Ameloblastic carcinoma (AC) represents a distinct challenge in the realm of odontogenic malignancies due to its rarity and aggressive nature. We present a unique case of AC in a 70-year-old male, retired dry cleaner, with symptoms initially suggestive of chronic allergic rhinitis and recurrent acute sinusitis with asymmetric facial edema and paresthesia. Detailed evaluation revealed a prominent mass in the right maxillary sinus with extensive cortical destruction. Pathological assessment post-right maxillectomy identified a high-grade AC with malignant spindle cell transformation. The patient underwent subsequent interventions, including neck dissection and radiation therapy. Twelve months post-presentation, the patient was recovering appropriately without evidence of recurrence of malignancy. This case highlights the diagnostic challenges posed by AC as well as its unique presentations emphasizing the importance of a comprehensive approach and multidisciplinary management. It also raises considerations about potential chemical exposure implications in AC development.
BACKGROUND: Trauma-induced orbital blowout fracture (OBF) with eyeball displacement into the maxillary sinus is rare. CASE PRESENTATION: We present the case of a 14-year-old with a closed head injury, OBF, and displacement of the eyeball into the maxillary sinus following a car accident. A prompt transconjunctival access surgery was performed for eyeball repositioning and orbital reconstruction in a single session, mitigating anaesthesia-related risks associated with multiple surgeries. At the 12-month follow-up, his visual acuity was 20/200. Despite limited eye movement and optic nerve atrophy, overall satisfaction with the ocular appearance was achieved. CONCLUSIONS: This report offers novel insights into the mechanisms of OBF occurrence and the development of postoperative complications.
Head Injuries, Closed , Ocular Motility Disorders , Orbital Fractures , Male , Humans , Adolescent , Maxillary Sinus , Eye , Orbital Fractures/complications , Orbital Fractures/diagnosis , Orbital Fractures/surgery , Head Injuries, Closed/complications
BACKGROUND: Maxillary sinus augmentation is one of the most performed procedures to increase the bone quantity of the atrophic maxilla to allow implant placement. The aim of the present case series was to describe a surgical protocol to perform maxillary sinus augmentation with the "bone lid technique," and its outcomes in a cohort of patients eligible for the procedure. METHODS: After the initial clinical evaluation, a cone-beam computed tomography (CBCT) examination was performed for preoperative assessment. Patients were then scheduled for surgical intervention. At 6-9 months follow-up, patients underwent a second CBCT scan to evaluate bone height following bone graft and to schedule implant placement. RESULTS: A total of 11 patients were enrolled in the study with a total of 13 sinus lift procedures. Membrane perforation was registered in 4 cases (30.76%). Mean surgical time was 67.69 min (SD 6.51). Postoperative period was uneventful in all patients, in the absence of complications. The mean graft volume increase was 2.46 cm3 (SD 0.85), and the mean height increase was 14.27 mm (SD 3.18). Mean membrane thickness was 1.40 mm (SD 0.75). In all the 4 cases with sinus membrane perforation, the membrane had a thickness lower than 1 mm. CONCLUSIONS: The present study highlights that the maxillary sinus augmentation with bone lid repositioning could provide repeatable results in terms of bone height increase. The technique appears reliable both in terms of bone gain and absence of complications. KEY POINTS: The bone lid technique for maxillary sinus augmentation provides repeatable results in terms of bone height increase. The favorable clinical outcomes can be related to an enhancement of bone formation due to the unique osteoconductive and osteoinductive properties of autogenous bone, along with a reduction of soft tissue ingrowth. Complications were not observed in any of the patients following the surgical procedures. The risk of Schneiderian membrane perforation is inversely proportional to membrane thickness; the thinner the membrane is, the higher the risk to perforate it.
In this article, we propose a consensus delineation of postoperative clinical target volumes for the primary tumour in maxillary sinus and nasal cavity cancers. These guidelines are developed based on radioanatomy and the natural history of those cancers. They require the fusion of the planning CT with preoperative imaging for accurate positioning of the initial GTV and the combined use of the geometric and anatomical concepts for the delineation of clinical target volume for the primary tumour. This article does not discuss the indications of external radiotherapy (nor concurrent systemic treatment) but focuses on target volumes when there is an indication for radiotherapy.
