RESUMEN
Objective:To build a VGG-based computer-aided diagnostic model for chronic sinusitis and evaluate its efficacy. Methods:â A total of 5 000 frames of diagnosed sinus CT images were collected. The normal group consisted of 1 000 framesï¼250 frames each of maxillary sinus, frontal sinus, septal sinus, and pterygoid sinusï¼, while the abnormal group consisted of 4 000 framesï¼1 000 frames each of maxillary sinusitis, frontal sinusitis, septal sinusitis, and pterygoid sinusitisï¼. â¡The models were trained and simulated to obtain five classification models for the normal group, the pteroid sinusitis group, the frontal sinusitis group, the septal sinusitis group and the maxillary sinusitis group, respectively. The classification efficacy of the models was evaluated objectively in six dimensions: accuracy, precision, sensitivity, specificity, interpretation time and area under the ROC curveï¼AUCï¼. â¢Two hundred randomly selected images were read by the model with three groups of physiciansï¼low, middle and high seniorityï¼ to constitute a comparative experiment. The efficacy of the model was objectively evaluated using the aforementioned evaluation indexes in conjunction with clinical analysis. Results:â Simulation experiment: The overall recognition accuracy of the model is 83.94%, with a precision of 89.52%, sensitivity of 83.94%, specificity of 95.99%, and the average interpretation time of each frame is 0.2 s. The AUC for sphenoid sinusitis was 0.865ï¼95%CI 0.849-0.881ï¼, for frontal sinusitis was 0.924ï¼0.991-0.936ï¼, for ethmoidoid sinusitis was 0.895ï¼0.880-0.909ï¼, and for maxillary sinusitis was 0.974ï¼0.967-0.982ï¼. â¡Comparison experiment: In terms of recognition accuracy, the model was 84.52%, while the low-seniority physicians group was 78.50%, the middle-seniority physicians group was 80.50%, and the seniority physicians group was 83.50%; In terms of recognition accuracy, the model was 85.67%, the low seniority physicians group was 79.72%, the middle seniority physicians group was 82.67%, and the high seniority physicians group was 83.66%. In terms of recognition sensitivity, the model was 84.52%, the low seniority group was 78.50%, the middle seniority group was 80.50%, and the high seniority group was 83.50%. In terms of recognition specificity, the model was 96.58%, the low-seniority physicians group was 94.63%, the middle-seniority physicians group was 95.13%, and the seniority physicians group was 95.88%. In terms of time consumption, the average image per frame of the model is 0.20 s, the average image per frame of the low-seniority physicians group is 2.35 s, the average image per frame of the middle-seniority physicians group is 1.98 s, and the average image per frame of the senior physicians group is 2.19 s. Conclusion:This study demonstrates the potential of a deep learning-based artificial intelligence diagnostic model for chronic sinusitis to classify and diagnose chronic sinusitis; the deep learning-based artificial intelligence diagnosis model for chronic sinusitis has good classification performance and high diagnostic efficacy.
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Sinusitis , Tomografía Computarizada por Rayos X , Humanos , Enfermedad Crónica , Tomografía Computarizada por Rayos X/métodos , Sinusitis/clasificación , Sinusitis/diagnóstico por imagen , Diagnóstico por Computador/métodos , Sensibilidad y Especificidad , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/clasificación , Seno Maxilar/diagnóstico por imagen , Curva ROCRESUMEN
Differentiating orofacial odontogenic pain/disorders from pain/disorders associated with maxillary sinusitis is important to avoid unnecessary dentalprocedures and to properly refer patients to colleagues/dentists and vice versa. AIM: To analyze the association between apical lesions and sinus changes and to evaluate the agreement between the diagnoses of an endodontist, a radiologist, an oral and maxillofacial surgeon, and an otolaryngologist. MATERIALS AND METHOD: 385 axial, coronal, and sagittal MSCT scans were selected using an image archiving andcommunication system (PACS). The examinations had been performed between 2018 and 2022. RESULTS: Apical lesions were observed in 36.10% of sinusitis cases, 73.8% of unilateralsinusitis cases, 48.7% of sinus floor discontinuity cases, and 67.2% of cases in which endodontic treatment had been performed. Agreement between the diagnoses made by the endodontist and those made by the other investigators was high for most study variables (k > 0.60). The exceptions were mucosal thickening, for which agreement between the endodontist and the other investigators was intermediate (k=0.397), and the presence of periapicallesions (k=0.010), previous endodontic treatment (k=0.013), and mucosal thickness (k=0.024), for which agreement between endodontists and radiologists was low. Conclusions: There was an association between sinus changes and apical lesions.
