Pathogenic factors of maxillary sinus mucosal thickening observed by cone-beam computed tomography (CBCT)

OBJECTIVE

To explore the pathogenic factors associated with maxillary sinus mucosal thickening with Cone-beam computed Tomography (CBCT).

METHODS

From 2016 through 2020, 93 patients with periapical periodontitis or periodontitis in the maxillary posterior dental region were selected.

RESULTS

The preoperative thickness of the periodontitis group was significantly higher than that of the periapical periodontitis group (P < 0.05). The difference achieves statistical significance for the comparison of the thickness change with various severity of inflammation (F = 54.824, P = 0.000), the change with time (F = 312.741, P = 0.000). and the change with the interaction severity of inflammation and time（F = 86.132, P = 0.000).

CONCLUSIONS

Patients with maxillary sinus mucosa thickening caused by periodontitis and periapical periodontitis should be extracted their infectious teeth and get thoroughly debridement. Maxillary sinus augmentation can perform favorable efforts 3-6 months after extracting teeth.

Difference of Antrochoanal Polyps Between Children and Adults in the Chinese Population

OBJECTIVE

This study aims to find the difference in clinical and immunopathological characteristics between children and adults with antrochoanal polyps (ACPs) in the Chinese population.

METHODS

The clinical data of 69 patients diagnosed with ACPs were retrospectively analyzed. Cytokine levels in 16 controls and 40 ACPs tissues were determined by quantitative real-time polymerase chain reaction (qPCR). The expression of matrix metalloproteinase (MMP)-9 was measured using qPCR, immunofluorescent staining, and western blot.

RESULTS

There were 51 (73.9%) children (<18 years old) and 18 (26.1%) adults (≥18 years old). The sex ratio differed significantly between the two groups (p = 0.0032). There were no significant differences in the nasal side of ACPs and approaches to surgery between the two groups. In both groups, the most common symptom was nasal obstruction, followed by nasal discharge. As for associated nasal diseases, there was a significant difference between the two groups in septal deviation (p = 0.0223). Adult patients showed significantly higher expression of IL-8 mRNA than children (p = 0.0424). The mRNA and protein levels of MMP-9 were also significantly higher in adult patients than in children (p = 0.0498 and 0.0009, respectively).

CONCLUSION

In the Chinese population, the comorbidities and immunopathological characteristics of adult ACP patients are different from those of children. The level of IL-8 and MMP-9 was significantly higher in ACPs of adults than in children, which may contribute to the more severe tissue remolding in adult ACP patients.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:2093-2099, 2024.

Association between maxillary sinus floor perforation by dental implants and mucosal thickening: A cone-beam computed tomography study

OBJECTIVE

To investigate the association of perforation of the maxillary sinus floor by dental implants with mucosal thickening and to describe its characteristics in perforated cases.

STUDY DESIGN

One-hundred and twenty-nine maxillary sinuses of 93 patients presenting 202 dental implants in the maxillary posterior region were retrospectively assessed in cone-beam computed tomography scans and classified according to maxillary sinus perforation, bone graft, mucosal thickening, and mucosal appearance. Logistic regression determined the chance of mucosal thickening in perforated maxillary sinuses. The chi-square test compared categorical variables between maxillary sinus perforated or not by implants and maxillary sinus with or without mucosal thickening. The significance level assumed was 5 % (α = 0.05).

RESULTS

There was perforation of 60 maxillary sinuses floor (46.5 %) by 74 dental implants. The chance of mucosal thickening was higher when the implant tip was trespassing on the maxillary sinus floor (p < 0.001). There was a significant association between maxillary sinus mucosal thickening and perforation by a dental implant with the tip trespassing the maxillary sinus floor (p < 0.05).

CONCLUSION

Maxillary sinus mucosal thickening is associated with sinus floor perforation by dental implants and does not depend on the number of implants perforating it.

CLINICAL RELEVANCE

There is an association between dental implants' perforation of the maxillary sinus floor and the thickening of the maxillary sinus. In those cases, the appearance of the mucosa thickening may be irregular, local, or total opacification of the sinus cavity.

