Does sinus membrane thickness influence the risk of perforation during lateral sinus lift surgery for dental implants? a systematic review and meta-analysis.

BACKGROUND: We reviewed the literature to examine if the thickness of the sinus membrane is a risk factor for perforation during lateral sinus lift surgery. MATERIAL AND METHODS: We searched Embase, PubMed, and Web of Science databases till 4th December 2023 for studies examining the risk of perforation with different sinus membrane thicknesses. Studies reporting sinus membrane thickness in perforation and non-perforation cases were also included. RESULTS: Eleven studies were eligible. All studies used cone beam computed tomography for measuring sinus membrane thickness. Meta-analysis showed that sinus membrane thickness was significantly lower in perforation cases as compared to non-perforation cases (MD: -0.91 95% CI: -1.48, -0.33 I2=94%). Four studies used 2mm as the cut-off to define thick and thin sinus membranes. Pooled analysis failed to demonstrate any significant difference in perforation rates (OR: 0.97 95% CI: 0.44, 2.17 I2=56%). Meta-analysis of studies using 1.5mm (OR: 0.66 95% CI: 0.29, 1.48 I2=72%) and 1mm cut-off (OR: 0.93 95% CI: 0.34, 2.56) also demonstrated similar non-significant results. CONCLUSIONS: Our study shows that the sinus membrane is significantly thinner in cases with perforations as compared to those with no perforations. However, a meta-analysis based on different membrane thickness cut-offs failed to demonstrate a relationship between thinner sinus membranes and a higher risk of perforation. There is a need for further studies examining the role of sinus membrane thickness on perforation rates.

[Large foreign bodies inside the orbit and maxillary sinus (clinical observation)]. / Krupnye inorodnye tela glaznitsy i verkhnechelyustnoi pazukhi (klinicheskoe nablyudenie).

The great variety of orbital traumas can surprise and challenge specialists attempting to cure its consequences with the best possible outcome. This article presents a clinical case of a patient diagnosed with cicatricial deformity of the free edge and trichiasis of the upper eyelid in the lateral angle area, keratopathy, enophthalmos on the left side; posttraumatic defect of the inferior orbital wall; multiple foreign bodies in the orbit and maxillary sinus on the left side. Patient examination included conventional ophthalmological study methods, as well as multislice computed tomography with 3D-reconstruction. Surgical treatment required involvement of an ophthalmologist, an otorhinolaryngologist and a maxillofacial surgeon. The first stage of surgical treatment addressed the deformity of the lateral part of the upper eyelid margin including resection of its fragment, trichiasis surgery, and lateral canthoplasty. In the second stage, the multidisciplinary team of surgeons removed foreign bodies through combined subciliary and endonasal access with placement of a mandibular autograft onto the inferior orbital wall. Radiological examination should be done in all patients with trauma to the orbital area in order to detect latent injuries. When choosing a treatment strategy, specialists should be aware of trauma complicity and necessity to enlist a multidisciplinary medical team. Patients should be informed that sometimes the consequences of the trauma may not be treated completely.

Does maxillary sinus size affect the risk for zygomatic complex fractures?

The purpose of the study was to measure the maxillary sinus sizes in patients with and without zygomatic bone fractures. In this cross-sectional study computed tomography data of a case group of consecutive treated patients with displaced zygomatic bone fractures were compared to a control group with mandibular fractures. Maxillary sinus sizes were measured in width, height, depth, and volume. We compared sinus sizes between the case and control group, followed by a subgroup analysis of slightly and severely displaced fractures using T-tests. We identified 89 cases, thereof 46 with slightly and 43 with severely displaced fractures. The control group consisted of 110 patients. The mean sinus volume of the case group (19,313 mm3 ± 5237) was significantly larger than in the control group (17,645 mm3 ± 4760; p = 0.02). Subgroup analyses revealed that this difference in volume was more pronounced between patients with severely displaced fractures (20,354 mm3 ± 5416; p = 0.003) and the control group. In two-dimensional measures, only sinus height was significantly greater in the case group (37.41 mm ± 4.25 vs. 35.33 mm ± 4.88; p = 0.002). The same holds for the subgroup with severely displaced fractures (38.27 mm ± 3.91; p = 0.001). Sinus width and depth showed no significant differences between the groups. A maxillary sinus volume larger than 20,000 mm3 is a predictive risk factor for a displaced zygomatic bone fracture. Greater sinus height indicates a larger surface area of the zygomaticomaxillary buttress that decreases the resistance to facial trauma.

