Nasal Antrostomy Research Articles

Keratocystic odontogenic tumour and marsupialisation: a preliminary result of 19 cases

With the plethora of recent literature suggesting lesser invasive treatment modalities for keratocystic odontogenic tumour (KCOT), we publish our observations in 19 cases treated with marsupialisation at first stage followed by removal of lesion and overlying mucosa at the second. The age of patients ranged from 24 to 47 years with a predominant male predilection. All these cases were diagnosed by an incisional biopsy. For mandibular cystic tumours, a window was created in the alveolus and a sterile radiopaque tube was inserted and sutured in place. Maxillary lesions were accessed via vestibular incision and nasal antrostomy was performed following which antiseptic paraffin soaked ribbon gauze was placed and tailed into the nasal cavity for removal at three weeks. After a mean follow-up of five months (range, four to nine months), the remaining lesion was removed along with the overlying mucosa (for mandibular lesions only). These cases were further followed on three-monthly regular visits (eight months to four and a half years). Bone fill as well as recurrence was assessed. In two cases, the lesion recurred and was enucleated and peripheral ostectomy was performed. In one of these recurring lesions, transformation into plexiform ameloblastoma was recorded. Although the follow-up period is limited, the results predict a promising response.

Management of an Infected Maxillary Periapical (Radicular) Cyst through Nasal Antrostomy

ABSTRACT The radicular cyst is an inflammatory cyst that is formed as a consequence of pulpal necrosis mostly due to caries, which is often found and associated with periapical inflammation. Most of the times, radicular cysts resemble the preexisting chronic periapical periodontitis lesions radiographically. In this paper, a case of radicular cyst in the maxillary anterior region is discussed. How to cite this article Nalini MS, Kumar B, Shroff S. Management of an Infected Maxillary Periapical (Radicular) Cyst through Nasal Antrostomy. J Health Sci Res 2016;7(2):58-62.

A method to control epistaxis after nasal antrostomy and Caldwell-Luc procedure

The Caldwell-Luc procedure is commonly used in a number of surgical situations, including retrieval of foreign bodies from the maxillary sinus, treatment and resection of pathologic lesions in the maxillary sinus, treatment of chronic sinusitis, management of orantral fistula, and repair of fractures of the antrum or zygoma.1 A nasal antrostomy is recommended to establish dependent drainage of the maxillary sinus after the Caldwell-Luc procedure is performed. This step is necessary because the maxillary osteum is placed superiorly in the sinus and depends on the ciliary action for drainage. Because the Caldwell-Luc procedure alters the normal ciliary flow, an alternative drainage system is necessary.

Maxillary bone grafting for insertion of endosseous implants: results after 12-124 months.

Insertion of endosseous implants in the atrophic maxilla is often complicated because of lack of supporting bone. Augmentation of the floor of the maxillary sinus with autogenous bone graft has been proven to be a reliable treatment modality, at least in the short term. The long-term clinical and radiographic outcome with regard to the grafts, the implants and satisfaction of the patients with their implant-supported overdenture was studied in 99 patients. The sinus floor was augmented with bone grafts derived from the iliac crest (83 subjects, 162 sinuses, 353 implants), the mandibular symphysis (14, 18, 37), or the maxillary tuberosity (2, 2, 2). Before implant installation, the width and height of the alveolar crest were increased in a first stage procedure in 74 patients, while in the other 25 patients augmentation and implant installation could be performed simultaneously (width and height of the alveolar crest >5 mm). Perforation of the sinus membrane occurred in 47 cases, which did not predispose to the development of sinusitis. Loss of bone particles and sequestration were observed in one (diabetic) patient only, in whom a dehiscence of the oral mucosa occurred. A second augmentation procedure was successful in this patient. Symptoms of transient sinusitis were observed in 3 patients. These symptoms were successfully treated with decongestants and antibiotics. 2 other patients developed a purulent sinusitis which resolved after a nasal antrostomy. In all cases, the bone volume was sufficient for implant insertion. 32 of 392 inserted Brånemark implants (8.2%) were lost during the follow-up. After the healing period of the bone grafts, no sinus pathology was observed. The patients received implant-supported overdentures (72 patients) or fixed bridges (27 patients). Overall, the patients were very satisfied with the prosthetic construction. We conclude that bone grafting of the floor of the maxillary sinus floor with autogenous bone for the insertion of implants is a reliable treatment modality with good long-term results.

Advances in the management of acute and chronic sinusitis

In recent years, the approach to the patient presenting with symptoms or imaging findings of sinusitis has changed markedly. Alteration in management has occurred not only as a result of advances in diagnosis and treatment, but also because of changes in the microbiology of the disease. Diagnostic advances include the use of computed tomography (CT) imaging as well as antral endoscopy. Treatment alternatives include conservative means using antibiotics, decongestants, and occasionally intranasal vasoconstrictors, or more aggressive measures such as antral aspiration and irrigation with or without nasal antrostomy. The development of resistant bacterial species has altered the recommended firstand second-line therapies used in treating these infections. In addition, the cause, the sinus involved, the setting of the treatment (ie, outpatient versus inpatient), and the chronicity of the condition all affect treatment. Each of these areas is addressed.