Intravascular papillary endothelial hyperplasia of the maxillary sinus extending into the contralateral nasal cavity

INTRODUCTION

Intravascular papillary endothelial hyperplasia (IPEH) predominantly occurs in the subcutaneous and dermal regions and rarely originates from the sinonasal mucosa.

CASE PRESENTATION

We report on the case of a 58-year-old male patient who presented with progressive bilateral nasal obstruction, left-sided epiphora, and intermittent epistaxis. Computed tomography revealed a soft tissue opacity in the left maxillary sinus with intersinusoidal nasal wall demineralization, extending into the surrounding ethmoid cells and the right nasal cavity through a contralateral deviation of the nasal septum. Contrast-enhanced T1-weighted magnetic resonance imaging further confirmed these findings. The IPEH originating from the maxillary sinus extended into the contralateral nasal cavity, and it was successfully removed using an endoscopic endonasal approach, avoiding overly aggressive treatment.

CONCLUSION

This case report highlights the diagnostic challenges of IPEH in the sinonasal region and the importance of considering IPEH as a differential diagnosis in patients presenting with nasal obstruction, epiphora, and intermittent epistaxis.

Elective neck dissection versus elective neck irradiation in cT3/4N0 maxillary sinus squamous cell carcinoma: a propensity score matching analysis

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.

[Proposal for the delineation of postoperative primary clinical target volumes in maxillary sinus and nasal cavity cancers]

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.

Prognostic Analysis of Individualized Treatments of Malignant Tumors Primary From Maxillary Sinus

OBJECTIVES

To investigate the prognosis and quality of life for primary malignant maxillary sinus tumors.

METHODS

This was a retrospective analysis. 164 patients diagnosed with primary malignant maxillary sinus tumors between 2005 and 2018 were recruited. Patients were treated according to the pathological type and the lesion range. Prognostic differences of different pathological types, surgical resection methods, repair methods, treatment methods, and different local recurrence sites were analyzed. Survival analysis and prognostic factors analysis were performed.

RESULTS

Overall survival (OS) rate was 74.7% at 3 years, 60.5% at 5 years, and 45.8% at 10 years. Disease-free survival (DFS) rate was 67.2% at 3 years, 45.6% at 5 years, and 30.8% at 10 years. There was significant difference in OS rate among different pathological types (χ2 = 14.18, P < 0.05). The order of 5-year OS rate was as follows: malignant transformation of inverted Papilloma (77.7%) > adenoid cystic carcinoma (74.1%) > squamous cell carcinoma (48.4%) > sarcoma (22.1%). The order of disease-free survival was as follows: total maxillary resection > subtotal maxillary resection > endoscopic nasal tumor resection ≥enlarged maxillary resection, the 5-year DFS rate were 68.6%, 53.5%, 46.2%, and 42.9%, respectively. The OS of postoperative radiotherapy was significantly better than that of preoperative radiotherapy (χ2 = 7.16, P < 0.05). There was significant difference in OS between recurrent and non-recurrent patients (χ2 = 68.57, P < 0.05).

CONCLUSIONS

The pathological type and the timing of radiotherapy are independent prognostic factors for primary malignant tumor of maxillary sinus. In addition, different local surgical resection methods are independent factors affecting the recurrence rate.

Periodontal Lesions among Maxillary Sinus Mucosal Thickening Visiting the Department of Oral Medicine and Radiology of a Tertiary Care Centre

Introduction

Maxillary sinus due to its proximity to posterior maxillary teeth could be affected by their pathology. Since cone beam computed tomography is the go-to for 3-D imaging in dental set-up. This study aimed to find out the prevalence of periodontal lesions among maxillary sinus mucosal thickening visiting the Department of Oral Medicine and Radiology of a tertiary care centre.

