Presence Of Maxillary Sinus Septa Research Articles

Le Fort I Osteotomy Complicated by Presence of Maxillary Sinus Septa.

Presence of maxillary sinus septa, an anatomical variant, has never been documented as a possible complication of Le Fort I orthognathic surgery procedure. This case report describes the difficulty faced by an experienced surgeon during Le Fort I down-fracture procedure. The osteotomized maxilla remained firm despite confirmation that all osteotomy cuts have been performed adequately. The presence of a bilateral sagittally oriented maxillary sinus septa extending from the floor to the roof of the sinus in this case had prevented separation of the lower maxilla during down-fracture maneuver. Such normal anatomical variant must be identified during orthognathic surgery treatment planning session to avoid grave complications.

Maxillary Sinus Septa: Prevalence and Variation with Gender and Location

Introduction: Maxillary sinus septa are partitions of cortical bone dividing the sinus into multiple compartments. Their presence and dimension are of relevance to periodontists, oral and maxillofacial surgeons as well as otolaryngologists. Objective: To determine the prevalence of maxillary sinus septa and its variation with gender and location in sampled Nepali population. Methods: An analytical cross-sectional study was conducted in Department of Periodontics, Kantipur Dental College Teaching Hospital and Research Centre after ethical clearance from Institutional Review Committee. Convenience sampling was done for 433 orthopantomograms (OPGs) with clearly visible maxillary sinus and absence of pathological or developmental changes. Each OPG was observed for presence of septa. Presence or absence of septa was noted along with position and site of septa. Gender of subjects was also noted. Statistical analysis was performed via SPSS 21.0. Results: Among observed radiographs, 148 (34.18%) showed presence of maxillary sinus septa. Septa were more prevalent among males (84, 56.76%) than females 64 (43.24%); with statistically significant difference (P <0.05). Unilateral occurrence (97, 65.54%) of septa was greater than bilateral (51, 34.46%). onclusion: This study may serve as baseline data for prevalence of maxillary sinus septa and may aid in treatment planning during dental implant placements and surgical procedures of maxillary sinus.

Risk Factor Analysis Affecting Sinus Membrane Perforation During Lateral Window Maxillary Sinus Elevation Surgery.

To analyze risk factors affecting sinus membrane perforation (SMP) during sinus floor elevation (SFE) procedures using the lateral window technique (LWT). For patients with SFEs using the LWT, patient-related risk factors (age/sex/smoking/diabetes) and surgical-anatomical-related risk factors (stage approach/sinus side/residual ridge height/sinus membrane thickness/previous surgical interventions) were compared between perforated and nonperforated sites and were evaluated for their influence affecting SMP. Additionally, SMPs were further subdivided into small/moderate (< 10 mm) or large (≥ 10 mm) in dimension, which were also analyzed for risk factors and consecutively for their influence on perforation. The study sample comprised 434 SFE procedures in 355 patients; 94/355 patients (26.5%) presented SMP in 103 of 434 SFE procedures (23.8%). SFE procedures with (n = 103) and without (n = 331) SMP did not differ for patient-related risk factors but differed significantly (P = .001) for surgical-anatomical factors as follows: residual ridge height (3.05 ± 1.35 mm vs 4.15 ± 1.46 mm), sinus membrane thickness (1.2 ± 0.5 mm vs 2.6 ± 1.1 mm), prevalence of staged procedures (78.6% vs 57.7%), presence of maxillary sinus septa (75.7% vs 14.2%), presence of thin (< 1.5 mm) mucosa biotype (62.1% vs 29%), and previous oral surgical interventions (37.9% vs 16.3%). In the multivariate analysis, significant associations of SMP were found with the presence of sinus septa (odds ratio [OR] = 31.992; P = .001), residual ridge height (OR = 1.563; P = .007), sinus membrane thickness (OR = 1.057; P = .001), presence of thin (< 1.5 mm) sinus biotype (OR = 8.883; P = .001), previous surgical interventions (OR = 4.689; P = .002), and smoking habits (OR = 2.238; P = .030). For inducing a large (≥ 10 mm) SMP, the presence of thin sinus membrane thickness/thin sinus membrane biotype (OR = 5.319; P = .006; OR = 22.222; P = .001) and reduced alveolar ridge height (OR = 0.629; P = .026) were assessed as being significant risk factors. In general, the presence of sinus septa, thin sinus mucosa, staged procedures, and previous surgical interventions are the main risk factors inducing SMP for SFE using the LWT. In particular, the presence of thin sinus membrane in conjunction with a staged procedure significantly increases the risk for a large SMP.

