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Konsulov S, Minkov T, Pazardzhikliev D, Milkov D, Markov D. Symptomatic Tornwaldt Cyst: A Case Report. Cureus 2024; 16:e58796. [PMID: 38784350 PMCID: PMC11112291 DOI: 10.7759/cureus.58796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Thornwaldt cyst is a rare cystic formation, located along the midline of the nasopharynx. We present the case of a 60-year-old man with impaired nasal breathing and a several months-long history of serous otitis media. His only concomitant disease was arterial hypertension. The diagnostic imaging tests revealed a well-rounded cystic formation involving the upper part of the nasopharynx, characteristic of Thornwaldt cyst. Following, endoscopic transnasal marsupialization was performed and the benign cystic nature was confirmed on histopathology. The patient responded to the administered treatment and reported no persistence or emergence of new symptoms. The current case presents a symptomatic Thornwaldt cyst successfully treated by endoscopic transnasal marsupialization.
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Affiliation(s)
- Stefan Konsulov
- Department of Otorhinolaryngology, Medical University of Plovdiv, Plovdiv, BGR
- Department of Otorhinolaryngology, University Hospital Kaspela, Plovdiv, BGR
| | - Taniel Minkov
- Department of Otorhinolaryngology, University Hospital Kaspela, Plovdiv, BGR
| | - Dimitar Pazardzhikliev
- Department of Otorhinolaryngology, Medical University of Plovdiv, Plovdiv, BGR
- Department of Otorhinolaryngology, University Hospital Kaspela, Plovdiv, BGR
| | - Denis Milkov
- Department of Otorhinolaryngology, Medical University of Plovdiv, Plovdiv, BGR
- Department of Otorhinolaryngology, University Hospital Kaspela, Plovdiv, BGR
| | - Daniel Markov
- Department of General and Clinical pathology, Medical University of Plovdiv, Plovdiv, BGR
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Kashi F, Dalili Kajan Z, Yaghoobi S, Khosravifard N. Frequency of Accessory Maxillary Ostium in Patients With/Without Sinusitis, and Its Correlation with Anatomical Variations of Paranasal Sinuses: A Cone Beam Computed Tomography Study. Indian J Otolaryngol Head Neck Surg 2024; 76:1645-1654. [PMID: 38566626 PMCID: PMC10982170 DOI: 10.1007/s12070-023-04376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/19/2023] [Indexed: 04/04/2024] Open
Abstract
This study assessed the frequency of accessory maxillary ostium (AMO) in patients with/without sinusitis and its correlation with anatomical variations using cone-beam computed tomography (CBCT). In this cross-sectional study, 244 CBCT scans were evaluated in two groups: with maxillary sinusitis having > 2 mm mucosal thickening and without max sinusitis as a normal group having normal or less than 2 mm mucosa. The CBCT scans of each group were carefully evaluated for the presence/absence of AMO, patency/obstruction of the primary maxillary ostium (PMO), and the presence of anatomical variations of the paranasal sinuses. Data were analyzed by independent t-test, Pearson Chi-square test, and Fisher's exact test (alpha = 0.05). CBCT scans of 134 females (54.9%) and 110 males (45.1%) with a mean age of 34.16 ± 19.01 years were evaluated. The presence of AMO had no significant correlation with maxillary sinusitis (P = 0.104). The two groups had no significant difference in the frequency of Haller cell, nasal septal deviation, and concha bullosa (P > 0.05). However, the frequency of paradoxical concha (PC; P < 0.001) and bifid concha (BC; P = 0.017) was significantly higher in the normal group, and the frequency of PMO obstruction was significantly higher in the sinusitis group (P < 0.001). AMO had no significant correlation with any anatomical variation in any group (P > 0.05). Gender had a significant effect on the presence of AMO (P = 0.013). The presence of AMO had no significant correlation with maxillary sinusitis. However, its frequency was significantly higher in females in normal group and males with sinusitis. The presence of AMO had no significant correlation with anatomical variations.