Methods

This descriptive cross-sectional study was conducted in the Department of Oral Medicine and Radiology of a tertiary care centre from 01 February 2021 to 30 June 2021 after obtaining ethical approval from the Institutional Review Committee. The medical records from 01 January 2019 to 31 December 2019 were retrieved. The identification of maxillary sinus mucosal thickening of more than 3 mm, in cone beam computed tomography images, was registered separately for the right and left sinuses of each patient. The presence of periodontal lesions of posterior teeth was recorded. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 195 maxillary sinus mucosal thickening, periodontal lesions were found in 74 (37.95%) (31.14-44.76, 95% Confidence Interval) maxillary sinuses of 46 patients. The mean age was 53.67±12.72 years and 30 (65.21%) were males.

Conclusions

The prevalence of periodontal lesions among maxillary sinus mucosal thickening in CBCT images was similar to other studies done in similar settings.

Keywords

cone beam computed tomography; maxillary sinus; periodontal disease; prevalence.

Prelacrimal Recess Approach in Unilateral Maxillary Sinus Lesions: What Is the Impact and Efficacy?

Background and Objectives: Chronic sinusitis is a commonly encountered diagnosis for otorhinolaryngologists. The profound negative effect of rhinosinusitis on patients' quality of life is frequently overlooked, and surgical lines of treatment are numerous. The aim of the study was to assess the comparative efficacy of endoscopic middle meatal antrostomy with the endoscopic prelacrimal recess approach, combined with middle meatal antrostomy in the treatment of unilateral chronic maxillary sinus lesion. Materials and Methods: Thirty patients with unilateral chronic maxillary sinus lesions enrolled in the study at Alahsa hospital. Patients were divided into two groups: 15 treated through a middle meatal antrostomy and 15 treated via a combined middle meatal antrostomy and prelacrimal recess approach. Demographic and clinical information of the patients, including the medical history, CT scan findings, diagnosis, recurrence, and complications, were gathered and analyzed. Pre- and postoperative clinical findings were graded utilizing the Lund-Kennedy Endoscopic Scoring System. Results: The enrolled patients varied in age from 18 to 56, with 60% being male and 40% being female. Antrochoanal polyp, maxillary sinus mucocele, and unilateral allergic fungal sinusitis were among the pathological diagnoses. The follow-up period averaged 14.3 months. Following surgery, two patients in Group II encountered nasal discomfort, which included synechia and epiphora. The success rate for preserving a patient's disease-free condition was 86.7%. A statistically significant difference in disease-free incidence was observed among the patients in group II. In group I, recurrence was identified in 26.7% of the patients. The postoperative symptoms diminished considerably, and the VAS score was reduced substantially. In Group II patients, however, there was no significant difference in scarring. Clinically significant differences were observed in the mean total Lund-Kennedy Endoscopic scores when compared to their preoperative values. Conclusions: Achieving endoscopic access to the sinus's anterior, lateral, inferior, and inferomedial regions is facilitated by operating via the prelacrimal recess, which is the most advantageous approach. This approach facilitates rapid mucosal healing by maintaining the integrity of the nasolacrimal duct and mucosal covering. The specific pathology, surgical objectives, surgeon expertise, and equipment accessibility influence the choice of endoscopic surgical technique.

Elective management of the N0 neck in maxillary sinus squamous cell carcinoma

OBJECTIVES

To demonstrate adequacy of radiation therapy alone to the neck in patients with maxillary sinus squamous cell carcinoma (MS-SCC) without clinical evidence of regional metastasis.

METHODS

Retrospective review between 2000 and 2018 from a single high-volume tertiary academic head and neck cancer center of all patients with MS-SCC.

RESULTS

A total of 55 patients were treated for MS-SCC at our center. A clinically uninvolved neck on presentation was found in 46 patients (83.6%) in the initial dataset. Of the 39 patients with radiologic N0 disease who were treated with primary surgical resection, 15.4% (6 patients) did not undergo any treatment of the neck, 2.6% (1 patient) underwent a neck dissection only, 69.2% (27 patients) received RT only, and 12.8% (5 patients) were treated with both a neck dissection followed by RT. Median follow-up was 26 months (mean 48 months, interquartile range 9-76 months). Five-year overall survival of all patients with N0 necks treated with upfront surgical resection was 46.5% (95% CI, 32.3%-66.9%). No patients with N0 necks had isolated regional recurrence regardless of neck management.