Imaging of chronic sinusitis in adults: X-ray, computed tomography, and magnetic resonance imaging

Two decades ago, otolaryngologists became aware that greater attention should be given to the area of the anterior ethmoid sinus. Before then, the maxillary sinus was the primary focus of attention. This was the site at which most surgical procedures were performed on patients with chronic sinusitis (Caldwell-Luc, nasal antrostomy, and irrigation procedures).’ A better understanding of the mucociliary clearance of the nasal cavity and paranasal sinuses underscores the shift in attention to the anterior ethmoid sinus.‘-’ Procto? believed that the seat of infectious disease in the nasal cavity and paranasal sinuses resided in the anterior ethmoid sinus. He suggested that disease in the anterior ethmoid sinus area was the cause of secondary inflammatory disease in the frontal and maxillary sinus. Messerklinge?, 6 was the first to use endoscopes to demonstrate the mucociliary pattern in the nasal cavity and paranasal sinuses, thus confirming Proctor’s beliefs. Messerklinger’s use of telescopes led to the innovative surgical technique of functional endoscopic surgery. The key to most inflammatory sinus disease is the air passage lateral to the middle turbinate, the middle meatus, and the communication with the adjacent sinuses through their respective ostia (ostiomeatal complex) (Fig. 1).‘.4,” The role of mucociliary clearance as it relates to the ostiomeatal complex is less well defined than the major functions of the nasal passages. However, a complete understanding of this area and the pattern of mucociliary clearance is crucial. The ostiomeatal complex is composed of narrow channels and is subject to wide normal anatomic variation (Fig. 2). It contains the ostia needed not only for the drainage of the anterior ethmoid sinuses but also for the frontal and maxillary sinuses. These sinuses are therefore dependent on the integrity of the

Root agenesis in developing canines as a complication of intranasal antrostomy

A case is reported in which the roots of both maxillary canines failed to develop, a defect that could be traced to antral surgery when the patient was 8 years of age. The differential diagnosis of such a finding is proffered. The maxillary antrum is described, and aspects of the surgical procedure, the nasal antrostomy, used in this patient are discussed. A brief outline of current thought on the mechanisms of eruption of teeth is appropriate, and treatment of the symptomatic tooth is mentioned.

The distal lacrimal ductal system and traumatic epiphora

While transient epiphora is well documented in the literature, the incidence of permanent epiphora associated with maxillofacial procedures (Le Fort I, II, III, osteotomies, nasal atrostomies and mid-face fractures) is rare. However, little attention has been paid to the distal lacrimal ductal system and its relationship to permanent epiphora. The distal nasolacrimal ductal system was studied in adult dry skulls and cadaver specimens. These findings were correlated by clinical observation. Specific areas of emphasis within this complex include the length, width, and angulation of this system. Clinical applications are discussed based on an anatomical rationale for the limitation of the superior repositioning of the maxilla as well as for proper placement of the antral window in nasal antrostomy procedures and what anticipated post-residual effects of mid-facial trauma are on the ductal system.

Incidence of nasolacrimal injury and turbinectomy — associated atrophic rhinitis with le fort I osteotomies

Injury to the lacrimal system can occur with trauma, craniofacial surgery, rhinoplasty and nasal antrostomy. Nasolacrimal duct injury may potentially occur with Le Fort I superior repositioning. Atrophic rhinitis is also a potential complication secondary to turbinectomy required during Le Fort I superior repositioning. A review of thirty-four cases over three years of Le Fort I osteotomies with superior repositioning found no postoperative lacrimal injury and no subsequent atrophic rhinitis associated with turbinectomy. An anatomical study relating the position of the nasolacrimal duct opening within the inferior meatus and the distance available for maxillary impaction is reviewed.

Treatment of chronic sinusitis with open drainage and cefaclor

A prospective study of 50 adult patients with chronic sinusitis was undertaken. Forty patients were treated with the Caldwell-Luc operation and postoperative cefaclor, and 10 underwent nasal antrostomy and treatment with cefaclor. Approximately 85% of the 40 patients had resolution of symptoms with this treatment. The microbiology of chronic sinusitis was studied through aerobic and anaerobic cultures of sinus secretions obtained at surgery. Staphylococcus aureus (coagulase-negative) and Propionibacterium sp were found to be the most common pathogens. The radiologic results of Caldwell-Luc surgery were studied through comparison of preoperative and postoperative radiographs in 33 of these patients. An air-fluid level is the only radiographic sign of consistent diagnostic significance in the postoperative radiograph.