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Affiliation(s)
- Faezeh Kashi
- Department of Maxillofacial Radiology, Guilan University of Medical Sciences, End of Professor Samii Blvd, Rasht, 41941-73774 Iran
| | - Zahra Dalili Kajan
- Department of Maxillofacial Radiology, Guilan University of Medical Sciences, End of Professor Samii Blvd, Rasht, 41941-73774 Iran
- Department of Maxillofacial Radiology, Dental Sciences Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Soophia Yaghoobi
- Department of Maxillofacial Radiology, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Negar Khosravifard
- Department of Maxillofacial Radiology, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
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Shetty S, Al Bayatti SW, Al-Rawi NH, Samsudin R, Marei H, Shetty R, Abdelmagyd HA, Reddy S. A study on the association between accessory maxillary ostium and maxillary sinus mucosal thickening using cone beam computed tomography. Head Face Med 2021; 17:28. [PMID: 34261509 PMCID: PMC8278720 DOI: 10.1186/s13005-021-00284-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accessory maxillary ostium (AMO) has a major role to play in the aetiology of maxillary sinusitis. Mucosal thickening is one of the key radiographic features of chronic maxillary sinusitis. The aim of this study was to identify the location of the AMOs and investigate the association between Mucosal Thickening [MT] and AMO using Cone Beam Computed Tomography [CBCT]. METHODS CBCT scans of 400 maxillary sinuses from the records of 200 patients who seeked various dental treatments at the Thumbay Dental Hospital, Gulf Medical University, Ajman, United Arab Emirates were evaluated. The incidence, anatomical position and maximal length of accessory maxillary ostia (AMO) in the maxillary antrum were reviewed using CBCT by two examiners. The association between MTs and AMOs were also analysed. RESULTS Among the 200 CBCT scans, 131 belonged to male patients and 69 scans belonged to female subjects within the age group of 18-65 years (mean age 41.32 years). AMOs were found in 142 maxillary antra (35.5 %). The inter-observer reliability for using CBCT to detect AMO was (k = 0.83). There was no significant difference in the frequency of AMOs when the age (P = 0.19) and gender (P = 0.54) distribution were considered. Sinuses with AMOs, showed significantly greater frequency of MTs (p = 0.001). AMOs with maximal length of less than 1mm were most commonly observed (51.40 %). AMOs with larger greater maximal length were associated with higher degrees of MT. The location of the AMOs, were not affected by the degree of MT. CONCLUSIONS The study demonstrates a clear association between degree of MT and occurrence of AMO in the maxillary sinus. However, the location of the AMO is independent of the degree of the MT. There is a greater probability of finding an AMO in the maxillary sinus if the MT in the sinus is more than 3 mm.
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Affiliation(s)
- Shishir Shetty
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.
| | - Saad Wahby Al Bayatti
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Natheer Hashim Al-Rawi
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rani Samsudin
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Hesham Marei
- College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
| | | | | | - Sesha Reddy
- College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
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Bani-Ata M, Aleshawi A, Khatatbeh A, Al-Domaidat D, Alnussair B, Al-Shawaqfeh R, Allouh M. Accessory Maxillary Ostia: Prevalence of an Anatomical Variant and Association with Chronic Sinusitis. Int J Gen Med 2020; 13:163-168. [PMID: 32440195 PMCID: PMC7217303 DOI: 10.2147/ijgm.s253569] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/24/2020] [Indexed: 01/30/2023] Open
Abstract
Introduction The role of the accessory maxillary ostium, a common anatomical variant, in the development of chronic sinusitis remains unclear. This study aimed to examine the association between chronic sinusitis and presence of an accessory maxillary ostium using computed tomography (CT) of the paranasal sinuses. Methods We conducted a retrospective study of 1188 paranasal sinus CT scans performed in a major tertiary medical center between January 1, 2016 and December 31, 2016. Axial and coronal and views were reviewed to evaluate the presence of accessory maxillary ostia and maxillary and ethmoid sinusitis. Results Nine hundred twenty-eight patients were included for analysis. A 52.8% were male. Mean patient age was 33.8 years. A right accessory maxillary ostium was detected in 274 patients (29.5%), which was the same number of patients with a left accessory maxillary ostium. Bilateral accessory maxillary ostia were found in 172. The presence of right maxillary sinusitis was significantly associated with male gender and the presence of a right accessory maxillary ostium. Male gender was the only factor significantly associated with the presence of left sinusitis. Left or right ethmoidal sinusitis was significantly associated with male gender and the presence of left or right maxillary sinusitis, respectively. Conclusion The presence of an accessory maxillary ostium may contribute to the development of maxillary and ethmoidal sinusitis. Further studies are needed to elucidate this association and determine indications for incorporating the natural and accessory ostia when performing middle meatus antrostomy during endoscopic sinus surgery.