CONCLUSIONS

Regional recurrence is rare for patients with radiologic N0 MS-SCC. Single-modality elective neck radiation provides excellent regional disease control in these patients.

Paranasal sinus angiosarcoma with facial paralysis as a novel manifestation: a case report and literature review

BACKGROUND

Paranasal sinus angiosarcoma is an uncommon malignancy, with only a few reported cases worldwide. Although it exhibits multiple symptoms, facial paralysis has not been previously documented as a noticeable presentation.

CASE PRESENTATION

In this case, we report a 40-year-old male who presented with facial numbness and pain for one month, weakness of his facial muscles for 15 days, and recurrent right epistaxis for 1 year. He had a history of nasal inflammatory polyps with chronic sinusitis. Computed tomography and magnetic resonance imaging showed space-occupying lesions in the right nasal cavity and maxillary sinus, with bone destruction occurring in the sinus wall and turbinate. This patient then underwent endoscopic surgery. According to the histopathological and immunohistochemical results, he was eventually diagnosed with paranasal sinus angiosarcoma in April 2021. To date, this patient has not initiated any radiotherapy or chemotherapy and has survived with lymphatic metastasis for at least 3 years.

CONCLUSIONS

This manuscript suggests that paranasal sinus angiosarcoma can present with facial paralysis. Moreover, pathological and immunohistochemical tests are still vital for diagnosing paranasal sinus angiosarcoma and differential diagnosis. Additionally, regular follow-up is crucial for patients with paranasal sinus angiosarcoma, enabling monitoring of recurrence, metastasis, and recovery while contributing valuable clinical data to understanding this rare disease and associated research endeavours.

A rare case of Odontogenic Keratocyst in the Maxillary Sinus: diagnosis and management

Odontogenic keratocyst is a benign intraosseous lesion of odontogenic origin which is characterized by its aggressive nature. It is usually present in the mandibular posterior area, although it can also be found in the maxilla, particularly in the canine region. We discuss a unique example of OKC in the maxillary sinus involving the 27&28 region. Due to comparable clinical signs, this lesion is more prone to be mistaken for other lesions of the maxillary sinus, such as sinusitis or polyps. On the other side, this benign disease has the potential to develop into Ameloblastoma or squamous cell carcinoma. A favorable prognosis thus depends on early identification, precise diagnosis, appropriate treatment, and follow-ups.

Computed Tomography and Magnetic Resonance Imaging Findings Contribute to Differentiating Solid- and Nonsolid-Type Adenoid Cystic Carcinoma in Maxillary Sinus

PURPOSE

This study aimed to evaluate the imaging features of maxillary sinus adenoid cystic carcinoma (ACC) on computed tomography (CT) and magnetic resonance imaging (MRI) and to investigate the imaging differences between solid and nonsolid maxillary sinus ACC.

METHODS

We retrospectively reviewed 40 cases of histopathologically confirmed ACC of the maxillary sinus. All the patients underwent CT and MRI. Based on the histopathological characteristics, the patients were classified into 2 groups: ( a ) solid maxillary sinus ACC (n = 16) and ( b ) nonsolid maxillary sinus ACC (n = 24). Imaging features such as tumor size, morphology, internal structure, margin, type of bone destruction, signal intensity, enhancement changes, and perineural tumor spread on CT and MRI, were evaluated. The apparent diffusion coefficient (ADC) was measured. Comparisons of imaging features and ADC values were performed between the solid and nonsolid maxillary sinus ACC using χ 2 and nonparametric tests.

RESULTS

The internal structure, margin, type of bone destruction, and degree of enhancement significantly differed between solid and nonsolid maxillary sinus ACC (all P < 0.05). The ADC of the solid maxillary sinus ACC was considerably lower than that of the nonsolid maxillary sinus ( P < 0.05).