Mouth Neoplasms , Paranasal Sinus Neoplasms , Humans , Maxillary Sinus/diagnostic imaging , Maxillary Sinus/surgery , Maxillary Sinus/pathology , Nasal Cavity/diagnostic imaging , Radiotherapy Planning, Computer-Assisted/methods , Mouth Neoplasms/pathology
The inflammatory process involving the maxillary sinus is often exacerbated by a functional obstruction due to laterally displaced uncinate process which obstructs the infundibulum and the natural ostium. Physiologically the drainage pathway may be adequate but during periods of inflammation resulting in nasal oedema, the ostium/infundibulum interface is inadequate, preventing adequate ventilation and drainage of the maxillary sinus. Incomplete removal of the uncinate process without including the natural ostium may result in failure and recurrence. This method of Middle meatal antrostomy that does not include the natural ostium of the maxillary sinus, leads to the missed ostium sequence and continued sinus disease. Here a case of missed maxillary sinus syndrome and its management is presented. A 28-year-old man with complaints of post nasal drip and Left facial pain for 4 months. 3 years prior the patient underwent functional endoscopic sinus surgery (FESS), following surgery patient had recurrent episode of sinusitis. Diagnostic nasal endoscopy revealed presence of mucopurulent discharge in left middle meatus, CT scan Paranasal sinus was suggestive of opacity in left maxillary sinuses and in left middle meatus with wide maxillary antrostomy. Revision FESS surgery was performed, where two ostia were present was converted into single wide middle meatal antrostomy using a back bitting forceps and microdebrider to avoid maxillary sinus mucus recirculation phenomenon. On follow up 1 year later, patient had no symptoms of repeated sinusitis. Missed maxillary sinus ostium syndrome has to be recognized and timely addressed by joining the natural and surgically created ostia as single wide middle meatal antrostomy window. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04385-x.
BACKGROUND: An oroantral fistula is a communication between the maxillary antrum and oral cavity. This pathological communication is formed mainly due to dental extraction of maxillary premolars and molars. Adequate management should include closing the oroantral fistula and eliminating sinus infections to prevent recurrence and sinusitis. PURPOSE: This study aimed to evaluate the effectiveness of using the pedicled buccal periosteal flap for closing an oroantral fistula without changing the native intraoral structure. PATIENTS & METHODS: Patients with oroantral fistulas were included in this study. The patients were examined clinically by Valsalva test and cheek-blowing test, the hole was probed, and the extent of the underlying bone defect was determined radiographically using computed tomography preoperatively. All patients underwent surgical closure of oroantral fistula using a pedicled buccal periosteal flap. RESULTS: All 10 patients obtained satisfactory results with marked improvement in the function of the maxillary sinus and complete healing of oroantral fistula with no recurrence except in Case No. 5, who had a recurrence of the oroantral fistula, also there was no statistically significant difference between the vestibular depth preoperatively and postoperatively. CONCLUSION: A pedicled buccal periosteal flap is a novel technique for oroantral fistula closure as it preserves vestibular depth with a tension-free closure flap and harbors the advantages of the regenerative potential of the periosteum. REGISTRATION DATE: 14/8/2023 REGISTRATION NUMBER: NCT05987943.
Fistula , Oroantral Fistula , Humans , Oroantral Fistula/surgery , Adipose Tissue , Surgical Flaps/surgery , Maxillary Sinus/surgery
PURPOSE: The purpose of this systematic review was to assess histological and imaging outcomes related to new bone formation around implants, inserted simultaneously with sinus augmentation, comparing different types of grafts. MATERIALS AND METHODS: Systematic Review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA), and the Cochrane Handbook for Systematic Reviews of Interventions. LILACS/BVS, Medline/PubMed, Cochrane Library and Embase databases, including gray literature and manual investigation, were searched to identify clinical trials reporting human histological and imaging data of bone formation around implants, inserted into the maxillary sinus at the same moment of the elevation and augmentation procedure, using several materials. Study selection, risk of bias (Rob 2.0 or ROBINS I), quality of evidence (GRADE), and data collection were performed by two independent reviewers. RESULTS: Of the 1101 potentially eligible articles, 44 were retrieved, 12 were assessed for eligibility and 5 were included in this systematic review (4 randomized and one controlled clinical trials). As a result, 130 grafted sinuses with 179 installed implants in 103 patients, aged between 24 and 79 years and followed up from 6 to 15 months, were analyzed. The heterogeneity between studies did not allow the data to be combined for meta-analyses. All graft materials proved to be viable options for the intervention. The use of BCP was related to higher bone-to-implant contact. CONCLUSION: All the assessed grafts are viable options for the intervention addressed. The use of some material is justified to maintain the sinus volume and allow bone formation in the apical site of implants under the sinus membrane. Longer chair time and the morbidity of the donor site should be considered when choosing autogenous bone. Synthetic biphasic materials can be selected for this intervention due to superior values of %BIC when compared to DBB.