Spontaneous Fracture of the Maxillary Sinus as a Consequence of Nose-Blowing.

ABSTRACT: Spontaneous fracture of the maxillary sinus without preceding trauma or pathology is extremely rare. Our patient presented with a maxillary sinus fracture related to recurrent nose-blowing, in the absence of any other cause. Although rare, spontaneous fracture of maxillary sinus should be considered in the differential diagnosis of pain and swelling of the cheek and eye in elderly patients.

Removal of Displaced Dental Implants in the Maxillary Sinus Using Endoscopic Approaches.

With the broad indications for dental implantation, complications rates have increased. Dental implant displacement into the maxillary sinus, although rare, can occur during the restoration of maxillary posterior teeth. We performed a 6-year retrospective review and found 3 cases with displaced implants in the maxillary sinus. Detailed information, including surgical indications and dental implant removal methods, is provided. Dental implants can be dislocated to the maxillary sinus perioperatively or postoperatively. Endoscopic sinus surgery can be performed to remove the implant and restore sinus patency. If the implant is displaced to deeper areas (commonly anterior and inferior) of the maxillary sinus, a prelacrimal recess approach can provide a panoramic view of the maxillary sinus and is a good alternative to the Caldwell-Luc operation in terms of mucosal preservation and postoperative complications.

COVID-19 with pleural effusion as the initial symptom: a case study analysis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly identified strain of coronavirus in the human body and was reported in Wuhan at the end of 2019. So far, the epidemic is continuing and very serious, with the number of infections and deaths increasing. Despite active investigations around the world to better understand the dynamics of transmission and the scope of clinical disease, COVID-19 continues to spread rapidly from person to person. The common signs and symptoms of SARS-CoV-2 infection include fever, fatigue, dry cough, and dyspnea; in severe cases, patients may have acute respiratory distress syndrome, septic shock, metabolic acidosis difficult to treat and coagulation disorder. However, some patients who test positive for SARS-CoV-2 in their respiratory tract may not have such clinical signs and symptoms. This report presents a case study analysis of a patient admitted in the Fourth Taiyuan People's Hospital, who had suffered traumatic injuries from a car accident and survived COVID-19, with pleural effusion as the initial symptom. We report a case of 2019-NCOV with pleural effusion as the first symptom. Describe in detail the differential diagnosis, diagnosis, clinical management, and cure of this case. In order to combat the novel CoronaviruscoVID-19 in the process to provide lessons and help.

Intrasinus bolstering of traumatic maxillary sinus fractures by using Foley catheter balloons in two foals.

OBJECTIVE: To describe the repair of unstable facial fractures by using Foley catheter balloons as intrasinus bolsters. STUDY DESIGN: Case report ANIMALS: Two weanling foals with unilateral fractures of the sinus and orbit secondary to kick injuries. Preoperative imaging that included positive contrast dacrocystorhinography and computed tomography confirmed severe comminution of facial fractures and nasolacrimal duct disruption in both foals. METHODS: Small bone fragments were surgically removed, and large fragments were retained even when denuded of periosteum. Repair procedures included nasolacrimal canaliculosinusotomy and suturing fracture fragments together with polydioxanone sutures. After fixation, the fracture fragments could be depressed into the sinus with manual pressure, so two intrasinus Foley catheters were placed to bolster the sinus wall, with the tubing exiting through a frontal sinus trephine. The skin was completely closed over the fractures. Catheters and nasolacrimal stenting were maintained in place during fracture healing. RESULTS: One foal prematurely dislodged catheters and nasolacrimal stent 11 days after fixation. The catheters and stenting were removed as planned 4 weeks after surgery in the second foal. Wound, fracture healing, and overall cosmesis was good in both foals, and epiphora resolved. Surgical site infection, sinusitis, and sequestration did not occur. Both foals became high-level performance horses with acceptable cosmetic outcome and good bilateral nasal airflow. CONCLUSION: Foley catheter balloons supported sinus fracture repair and maintained stability of the surgical reconstruction during convalescence. CLINICAL SIGNIFICANCE: Suture repair of comminuted sinus fractures can be supported by using Foley catheters, which are readily available.

