Detection of maxillary sinus fungal ball via 3-D CNN-based artificial intelligence: Fully automated system and clinical validation.

BACKGROUND: This study aims to develop artificial intelligence (AI) system to automatically classify patients with maxillary sinus fungal ball (MFB), chronic rhinosinusitis (CRS), and healthy controls (HCs). METHODS: We collected 512 coronal image sets from ostiomeatal unit computed tomography (OMU CT) performed on subjects who visited a single tertiary hospital. These data included 254 MFB, 128 CRS, and 130 HC subjects and were used for training the proposed AI system. The AI system takes these 1024 sets of half CT images as input and classifies these as MFB, CRS, or HC. To optimize the classification performance, we adopted a 3-D convolutional neural network of ResNet 18. We also collected 64 coronal OMU CT image sets for external validation, including 26 MFB, 18 CRS, and 20 HCs from subjects from another referral hospital. Finally, the performance of the developed AI system was compared with that of the otolaryngology resident physicians. RESULTS: Classification performance was evaluated using internal 5-fold cross-validation (818 training and 206 internal validation data) and external validation (128 data). The area under the receiver operating characteristic over the internal 5-fold cross-validation and the external validation was 0.96 ±0.006 and 0.97 ±0.006, respectively. The accuracy of the internal 5-fold cross-validation and the external validation was 87.5 ±2.3% and 88.4 ±3.1%, respectively. As a result of performing a classification test on external validation data from six otolaryngology resident physicians, the accuracy was obtained as 84.6 ±11.3%. CONCLUSIONS: This AI system is the first study to classify MFB, CRS, and HC using deep neural networks to the best of our knowledge. The proposed system is fully automatic but performs similarly to or better than otolaryngology resident physicians. Therefore, we believe that in regions where otolaryngology specialists are scarce, the proposed AI will perform sufficiently effective diagnosis on behalf of doctors.

Primary Ewing's Sarcoma of Maxillary sinus: A Case Report.

Ewing's sarcoma are small round cell tumors belonging to Ewing's family of tumors and the second most common bone tumor seen in children. The most common affected sites are long bones of extremities followed by pelvis and ribs. Primary arising in head and neck region is uncommon and maxillary Ewing's sarcoma is rarely seen. Histologically it is one of many small round cell tumors found in children and therefore immunohistochemical and occasionally molecular studies are required to establish the diagnosis. Imaging features include aggressive bony destruction with periosteal reaction and associated soft tissue mass. Treatment of this tumor is a combination of induction chemotherapy followed by surgery and/or radiation with completion of chemotherapy due to aggressive nature and a high propensity for metastases. Our case is an 11year-old boy diagnosed with primary non-metastatic Ewing's sarcoma of left maxilla. The tumor was positive for CD 99 and FLI-1 and negative for CD 45 and Tdt on immuno-histocytochemical examination. The patient was treated with induction chemotherapy comprising of alternating 3 weekly cycles of Vincristine, Adriamycin and Cyclophosphamide with Etoposide and Ifosfamide. This was followed by radical conformal radiation to a dose of 55.8Gy in 31 fractions with good response. Keywords: Ewing's sarcoma, maxilla, IHC, chemotherapy, radiation.

Challenges in diagnosing odontogenic lesions in maxillary sinuses.

<b>Objectives:</b> The study aimed to identify the patients with pathological lesions in the maxillary sinuses in which the reported symptoms might be indicative of odontogenic origin, as well as to establish specific causative risk factors promoting their development. <br><b>Methods and Materials:</b> The study covered 44 patients with suspected odontogenic maxillary sinusitis. Dental examination and Cone Beam Computed Tomography were completed. The age of patients ranged between 19 and 69 years, and the mean age was 43 (SD = 13.9) years. <br><b>Results:</b> Out of 44 patients, 22 (50%) had non-odontogenic lesions in maxillary sinuses, while in 15 (34.1%) dental origin was established. In the remaining 7 (15.9%) patients, no pathological changes were found in the sinuses. The median of reported symptoms was 10 months (Q1 = 4, Q3 = 24). The reported complaints were not associated with the actual cause of pathological lesions. <br><b>Conclusions:</b> Odontogenic cause of the lesions in the sinuses should primarily be hypothesized, especially in patients with long-term disease symptoms, also regarding any unilateral inflammations.