CONCLUSIONS

Computed tomography and MRI may aid in the differentiation of solid and nonsolid types of maxillary sinus ACC.

Clinical, radiographic, and histological/histomorphometric analysis of maxillary sinus grafting with deproteinized porcine or bovine bone mineral: A randomized clinical trial

OBJECTIVE

The present study aimed to compare histomorphometrically evaluated new bone formation, radiographically measured graft stability, and clinical implant outcome between maxillary sinus grafting with either deproteinized porcine bone mineral (DPBM) or deproteinized bovine bone mineral (DBBM).

MATERIALS AND METHODS

Thirty maxillary sinuses were initially included and randomly assigned to the test group (TG; DPBM, n = 15) or control group (CG; DBBM, n = 15). After a healing period (6 months), axially retrieved bone biopsies of the molar region were used for histological/histomorphometric analysis of new bone formations. Additionally, radiographically measured graft stability and clinical implant outcome were assessed.

RESULTS

Twenty-three sinus sites with 10 sinuses of the TG and 13 of the CG were ultimately available for data and statistical analysis. In the TG, a slightly, but yet significantly (p = .040) higher proportion of new bone formation (TG: 27.7 ± 5.6% vs. CG: 22.9 ± 5.1%) and a lesser (p = .019) amount of connective (non-mineralized) tissue (TG: 47.5 ± 9.5% vs. CG: 56.1 ± 9.5%) was found than in the CG. However, both xenografts showed comparable (n.s.) residual bone graft (TG: 23.7 ± 7.2% vs. CG: 21.1 ± 9.85.6%), bone-to-graft contacts (TG: 26.2 ± 9.8% vs. CG: 30.8 ± 13.8%), similar graft height reduction over time (TG: 12.9 ± 6.7% CG: 12.4 ± 5.8%) and implant survival/success rate (100%). At the 3-year post-loading evaluation, the peri-implant marginal bone loss (TG: 0.52 ± 0.19 mm; CG: 0.48 ± 0.15 mm) and the peri-implant health conditions (TG: 87.5%/CG: 81.2%) did not differ between implants inserted in both xenografts used.

CONCLUSIONS

The use of DPBM or DBBM for maxillary sinus augmentation is associated with comparable bone formation providing stable graft dimension combined with healthy peri-implant conditions.

Computed tomographic imaging of a maxillary sinus mucocele in an 8-year-old French Bulldog

An 8-year-old male neutered French Bulldog was referred for continued nasal dyspnea following a staphylectomy revision performed one month prior to presentation. The patient had a prior history of skin allergies and underwent brachycephalic airway surgery performed at one year of age. Computed tomography (CT) revealed an osseous-encased, cystic mass arising from the right maxillary sinus. Surgical biopsies were performed and a mucocele with sinusitis and glandular hyperplasia was diagnosed. Based on our systematic review of the literature, maxillary sinus mucocele has not been reported in the dog and should be among the differentials for sinus cystic masses.

Extended Endoscopic Pre-Lacrimal Medial Maxillectomy To the Anterior Maxillary Sinus Wall

Endoscopic pre-lacrimal medial maxillectomy involving the resection of the antero-medial maxillary sinus wall is a novel expanded procedure that allows the management of far lateral or antero-medial benign pathologies of the maxillary sinus, without increasing peri-operative morbidity. Laryngoscope, 133:2874-2877, 2023.

Maxillary Sinus Mucocele With Fungal Ball

Mucocele is a benign, expansile, and oppressive lesion, more common in the frontal and ethmoid sinus and less in the maxillary sinus. Sinus mucocele mainly causes cheek swelling pain and nasal obstruction. In some cases, the paranasal mucocele grows large enough to compress periorbital structures and lead to impaired vision. Generally, mucocele is full of simple mucus, but pathogens can be found if co-infected, which means a poor prognosis. Functional endoscopic sinus surgery is an effective treatment for this disease. Here, the authors report a case that a mucocele occurred in the maxillary sinus, and a fungal ball was also found during the operation, which is a result of Paecilomyces farinosus co-infection.

