular pressure decreased to 8 mmHg. No further surgery was required, tracheal extubation was performed at the end of the procedure, and the patient had an uncomplicated recovery. Although the use of awake video-assisted laryngoscopy for difficult airways has recently been described in the literature, this case re-emphasizes the role of flexible fibreoptic intubation as the ‘‘gold standard’’ in selected complex airway situations.

The Effects of Sinus Mucosal Removal during Orbital Wall Reconstruction in an Experimental Model

BACKGROUND: Various kinds of implants have been used for reconstruction of blowout fracture, but they have the possibility of infection. Although infection after orbital reconstruction is not common, it could leave serious sequelae to the patients. For this reason, some surgeons routinely removed the sinus mucosa during the repair of the blowout fracture. In this study, we evaluated the effect of mucosal removal to the healing process with implant and inflammatory reaction, using histopathologic analysis of the rabbit model. METHODS: Studies were performed with fifteen “New Zealand White Rabbits”. A 1.5 cm x 1.5 cm sized bone window was made at the maxillary sinus wall. One side of the maxilla was chosen randomly as an experimental group (n=15), and the other side became the control group (n=15). The sinus mucosa of the experimental group was totally strapped and that of control group was left intact. Bioabsorbable poly-L-lactide-conglydolida plate (Rapidorsorb, synthes) was inserted to cover the bony defects. Total maxillectomy including implant at 3 weeks, 6 weeks, and 9 weeks after implantation was conducted and composition of tissue was analyzed. The grade of inflammatory reaction, the proportion of woven bone, the amount of fibrovascular proliferation (b-FGF,CD31) and capsule thickness around the implant were assessed. RESULTS: The early inflammatory reactions around the implant were grade 1.13 (mean value, experimental group) and 2.2 (mean value, control group) in 3 weeks. Woven bone formation was more prevalent in the experimental group. Calculated area of woven bone formation was 16.27% in 3 weeks, 22.20% in 6 weeks, and 36.16% in 9 weeks. In the control group, more fibrotic connective tissue change rather than woven bone formation was observed (p=0.011) (Table 1). Also, the thickness of capsule around the implants were thinner in experimental group (p=0.04) (Table 2).Table 1: The proportion of woven bone formation (%).Table 2: Thickness of implant capsule (um).CONCLUSIONS: This study suggests that less inflammatory reaction not only stimulates formation of woven bone but also reduces the fibrosis around the absorbable implant. Therefore, removal of sinus mucosa during the orbital reconstruction can be accepted as an effective option to achieve faster bone healing process with less inflammatory reaction.

Verification of posterior superior alveolar artery distribution in lateral wall of maxillary sinus by location and defect pattern.

Maxillary sinus augmentation is used when performing implant treatment in the maxillary molar region with inadequate bone height. Posterior superior alveolar artery (PSAA) is the branch of the maxillary artery that supplies the lateral sinus wall and sinus membrane. When performing an osteotomy via lateral approach, however, damage to the PSAA can occur, because it runs inside the lateral wall of the maxillary sinus, causing hemorrhage and hampering surgery. The objective of the present study was to compare the defect patterns with the distances from the alveolar crest and sinus floor to the PSAA. 280 lateral regions in 235 patients with at least three missing consecutive posterior teeth were measured. Measurement locations were the 1st premolar (P1), the 2nd premolar (P2), the 1st molar (M1), and the 2nd molar (M2). The detection rate was 29% to 59%, and the longest diameter was between 1.1 mm and 1.3 mm. The average distances between the PSAA and the alveolar crest were 24.1 mm, 21.3 mm, 15.4 mm, and 15.3 mm (P1-M2), with statistically significant differences in all locations except M1 and M2. The average distances between the PSAA and the maxillary sinus floor were 10.4 mm, 10.4 mm, 9.0 mm, and 8.5 mm (P1-M2), with no significant differences. There were no significant differences between different defect patterns in the distance between the PSAA and either the alveolar crest or the maxillary sinus floor. PSAA detection rate and the longest diameter were related to the spatial resolution of the computed tomography (CT) scan. Although the distance between the PSAA and the alveolar crest was significantly shorter in the molar region than in the premolar region, it did not affect the defect pattern.

Antrochoanal polyp: clinical presentation and retrospective comparison of endoscopic sinus surgery and endoscopic sinus surgery plus mini-Caldwell surgical procedures.