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Affiliation(s)
- Majid Bani-Ata
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Abdelwahab Aleshawi
- King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Abdullah Khatatbeh
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Derar Al-Domaidat
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Bayan Alnussair
- Radiology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Raneem Al-Shawaqfeh
- King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mohammed Allouh
- Department of Anatomy, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain 17666, United Arab Emirates
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Şimşek Kaya G, Daltaban Ö, Kaya M, Kocabalkan B, Sindel A, Akdağ M. The potential clinical relevance of anatomical structures and variations of the maxillary sinus for planned sinus floor elevation procedures: A retrospective cone beam computed tomography study. Clin Implant Dent Relat Res 2018; 21:114-121. [PMID: 30556642 DOI: 10.1111/cid.12703] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/23/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Complications arising from sinus floor elevation (SFE) with lateral approach surgery can be avoided by means of maxillary sinus examination in the preoperative period. PURPOSE To investigate anatomical variations in the maxillary sinus by making use of cone beam computed tomography (CBCT) in terms of SFE with a lateral approach. MATERIALS AND METHODS Two hundred twenty eight maxillary sinuses in 114 patients were included. Parameters such as the position and diameter of the posterior superior alveolar artery (PSAA) canal, the frequency and localization of the septa or accessory maxillary ostium (AMO), and lateral wall thickness values were subjected to statistical analysis. RESULTS Septa were observed in 35.1% of sinuses. The majority of septa were determined in the middle region (48.8%). Additionally, 71.1% of PSAA canals were intraosseous, generally exceeding 1 mm in diameter (68.9%). The shortest mean perpendicular distance between the sinus floor and the PSAA canal was determined in the first molar region (9.22 ± 5.66 mm). Similarly, the highest mean sinus lateral wall thickness was determined in the first molar region, in the area 3 mm distant from the sinus floor (2.42 mm ± 0.88 mm). AMO was detected in 40.8% of sinuses. CONCLUSION CBCT-guided treatment planning may be beneficial prior to SFE procedures in order to avoid surgical complications.
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Affiliation(s)
- Göksel Şimşek Kaya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Özlem Daltaban
- Department of Periodontology, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Mahir Kaya
- Department of Medical Imaging Techniques, Vocational School of Health Services, Akdeniz University, Antalya, Turkey
| | - Burak Kocabalkan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Alper Sindel
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Mehmet Akdağ
- Department of Otorhinolaryngology, Atatürk State Hospital, Antalya, Turkey
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Penttilä M. Accessory maxillary ostium repair using middle turbinate flap: a case series of 116 patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2018; 8:1204-1210. [PMID: 29883049 DOI: 10.1002/alr.22159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/03/2018] [Accepted: 05/18/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The ostiomeatal complex (OMC), comprising a small natural maxillary sinus ostium and narrow infundibulum, transmits the air diffusion into the antrum and mucociliary transport from the antrum, and is considered a key area in chronic rhinosinusitis (CRS). Thin membranous anterior and posterior fontanelle areas below the OMC can rupture forming a perforation, accessory maxillary ostium (AMO), that increases antral airflow changing the anatomy and function of the sinus. The purpose of this study was to report the first case series of CRS patients who had undergone repair of fontanelle defects aiming to reconstruct normal structures. METHODS Between 2011 and 2017, a total of 157 perforations were diagnosed and repaired in 121 of 525 consecutive endoscopic sinus operations performed by the author. Defects were 3 mm to 4 mm in size (range, 1 mm to 7 mm). A flap cut from the undersurface of the middle turbinate was used. In total, 101 patients received concurrent balloon catheter dilation (BCD), while 15 patients had only an AMO repair. The mean endoscopic follow-up time was 16 weeks (range, 1 to 188 weeks). RESULTS Overall, 101 perforations were closed, 21 open, and 17 partially open. A history of earlier endoscopic sinus surgery (ESS) or BCD surgery, presence of nasal polyposis or whether the repair was made without simultaneous BCD did not influence the closure rate. Postoperative febrile sinusitis occurred in 26 patients. CONCLUSION Repair of AMO is in theory a beneficial and technically feasible office procedure with only transient side effects. Three out of 4 perforations were closed after repair.
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Affiliation(s)
- Matti Penttilä
- Department of Otorhinolaryngology, University of Tampere, Tampere, Finland.,Terveystalo Healthcare Inc., Tampere, Finland.,Terveystalo Healthcare Inc., Helsinki, Finland.,Pihlajalinna Koskiklinikka, Tampere, Finland
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