Clinical Presentation and Outcome of Sinonasal Extraosseous Plasmacytoma in Denmark: A Nationwide Cohort From 1980 to 2017

OBJECTIVES

Extraosseous plasmacytoma (EOP) is a rare plasma cell neoplasm that tends to convert to plasma cell myeloma (PCM) in about 11% to 35% of cases. It has a predilection for the upper respiratory tract, prototypically affecting the nasal cavity and paranasal sinuses. Contemporary first-line treatment is radiotherapy, with more recent studies showing an added benefit of combining radiation with surgery. In this cohort study, we aimed to examine clinical presentation, treatment, and prognosis for all patients nationwide from 1980 through 2017. Furthermore, we determined the size and extension of tumors, investigating the rate at which minimally invasive surgery would have been possible.

METHODS

Patients were found in the national pathology registry, and all biopsies were collected for pathology review by a hematopathologist. We performed survival statistics for overall survival (OS), progression-free survival (PFS), and the cumulative incidence of conversion to PCM.

RESULTS

Twenty-three patients were included. The median age was 65, and patients were primarily men (78%). Tumors were located in either the nasal cavity (57%), maxillary sinus (39%), or sphenoid sinus (4%). In most cases, the tumor was <5 cm (65%) without extension to adjacent structures (60%). The national incidence was 0.02/100,000 person-years, the median symptom duration until diagnosis was 5 months, and none of the patients presented with contiguous spread to regional lymph nodes. Stand-alone radiotherapy was the predominant treatment (61%). In the entire cohort, one patient died from the initial disease, and six patients died from either relapse of EOP or PCM. The 5-year OS, PFS, and conversion rate to PCM were 78%, 56%, and 23%, respectively.

CONCLUSION

SN-EOP responds well to radiotherapy, but relapse and conversion to PCM were not uncommon and entailed a poor prognosis. Most tumors were endoscopically resectable and non-invasive, making the majority of tumors suitable for surgery as an addition to radiation.

Change in Maxillary Sinus Mucosal Thickness in Patients with Preoperative Maxillary Sinus Mucosal Thickening as Assessed by Otolaryngologists: A Retrospective Study

Background and Objectives: Maxillary sinus pathologic conditions may increase the risk of complications during posterior maxillary sinus augmentation surgery. The purpose of this study was to evaluate the changes in participants with preoperative maxillary sinus mucosal thickening and to assess this factor as a preoperative risk indicator for sinusitis after maxillary dental implantation. Materials and Methods: We compared the preoperative and postoperative maxillary sinus mucosal thickness (MSMT), the distance between the maxillary sinus ostium and sinus floor (MOD), and the MSMT/MOD ratio. The participants were divided into three groups (sinus augmentation, bone grafting, and no grafting). Results: The mean preoperative MSMT was 4.3 ± 2.0 mm, and the mean MSMT/MOD ratio was 0.13 ± 0.05. No postoperative sinusitis was observed in these patients, including cases caused by anatomical variations. The mean postoperative MSMT was 4.5 ± 2.3 mm, and the mean postoperative MSMT/MOD ratio was 0.15 ± 0.06. There was no statistically significant difference between the groups at each time point (p > 0.05). Conclusions: The study found no significant change in MSMT at post-treatment evaluation, even when considering different subgroups. It underscores the importance of preoperative maxillary sinus radiographic assessments and collaboration between dentists and otolaryngologists for better outcomes in patients with preoperative maxillary sinus mucosal thickening.

Endonasal Lacrimal Transposition to Expand Pre-Lacrimal Medial Maxillectomy Approach

EPLA lacrimal transposition facilitates management of maxillary sinus/pterygopalatine fossa lesions and overcomes limitations such as the Simmen type I recess or IPMS pedicled on the medial wall, without increasing peri-operative morbidity. Laryngoscope, 133:2090-2094, 2023.