Diferenciar a dor/desordens odontogénicas orofaciais da dor/desordens as sociadas á sinusite maxilar é importante para evitar procedimentos odontológicos desnecessários e para encaminhar adequadamente os pacientes aos colegas/dentistas e vice-versa. OBJETIVO: Analisar a associagdo entre lesoes apicais e alteragóes sinusais e avaliar a concordáncia entre os diagnósticos de um endodontista, um radiologista, um cirurgido bucomaxilofacial e um otorrinolaringologista. MATERIAL E MÉTODO: foram avaliadas 385 imagens. RESULTADOS: Aslesoes apicais foram observadas em 36,10% dos casos de sinusite, em 73,8% dos casos de sinusite unilateral, em 48,7% dos casos de descontinuidade do assoalho do seio e em 67,2%odos casos em que o tratamento endodontico havia sido realizado. A concordancia entre os diagnósticos feitos pelo endodontista e os feitos pelos outros pesquisadores foi alta para a maioria das variáveis do estudo (k > 0,60). As excegoes foram o espessamento da mucosa, para o qual a concordáncia entre o endodontista e os outros pesquisadores foi intermediária (k=0,397) e a presenga delesoes periapicais (k=0,010), tratamento endodontico prévio (k=0,013) e espessura da mucosa (k=0,024), para os quais a concordáncia entre endodontistas e radiologistas foi baixa. CONCLUSÕES: Houve uma associagdo entre as alteragóes sinusais e aslesoes apicais.
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Tomografía Computarizada Multidetector , Humanos , Femenino , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector/métodos , Adulto , Enfermedades Periapicales/diagnóstico por imagen , Sinusitis Maxilar/diagnóstico por imagen , Anciano , Adulto Joven , Adolescente , Diagnóstico DiferencialAsunto(s)
Sinusitis Maxilar , Tomografía Computarizada por Rayos X , Humanos , Sinusitis Maxilar/diagnóstico , Sinusitis Maxilar/cirugía , Sinusitis Maxilar/diagnóstico por imagen , Diagnóstico Diferencial , Endoscopía , Masculino , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/patología , Femenino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To construct the deep learning convolution neural network (CNN) model and machine learning support vector machine (SVM) model of bone remodeling of chronic maxillary sinusitis (CMS) based on CT image data to improve the accuracy of image diagnosis. METHODS: Maxillary sinus CT data of 1000 samples in 500 patients from January 2018 to December 2021 in our hospital was collected. The first part is the establishment and testing of chronic maxillary sinusitis detection model by 461 images. The second part is the establishment and testing of the detection model of chronic maxillary sinusitis with bone remodeling by 802 images. The sensitivity, specificity and accuracy and area under the curve (AUC) value of the test set were recorded, respectively. RESULTS: Preliminary application results of CT based AI in the diagnosis of chronic maxillary sinusitis and bone remodeling. The sensitivity, specificity and accuracy of the test set of 93 samples of CMS, were 0.9796, 0.8636 and 0.9247, respectively. Simultaneously, the value of AUC was 0.94. And the sensitivity, specificity and accuracy of the test set of 161 samples of CMS with bone remodeling were 0.7353, 0.9685 and 0.9193, respectively. Simultaneously, the value of AUC was 0.89. CONCLUSION: It is feasible to use artificial intelligence research methods such as deep learning and machine learning to automatically identify CMS and bone remodeling in MSCT images of paranasal sinuses, which is helpful to standardize imaging diagnosis and meet the needs of clinical application.