Reverse Squeeze Maxillary Sinus Barotrauma.

A young female patient presented to ear, nose, and throat clinic with long history of left sided facial pain exacerbated while flying and being in high altitude. Examination of nasal cavity and computed tomography scan of sinuses suggested left maxillary sinus barotrauma. Endoscopic sinus surgery was performed completely resolving her symptoms. Based on her symptoms and examination findings she had reverse squeeze sinus barotrauma.

Non-Cross-Linked Versus Cross-Linked Collagen Membrane In Maxillary Sinus Perforation Repair: A Comparative Histologic Study In A Rat Model.

PURPOSE: To compare and evaluate maxillary sinus perforation repair, bone regeneration, and membrane degradation with cross-linked and non-cross-linked collagen membranes in rat sinuses at 2, 4, and 10 weeks, respectively. MATERIALS AND METHODS: Fifty-one Sprague-Dawley rat models were included in the study. Bilateral maxillary sinus perforations were made with a straight bur. In the control site, cross-linked collagen membrane (Ossix Plus) was placed, and in the test site, non-cross-linked collagen membrane was used (Pro-Tiss). Euthanasia was carried out under carbon dioxide asphyxia where 17 rats were sacrificed at weeks 2, 4, and 10. Histologic evaluation of the specimens was subsequently done. RESULTS: At 2 (P = .001), 4 (P = .031), and 10 (P = .024) weeks, there was a significant regeneration of maxillary sinus lining in sites treated with non-cross-linked collagen membrane over the cross-linked collagen membrane. No significant differences were observed in measures of bone regeneration (P = .92; 10 weeks) and membrane degradation (P = .06; 4 weeks) at the end of the study period between the two groups. CONCLUSION: The non-cross-linked collagen membrane appears to be more beneficial in maxillary sinus repair. However, they do not seem to confer additional benefits in bone regeneration or membrane degradation over cross-linked collagen membranes.

Posttraumatic Middle Meningeal Artery Pseudoaneurysm: Case Report and Review of the Literature.

BACKGROUND: Intracranial pseudoaneurysm is a rare entity, with few cases described in the literature, and is mostly associated with a history of traumatic brain injury. Traumatic aneurysms comprise <1% of all intracranial aneurysms. In particular, middle meningeal artery (MMA) aneurysms are uncommon and usually caused by a skull fracture in the temporal region. About 40 traumatic MMA aneurysms are reported in the literature, and only 28 nontraumatic aneurysms are reported, usually related to high-flow conditions. The behavior of these aneurysms is largely unknown: both spontaneous resolution and aneurysm growth, leading to subsequent rupture, have been reported. Surgical and endovascular management are feasible for MMA aneurysms; however, the criterion standard treatment is not defined. CASE DESCRIPTION: We report the case of a traumatic pseudoaneurysm of the right MMA treated with an endovascular approach and provide a review of the literature. CONCLUSIONS: Aneurysms of the MMA are a rare entity that must be taken into account in the setting of a traumatic brain injury or predisposing factors. The diagnosis and aggressive treatment are mandatory, preventing the devastating consequences of their rupture. Endovascular and surgical techniques are well defined and available, even though there is not a demonstrated superiority in any of them.

Potential risk factors for maxillary sinus membrane perforation and treatment outcome analysis.