BACKGROUND: Maxillary sinus squamous cell carcinoma (MS-SCC) is an infrequent malignancy, and determining the optimal neck management for patients with cT3/4N0 MS-SCC remains a topic of ongoing debate. The purpose of this study was to compare the prognoses and quality of life outcomes of patients who underwent either elective neck dissection (END) or elective neck irradiation (ENI) for cT3/4N0 MS-SCC. METHODS: In this retrospective study, we enrolled patients with surgically treated cT3/4N0 MS-SCC, and the impact of different neck management strategies on regional control and disease-specific survival was compared using propensity score matching. The effect of surgical intervention on quality of life was evaluated using the Mann-Whitney U test. RESULTS: Of the 120 patients included, 36 underwent END. After propensity score matching, our analysis indicated that END did not lead to superior outcomes than ENI, as demonstrated by comparable rates of regional control (p = 0.990) and disease-specific survival (p = 0.999). However, in the 70 returned questionnaires, patients who underwent END reported higher scores in the domains of appearance, chewing, and speech than did patients who underwent ENI. CONCLUSIONS: Our findings suggest that while END and ENI contribute to similar prognoses, END yields superior functional outcomes.
Carcinoma, Squamous Cell , Head and Neck Neoplasms , Humans , Neck Dissection , Maxillary Sinus/pathology , Carcinoma, Squamous Cell/pathology , Retrospective Studies , Propensity Score , Quality of Life , Squamous Cell Carcinoma of Head and Neck/pathology , Head and Neck Neoplasms/pathology , Neoplasm Staging
The aim of the present systematic review was to investigate the clinical outcomes after the perforation of the maxillary sinus by dental implants, or after maxillary sinus membrane perforation during sinus lift procedure. Twenty-nine publications were included. Failure rates of implants in cases where perforation of sinus floor had happened (11 studies) was generally low, and only one case of transient sinusitis was reported. The estimated failure rate of these implants was 2.1% (SE 1.0%, p = 0.035). There were 1817 implants (73 failures) placed in augmented sinuses in which the sinus membrane was perforated and 5043 implants (274 failures) placed in sinuses with no perforated membrane, from 18 studies. The odds of implant failure difference between the groups were not significant (OR 1.347, p = 0.197). log OR of implant failure between perforated and non-perforated membrane groups did not significantly change with the follow-up time (-0.004/month; p = 0.500). In conclusion, implant failure rate is generally low either for implants penetrating in the floor of the maxillary sinus or implants placed in augmented sinuses in which the sinus membrane was perforated. The prevalence of postoperative infection/sinusitis is low, and it may depend either on the dimensions of the perforation or on the anatomical predisposition.
Introduction Jet aircraft pilots are exposed to huge pressure variation during flight, which affect physiological functions as systems, such as the respiratory system. Objectives The objective of the present investigation was to evaluate inflammatory changes of paranasal sinuses of jet aircraft pilots before and after a jet aircraft training program, using multislice computed tomography (CT), in comparison with a group of nonairborne individuals with the same age, sex, and physical health conditions. A second objective of the present study was to assess the association between the ostiomeatal complex obstruction and its anatomical variations. Methods The study group consisted of 15 jet aircraft pilots participating in the training program. The control group consisted of 41 nonairborne young adults. The 15 fighter pilots were evaluated before initiating the training program and after their final approval for the presence of inflammatory paranasal sinus disease. The ostiomeatal complex anatomical variations and obstructions were analyzed in pilots after the training program. Results Jet aircraft pilots presented higher incidence of mucosal thickening in maxillary sinus and anterior ethmoid cells than controls. Prominent ethmoidal bulla showed significant association with obstruction of the osteomeatal complex. Conclusions Jet aircraft pilots present increased inflammatory disease when compared with nonairborne individuals. The presence of a prominent ethmoidal bulla is associated with ostiomeatal complex obstruction.