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Remodelación Ósea , Aprendizaje Profundo , Sinusitis Maxilar , Sensibilidad y Especificidad , Máquina de Vectores de Soporte , Tomografía Computarizada por Rayos X , Humanos , Sinusitis Maxilar/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Enfermedad Crónica , Femenino , Masculino , Persona de Mediana Edad , Adulto , Redes Neurales de la Computación , Anciano , Inteligencia ArtificialRESUMEN
INTRODUCTION: Orthognathic surgery can lead to sinus alterations, including sinusitis, attributed to the exposure of maxillary sinuses during Le Fort I osteotomy. Furthermore, being a hospital-based procedure, there is potential risk of complications arising from bacteria prevalent in such environments. This study evaluated maxillary sinusitis occurrence and the presence of multidrug-resistant bacteria in the nasal cavity before and after orthognathic surgery. METHODS: Ten patients with dentofacial deformities underwent Le Fort I osteotomy. Clinical evaluations using SNOT-22 questionnaire were performed, and nasal cavity samples were collected pre-surgery and 3-6 months post-surgery to quantify total mesophilic bacteria and detect Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Cone Beam Computed Tomography (CBCT) was performed pre- and post-operatively, and the results were evaluated using the Lund-Mackay system. This study was registered and approved by the Research Ethics Committee of PUCRS (No. 4.683.066). RESULTS: The evaluation of SNOT-22 revealed that five patients showed an improvement in symptoms, while two remained in the same range of interpretation. One patient developed post-operative maxillary sinusitis, which was not detected at the time of evaluation by SNOT-22 or CBCT. CBCT showed a worsening sinus condition in three patients, two of whom had a significant increase in total bacteria count in their nasal cavities. The Brodsky scale was used to assess hypertrophy in palatine tonsils, where 60% of the subjects had grade 1 tonsils, 20% had grade 2 and 20% had grade 3. None of the patients had grade 4 tonsils, which would indicate more than 75% obstruction. Two patients harboured S. aureus and K. pneumoniae in their nasal cavities. Notably, K. pneumoniae, which was multidrug-resistant, was present in the nasal cavity of patients even before surgery, but this did not result in maxillary sinusitis, likely due to the patients' young and healthy condition. CONCLUSION: There was an improvement in signs and symptoms of maxillary sinusitis and quality of life in most patients after orthognathic surgery. However, some patients may still harbour multidrug-resistant bacteria, even if they are asymptomatic. Therefore, a thorough pre-operative assessment is essential to avoid difficult-to-treat post-operative complications.
Asunto(s)
Tomografía Computarizada de Haz Cónico , Farmacorresistencia Bacteriana Múltiple , Sinusitis Maxilar , Cavidad Nasal , Osteotomía Le Fort , Humanos , Femenino , Masculino , Cavidad Nasal/microbiología , Cavidad Nasal/diagnóstico por imagen , Sinusitis Maxilar/microbiología , Sinusitis Maxilar/diagnóstico por imagen , Adulto , Adulto Joven , Acinetobacter baumannii/aislamiento & purificación , Klebsiella pneumoniae/aislamiento & purificación , Adolescente , Staphylococcus aureus/aislamiento & purificación , Deformidades Dentofaciales/cirugía , Deformidades Dentofaciales/microbiología , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/diagnóstico por imagenRESUMEN
Accidentally extruded root canal filler within the sinuses may induce maxillary sinusitis with fungal mass. The authors describe 2 cases of gutta-percha-induced fungal masses in the left maxillary sinus of 2 women. The lesions were evaluated preoperatively using both computed tomography and magnetic resonance imaging, providing comprehensive insights into the condition. In one patient, the lesion was located such that it could be resected through the middle meatal antrostomy alone. However, the second patient presented with an anteroinferiorly situated lesion that necessitated not only a transnasal approach but also an endoscopic modified medial maxillectomy. Both patients recovered uneventfully after surgery. This case series is the first published report of 2 cases of gutta-percha-induced maxillary sinus fungal masses, with their imaging findings, successfully treated through different routes through transnasal endoscopic surgery. These reports highlight the need for a collaborative approach between dental practitioners and otolaryngologists. In addition to the patient's wishes, surgical interventions must consider the unique characteristics of each case and the potential for collaboration across different medical specialties.
Asunto(s)
Imagen por Resonancia Magnética , Seno Maxilar , Tomografía Computarizada por Rayos X , Humanos , Femenino , Seno Maxilar/cirugía , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/microbiología , Endoscopía/métodos , Gutapercha/uso terapéutico , Sinusitis Maxilar/cirugía , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/microbiología , Persona de Mediana Edad , Materiales de Obturación del Conducto Radicular/uso terapéutico , Adulto , Micosis/cirugía , Micosis/diagnóstico por imagen , Cirugía Endoscópica por Orificios Naturales/métodosRESUMEN
OBJECTIVE: To assess the differences between endoscopic and radiological methods of analysis for diagnosing chronic maxillary sinusitis (CMS) in archaeological skeletal remains. MATERIALS: 32 crania from a Dutch post-medieval rural population. METHODS: We assessed the presence of bone changes indicative of CMS (i.e., bone growth and bone resorption) both endoscopically and through computed tomography (CT), and then compared results. RESULTS: We observed moderate agreement between bone growth scores obtained through endoscopy and CT, and fair agreement when assessing bone resorption. CONCLUSIONS: CMS prevalence rates observed through CT may be comparable to rates assessed endoscopically, although caution is needed when making direct comparisons. SIGNIFICANCE: This is the first study comparing data obtained through endoscopy and radiological methods in the study of CMS, informing paleopathologists about potential biases in data comparison. LIMITATIONS: Our small sample size likely impacted results. SUGGESTIONS FOR FURTHER RESEARCH: Further research is advised to fully explore the comparability of endoscopic and radiological method of analysis in the study of sinusitis. DATA AVAILABILITY: The datasets generated and analyzed during the current study are available upon request.