BACKGROUND: Most common complication of sinus floor elevation (SFE) is sinus membrane perforation (SMP). PURPOSE: To investigate the correlation between SMP and potential risk factors and to evaluate SMP treatment outcomes. MATERIALS AND METHODS: This study included patients who had undergone a SFE at Division of Oral Surgery and Orthodontics, Medical University of Graz from 2013 to 2017. Analysis of patients' records and CBCT focused on patient-related risk factors (sinus contours, thickness of membrane and lateral sinus wall, interfering septa, crossing vessels, former oroantral communication) and intervention-related risk factors (surgical approach, sides, number of tooth units, and sites). The outcome of SMP treatment was analyzed in the recalls. RESULTS: In all, 121 patients underwent 137 SFE. There were 19 cases of SMP (13.9%). Two significant factors were identified: maxillary sinus contours (P = .001) and thickness of the sinus membrane (P = .005). The sinus membrane perforation rate was highest in narrow tapered sinus contours and when the sinus membrane was thinner than 1 mm. Among 19 cases with SMP, no complications were seen upon recall. CONCLUSIONS: Maxillary sinus contours and sinus membrane thickness seem to be relevant factors for SMP. Sinus membrane perforations were successfully treated by coverage with collagen membrane.

Traumatic displacement of teeth into maxillary sinus and the retrieval assisted by computer-assisted navigation: A case report.

RATIONALE: Traumatic displacement of teeth into the maxillary sinus is rare. This report described a case of 2 molars accidentally displaced into the maxillary sinus and the retrieval of teeth assisted by computer-assisted navigation. PATIENT CONCERN: A 16-year-old male patient suffered from maxillofacial trauma with the first and second molars in the left maxilla were missing, and an orificium fistula to the maxillary sinus appeared in the dentition region of molars. DIAGNOSE: The tomography revealed 2 tooth-like hyperdensity images in the left maxillary sinus. INTERVENTION: Computer-assisted navigation surgery was scheduled for the retrieval surgery, and the displaced teeth were removed from the maxillary sinus smoothly. OUTCOMES: The patient displayed uneventful wound healing without postoperative complications in the maxillary sinus. LESSONS: Surgeons should be alert to the presence of missing teeth in maxillofacial trauma and avoid missed diagnosis, and computer-assisted navigation is recommended for the retrieval of teeth displaced into the maxillary sinus.

Progressive ossifying paranasal sinus mass of suspected traumatic origin in a mare: Surgical treatment and follow-up.

This report describes a case of a multilobular, osseous mass including parts of the right orbit, concho frontal sinus and right ventral and dorsal conchal sinuses that developed after a traumatic insult to the right maxillary sinus 4 years prior to presentation. Surgical removal of the mass including parts of the bony orbit and long-term outcome are reported.

Masse des sinus paranasaux à ossification progressive d'origine traumatique soupçonnée chez une jument : traitement chirurgical et suivi. Ce rapport décrit une masse multilobulaire et osseuse comprenant des parties de l'orbite droite, des cornets nasaux frontaux et des sinus ventral et dorsal droits qui s'est développée après un traumatisme du sinus maxillaire droit 4 années avant la présentation. L'ablation chirurgicale de la masse, incluant des parties de l'orbite osseuse et les résultats à long terme sont signalés.(Traduit par Isabelle Vallières).

Influence of orthodontic mini-implant penetration of the maxillary sinus in the infrazygomatic crest region.

INTRODUCTION: Mini-implants are widely used for predictable tooth movements, but insertion is often restricted by anatomic structures. The aims of this study were to investigate the incidence of penetration of mini-implants into the sinus and the relationship between penetration depth and sinus tissue. METHODS: Data from 32 patients who received mini-implants in the infrazygomatic crest were collected from a data base. The success rate of mini-implants was determined by clinical retrospective analysis. The incidence of penetration, penetration depth, and sinus configuration were investigated and compared between cone-beam computed tomography scans obtained immediately after insertion and before mini-implant removal. RESULTS: The overall success rate of mini-implants in the infrazygomatic crest was 96.7%, and 78.3% penetrated into the sinus. In the group in which penetration exceeded 1 mm, the incidence of membrane thickening was 88.2%, and the mean value of thickening was 1.0 mm; however, the variable values of penetration in the 1-mm group were only 37.5% and 0.2 mm, respectively (P <0.05). CONCLUSIONS: The incidence of penetration of infrazygomatic crest mini-implants into the sinus may be high. Penetration through double cortical bone plates with limitation of the penetration depth within 1 mm is recommended for infrazygomatic crest mini-implant anchorage.

Risk factors and clinical outcomes of sinus membrane perforation during lateral window sinus lifting: analysis of 120 patients.

