Mucous Membrane Thickening Research Articles

Association between Odontogenic and Maxillary Sinus Conditions: A Retrospective Cone-Beam Computed Tomographic Study.

Odontogenic infections can directly trigger maxillary sinusitis. CBCT is an excellent choice for precise examination of maxillary sinuses and hard tissues within the oral cavity. The objective of this retrospective and the cross-sectional study was to analyze the influence of odontogenic conditions on the presence and intensity of maxillary sinus mucous membrane thickening using CBCT imaging. Moreover, periodontal bone loss and anatomic relationship between adjacent teeth and maxillary sinuses were assessed to evaluate its possible impact on creating maxillary thickening. The study sample consisted of 200 maxillary sinuses of 100 patients visible on CBCT examination with a field of view of 13 × 15 cm. The presented study revealed a significant influence of periapical lesions, inappropriate endodontic treatment, severe caries, and extracted teeth on the presence of increased thickening of maxillary sinus mucous membrane. In addition, an increase in the distance between root apices and maxillary sinus floor triggered a significant reduction of maxillary sinus mucous membrane thickening. The presence of periodontal bone loss significantly increases maxillary sinus mucous membrane thickening.

Does the quality of residual alveolar bone apical to a periodontal lesion beneath the maxillary sinus play a vital role in preventing the extension of periodontal disease to maxillary sinus? A CBCT-assisted retrospective study.

The mucous membrane of the maxillary sinus is sensitivis susceptible to infection or inflammation adjacent to it, which may contribute to mucous membrane thickening (MMT). Residual alveolar bone quality (RABQ) is considered a quality of the remaining bone apical to periodontal defect adjoining to the floor of the maxillary sinus. The current study aimed to analyze the minimum RABQ to prevent the extension of periodontal pathology from reaching maxillary sinus using cone-beam computed tomography (CBCT). In this retrospective observational study, 240 sinus exposure CBCT records of 146 patients were evaluated. Patients with at least one sinus exposure were included. RABQ and MMT were calculated using CBCT inbuilt tools. RABQ was divided into four groups based on gray scale values (GSV). Statistical analysis was performed using one way ANOVA and independent sample t-tests. Correlation was completed applying Pearson's correlation coefficient. A significant difference (p< 0.05) was observed between the MMT values of the four RABQ groups. Inverse correlation was observed between mean MMT and GSV values. Mean MMT was higher than pathological MMT range (> 2mm), with significant differences in groups A and B, where mean GSV values are less than 500. Mean GSV greater than 500 in groups C and D show non-pathological MMT. Prevalence of MMT is 91.4% if GSV is < 500 and 7.5% if GSV is > 500. Our study suggests that MMT is present if RABQ has GSV values < 500. Maxillary sinusitis and its etiology from periodontal pathology can be excluded based on RABQ adjoining periodontal lesion. Early detection and prompt treatment along with appropriate regenerative protocols can be performed to increase the RABQ. Further microbiological investigation is required to support the present results.

Does residual bone thickness apical to periodontal defect play a major role in maxillary sinus mucous membrane thickness?: A cone-beam computed tomography-assisted retrospective study

The mucous membrane of the maxillary sinus is very sensitive to foreign bodies and infections. Any triggering may lead to mucous membrane thickening (MMT). Residual bone thickness (RBT) is the remaining bone apical to the periodontal defect until the floor of the maxillary sinus acts as a barrier for the periodontal infections to reach the sinus. The aim of our current study was to evaluate the minimal RBT to prevent periodontal infection to reach Schneiderian membrane using cone-beam computed tomography (CBCT). In this descriptive study, 144 maxillary sinus exposure records of 100 patients were collected retrospectively. Patients with minimum one sinus exposure were considered. MMT and RBT were calculated with the CBCT assistance. Statistical analysis was done using Mann-Whitney U-test, Kruskal-Wallis and Chi-square test. (P < 0.05) was considered as statistically significant. Significant difference (P < 0.001) was observed in MMT among three RBT groups. Significantly, higher mean MMT was observed with <2 mm and 2-4 mm RBT groups. The prevalence of MMT with >4 mm group is less (7%) compared to <2 mm group and 2-4 mm RBT groups (91.2% and 90.2%, respectively). Furthermore, there is no significant difference in MMT between angular and furcation defects (P = 0.890). Probability of MMT was increased if RBT is <4 mm. Early detection and prompt periodontal treatments associated with regenerative procedures can be instituted wherever possible to improve RBT and to reduce MMT. Further, microbiological studies are required to confirm the analysis.