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Sinusitis Maxilar , Tomografía Computarizada por Rayos X , Humanos , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/historia , Sinusitis Maxilar/patología , Tomografía Computarizada por Rayos X/métodos , Enfermedad Crónica , Masculino , Endoscopía/métodos , Femenino , Países Bajos , Adulto , Paleopatología/métodos , Persona de Mediana EdadRESUMEN
OBJECTIVE: Maxillary sinusitis can be a sequela of medication-related osteonecrosis of the jaw (MRONJ). This study aims to characterize the microbiome of maxillary MRONJ with concurrent maxillary sinusitis and radiographic maxillary sinus opacification to determine if there is a relationship between the microbiome of MRONJ and sinus disease. STUDY DESIGN: This retrospective case series was conducted using electronic health records from the University of Pennsylvania and affiliated hospitals. The target population was surgically managed maxillary MRONJ patients. The primary predictor variables were tissue culture results. The primary outcomes were maxillary sinusitis or maxillary sinus opacification. Statistical analysis was performed using chi-squared tests at the 95% confidence interval. RESULTS: Thirty-nine subjects were selected: 25 had sinus opacification and 11 had sinusitis. Resident bacteria were present in 90% of subjects, nonresident bacteria in 74%, and opportunistic organisms in 15%. There were significantly more subjects with chronic sinusitis microbes (79%) than without. There were significantly more gram-positive anaerobes, specifically Propionibacterium, as well as the gram-negative facultative anaerobe, Capnocytophaga, in subjects with concurrent sinusitis. CONCLUSIONS: Maxillary MRONJ with concurrent maxillary sinusitis may be associated with gram-positive anaerobic species, Propionibacterium, and Capnocytophaga colonization. Maxillary MRONJ patients may benefit from sinus evaluation and concurrent surgical intervention.
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Sinusitis Maxilar , Enfermedades de los Senos Paranasales , Sinusitis , Humanos , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/microbiología , Seno Maxilar/diagnóstico por imagen , Estudios Retrospectivos , Sinusitis/microbiologíaRESUMEN
ABSTARCT: Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of unique clinical features, OMS is difficult to distinguish from other types of rhinosinusitis. Besides, the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis. Its current diagnosis and treatment are thus facing great difficulties. The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS. However, this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality. Based on systematically reviewed literature and practical experiences of expert members, our consensus focuses on characteristics, symptoms, classification and diagnosis of OMS, and further put forward multi-disciplinary treatment decisions for OMS, as well as the common treatment complications and relative managements. This consensus aims to increase attention to OMS, and optimize the clinical diagnosis and decision-making of OMS, which finally provides evidence-based options for OMS clinical management.
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Sinusitis Maxilar , Rinosinusitis , Humanos , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/etiología , Sinusitis Maxilar/terapia , Consenso , Seno Maxilar , OdontogénesisRESUMEN
PURPOSE: The study analyses outcomes of the surgical treatment of odontogenic sinusitis that concurrently address sinusitis and its dental source. METHODS: A total of 364 adult patients were included, representing 13% of all patients we have operated on for any rhinosinusitis over the past 18 years. The diagnosis was based on both ENT and dental examinations including CT imaging. Patients were divided into three groups: (1) FESS with dental surgery without antrotomy, (2) FESS with intraoral antrotomy, and (3) intraoral surgery without FESS. The mean postoperative follow-up was 15 months. RESULTS: First group involved 64%, second group 31%, and third group 6% of the cases. The one-stage combined ENT and dental approach was used in 94% of cases (group 1 and 2) with a success rate of 97%. Concerning FESS, maxillary sinus surgery with middle meatal antrostomy only was performed in 54% of patients. Oroantral communication flap closure was performed in 56% of patients (success rate 98%). Healing was achieved within 3 months. The majority (87%) of patients were operated on unilaterally for unilateral findings. Over the past 18 years, a 6% increase of implant-related odontogenic sinusitis was observed. CONCLUSION: Odontogenic sinusitis is common, tending to be unilateral and chronic. Its dental source needs to be uncovered and treated and should not be underestimated. Close cooperation between ENT and dental specialists has a crucial role in achieving optimal outcomes. The one-stage combined surgical approach proves to be a reliable, safe, fast and effective treatment.