The aim of this study was to identify the risk factors associated with sinus membrane perforation and the effect of sinus membrane perforation and other risk factors on graft success and postoperative sinusitis. Sinus membrane perforation, graft failure, and postoperative sinusitis were tested for an association with age, sex, operator experience, side of the operation, residual bone height, presence of septa, presence of a mucous retention cyst, and smoking (χ2 test). Logistic regression analysis was used to model the odds ratio (OR) with corresponding risk factors. One hundred and twenty patients were included in this study. A total of 22 (18.3%) perforations occurred. A residual bone height of 3-6mm (OR 6.808, P=0.002) and presence of septa (OR 4.023, P=0.025) were identified as significant risk factors. Twenty-eight (23.3%) sinus grafts were classified as failed. Membrane perforation (OR 16.819, P<0.005) and residual bone height of 3-6mm (OR 5.363, P=0.01) were identified as significant risk factors for graft failure. None of the risk factors investigated in this study was significantly associated with postoperative sinusitis. These results suggest that the presence of septa and a residual bone height of 3-6mm are associated with an increased risk of sinus membrane perforation, and that sinus membrane perforation has a negative effect on graft success.

Localization of the Maxillary Ostium in Relation to the Reduction of Depressed Nasomaxillary Fractures.

The aim of this study was to elucidate the precise location of the maxillary ostium using computed tomography for the reduction of depressed nasomaxillary fractures.Computed tomography images (61 males, 42 females; age range, 3-97 years) were analyzed. Coronal sections were cut every 3 mm.The primary maxillary ostium (PMO) was located 24.7% ±â€Š3.9% of bizygomatic distance (BZD) lateral to septum. The horizontal distance of the PMO significantly increased with age (P = 0.032). The PMO was located 53.3% ±â€Š8.0% of nasal length (NL) above superior surface of the palatal bone (SP). The vertical-to-horizontal ratio of the PMO decreased with age (P = 0.013). The PMO was located 30.3 ±â€Š4.3 mm posterior to the tip of nasal bone. The PMO was located 24.6 ±â€Š4.8 mm posterior to the anterior nasal spine (ANS). The ANS-PMO distance significantly increased with age (P = 0.027). The hiatus semilunaris (HS) was located 11.9% ±â€Š3.2% of BZD lateral to septum. The HS was located 62.4% ±â€Š10.3% of NL above SP. The vertical distance of the HS significantly decreased with age (P = 0.019). The accessory maxillary ostium (AMO) was located 14.9% ±â€Š2.8% of BZD lateral to septum. The horizontal distance of the AMO significantly increased with age (P = 0.027). The AMO was located 44.8% ±â€Š6.9% of NL above SP. The vertical distance of the AMO significantly decreased with age (P < 0.001). The vertical-to-horizontal ratio of the AMO decreased with age (P < 0.001).The distances of the ostium from surgical landmarks measured in this study might be helpful when inserting a small curved elevator into the maxillary ostium in the reduction of medial maxillary fractures.

Repair of a perforated sinus membrane with an autogenous periosteal graft: a study in 24 patients.

We describe a technique for repairing a perforation of the sinus membrane with a periosteal graft. Of 117 patients who had augmentation of the sinus floor, the sinus membrane perforated in 24, and these were repaired with autogenous periosteal grafts. Patients were followed up daily for the first 10days and monthly for the next six months, and clinical and radiographic variables were recorded. Patients had to be free of complications such as wound dehiscence, sinus infections, exposure of the graft, local inflammation, or pain. The radiographs showed correct osseointegration of all implants. Periosteal grafts are an effective alternative for repair of a perforation of the sinus membrane.