Pneumosinus dilatans and multiplex: report of three rare cases and review of the literature

Pneumosinus dilatans is a term used to describe a localized abnormal dilatation of one or more paranasal sinuses without radiological evidence of localized bone destruction, hyperostosis or mucous membrane thickening. The involvement of all paranasal sinuses and mastoid air cells has been named pneumosinus dilatans multiplex. Although the involvement of one or more paranasal sinuses has been reported widely, all paranasal sinuses and the concomitant involvement of mastoid air cells has been reported in only one case. Herein, we present three unusual cases of pneumosinus dilatans (one is a second case of pneumosinus dilatans multiplex in English literature, another is the first reported case of a frontal pneumosinus dilatans case associated with frontoethmoidal meningocele, mental retardation and facial asymmetry and the third one is pneumosinus dilatans with a huge arachnoid cyst) along with the review of relevant literature.

Spontaneous pneumocephalus caused by the association of pneumosinus dilatans and meningioma

Pneumosinus dilatans (PSD) refers to an abnormally enlarged, air-filled paranasal sinus without radiological evidence of localized bone destruction, hyperostosis, or mucous membrane thickening. This disorder has been associated with meningioma, especially optic nerve sheath meningioma, but its pathophysiology remains unclear. Spontaneous pneumocephalus is an exceptional presentation of PSD and, to our knowledge, has never been associated with meningioma.

Sinusitis in Infants and Children

The major clinical problem in considering a diagnosis of sinusitis is differentiating uncomplicated upper respiratory tract infection from a secondary bacterial infection of the paranasal sinuses that may benefit from antimicrobial therapy. A diagnosis of sinusitis is suggested by presentation with protracted upper respiratory tract symptoms or a cold that is more severe than usual with fever and purulent nasal discharge. Confirmatory tests of sinus disease are transillumination (useful in adolescents if interpretation is confined to the extremes--normal or absent); radiographic findings of opacification, mucous membrane thickening, or an air-fluid level; and sinus aspiration (indicated for severe pain, clinical failures, or complicated disease). When clinical signs and symptoms are accompanied by abnormal radiographic findings, bacteria in high colony count are recovered from the maxillary sinus aspirate in 70% of patients. The common bacterial species recovered from children with acute maxillary sinusitis are Streptococcus pneumoniae, Moraxella (Branhamella) catarrhalis, and Hemophilus influenzae.

The effects of periodontal treatment on mucous membrane thickening in the maxillary sinus.

This study was performed to elucidate the effect of periodontal treatment on the sinus mucosa. 21 patients with periodontal lesions of the upper molars and/or premolars and chronic mucous membrane thickening in the maxillary sinus diagnosed radiographically participated in the study. No teeth in the regions studied showed pulpal or periapical changes. Altogether, the patients exhibited 36 maxillary sinuses with mucous membrane thickening. 15-20 months after the final periodontal treatment, a marked reduction of the plaque index, gingival index and probing depth was recorded. Radiographic examination of the sinus mucosa before and after periodontal treatment showed that successful periodontal treatment in all quadrants resulted in normalisation of the sinus mucosa. Periodontal treatment was not successful in 2 quadrants. In one of these cases the thickness of the mucosa was unchanged and in the other case, further thickening of the mucosa seemed to have occurred. The study shows that severe periodontitis of the upper molars and/or premolars may initiate mucous membrane thickening in the maxillary sinus, and that successful periodontal treatment results in normalisation of the sinus mucosa.