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Sinusitis Maxilar , Sinusitis , Adulto , Humanos , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/etiología , Sinusitis Maxilar/cirugía , Estudios Prospectivos , Endoscopía/métodos , Sinusitis/complicaciones , Sinusitis/cirugía , Seno Maxilar/cirugíaRESUMEN
It is rare that cavernous sinus complications are caused by maxillary sinus lesions because the locations of these lesions are some distant from each other. The authors describe an unusual presentation that the primary lesion was located in the maxillary sinus and triggered cavernous sinus syndrome and optic nerve symptoms. The most likely possibility was that the infection traveled retrograde along the vascular plexus. Removal of maxillary sinus lesions and establishment ventilation may achieve source control.
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Síndromes del Seno Cavernoso , Seno Cavernoso , Sinusitis Maxilar , Micosis , Sinusitis , Humanos , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/cirugía , Sinusitis/complicaciones , Sinusitis/diagnóstico por imagen , Sinusitis/terapia , Micosis/complicaciones , Seno Cavernoso/diagnóstico por imagen , Seno Cavernoso/patología , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/cirugíaRESUMEN
La celulitis orbitaria es una patología grave que está asociada con sinusitis paranasal. Éstas suelen presentar edema periorbitario, dolor, y movimiento extraocular restringido. La mayoría de los casos presentan pronóstico favorable, asociado a terapia antibiótica o drenaje quirúrgico. Las celulitis de origen odontogénico representan 2 a 5 % de todos los casos; se caracterizan por una diseminación del proceso infeccioso desde los ápices de las raíces, infectando al seno maxilar, llegando a la órbita a través de la fisura orbitaria inferior o a través de un defecto en el piso de la órbita. En el presente estudio se reporta el caso de un paciente masculino de 28 años que consulta por aumento de volumen periorbitario izquierdo con 4 días de evolución, posterior a exodoncia de segundo molar superior izquierdo. Al examen extraoral presenta aumento de volumen izquierdo con eritema periorbitario, proptosis ocular ipsilateral con visión conservada, y salida de líquido purulento por fosa nasal izquierda. En los exámenes de laboratorio e imagenológicos se pesquisa compromiso de seno maxilar, etmoidal y esfenoidal, decidiendo su hospitalización y manejo quirúrgico en tres tiempos operatorios, los cuales permiten acceso a pared anterior del seno maxilar y a espacio pterigoideo. Dentro de los diagnósticos de celulitis orbitaria pueden incluir reacciones alérgicas, conjuntivitis o herpes. Se excluyeron los diagnósticos mencionados debido a que no se observaron alteraciones dermocutáneas periorbitarias. Por el contrario, el compromiso unilateral, movimiento ocular alterado y doloroso indica que el cuadro abarcaba espacios profundos. La infección de senos paranasales posterior a una exodoncia es una complicación poco frecuente. Un diagnóstico temprano adecuado disminuye la morbilidad y mortalidad de esta condición. Debemos estar alertas a complicaciones posteriores en procedimientos realizados, tener conocimiento en diagnóstico y manejo de posibles evoluciones tórpidas en pacientes.
Orbital cellulitis is a serious pathology that is associated with paranasal sinusitis. These medical conditions usually present with periorbital edema, pain, and restricted extraocular movement. Most cases have a favorable prognosis, associated with antibiotic therapy or surgical drainage. Cellulitis of odontogenic origin represents 2 to 5 % of all cases. They are characterized by a spread of the infectious process from the apices of the roots, infecting the maxillary sinus, reaching the orbit through the inferior orbital fissure or through a defect in the floor of the orbit. The present study reports the case of a 28-year-old male patient, who consulted for a volume increase in left periorbital volume with 4 days of evolution, after extraction of the upper left second molar. Extraoral examination showed left volume increase with periorbital erythema, ipsilateral ocular proptosis with preserved vision, and discharge of purulent fluid from the left nostril. The laboratory and imaging tests showed compromise of the maxillary, ethmoid and sphenoid sinus deciding on hospitalization and surgical management in three operative times, which allow access to the anterior wall of the maxillary sinus and the pterygoid space. Diagnoses of orbital cellulitis may include allergic reactions, conjunctivitis, or herpes. These diagnoses were excluded because no periorbital dermocutaneous alterations were observed. In contrast, unilateral involvement, impaired eye movement, and pain indicate that the condition involved deep spaces. Paranasal sinus infection after tooth extraction is a rare complication. An early diagnosis adequately decreases the morbidity and mortality of this condition. We must be alert to subsequent complications in procedures performed, have knowledge in diagnosis and management of possible torpid evolutions in patients.