Combination of leukocyte and platelet-rich fibrin and demineralized bovine bone graft enhanced bone formation and healing after maxillary sinus augmentation: a randomized clinical trial

BACKGROUND AND OBJECTIVE

The resorption of alveolar ridge bone and maxillary sinus pneumatization are challenges to implant-supported prosthetic rehabilitation. Bone regeneration using bone substitutes and growth factors are alternatives for maxillary sinus augmentation (MSA). Therefore, we sought to evaluate the effects of the association between leukocyte and platelet-rich fibrin (L-PRF) and deproteinized bovine bone mineral (DBBM) in MSA procedures.

MATERIALS AND METHODS

Thirty-six maxillary sinuses from 24 individuals were included in this randomized clinical trial. The maxillary sinuses were randomly grafted with LPRF and DBBM (test group) or grafted only with DBBM (positive control). Dental implants were installed in the test group following two periods of evaluation: after 4 (DBBM+LPRF4) and 8 (DBBM+LPFR8) months of sinus graft healing, while the control group received implants only after 8 months. Cone beam computed tomography (CBCT) was taken 1 week after surgery (T1) and before implant placement (T2). Bone samples were collected during implant placement for histomorphometric and immunohistochemical (IHC) analysis. The primary implant stability was assessed by resonance frequency analysis.

RESULTS

CBCT analysis demonstrated a significant decrease in bone volume from T1 to T2 in all groups without differences among them. Histologically, the test group showed significantly increase in bone neoformation in both periods of evaluation (LPRF+DBBM4: 44.70±14.01%; LPRF+DBBM8: 46.56±12.25%) compared to the control group (32.34±9.49%). The control group showed the highest percentage of residual graft. IHC analysis showed increased staining intensity of osteocalcin (OCN), vascular endothelial growth factor (VEGF), and runt related transcription factor 2 (RUNX-2) in LPRF+DBBM4 group, and osteopontin (OPN) in the L-PRF+DBBM8. Primary implant stability was successfully achieved (above 60 in implant stability quotient) in all the evaluated groups.

CONCLUSION

Combination of L-PRF and DBBM increased and accelerated new bone formation allowing early implant placement probably due to the higher protein expression of RUNX2, VEGF, OCN, and OPN. These data suggest that the use of L-PRF might be an interesting alternative to use in combination with DBBM for augment the maxillary sinuses allowing the installation of appropriate length implants in shorter period of time.

CLINICAL RELEVANCE

This study showed improvement in bone neoformation and accelerated healing when associating L-PRF and DBBM for maxillary sinus augmentation procedures.

TRIAL REGISTRATION

This study was registered before participant recruitment in Brazilian Registry of Clinical Trials (ReBEC - RBR-95m73t).

Mucosal adhesion phenomenon after maxillary sinus floor elevation: A preclinical study

AIM

To describe the histological events that occur after maxillary sinus floor elevation when the elevated and undetached sinus mucosa are in close proximity or in contact with each other.

MATERIALS AND METHODS

From 76 rabbits, 152 elevated maxillary sinuses were analyzed histologically. Sites without adhesions were classified as "No proximity," whereas the adhesion stages were divided into "Proximity," "Fusion," and "Synechia stages." The width of the pseudostratified columnar epithelium and the distance between the two layers of the elevated and undetached sinus mucosae were measured at various standardized positions.

RESULTS

Thirty-one sites presenting with adhesions were found. Twelve sites were in the proximity stage," presenting cilia of the two epithelial layers that were shortened and interlinked within the mucous context. Hyperactivity of the goblet cells was also observed. In the other cases, the hyperplastic epithelium showed attempts to reach the contralateral mucosa. The 15 "fusion stage" sites presented regions with epithelial cells of the two mucosal layers that penetrated each other. Four sites presented "synechiae stages," represented by bridges of connective tissue connecting the two lamina propria.

CONCLUSIONS

Close proximity or tight contact between the elevated and undetached mucosa adhering to the bone walls might occur after maxillary sinus floor elevation. This induced hyperplasia of the epithelial cells and adhesion of the two layers until synechiae formation.