Maxillary Sinus Radiographs in Children with Nonrespiratory Complaints

An attempt was made to determine the frequency of abnormal maxillary sinus radiographs in a group of unselected children having diagnostic skull radiographs performed for indications unrelated to respiratory infection. An occipitomental, or Water's, view was obtained in every case in order to evaluate the maxillary sinuses. Prior to performance of the radiographs, a history of recent respiratory symptoms was obtained and a physical examination of the ears, nose, and throat was performed. An abnormal maxillary sinus radiograph was defined as one that revealed an air-fluid level, partial or complete opacification, or mucous membrane thickening of 4 mm or greater. Fifty-nine (53%) of 112 presumably "normal" children had evidence of recent respiratory inflammation by history or at physical examination. In 50 subjects less than 1 year of age, abnormal maxillary sinus radiographs were common, irrespective of respiratory symptoms and signs. In contrast, eight of 14 children (57%) aged 1 to 16 years with both symptoms and signs of respiratory inflammation had abnormal maxillary radiographs, compared with only two of 31 children (7%) with neither symptoms nor signs (P less than .005). Crying alone was not associated with abnormal radiographs in the older age group. In children more than 1 year of age, abnormal maxillary sinus radiographs are infrequent and are generally related to inflammation of the upper respiratory tract.

Mycotic infection of the paranasal sinuses. Radiographic manifestations.

In the past few decades the incidence of mycotic infection of the paranasal sinuses has increased considerably, primarily because of the expanded use of antibiotics and chemotherapeutic agents, such as folic acid antagonists and nitrogen mustards. Clinical awareness of the existence of mycotic infection and advancement in the knowledge and technic of fungus identification also account for the rising incidence. When interpreting a roentgen examination of the paranasal sinuses, the radiologist may see mucous membrane thickening, clouding of the sinuses, and bone destruction. These changes may occur in malignant tumors and in bacterial or mycotic infection. Case Reports Case I: A. B., a 68-year-old white man, was admitted to Bellevue Hospital on Aug. 4, 1959, with a history of recent bloody discharge from the left nostril, associated with erythematous swelling and tenderness over the left maxillary and orbital regions. There was a long history of poorly controlled diabetes. The only significant laboratory studies were a fasting blood sugar of 225 mg per 100 cc, a white blood cell count of 14,000 per mm3, and a serum carbon dioxide content of 17.1 mEq∕1. Radiographic studies of the paranasal sinuses showed mucous membrane thickening and changes suggestive of bone destruction in the medial and lateral walls of the left antrum. There was soft-tissue swelling of the left side of the nose (Fig. 1). A biopsy of the left inferior nasal turbinate revealed mucormycosis. Subsequently, there developed bilateral exophthalmos, blindness of the left eye, and left facial paralysis. Within a few weeks of admission the patient died of infection. At postmortem examination mucormycosis was found to involve the palate, nasopharynx, and paranasal sinuses. Case II: T. D., a 41-year-old white male, was admitted to New York University Hospital on Dec. 10, 1962, with signs and symptoms of diabetic acidosis. On the day of admission his condition improved with insulin, fluid replacement, and other supportive measures. On the second hospital day, erythematous swelling developed in the left upper and lower eyelids and left cheek; the left nasal turbinates were also swollen, and there were mucopurulent nasal discharge and a fever of 103°F. On the fourth hospital day, a paralysis of the external ocular muscles and blindness of the left eye occurred. A palatomaxillary fistula developed a few days later. Radiographic examination of the facial bones showed clouding of the left maxillary antrum and bone erosion of its walls (Fig. 2). When cultures of the sputum and secretions from the left maxillary antrum grew Mucor and Rhizopus organisms, oral nystatin and systemic and local amphotericin B were administered. The involved antrum was also drained surgically.