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Humanos , Masculino , Adulto , Sinusitis Maxilar/cirugía , Sinusitis Maxilar/diagnóstico por imagen , Seno Maxilar/cirugía , Extracción Dental/efectos adversos , Tomografía Computarizada por Rayos X/métodos , Celulitis Orbitaria/cirugía , Infección Focal Dental/terapiaRESUMEN
PURPOSE: Understanding the anatomy of the paranasal sinuses and their variations is essential to achieving safe and effective endoscopic sinus surgery. The ethmomaxillary sinus (EMS) is a relatively under-researched anatomical variation. This study investigated the prevalence, clinical features, and effect of EMS on the maxillary sinus in comparison with Haller's cells. METHODS: Patients who visited the Rhinology Clinic at our hospital for rhinologic symptoms between January 2020 and December 2020. Computed tomography (CT) scans of paranasal sinuses were obtained at 1 mm-section thickness. Using CT scans, we investigated the clinical features of EMS, measured maxillary sinus volume, and analyzed the presence of maxillary sinusitis. RESULTS: EMS was observed in 26 of the 250 patients (10.4%). The male-to-female ratio was equal. The age ranged from 18 to 83 years (mean age, 56.3). Of the patients with EMS, 65.4% were unilateral and 34.6% were bilateral. The prevalence of Haller's cells was similar to that in EMS (10.8%). In the analysis of patients with unilateral EMS, the EMS side was found to have a significantly reduced maxillary sinus volume compared to the opposite side, whereas the difference was not significant in Haller's cells. There was no significant relationship between EMS or Haller's cells and maxillary sinusitis. CONCLUSIONS: EMS can significantly affect maxillary sinus volume. Therefore, surgeons should thoroughly review PNS CT scans before paranasal sinus surgery to determine the presence and features of EMS.
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Sinusitis Maxilar , Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/cirugía , Senos Etmoidales/diagnóstico por imagen , Senos Etmoidales/cirugía , Senos Etmoidales/anatomía & histología , Seno Maxilar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , EndoscopíaRESUMEN
The pterygopalatine fossa is a clinically inaccessible space deep in the face, and reports of pterygopalatine fossa abscesses are rare. The authors present the case of a 63-year-old woman presenting with a severe headache owing to an abscess involving the pterygopalatine fossa. On a computed tomography scan, inflammation of the right pterygopalatine fossa associated with right maxillary sinusitis and periapical inflammation and a cystic lesion around the tooth were observed. After administering appropriate antibiotics, the headache improved considerably, and endoscopic nasal surgery resulted in adequate abscess drainage. To the authors' knowledge, this case study is one of the few reporting the successful treatment of an abscess in the pterygopalatine fossa through an endoscopic transnasal approach.
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Absceso , Sinusitis Maxilar , Femenino , Humanos , Persona de Mediana Edad , Absceso/diagnóstico por imagen , Absceso/cirugía , Fosa Pterigopalatina/diagnóstico por imagen , Fosa Pterigopalatina/cirugía , Endoscopía/métodos , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/cirugía , Drenaje , CefaleaRESUMEN
OBJECTIVE: We investigated the efficacy of using diffusion-weighted imaging (DWI) with quantitative apparent diffusion coefficient (ADC) mapping in the diagnosis of maxillary diseases. STUDY DESIGN: We evaluated 146 cases of maxillary diseases (32 malignant tumors, 11 benign tumors, 28 maxillary cysts, 60 cases of maxillary sinusitis, and 15 maxillary sinus retention cysts) that had been examined using magnetic resonance imaging. The DWI sequence was obtained with b values of 0 and 800 s/mm2 and ADC values were calculated. We used one-way analysis of variance and the Tukey honestly significant difference test to identify differences within and between the types of diseases. RESULTS: Mean ADC values for malignant tumors (1.07 × 10-3 mm2 s-1) were significantly lower than ADCs for benign tumors (1.85 × 10-3 mm2 s-1), maxillary cysts (1.77 × 10-3 mm2 s-1), maxillary sinusitis (2.34 × 10-3 mm2 s-1), and maxillary sinus retention cysts (2.52 × 10-3 mm2 s-1), with P < 0.001. Mean ADC differed significantly between all disease types except between maxillary sinusitis and maxillary sinus retention cysts. ADC values also significantly differed between specific lesions within the malignant tumor and maxillary cyst groups. CONCLUSIONS: The use of ADC values can be useful in the differential diagnosis of malignant maxillary diseases, benign lesions, cysts, and inflammatory and reactive conditions.