Efficacy of Alveolar Ridge Preservation after Maxillary Molar Extraction in Reducing Crestal Bone Resorption and Sinus Pneumatization: A Multicenter Prospective Case-Control Study.

AIM: To evaluate, with three-dimensional analysis, the effectiveness of alveolar ridge preservation (ARP) after maxillary molar extraction in reducing alveolar bone resorption and maxillary sinus pneumatization when compared to unassisted socket healing. METHODS: Patients were included in the study following inclusion criteria and underwent minimally traumatic maxillary molar extraction followed by ARP using synthetic nanohydroxyapatite (Fisiograft Bone, Ghimas, Italy) (test group) or unassisted socket healing (control group). Cone-beam computerized tomographies (CBCT) were performed immediately after tooth extraction (T0) and 6 months postoperatively (T1). CBCTs were superimposed by using a specific software (Amira, Thermo Fisher Scientific, USA) and the following items were analyzed in both groups: (i) postextractive maxillary sinus floor expansion in coronal direction and (ii) postextractive alveolar bone dimensional changes (both vertical and horizontal). All data were tested for normality and equality of variance and subsequently analyzed by independent samples T-test and Mann-Whitney test. RESULTS: Thirty patients were treated by three centers and twenty-six (test n=13; control n=13) were included in the final analysis. Mean sinus pneumatization at T1 was 0.69±0.48 mm in the test group and 1.04±0.67 mm in the control group (p=0.15). Mean vertical reduction of the alveolar bone at T1 was 1.62±0.49 mm in the test group and 2.01±0.84 mm in the control group (p=0.08). Mean horizontal resorption of crestal bone at T1 was 2.73±1.68 mm in test group and 3.63±2.24 mm in control group (p=0.24). CONCLUSIONS: It could be suggested that ARP performed after maxillary molar extraction may reduce the entity of sinus pneumatization and alveolar bone resorption, compared to unassisted socket healing. This technique could decrease the necessity of advanced regenerative procedures prior to dental implant placement in posterior maxilla.

Investigation of flow characteristics in the maxillary sinus where polypoid changes develop.

Flow behavior in the maxillary sinus where polypoid changes develop was investigated using computational fluid dynamics. A nasal cavity model was constructed, after performing a virtual polypectomy based on computed tomography images of a patient, using a computer-aided design software to artificially remove polypoid changes inside the maxillary sinus. Local flow characteristics in the maxillary sinus were examined for one full respiration period. The results showed that the epithelial surfaces where polypoid changes occur are located in the lower part of the maxillary sinus which contains a protruding zone of the sinus and are characterized by stagnation of air during the entire respiration period. Due to the geometric characteristics, a very slow recirculating motion was found to occur in the bulging area for approximately half of the respiration period as a result of interaction with a larger-scale, counter-rotating vortex filling the middle of the maxillary sinus. With a much smaller velocity inside the maxillary sinus compared to that typically found in the airway passage through the middle meatus, both wall shear and pressure changes were found to be vanishingly small along the epithelial surface of the maxillary sinus where polypoid changes were found.

Clinical evaluation of modified transalveolar sinus floor elevation and osteotome sinus floor elevation in posterior maxillae: study protocol for a randomized controlled trial.