Antrochoanal polyp is a benign polypoid lesion orginating from the maxillary sinus antrum and extending to the choana. Our aim was to assess the clinical presentation and associated rhinological findings of antrochoanal polyp patients and to evaluate results of 2 surgical treatments termed endoscopic sinus surgery (ESS) and ESS plus mini-Caldwell operation. The study included 46 patients. Factors such as patient age, sex, history of chronic sinusitis, allergic rhinitis, septal deviations, chonca bullosa, turbinate hypertrophy, and the origin of the polyp were assessed. We also evaluated ESS and ESS plus mini-Caldwell surgical procedures for recurrences, synechia, bleeding, and ostium stenosis. Overall, there were 27 men and 19 women. The ESS approach was used in 26 cases, and 20 cases had combined ESS and mini-Caldwell procedures. The statistical significant difference between the 2 groups was only recurrence (P < 0.05). In the ESS group, bleeding, synechia, and ostium stenosis were seen more than in the ESS + mini-Caldwell group, but there was no significant difference between the 2 groups in bleeding, synechia, and ostium stenosis (P > 0.05). We thought that lower rate of recurrence found in ESS + Caldwell group in this study was associated with better visualization of the maxillary sinus walls and, therefore, easier resection of the remnant polyp. We concluded that higher incidences of bleeding and synechia were related to the mucosal damage occurring in the septum and the inferior concha due to excessive manipulation of endoscope and surgical instruments.

Alveolar Antral Artery: Does its Diameter Correlate with Maxillary lateral wall Thickness in Dentate Patients?

Knowledge of the presence of the alveolar antral artery in the lateral maxillary sinus wall is essential for surgeons who operate in this region. The purpose of this study was to investigate the correlation between alveolar antral artery diameter and lateral maxillary bony wall thickness in dentate patients. Thirty five Cone-Beam Computed Tomography (CBCT) scans from 35 dentate patients were selected in coronal sections in three locations; second premolar (P2), first molar (M1), and second molar (M2). The presence of the alveolar antral artery in each situation was determined and the bone thickness in the region of alveolar antral artery was measured perpendicular to the lateral wall of the maxilla. The alveolar antral artery was present in 67.1% CBCTs. The difference between the alveolar antral artery diameter was only significant in the first and second molar area (P=0.039).There were significant differences between bone thickness in three locations, with the thickest bone in the first molar area followed by the second molar and second premolar, respectively. The correlation coefficient showed that there is a positive correlation between bone thickness and alveolar antral artery diameter. This study showed that the thicker the bones in dentate patients, the greater the chance of interference with the large caliber intra-osseous alveolar antral artery.

A Diagnosis of Maxillary Sinus Fracture with Cone-Beam CT: Case Report and Literature Review.

The purpose of this article is to present the case of maxillofacial trauma patient with maxillary sinus fracture diagnosed with cone-beam computed tomography (CBCT) and to explore the applications of this technique in evaluating the maxillofacial region. A 23-year-old male patient attempted to our clinic who had an injury at midface with complaints of swelling, numbness. The patient was examined before in emergency center but any diagnosis was made about the maxillofacial trauma. The patient re-examined clinically and radiographically. A fracture on the frontal wall of maxillary sinus is determined with the aid of CBCT. The patient consulted with the department of maxillofacial surgery and it is decided that any surgical treatment was not necessary. The emerging technique CBCT would not be the primary choice of imaging maxillofacial trauma. Nevertheless, when advantages considered this imaging procedure could be the modality of choice according to the case.

Multidetector computed tomographic evaluation of maxillofacial trauma

Introduction: Maxillofacial injuries are one of the most frequently encountered entities accounting for a large proportion of patients in emergency department. Present study was performed to assess the role of multidetector computed tomography (MDCT) in patients of maxillofacial trauma and to describe the spectrum of various patterns of injuries in maxillofacial region in this part of Nepal. Methods: The study was carried out on a prospective basis over a period of one year. All the patients referred for evaluation of maxillofacial trauma were included in the study. MDCT was done in patients of maxillofacial injury and the data was recorded and analyzed. Volumetric MDCT scan of the maxillofacial region was performed in axial plane with multiplanar reconstruction in coronal and sagittal planes were obtained wherever required. Results: Out of 60 patients of maxillofacial trauma 42 (70%) were males and 18 (30%) were females and age ranges from 12 to 70 years. The 11?30 years age group has the highest percentage (55%) of maxillofacial trauma, followed by 31?40 (20%). The common cause of injuries in our study was road traffic accidents (58.33%), fall from height (20%), physical assault (16.66%) and sport injuries (5%). Out of 60 patients there was total of 115 fractures. The frequency and types of fracture was as follows: orbital floor fracture in 21 (35%), maxillary sinus wall fracture in 18 (30%), nasal bone fracture in 17 (28.33%), jaw fracture in 15 (25%), zygomatic bone fracture in 13 (21.66%), orbital wall fracture in 11 (18.33%), naso?ethmoidal fractures in 9 (15%), frontal sinus fracture in 7 (11.66%), Lefort fracture in 1 (1.66%) and others 3 (5%). The highest percentage of fracture was of orbital floor (35%) followed by fracture of wall of maxillary sinus (30%) and nasal bone fracture (28.33%). Three cases had simultaneous injury of the globe and cervical spine; they underwent computed tomography/magnetic resonance imaging for the assessment of spine. Conclusion: Injuries to maxillofacial region is one of the most common emergency requiring accurate and early diagnosis for preventing unnecessary investigations and proper management. MDCT has high sensitivity and specificity and has high accuracy for detection of fracture. DOI: http://dx.doi.org/10.3126/ajms.v5i4.9561 Asian Journal of Medical Sciences 2014 Vol.5(4); 39-43