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Quistes , Sinusitis Maxilar , Humanos , Sinusitis Maxilar/diagnóstico por imagen , Sensibilidad y Especificidad , Imagen de Difusión por Resonancia Magnética/métodos , Imagen por Resonancia Magnética , Diagnóstico Diferencial , Quistes/diagnósticoRESUMEN
BACKGROUND: There are multiple treatment methods for odontogenic sinusitis (OS); however, the optimal treatment remains unclear. AIMS/OBJECTIVE: To determine the cure rate of OS after tooth extraction and the factors contributing to the cure. MATERIAL AND METHODS: We prospectively identified 37 patients diagnosed with OS with an indication for causative tooth extraction. Before and three months after tooth extraction, the patients were assessed using sinus computed tomography and classified as either cured or uncured based on the absence or presence of soft tissue shadow in the maxillary sinus. The prognostic factors were analysed by comparing the two groups. RESULTS: There were ten patients for whom all data could be obtained. The mean age of the patients at the time of tooth extraction was 53.8 ± 12.9 years (range, 34-75 years). In seven patients, the soft tissue shadow in the maxillary sinus disappeared; these patients were classified as cured. Uncured patients were significantly younger than cured patients (59.9 vs. 39.7 years). CONCLUSIONS AND SIGNIFICANCE: Tooth extraction effectively treated OS in 70% of patients. However, even after tooth extraction, OS may not improve, particularly in younger patients.
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Sinusitis Maxilar , Sinusitis , Humanos , Adulto , Persona de Mediana Edad , Anciano , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/etiología , Sinusitis Maxilar/cirugía , Sinusitis/complicaciones , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/cirugía , Tomografía Computarizada por Rayos X , Extracción Dental/efectos adversosRESUMEN
INTRODUCTION: The overall prevalence of maxillary sinusitis of odontogenic origin (MSOO) is still unknown. Therefore, this study aimed to determine the pooled prevalence of MSOO and verify associations between different odontogenic conditions and MSOO. METHODS: Six electronic databases and the gray literature were searched on August 25, 2022. Two independent reviewers selected observational studies reporting the prevalence of MSOO and associated conditions in adults. Studies that did not use computed tomography for diagnosis were excluded. The methodological quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies. Data were analyzed by proportion and association meta-analyses. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Thirty-eight studies were included in the qualitative analysis and thirty-one in the meta-analyses. Only 12 studies (31.6%) fulfilled all items of the methodological quality checklist. Overall, the studies reported prevalence measures per maxillary sinus or patient. Thus, the pooled prevalence of MSOO was 51% per sinus (95% confidence interval [CI] [40%-61%]) and 50% per patient (95% CI [41%-59%]). Apical lesion (odds ratio [OR]: 4.03, 95% CI [2.26-7.19]), periodontitis (OR: 5.49, 95% CI [2.27-13.24]), moderate (OR: 2.57, 95% CI [1.85-3.57]) and severe bone loss (OR: 13.80, 95% CI [2.81-67.85] were significantly associated with MSOO. The certainty of the evidence for the associations was very low. CONCLUSIONS: The pooled prevalence of MSOO on computed tomography assessment was 51% per maxillary sinus and 50% per patient. Therefore, half of the maxillary sinusitis may be of odontogenic origin. Apical lesion, periodontitis, and moderate and severe bone loss were significantly associated with MSOO.
Asunto(s)
Sinusitis Maxilar , Adulto , Humanos , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/epidemiología , Sinusitis Maxilar/etiología , Prevalencia , Estudios Transversales , Seno Maxilar , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Endodontic pathology is one of the most common causes of odontogenic sinusitis, and its evaluation is challenging. Omission of periapical lesions in diagnostic process leads to recurrent sinusitis after cessation of medical therapy. METHODS: Sixty-one symptomatic patients presented with odontogenic sinusitis with periapical lesions of teeth adjacent to the maxillary sinus were included in the study. Symptoms evaluated with SNOT-22 and OHIP-14 questionnaires were compared to signs during endoscopic and radiological evaluation. RESULTS: Coexistence of odontogenic sinusitis with nasal polyps significantly decreases the quality of life, especially concerning the emotional domain (p = 0.047). Patency of ostiomeatal corresponds well with the severity of sinonasal symptoms reported with SNOT-22 (p = 0.051). Extent of maxillary sinus opacifications scored with Zinreich scale correlates positively with the presence of discharge (p = 0.001) and edema (p = 0.072) in the endoscopic Lund-Kennedy scale. Among 67 teeth with periapical lesions, 73.1% had undergone previous root canal treatment, but in 47.8% of cases, it was defined as incomplete. Endodontic status did not affect the severity of patient's complaints. CONCLUSION: In case of odontogenic sinusitis of endodontic origin, endoscopic signs correlate better than radiological with the self-reported symptoms. In order to better evaluate the severity of the disease and possible need of surgical intervention, both otolaryngologists and dental specialists should focus on extent of inflammatory lesions in the maxillary sinus.