Pólipos bucales como complicación de una fractura de la tuberosidad / Oral polyps as a complication of a tuberosity fracture

Introducción: la importancia de los senos maxilares se vuelve más clara cuando se entiende que los dientes son responsables del 10 al 12 por ciento de las sinusitis maxilares. Objetivo: caracterizar un caso de pólipos bucales como complicación de una fractura de la tuberosidad. Presentación del caso: se valora una paciente femenina de 62 años que refiere tener una bolita en la boca desde hace 3 semanas, que le ha ido en aumento. Al examen físico bucal encontramos un aumento de volumen en la región posterior maxilar izquierda. Al profundizar en el interrogatorio la paciente refiere que le realizaron una extracción de un molar en el área del aumento de volumen 6 meses atrás, que salió con un fragmento de hueso y que sentía que se le salía el aire, por lo que le suturaron en ese momento. Indicamos medios auxiliares de diagnóstico. Se llegó al diagnóstico de que se trataba el aumento de volumen de pólipos sinusales en una fístula bucoantral como complicación de una fractura de la tuberosidad antigua. Se decidió realizar tratamiento mediante la indicación de antimicrobiano, gotas nasales, inhalaciones, y la realización una técnica de Caldwell Luc, con eliminación de los pólipos presentes, más fistulectomía y cierre mediante colgajo vestibular deslizante. Se tomó muestra para biopsia que informó la presencia de una sinusitis crónica polipoide. Conclusiones: la cirugía bucal es de imprescindible conocimiento para todos los profesionales de la rama estomatológica. El caso presentado de pólipos bucales en una fístula bucoantral como complicación de una fractura de la tuberosidad, de infrecuente presentación en la clínica, contribuye a resaltar la importancia de realizar un correcto interrogatorio para determinar las herramientas diagnósticas y terapéuticas a emplear(AU)

Introduction: the importance of the maxillary sinuses becomes clearer when it is understood that the teeth are responsible for 10 to 12 percent of the cases of maxillary sinusitis. Objective: present a case of oral polyps as a complication of a tuberosity fracture. Case presentation: a 62-year-old female patient attends consultation with a lump in her mouth which she has had for three weeks, during which time it has grown larger. Physical examination reveals a growth in the left posterior maxillary region. During interrogation the patient explained that six months before she was removed a molar from the area of increased volume. The molar had come out with a bone fragment, and she had felt air escaping through the opening, so they sutured right away. We indicated auxiliary diagnostic means. Diagnosis was an increase in the volume of paranasal polyps in an oroantral fistula as a complication of a fracture of the former tuberosity. The treatment indicated was an antimicrobial, nose drops, vaporizations, and performance of a Caldwell Luc technique with removal of the polyps, plus fistulectomy and closure by sliding vestibular flap. A sample was taken for biopsy, which revealed the presence of chronic polypoid sinusitis. Conclusions: training in oral surgery is essential for all dental professionals. The case presented of oral polyps in an oroantral fistula as a complication of a tuberosity fracture, of infrequent clinical presentation, contributes to highlight the importance of proper interrogation to determine the diagnostic and therapeutic tools to be used(AU)

Transnasal endoscopic ultrasound-guided reduction of maxillary sinus wall fracture.

Surgical morbidity from open reduction and internal fixation (ORIF) of maxillary sinus wall fracture often surpasses the benefits of ORIF. Hence, the authors devised transnasal endoscopic-assisted reduction of maxillary sinus wall fracture (TERM) without internal fixation as a minimally invasive surgery for maxillary sinus wall fracture. The purpose of this study was to investigate the feasibility of TERM in cadavers and patients. Six cadavers were dissected to evaluate the feasibility of TERM. In addition, 20 patients with maxillary sinus wall fractures who underwent TERM in a tertiary hospital from August of 2013 to December of 2015 were enrolled in this study. Demographic factors, type of anesthesia, computed tomography (CT) scans, clinical characteristics of patients, and patient satisfaction with surgery were analyzed. Cadaveric study showed that endoscopic inferior meatus antrostomy is a feasible method of approaching the maxillary sinus wall in cadavers. In addition, counterforce could be applied to the maxillary sinus wall by pushing packed Vaseline-soaked gauze or using a zygomatic process approach via a Gillies incision. Clinical experience revealed that patients experienced good facial contour restoration postoperatively. The extent of fractured bony segments was reduced on postoperative CT without complications. Patient satisfaction with TERM was greater than that with ORIF (p = 0.031). TERM showed its feasibility in both cadaveric study and clinical study. TERM can be a good alternative to ORIF, especially in patients who are reluctant to undergo a facial incision.