OBJECTIVES: This study aimed to evaluate the prognostic value of magnetic resonance imaging (MRI) findings in predicting local recurrence in patients with maxillary sinus cancer treated with super-selective intra-arterial infusion of high-dose cisplatin with concomitant radiotherapy (RADPLAT). METHODS: This single-center retrospective study included consecutive patients with maxillary sinus squamous cell carcinoma, who underwent RADPLAT between October 2016 and September 2021. MRI was performed before (within 2 weeks) and 1 month after (post-treatment MRI) the start of treatment. Tumor reduction rates and pre-treatment cross-sectional areas were calculated from the maximum cross-sectional areas on pre- and post-treatment MRI T2-weighted axial images. Statistical analyses, including receiver operating characteristic analysis, were performed to assess the predictive value of the tumor reduction rates. RESULTS: Twenty-four patients were included in this study. Recurrence occurred in seven patients with a median time of 213 days. The tumor reduction rates were significantly higher in the benign post-treatment changes group compared to the recurrence group (median, 0.814 vs. 0.174; p < 0.001). The cut-off value for the reduction rate between the groups was 0.3578. No significant difference was observed in the maximum pre-treatment cross-sectional area between the groups (p = 0.664). The inter-observer agreement for the tumor areas was excellent. CONCLUSIONS: The tumor reduction rate calculated from MRI T2-weighted images may be a predictor of local recurrence in patients with maxillary sinus cancer treated with RADPLAT. Patients with lower reduction rates may benefit from early salvage surgeries.
Background: Sex estimation is crucial to forensic examinations. In order to estimate sex, intact bones are used if the majority of bones are severely deformed and recovered in fragments. This study aims to analyze sexual dimorphism in intact maxillary sinuses using CBCT scanning to evaluate morphometric properties for sex identification. Methods: A total of 318 subjects, consisting of 159 males and 159 females, aged between 20 and 60 years without sinus pathology were included in this diagnostic, retrospective cross-sectional study. Bilateral measurements of the volume, height, width, and length of the maxillary sinuses were obtained and compared to evaluate the differences between sexes. Subsequently, a descriptive analysis using mean and standard deviation was performed, followed by a comparison between sexes with a p-value being less than 0.05 and Student's t-test. Finally, a discriminant analysis was performed separately for the right and left maxillary sinuses. Results: Males and females showed statistically significant variations in the length, width, and volume of the maxillary sinuses. Specifically, on the right side, males had longer maxillary sinuses than females (t = 5.6203, p < 0.0001). Meanwhile, on the left side, females had wider maxillary sinuses than males (t = 8.621, plt0.0001). In addition, males had greater volumes of maxillary sinuses on the right (t = 6.373, p < 0.0001) and left (t = 3.091, p < 0.0001) sides than females. The results of the discriminant analysis showed that the left width parameter had the highest accuracy of sex estimation (74.21%), followed by the Right Length (70.07%) and left volume (66.66%) parameters. The left height parameter had the lowest accuracy of sex estimation (49.37%). Conclusion: In forensic odontology, the volume of maxillary sinus can serve as a valid radiographic indicator of sex estimation.
