Quantitative assessment of the maxillary sinusitis using computed tomography texture analysis: odontogenic vs non-odontogenic etiology.

OBJECTIVES: The purpose of this study was to investigate computed tomography (CT) texture features of mucosal thickening of maxillary sinus mucosa to differentiate odontogenic maxillary sinusitis (OMS) from non-odontogenic maxillary sinusitis (NOMS). METHODS: Eighteen OMS patients and age- and gender-matched 18 NOMS patients who underwent sinus CT were retrospectively reviewed. OMS patients were identified by histopathological examination of tissues excised at surgery combined with CT imaging findings. Patients with mucosal thickening in the maxillary sinus without apical periodontitis or advanced periodontal bone loss near the maxillary sinus on CT were defined as NOMS. Patients with thin mucosal thickening (< 10 mm), cyst, tumor, post-operative deformity, severe metal artifact precluding visualization of the maxillary sinus, and age younger than 20 years were excluded. CT texture features of the mucosal thickening were analyzed using an in-house developed Matlab-based texture analysis program. Forty-five texture features were extracted from each segmented volume. The results were tested with the Mann-Whitney U test. RESULTS: Six histogram features (mean, median, standard deviation, entropy, geometric mean, harmonic mean) and two gray-level co-occurrence matrix features (entropy, correlation) showed significant differences between OMS and NOMS patients. CONCLUSIONS: CT texture analysis revealed the quantitative differences between OMS and NOMS. The texture features can serve as a quantitative indicator of maxillary sinusitis to differentiate between OMS and NOMS and help prevent incorrect treatment choices.

Comparative assessment of periapical radiography and CBCT imaging for radiodiagnostics in the posterior maxilla.

Close proximity of the maxillary roots and the sinus floor makes a dental disease a probable cause of maxillary sinusitis. The aim of this study was to evaluate the ability of periapical radiography and cone beam computed tomography in defining the topographic relationship of maxillary teeth to the sinus floor and detecting apical periodontitis and other odontogenic causes of the maxillary sinusitis. Out of 145 dental records from subjects (mean age 52 years, range 20-75 years; 89 females) referred to the Oral Imaging Centre, KU Leuven, periapical and CBCT images of the posterior maxilla were selected for further analysis. Anatomical relationship of maxillary teeth to the sinus floor, apical periodontitis and other etiological causes of soft tissue thickening were assessed with both imaging modalities. The results of this study demonstrated that periapical radiographs are not adequate in observing the anatomical relationship between maxillary molars and the sinus floor. CBCT showed an intimate relationship of 1st and 2nd molar with the maxillary sinus in 50 and 45% of the cases, respectively. Periapical radiography could only spot approximately 40% of apical periodontitis on posterior maxillary teeth and 3% of all apical infections extending to the sinus, seen on CBCT.

Sinus balloon dilators: one surgeon's experience and proposed indications for their use.

From October 2006 through September 2007, balloon sinusotomies were attempted on 89 sinuses in 45 patients with chronic sinus disease. Ninety-eight percent of sinuses were successfully dilated, 3.4% required revision surgery, and one complication (unlikely related to use of the balloon) occurred. Forty-four percent had previous conventional endoscopic sinus surgery (ESS), 87% were hybrid cases (combination of balloon and conventional ESS instruments used), 33% had nasal polyposis, and 1.98 sinuses per patient were dilated. Preoperative Lund-Mackay radiographic sinus-staging scores averaged 12.62. Sinus balloon dilators (SBDs) were used on the frontal sinuses 81% of the time, sphenoids 13%, and maxillary sinuses 6%. SBDs were found to be efficacious and safe. The devices were useful in identifying and dilating the frontal recess, especially in cases with altered anatomy or limited visibility. When compared to conventional ESS instrumentation, however, SBDs were found to offer little advantage in opening the maxillary or sphenoid sinuses. In frontal sinus hybrid cases, using the author's proposed surgical algorithm reduces operative time, costs and, in some cases, the need for balloon dilatation. SBDs have limited indications in a select group of patients.

[Maxillary puncture: endoscopic assessment].

Frequency of the injury of the nasolacrimal duct ostium during maxillary puncture through the lower nasal passage was estimated endoscopically. Changes in the maxillary medial wall during the puncture were also studied. Anatomic features of the ostiomeatal complex which may contribute to development of chronic inflammation were determined. Forty one sinuses of 27 deceased middle-aged patients were examined within 24 hours after death. One third of patients in a random population had chronic maxillary inflammation caused by structural anomalies in the ostiomeatal complex. Half of the punctures were made with severe traumas of the nasolacrimal duct ostium. Natural anastomosis of the sinus did not function in about 20% cases. Accessory anastomosis in the posterior fontanelle was registered in 12.2% cases. The posterior fontanelle broke during sinus lavage in 3 cases. Indications for maxillary puncture in acute and chronic maxillary sinusitis should be considered much more carefully in the presence of stable alterations in the ostiomeatal complex and block of the natural anastomosis.

Computed tomographic assessment of chronic rhinosinusitis with asthma.

BACKGROUND: The purpose of this study was to investigate differences in the extent of disease in patients with chronic rhinosinusitis (CRS) both with and without asthma. METHODS: Medical records and computed tomographic (CT) scans of 48 consecutive asthmatic patients and 523 nonasthmatic patients with CRS between April 1995 and December 2001 were reviewed, retrospectively. Each sinus in the ostiomeatal complex CT scans was assigned a score of 0-2 according to the extent of disease using the Lund-Mackay scoring system, and the ratios of the score of each sinus to the total score were analyzed for the difference between the asthmatic and nonasthmatic groups. A Mann-Whitney test was used for statistical evaluation, with p < 0.05 accepted as statistically significant. RESULTS: The ratios of ethmoid sinus score to total score were higher in asthmatic patients than in nonasthmatic patients (p < 0.001), and the ratios of the score of maxillary sinus to total score were lower in asthmatic patients than in nonasthmatic patients (p < 0.001). CONCLUSION: Our study shows that the ethmoid sinus is the preferred site of CRS in patients with coexisting asthma.

Diagnostic value of HRCT and 3DCT in the assessment of chronic maxillary sinusitis.

In a group of 37 patients with chronic maxillary sinusitis in whom CT examination had been performed diagnostic value of secondary spatial reconstructions and high-resolution sections was analysed. It was found that the supplementation of standard CT examination with high-resolution sections and spatial pictures increases diagnostic possibilities in the assessment of maxillary sinusitis as for recognising, differentiating and determining anatomical etiologic factors.

Maxillary antrum involvement in multibacillary leprosy: a radiologic, sinuscopic, and histologic assessment.

Thirty patients having lepromatous leprosy (22 males, 8 females) and showing radiological involvement of the maxillary antrum were subjected to sinuscopy, biopsy, and histopathological examination. Radiological observations showed diffuse opacity in 33.3% of the sinuses, localized mucosal thickening in 28.6%, and generalized thickened mucosa in 38.1%. Sinuscopy revealed inflamed mucosa as the most common finding (40%), followed by ulcerative (26.7%) and granulomatous (10%) lesions of the mucosal lining. The mucosal thickening (localized or generalized) evident on radiology was always associated with granuloma formation and acid-fast bacilli in the histology. The presence of an external nasal deformity indicated a statistically significant chance of encountering mucosal involvement on sinuscopy and histopathology (p < 0.05). There was more chance of finding positive sinuscopic lesions in those patients with a bacterial index above 3+.