A retrospective study of treatment of orbital floor fractures with the maxillary sinus approach

The Cook County Hospital, Chicago, Illinois, protocol for the management of orbital fractures is presented. Diplopia which fails to resolve in 1 week or appears after oedema subsides, enophthalmos or radiographic depression of the orbital floor, associated tripod fracture deformity, or purulent maxillary sinusitis are indications for surgery. The surgical procedure is a modification of the maxillary sinus approach, which includes the use of iodoform gauze packing, nasal antrostomy, a double layer oral closure and prophylactic antibiotics. A review of 102 patients treated surgically over a 6-year period is presented. Post-operative diplopia was 9% and there were minor complications in 3%, which were significantly lower than previously reported series of orbital fractures treated either non-operatively, or through an orbital exploration approach. No patient treated non-operatively required surgery in the future. The protocol presented can eliminate unnecessary exploration and yields excellent results with a simple surgical procedure.

Photographic measurement with a nasendoscope.

Narrowing of the maxillary ostium is often the root cause of chronic sinusitis. By performing an intra nasal antrostomy the condition can be improved. A quantitative photogrammetric study was required to measure the creation of an opening from the maxillary sinus into the nose; to measure the size of each antrostomy at every visit and to determine the degree of closure. Attempts were made to obtain accurate measurements using a modified nasendoscope which was attached to a 35 mm camera.

The Caldwell-Luc Operation Revisited

The controversy concerning the indications for intranasal antrostomy versus the Caldwell-Luc operation has been debated for many years. Arguments against the Caldwell-Luc procedure are primarily based upon morbidity of the procedure, while arguments against nasal antrostomy point to inadequate access, exposure, and failure to eradicate disease. This presentation reviews the literature and the author's experience with over 270 Caldwell-Luc procedures. Some technical considerations that have produced good results are suggested. The exact indications for nasal antrostomy remain unclear.

Correction of a Lower Eyelid Deformity Caused by Multiple Extrusions of Alloplastic - Orbital Floor Implants

The case of a young woman is presented in whom a silicone orbital floor implant became extruded into the maxillary sinus 8 years after its insertion for an orbital floor fracture. Two subsequent attempts at correction using silicone only compounded the problem. Ultimate correction, in two stages, required (1) an iliac bone graft to the infraorbital rim and orbital floor defects, along with a temporal muscle flap and nasal antrostomy; and (2) an upper lateral cartilage chondromucosal graft and a full-thickness postauricular skin graft. A warning is sounded against the use of alloplastic materials for major orbital floor defects, particularly when there have been problems with these materials.

Cryosurgery with nitrous oxide : CHAPIN M. E. Dent Abstr.22 (1977) 39

Removal of localized polypous maxillary sinus membrane is, in our opinion, occasionally indicated in conjunction with surgical closure of oro-antral communication. An alternative to nasal antrostomy is presented in this paper. Packing the maxillary sinus with gauze to prevent the collection of blood and to secure drainage is achieved by carrying the end of the gauze strip subperiosteally and through the vertical incision in the anterior part of the vestibule. This technique was applied in the treatment of the 12 patients included in this study. All of these were treated as outpatients. At follow-up visits after 2 months to 1 year, all patients were found to be without symptoms or complaints.

Epiphora Following Rhinoplasty and Caldwell-Luc Procedures

Cosmetic rhinoplasty and maxillary sinus surgery are rare causes of lacrimal obstruction. The lacrimal sac is quite vulnerable to damage by the lateral osteotomy of the rhinoplasty. While obstruction from such damage usually resolves in three months, these three cases illustrate the risk of perisitent obstruction, particularly in complicated cases. The nasoantral window in the Caldwell-Luc may damage the distal lacrimal opening if it is placed too high, or made too large. Occasionally, the duct will extend more anterior and inferior and be quite vulnerable to damage by the nasal antrostomy.

Oral antrostomy

Removal of localized polypous maxillary sinus membrane is, in our opinion, occasionally indicated in conjunction with surgical closure of oro-antral communication. An alternative to nasal antrostomy is presented in this paper. Packing the maxillary sinus with gauze to prevent the collection of blood and to secure drainage is achieved by carrying the end of the gauze strip subperiosteally and through the vertical incision in the anterior part of the vestibule. This technique was applied in the treatment of the 12 patients included in this study. All of these were treated as outpatients. At follow-up visits after 2 months to 1 year, all patients were found to be without symptoms or complaints.

Obliteration of the Cavity of the Antrum After Nasal Antrostomy

Obliteration of the Cavity of the Antrum After Nasal Antrostomy

Antrum Suppuration: Nasal Antrostomy followed by Blocking of the Nasal Duct.

Antrum Suppuration: Nasal Antrostomy followed by Blocking of the Nasal Duct.