Cone-Beam Computed Tomography , Maxillary Sinus , Male , Female , Humans , Young Adult , Adult , Middle Aged , Maxillary Sinus/diagnostic imaging , Retrospective Studies , Cross-Sectional Studies , Sex Characteristics
OBJECTIVES: The study aims to develop an artificial intelligence (AI) model based on nnU-Net v2 for automatic maxillary sinus (MS) segmentation in Cone Beam Computed Tomography (CBCT) volumes and to evaluate the performance of this model. METHODS: In 101 CBCT scans, MS were annotated using the CranioCatch labelling software (Eskisehir, Turkey) The dataset was divided into three parts: 80 CBCT scans for training the model, 11 CBCT scans for model validation, and 10 CBCT scans for testing the model. The model training was conducted using the nnU-Net v2 deep learning model with a learning rate of 0.00001 for 1000 epochs. The performance of the model to automatically segment the MS on CBCT scans was assessed by several parameters, including F1-score, accuracy, sensitivity, precision, Area Under Curve (AUC), Dice Coefficient (DC), 95% Hausdorff Distance (95% HD), and Intersection over Union (IoU) values. RESULTS: F1-score, accuracy, sensitivity, precision values were found to be 0.96, 0.99, 0.96, 0.96 respectively for the successful segmentation of maxillary sinus in CBCT images. AUC, DC, 95% HD, IoU values were 0.97, 0.96, 1.19, 0.93, respectively. CONCLUSIONS: Models based on nnU-Net v2 demonstrate the ability to segment the MS autonomously and accurately in CBCT images.
The article presents a case of chronic odontogenic maxillary sinusitis and the results of its surgical treatment. The cause of the sinusitis, confirmed by the results of X-ray and pathohistological studies, was an inflammatory process affecting the bone tissue around the implant, installed in the place of the upper first molar which was accompanied by the development of an oroantral fistula. During the surgical intervention, the communication between the oral cavity and the maxillary sinus was eliminated, and the implant with the abutment, which was entirely in its cavity, was also removed.
Dental Implants , Maxillary Sinusitis , Humans , Maxillary Sinusitis/diagnosis , Maxillary Sinusitis/etiology , Maxillary Sinusitis/surgery , Dental Implants/adverse effects , Maxillary Sinus/diagnostic imaging , Maxillary Sinus/surgery , Oroantral Fistula/diagnosis , Oroantral Fistula/etiology , Oroantral Fistula/surgery , Chronic Disease
Pseudomyogenic hemangioendothelioma (PMHE) is a rare vascular neoplasm with an intermediate to low-grade malignant potential. Only 5% of PMHEs occur in the head and neck. This tumor exhibits different histological patterns and mimics other vascular tumors, myoid tumors, or carcinomas. The distinction between these tumors can be a very challenging situation for pathologists. In this article, we report the first case, to our knowledge, of PMHE arising in the maxillary sinus, to highlight this uncommon entity and discuss differential diagnoses.
Objectives: To identify risk factors and evaluate the impact of various facial fractures and reconstruction surgeries on postoperative weight change. Methods: Retrospective, monocentric study was performed at a tertiary care center. Medical history, type and mechanism of fracture, operative factors, and postoperative weights at follow-up appointments for 145 adult patients undergoing surgical repair for maxillofacial fractures were collected. Further information was obtained on postoperative diet and whether patients received maxillomandibular fixation (MMF). Univariate and multivariate analyses were utilized to evaluate effects of surgical reconstruction after facial trauma on postoperative weight loss. Results: Patients lost 3.2 ± 4.9 kg (95% confidence interval = 2.7-4.1, P < .0001) on average, with maximum loss between date of surgery and first follow-up. Univariate analysis demonstrated that intensive care unit admission (5.9 kg, SD 5.4, P = .001), nasogastric tube placement (5.1 kg, SD 4.6, P = .012), and MMF (4.4 kg, SD 5.4, P < .0001) were associated with more severe weight loss. Multivariate analyses showed that only MMF remained a significant risk factor for increased weight loss (avg. 6.0, standard error 1.93, t value 3.11, P = .0024). Conclusions: We report significant weight loss following facial trauma and reconstruction, which emphasizes the need to perform further studies on nutrition protocols for this patient population to optimize wound healing.