BACKGROUND: Implant placement in the posterior maxilla is often complicated by the insufficient bone volume. While transalveolar sinus floor elevation (TSFE) has been proven as a predictable surgical procedure to increase the bone height in the posterior maxilla, questions in regard to the necessity of the bone grafting during the sinus lift and the question of whether TSFE could be performed when the residual bone height is below 5 mm are still debated. Furthermore, high-quality evidence comparing the clinical outcome of transalveolar sinus floor elevation with osteotome and modified sinus floor elevation with crestal non-cutting drills is limited. METHODS/DESIGN: One hundred twenty adult patients who fit the inclusion criteria are being recruited from the Peking University Hospital of Stomatology First Clinical Division (Beijing, China). All patients are assigned to one of four groups according to a table of random numbers. Participants will receive (1) TSFE using osteotomes with bone grafting, (2) TSFE using osteotomes without bone grafting, (3) modified TSFE with bone grafting, or (4) modified TSFE without bone grafting. In a one-year follow-up period, implant survival rates, complications, implant stability, bone remodeling around the implant, and patient-reported outcome (visual analog scale for intraoperative discomfort and postoperative pain) will be observed and documented. The implant stability will be gauged by the resonance frequency analysis six times (at baseline and weeks 6, 8, 12, 16, and 26), and the bone remodeling will be observed and compared via radiographic examinations. DISCUSSION: The result of the trial will potentially contribute to better decision making in atrophic posterior maxilla when implant placement is needed. Therefore, if the outcome is deemed favorable, the use of the modified TSFE would achieve an outcome equivalent to that of the traditional TSFE while introducing less trauma and postoperative discomforts. Separately, whether the bone graft procedure is necessary for the TSFE will also be discussed. TRIAL REGISTRATION: The study has been registered in ClinicalTrials.gov under the identifier number NCT03445039 . Registered on 26 February 2018.

Inferior Turbinate Swing Technique: A Novel Surgical Route to Approach Maxillary Sinus Area Pathology.

The inferior turbinate is an important structure for maintenance of adequate physiologic function within the nasal cavity. However, it hampers access to lesions involving maxillary sinus areas, including postoperative mucocele or benign tumor, and acts as an inferior limit to widening the natural ostium of a maxillary sinus. Here, we introduce a novel technique, interior turbinate swing, to facilitate entry to the inferior meatus or maxillary sinus while maintaining integrity of the inferior turbinate. In this technique, the anterior part of inferior turbinate is cut with sharp scissors, rotated posteriorly, and held in the nasopharynx. The inferior turbinate swing technique was employed in 38 subjects, and no patients exhibited recurrence of the causative disease without complication. Therefore, we may conclude that the inferior turbinate swing technique is a simple, effective, and safe treatment option for the management of postoperative mucocele, maxillary sinusitis with narrow inlet, or benign tumors.

Atelectasia maxilar crónica bilateral con resolución espontánea / Bilateral chronic maxillary atelectasis with spontaneous resolution

RESUMEN La atelectasia maxilar crónica (AMC) es una condición adquirida y rara que consiste en la disminución persistente y progresiva del volumen del seno maxilar, con retracción centrípeta de sus paredes secundaria a la oclusión completa de tipo valvular del ostium natural. Esta condición genera presión negativa dentro del seno maxilar, conduciendo a atelectasia y colapso de la pared. La fisiopatología es compartida con síndrome de seno silente, por lo que se postula que se podrían englobar a ambas dentro de la misma enfermedad. Presentamos el caso de un paciente con diagnóstico de AMC bilateral por tomografía axial computarizada a la edad de 3 años, que se resolvió en forma espontánea en forma bilateral; el maxilar derecho a los 6 años y el izquierdo a los 10 años.

ABSTRACT Chronic maxillary atelectasis (CMA) is a rare and developed condition that consists in the progressive and persistent decrease volume of the maxillary sinus, with centripetal retraction of the walls secondary to the complete occlusion of the natural ostium. This condition generates negative pressure inside the maxillary sinus, heading to atelectasis and collapse of the walls. It is proposed that the disease includes the silent sinus syndrome, as the physiopathology is shared between them. We present the case of a 3 years old boy with bilateral chronic maxillary atelectasis observed in the CT scan, who evolved with spontaneous bilateral resolution. The right maxillary sinus CMA resolved at 6 years old, and the left at 10 years old.

Maxillary Sinus Floor Augmentation Using an Equine-Derived Graft Material: Preliminary Results in 17 Patients.

OBJECTIVE: Sinus floor elevation with lateral approach is probably the most frequently performed reconstructive procedure to rehabilitate posterior maxilla when a bone deficiency is present. Different graft materials have been proposed and tested, often with high clinical performances and predictable results. Histological analysis is required when evaluating new materials. We investigated human biopsies retrieved after sinus floor elevation procedure by histomorphometric evaluation to test the performance of an equine-derived bone grafting material. STUDY DESIGN: Seventeen consecutive patients were enrolled and sinus lift surgeries were performed using an equine bone graft. Six months after surgery, at implant placement, bone samples were collected. Histomorphometry analysis was carried out on decalcified samples. RESULTS: All surgeries were uneventful and no additional grafting was required prior to implant insertion. Forty percent of new bone formation was detected, which represented the most abundant tissue retrieved, followed by the residual graft material (33%) and fibrous tissue (27%). A significant reduction in particles size demonstrates a remodeling activity of the graft material. CONCLUSION: Within the limitations of this study, this equine-derived bone graft proved to be an effective material to induce new bone formation in the sinus floor elevation procedure.