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Sinusitis Maxilar , Sinusitis , Humanos , Sinusitis Maxilar/diagnóstico , Sinusitis Maxilar/diagnóstico por imagen , Calidad de Vida , Seno Maxilar , Sinusitis/diagnóstico , Sinusitis/diagnóstico por imagen , RadiografíaRESUMEN
OBJECTIVES: With the increase in dental implants for tooth loss, odontogenic sinusitis following maxillary dental implants is frequently encountered in otorhinolaryngology practice. The authors aimed to reveal the association between implant extrusion into maxillary sinus, along with implant-related complications in patients diagnosed with implant-related odontogenic sinusitis (IR-ODS). STUDY DESIGN: Case-control study. METHODS: This study enrolled 60 patients who received functional endoscopic sinus surgery due to IR-ODS. The preoperative sinus computed tomography was retrospectively reviewed. Among the 120 maxillary sinuses of the 60 patients, 68 sides were diagnosed with IR-ODS sides, whereas 27 sides showed no clinical or radiological evidence of this condition after the implant insertion and were defined as the control sides. Statistical analysis between these two groups was conducted, in addition to odds ratio (OR) calculations for associations with IR-ODS. RESULTS: The mean age of the IR-ODS subjects was 59.5 ± 19.1, with a male to female ratio of 32/28 (53.3%/46.7%). Implants extruding by more than 4 mm into the maxillary sinus, peri-implantitis, bone graft disruption-extrusion were associated with a significantly higher incidence in the IR-ODS (p = 0.035, p = 0.003, p = 0.011, respectively). The IR-ODS sides showed an adjusted-OR (95% confidence interval) of 27.4 (2.7-276.5) for extrusion length >4 mm, 11.8 (3.0-46.5) for peri-implantitis, and 34.1 (3.3-347.8) for bone graft disruption (p = 0.005, p < 0.001, and p = 0.003, respectively). CONCLUSION: Maxillary dental implants extruding more than 4 mm into the maxillary sinus, peri-implantitis, and disrupted-extruded bone grafts show significant association with IR-ODS. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:237-243, 2023.
Asunto(s)
Implantes Dentales , Sinusitis Maxilar , Periimplantitis , Sinusitis , Humanos , Masculino , Femenino , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/etiología , Sinusitis Maxilar/cirugía , Implantes Dentales/efectos adversos , Periimplantitis/complicaciones , Estudios Retrospectivos , Estudios de Casos y Controles , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/cirugía , Sinusitis/complicacionesRESUMEN
OBJECTIVES: To clarify the performance of transfer learning with a small number of Waters' images at institution B in diagnosing maxillary sinusitis, based on a source model trained with a large number of panoramic radiographs at institution A. METHODS: The source model was created by a 200-epoch training process with 800 training and 60 validation datasets of panoramic radiographs at institution A using VGG-16. One hundred and eighty Waters' and 180 panoramic image patches with or without maxillary sinusitis at institution B were enrolled in this study, and were arbitrarily assigned to 120 training, 20 validation, and 40 test datasets, respectively. Transfer learning of 200 epochs was performed using the training and validation datasets of Waters' images based on the source model, and the target model was obtained. The test Waters' images were applied to the source and target models, and the performance of each model was evaluated. Transfer learning with panoramic radiographs and evaluation by two radiologists were undertaken and compared. The evaluation was based on the area of receiver-operating characteristic curves (AUC). RESULTS: When using Waters' images as the test dataset, the AUCs of the source model, target model, and radiologists were 0.780, 0.830, and 0.806, respectively. There were no significant differences between these models and the radiologists, whereas the target model performed better than the source model. For panoramic radiographs, AUCs were 0.863, 0.863, and 0.808, respectively, with no significant differences. CONCLUSIONS: This study performed transfer learning using a small number of Waters' images, based on a source model created solely from panoramic radiographs, resulting in a performance improvement to 0.830 in diagnosing maxillary sinusitis, which was equivalent to that of radiologists. Transfer learning is considered a useful method to improve diagnostic performance.