Evaluation of the Relationship of Dimensions of Maxillary Sinus Drainage System with Anatomical Variations and Sinusopathy: Cone-Beam Computed Tomography Findings

Objective: The aim of this study was to evaluate the correlation between the length of the infundibulum and ostium height with the anatomic variations of osteomeatal complex (OMC) and sinus pathology using cone-beam computed tomography (CBCT). Methods: CBCT images of 204 patients (408 maxillary sinuses) were evaluated retrospectively. The height of the ostium and the length of the infundibulum were measured. The presence of maxillary sinus pathology, nasal septal deviation, Haller cells, concha bullosa, and sinus septa were analyzed. The correlation between the size of the maxillary sinus drainage system and anatomic variations was compared using the t test, Fisher’s exact test, and χ² test. The effect of tooth loss on the length of the infundibulum and ostium height was also analyzed using ANOVA. Results: The height of the ostium and the maximal septal deviation angle were found to be significantly greater in males (p < 0.05). As ostium height increased, the presence of maxillary sinus septa increased (p < 0.05). No statistically significant association was detected between other variations and the length of infundibulum or ostium height. The relationship between tooth loss and both the length of the infundibulum and ostium height were found to be insignificant (p > 0.05). Conclusions: Radiographic examination, especially on CBCT images, is important for an evaluation of maxillary sinuses. here, we demonstrated a significant relationship between ostium height and the presence of maxillary sinus septa. However, it was found that nasal septal deviation, concha bullosa, Haller cells, and other sinusopathies did not have a major effect on the size of the maxillary sinus drainage system.

A radiologic evaluation of the incidence and morphology of maxillary sinus septa in Japanese dentate maxillae.

Evaluation of the inner aspect of the maxillary sinus is important for the success of a sinus lift procedure. The most common surgical complication is perforation of the Schneiderian membrane, which is thought to occur because of the presence of maxillary sinus septa. Therefore, we retrospectively investigated the incidence and morphology of maxillary sinus septa using multiplanar reformatted computed tomographic (CT) images from dentate Japanese patients. A total of 276 patients and 552 maxillary sinus segments were evaluated. The maxillary sinus septa were divided into four locations: forefront, anterior, middle, and posterior. The heights of the septa were measured at three sites from the deepest point of the sinus floor: lateral, mid-point, and medial. Sinus septa were identified in 191 of 552 (34.6%) maxillary sinus segments obtained from 111 of 276 (40.2%) patients. One unilateral septum was most commonly detected, and the sinus septa were most often located in the middle of the maxillary sinus. The average height of the identified septa was 8.69 ± 4.68mm (mean ± standard deviation). Multiplanar reformatted CT images can identify maxillary sinus septa in any plane. The height of maxillary sinus septa in the dentate maxillae was higher than detected in previous studies. Appropriate treatment planning using CT images should be considered to prevent surgical complications.

What are the risk factors for maxillary sinus pathologies? A CBCT study.

Some anatomic variations may interfere with proper airflow in the maxillary sinus and predispose to maxillary sinus pathologies. It was also reported that as a result of the transport of microorganisms from infected periapical tissues, maxillary sinus pathologies can develop. The objective of this study was to determine the potential relationships of maxillary sinus septa, concha bullosa, nasal septal deviation, and teeth with periapical lesion to maxillary sinus pathologies. 200 cone beam computed tomography scans obtained at Necmettin Erbakan University, Faculty of Dentistry from 2013 to 2018 were retrospectively reviewed for the presence of maxillary sinus septa, concha bullosa, nasal septal deviation, teeth with periapical lesions, and maxillary sinus pathologies. When maxillary sinus mucosal thickening exceeded 2mm, it was considered as a pathological condition. Logistic regression analysis was used to determine the risk factors for maxillary sinus pathologies. p < 0.05 considered statistically significant. 185 (46.2%) of the 400 maxillary sinuses showed maxillary sinus pathologies. Maxillary sinus septa, concha bullosa, and nasal septal deviation were not found to be as a risk factor for the maxillary sinus pathologies (p > 0.05). At least one apical lesion adjacent to the maxillary sinus increased the maxillary sinus pathology by 5.24 times on the right (OR 5.24, p < 0.001) and by 4.67 times on the left side (OR 4.67, p < 0.001). To prevent maxillary sinus pathologies, it is important for the teeth adjacent to the maxillary sinus to be healthy.

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 %).

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.

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.

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.

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.

Maxillary sinus septa: A systematic review

This review analyzes articles published on the presence of septa in maxillary sinuses. An automated search was conducted on PubMed using different key words. This search resulted in 11 papers in which the presence of antral septa was assessed. These septa are barriers of cortical bone that arise from the floor or from the walls of the sinus and may even divide the sinus into two or more cavities. They may originate during maxillary development and tooth growth, in which case they are known as primary septa; or they may be acquired structures resulting from the pneumatization of maxillary sinus after tooth loss, in which case they are called secondary septa. Several methods have been used in their study, direct observation on dried skulls or during sinus lift procedures; and radiographic observation using panoramic radiographs or computed tomographs. Between 13 and 35.3% of maxillary sinuses have septa. They can be located in any region of the maxillary sinus and their size can vary between 2.5 and 12.7 mm in mean length. Some authors have reported a higher prevalence of septa in atrophic edentulous areas than in non-atrophic ones. If a sinus lift is conducted in the presence of maxillary sinus septa, it may be necessary to modify the design of the lateral window in order to avoid fracturing the septa.