[CFD-simulation of the air flows in the maxillary sinus]. / CFD-modelirovanie vozdushnykh potokov v verkhnecheliustnoi pazukhe.

This article summarizes the results of computer simulation of the air flows in the nasal cavity and the maxillary sinus by the computational fluid dynamics (CFD) method. The objective of the study was to apply the method of computational aerodynamics to simulate the air flows in the nasal cavity and the maxillary sinus under the normal conditions and after the surgical interventions on the middle nasal meatus. The normal air space of the nasal cavity and paranasal sinuses was simulated and the computer modeling of the main options for the surgical approach to the maxillary sinus through the middle nasal meatus was performed including balloon sinuplasty, functional endoscopic sinus surgery, and uncinate process mobilization. The study has demonstrated the increase of the air flow velocity in the maxillary sinus after computer-assisted balloon sinuplasty. The computer simulation of functional endoscopic sinus surgery including the removal of the uncinated process revealed the mass exchange between the maxillary sinus and the nasal cavity.

The effects of the stem cell on ciliary regeneration of injured rabbit sinonasal epithelium.

Defects in mucosal healing after sinonasal surgery cause infection, scar formation causing obstruction, relapse of the disease within a shorter period and revision surgery. The present study aimed to create a functional ciliated epithelium using a stem cell and stem cell sheet of adipose tissue origin and to show such regeneration ultra-structurally on experimentally injured rabbit nasal epithelium. This was an experimental animal study and basic research. A total of 18 white New Zealand rabbits were divided into three groups. The medial wall of the maxillary sinus of the subjects was peeled off bilaterally. No additional procedure was applied to the subjects in Group 1. In Group 2, adipose tissue-derived mesenchymal stem cell was implanted on the wound edges of the subjects. In Group 3, a stem cell sheet of three layers was laid onto the defect area. All subjects were killed after 3 weeks. The presence of the stem cell stained with bromo-deoxyuridine was assessed with a light microscope, whereas cilia density, ciliated orientation and cilia structure were evaluated with a scanning electron microscope. Ciliary densities in Group 2 and Group 3 were statistically superior compared to the control group (p < 0.001, p = 0.007). Cilia morphology in Group 2 and Group 3 was also better than the control group (p < 0.01, p = 0.048). Ciliary orientation in Group 2 was scored highest (p < 0.01). The ratio of BrDu-stained cells was observed to be 27% in Group 3 and 8% in Group 2. Sub-epithelial recovery was observed to be better in Group 3. Adipose tissue-derived mesenchymal stem cell increased the healing of the injured maxillary sinus mucosa of the rabbits in terms of cilia presence, density and morphology regardless of the implementation technique. Level of evidence NA.

Maxillary Sinus Augmentation with Decellularized Bovine Compact Particles: A Radiological, Clinical, and Histologic Report of 4 Cases.

Background. One of the most problematic regions for endosseous implants is the posterior maxilla, not only having poor bone density, but also lacking adequate vertical height as a result of sinus pneumatization. The purpose of the present study was a radiologic, histological, and histomorphometrical evaluation, in humans, of specimens retrieved from sinuses augmented with decellularized bovine compact particles, after a healing period of 6 months. Methods. Four patients, with atrophic resorbed maxillas, underwent a sinus lift augmentation with decellularized bovine compact bone from bovine femur. The size of the particles used was 0.25-1 mm. A total of four grafts and 5 biopsies were retrieved and processed to obtain thin ground sections with the Precise 1 Automated System. Results. The mean volume after graft elevation calculated for each of the 4 patients was 2106 mm3 in the immediate postoperative period (5-7 days), ranging from 1408.8 to 2946.4 mm3. In the late postoperative period (6 months) it was 2053 mm3, ranging from 1339.9 to 2808.9 mm3. Histomorphometry showed that newly formed bone was 36 ± 1.6% and marrow spaces were 34 ± 1.6%, while the residual graft material was 35 ± 1.4%. Conclusion. In conclusion, based on the outcome of the present study, Re-Bone® can be used with success in sinus augmentation procedures and 6 months are considered an adequate time for maturation before implant placement.