(1) Background: In this study, the impact of odontogenic risk factors with nasal septum deviation on maxillary sinus mucosal thickening was assessed using Cone-beam computed tomography CBCT. (2) Methods: A total of 328 maxillary sinus regions from 164 patients (85 males and 79 females) were examined. Images were interpreted by dental specialists and Otolaryngologists. Coronal and sagittal sections were examined to assess the proximity of the root tips of posterior maxillary teeth (RPMT) to the maxillary sinus. The periodontal bone loss for all maxillary posterior teeth was also assessed. Consequently, maxillary sinus mucosal thickening (MT) was further classified into three gradings. Multilevel modeling regression analysis was used due to the hierarchical structuring of the data. Four models were developed, a null model with no factors, a model with tooth-level factors (RPMT, PBL, tooth condition, and root length), a model with patient-level factors (gender and nasal septum deviation), and a model with combined patient- and tooth-level factors. Regression estimates (AOR) and 95% confidence intervals (CIs) of individual and tooth factors were calculated. (3) Results: Multilevel regression analysis showed that RPMT was significantly associated with MT of maxillary sinus (p < 0.001), where patients who had RPMT > 0 had higher odds of MT of maxillary sinus. Tooth condition was also found to be significantly associated with MT of maxillary sinus, where teeth with failed RCT (p < 0.001) and teeth with restorations (p < 0.008) had higher odds of MT of maxillary sinus (AOR = 2.87, 95%CI 1.65, 4.42, AOR = 1.64, 95%CI 1.14, 2.36, respectively). (4) Conclusions: In order to plan preoperative treatment for maxillary posterior teeth, it is important to assess the anatomical relationship between the sinus floor and the root tips of the maxillary posterior teeth. Additionally, we establish a better understanding of the clinician before surgical intervention is conducted.
The present study was designed to test the hypothesis that there would be a correlation between nasal septum deviation (NSD) and a decreased maxillary sinus volume (MSV) in a Colombian population, using Cone Beam Computed Tomography (CBCT); other sinusal anatomical structures found during the reading were described and analyzed. A retrospective analysis of 537 CBCT scans of adult patients taken between January 2014 and January 2017 included measuring the maxillary sinus diameter in the vertical, horizontal, and sagittal planes. NSD was quantified and related to MSV using the same field of view (FOV). The volume of the right and left maxillary sinuses showed a median and interquartile range (IQR) of 8.18 mm3 (IQR: 6.2-10.33) and 8.3 mm3 (IQR: 6.4-10.36). Statistically significant differences were observed between sex and right and left MSV (p = 0.000), with higher MSV in men. The presence of NSD was observed in 96.81% of the sample and was evaluated in degrees, observing a median of 11° (IQR: 7-16) where 40% of the sample had moderate angles (9-15°). There was no correlation between NSD and a decreased MSV in the population studied. Detailed CBCT analysis with a large FOV is crucial for the analysis of anatomical structures before performing surgical procedures that involve the MS as a preventive diagnostic and therapeutic step for appropriate treatment.
Introduction Odontogenic infections are one of the common causes of maxillary sinusitis. With the close proximity of the roots of maxillary posterior teeth to the sinus floor, the infection may spread into the sinus causing sinus mucosal thickening. This study aims to evaluate the association between maxillary posterior teeth periapical pathologies and maxillary sinus mucosal changes using cone-beam computed tomography (CBCT) images. Methods One-hundred six maxillary posterior teeth with periapical lesions were included in this study and were assessed using CBCT images by two maxillofacial radiologists. The proximity of the roots to the sinus floor, the proximity of the top edge of the periapical lesion to the sinus floor, and the sinus mucosal changes associated with the periapical lesions were studied. The size of the periapical lesion was measured and scored using CBCT periapical index. Mucosal thickening more than 2 mm was considered pathological and the type, pattern, and severity of mucosal thickening were assessed. Data were analyzed using chi-squared tests at a level of significance set at p -value less than 0.05. Results Among the 106 teeth with periapical lesions, 99 teeth (93.4%) revealed the presence of maxillary sinus mucosal thickening. The prevalence of mucosal thickening increased significantly with the presence of cortical bone destruction, the close proximity of the root, and the periapical lesion to the sinus floor. The generalized type of mucosal thickening was more prevalent with larger periapical lesions and a significant increase in the severity of the thickening was observed closer spatial relationship of the root to the sinus floor. Conclusion Periapical pathologies of maxillary posterior teeth often cause sinus mucosal thickening. The early diagnosis and management of these pathologies will be helpful in preventing the spread of infection into the maxillary sinus.