[The influence of accessory ostia on the development and the course of the inflammatory processes in the maxillary sinuses].

The objective of the present study was to detect accessory ostia in the patients presenting with various diseases of the maxillary sinuses. We undertook the endoscopic examination of the middle meatuses in 250 patients. It was shown that accessory ostia can be especially frequently seen in the patients with chronic maxillary sinusitis and nasal septum deviation.

Numerical study on the effect of uncinectomy on airflow modification and ventilation characteristics of the maxillary sinus.

In this study, we examined the effect of uncinectomy on the alteration in local airflows and on the resulting effect on gas exchange in the maxillary sinus, by using computational fluid dynamics in two nasal cavity models: one with a preserved uncinate process, and the other with the uncinate process removed virtually. Uncinectomy distinctively changed the local flow topology by triggering the formation of counter-rotating vortices in the ostiomeatal complex, except for the instants with relatively low airflow rate when the respiration phase changed, ultimately leading to a change in the velocity field inside the ostium and maxillary sinus. Despite a significant increase in the maximum air velocity through the maxillary ostium, ventilation was found to increase only slightly when the uncinate process was removed. Furthermore, the degree of maxillary sinus ventilation by inhaled air was comparable to that by exhaled air. This was true to both models and was independent of the presence of the uncinate process.

Association between maxillary sinus pathologies and healthy teeth / Relação entre doenças no seio maxilar e dentes hígidos

ABSTRACT INTRODUCTION: The proximity of the roots to the maxillary sinus can create a variety of risks. OBJECTIVE: To evaluate the relationship between the roots of healthy teeth and the maxillary sinus, as well as the occurrence of sinus pathologies. METHODS: Three radiologists analyzed 109 cone beam computed tomography (CBCT) images. The Kappa test was used to assess the intra- and inter-rater agreement. The chi-squared test and prevalence ratio were used to test the hypothesis that roots of healthy teeth in the maxillary sinus favored the occurrence of sinus pathologies ( p = 0.01). RESULTS: Intra- and inter-rater agreement ranged from good to excellent. The chi-squared test demonstrated a statistically significant difference ( p = 0.006) between the tooth roots in diseased maxillary sinuses (6.09%) and those in normal sinuses (3.43%). The prevalence ratio test showed a statistically significant higher prevalence of tooth roots in diseased sinuses than in normal sinuses ( p < 0.0001). Roots in the maxillary sinus were 1.82 times more associated with diseased sinuses. CONCLUSION: Dental roots in the maxillary sinus are almost twice as likely to be associated with diseased sinuses than normal sinuses. Healthy teeth whose roots are inside the maxillary sinus may induce an inflammatory response in the sinus membrane. It is suspected that dental procedures may exacerbate the condition.

RESUMO INTRODUÇÃO: A proximidade das raízes com o seio maxilar pode criar uma variedade de riscos. OBJETIVO: Avaliar a relação entre as raízes dos dentes hígidos com o seio maxilar, assim como com a ocorrência de doenças sinusais. MÉTODO: Três radiologistas analisaram 109 imagens de tomografia computadorizada de feixe cônico (TCFC). O teste Kappa avaliou a concordância intra e interexaminadores. Os testes de Qui-quadrado e Razão de Prevalência foram utilizados para testar a hipótese de que raízes de dentes hígidos dentro do seio maxilar favorecem a ocorrência doenças sinusais (nível de significância = 0,01). RESULTADOS: A concordância intra e interexaminadores variou de boa a excelente. O teste Qui-quadrado mostrou uma diferença estatisticamente significante (p = 0,006) entre as raízes dentárias dentro do seio maxilar patológico (6,09%) e aquelas dentro do seio normal (3,43%). O teste de Razão de Prevalência mostrou uma ocorrência de raízes dentárias dentro de seios patológicos estatisticamente maior do que dentro de seios normais (p < 0,0001). As raízes dentro do seio maxilar foram encontradas 1,82 vezes mais associadas a seios patológicos. CONCLUSÃO: Raízes dentárias dentro do seio maxilar são quase duas vezes mais associadas a seios patológicos do que a seios normais. Dentes hígidos que têm raízes dentro do seio maxilar podem induzir uma resposta inflamatória da mucosa sinusal. Suspeita-se que procedimentos odontológicos possam agravar tal situação.

Association between maxillary sinus pathologies and healthy teeth.

INTRODUCTION: The proximity of the roots to the maxillary sinus can create a variety of risks. OBJECTIVE: To evaluate the relationship between the roots of healthy teeth and the maxillary sinus, as well as the occurrence of sinus pathologies. METHODS: Three radiologists analyzed 109 cone beam computed tomography (CBCT) images. The Kappa test was used to assess the intra- and inter-rater agreement. The chi-squared test and prevalence ratio were used to test the hypothesis that roots of healthy teeth in the maxillary sinus favored the occurrence of sinus pathologies (p=0.01). RESULTS: Intra- and inter-rater agreement ranged from good to excellent. The chi-squared test demonstrated a statistically significant difference (p=0.006) between the tooth roots in diseased maxillary sinuses (6.09%) and those in normal sinuses (3.43%). The prevalence ratio test showed a statistically significant higher prevalence of tooth roots in diseased sinuses than in normal sinuses (p<0.0001). Roots in the maxillary sinus were 1.82 times more associated with diseased sinuses. CONCLUSION: Dental roots in the maxillary sinus are almost twice as likely to be associated with diseased sinuses than normal sinuses. Healthy teeth whose roots are inside the maxillary sinus may induce an inflammatory response in the sinus membrane. It is suspected that dental procedures may exacerbate the condition.

Large Reactional Osteogenesis in Maxillary Sinus Associated with Secondary Root Canal Infection Detected Using Cone-beam Computed Tomography.

Inflammatory injuries in the maxillary sinus may originate from root canal infections and lead to bone resorption or regeneration. This report describes the radiographic findings of 4 asymptomatic clinical cases of large reactional osteogenesis in the maxillary sinus (MS) associated with secondary root canal infection detected using cone-beam computed tomographic (CBCT) imaging. Apical periodontitis, a consequence of root canal infection, may lead to a periosteal reaction in the MS and osteogenesis seen as a radiopaque structure on imaging scans. The use of a map-reading strategy for the longitudinal and sequential slices of CBCT images may contribute to the definition of diagnoses and treatment plans. Root canal infections may lead to reactional osteogenesis in the MS. High-resolution CBCT images may reveal changes that go unnoticed when using conventional imaging. Findings may help define initial diagnoses and therapeutic plans, but only histopathology provides a definitive diagnosis. Surgical enucleation of the periapical lesion is recommended if nonsurgical root canal treatment fails to control apical periodontitis.

[The mechanical properties of the bone tissue from the middle facial region].

The objective of the present work was to study age-related features of the reaction of the maxillary sinus cavity walls to a variety of impacts associated with the surgical interventions. To this effect, a variety of stress-strain conditions were simulated that are known to arise in the maxillary sinus cavity walls under the action of different force vectors taking into consideration the age-specific peculiarities of the mechanical structure of the bone tissue. The 3D model of the maxillary sinus cavity was built up based on the results of spiral computed tomography with the use of the Solid Works 2012 software package (USA). The finite element method (FEM) was employed to construct the grid. Three variants of force application were simulated, one to the canine fossa region, another to the upper portion of the alveolar process at the border between the upper and lower walls of the sinus, and the third to the anterior part of the inferior nasal passage. The study has demonstrated that the bone wall of the maxillary sinus differently responds to the impacts of similar magnitude depending on the application point and age-related physical and mechanical properties of the bone tissue. This finding should be taken into account in the choice of the optimal surgical approach to the maxillary sinus. It was calculated that endonasal interventions should be preferred for the treatment of patients above 60 years of age as the minimally injurious ones to the bone tissue. Moreover, special caution is needed when the intervention is performed beneath the canine fossa, where the bone is extremely fragile and the risk of injury extension to the floor of the maxillary sinus is especially high.