Differentiated Papillary NUT Carcinoma: An Unexpected, Deceptively Bland Presentation of a Sinonasal Carcinoma

BACKGROUND

In recent years, the list of tumor entities in the sinonasal tract has significantly expanded, requiring advanced diagnostic testing. We report the case of a 32-year-old patient with an unusual NUT carcinoma originating in the maxillary sinus, which showed extensive well-differentiated, papillary squamous morphology, similar to the spectrum of the recently described DEK::AFF2 fusion-associated carcinoma.

METHODS

We performed immunohistochemical and molecular studies including EBV- and HPV-testing, as well as DNA/RNA next generation sequencing.

RESULTS

The tumor showed predominantly exophytic papillary growth with mature squamous differentiation. An additional component harbored atypical, less differentiated basaloid tumor cells with infiltration of the adjacent stroma. Conspicuous inflammation was evident. There was no evidence of HPV DNA or EBV RNA. Next-generation sequencing revealed a NUT::NSD3 gene fusion corresponding to ("speckled-type") immunopositivity of NUT in the tumor cells.

CONCLUSIONS

We describe a NUT::NSD3 gene fusion-associated NUT carcinoma of the sinonasal tract with a deceptively well-differentiated papillary growth pattern, thus expanding the morphological spectrum of this typically poorly differentiated neoplasm.

Using Platelet-Rich Fibrin in Combination With Allograft Bone Particles Can Induce Bone Formation in Maxillary Sinus Augmentation

BACKGROUND

Sinus pneumatization secondary to posterior maxillary tooth extraction can hinder proper implant installation. Maxillary sinus floor augmentation is a surgical procedure that has been proposed to overcome this issue.

PURPOSE

The aim of this study was to evaluate and compare the histomorphometric outcomes of sinus floor elevation using allograft bone particles with or without platelet-rich fibrin (PRF).

STUDY DESIGN, SETTING, SAMPLE

This randomized clinical trial included patients scheduled for maxillary sinus floor elevation in the Implant Department of Mashhad Dental School. Healthy adults with an edentulous maxilla and residual alveolar bone height of 3 mm or less were eligible to participate and were randomly allocated to intervention (A) or control (B) groups. Bone biopsies were obtained 6 months postoperatively.

PREDICTOR VARIABLE

The predictor variable was using a PRF membrane for maxillary sinus augmentation. In group A, sinus floor elevation was performed using PRF combined with bone allografts, while in group B only allograft particles were used.

MAIN OUTCOME VARIABLES

The primary outcome variables were the recorded postoperative histologic parameters, as in the area of newly formed bone, new bone marrow, and residual graft particles (μm2). The secondary outcome variables were the radiographically measured postoperative bone height and width at the graft site.

COVARIATES

Age and sex.

ANALYSES

Independent sample t-test was employed to compare the postoperative histomorphometric parameters between groups A and B. P value ≤ .05 was considered statistically significant.

RESULTS

A total of 20 patients (10 per group) completed the study. The mean rate of new bone formation was 43.25 ± 5.22% in group A and 38.25 ± 7.01% in group B. This difference was statistically insignificant (P = .087). The mean amount of newly formed bone marrow was significantly more in group A compared to group B (6.81 ± 2.19% vs 10.23 ± 4.49%; P = .044). The average amount of remaining particles was also significantly less in group A patients (9.35 ± 3.43% vs 13.18 ± 3.67%; P = .027).

CONCLUSION AND RELEVANCE

Incorporating PRF as an adjunctive grafting material results in fewer residual particles of allograft and in more bone marrow formation and may serve as a treatment option for developing the atrophic posterior maxilla.

Prevalence and pattern of proximity of maxillary posterior teeth to maxillary sinus with mucosal thickening: A cone beam computed tomography based retrospective study

Context

Odontogenic sinusitis is a prevalent but frequently unrecognized condition, and periapical pathologies of maxillary posterior teeth are accused as one of the main causative factors.

Aim

This study aimed to evaluate the relationship between the periapical status of maxillary posterior teeth and its proximity to the maxillary sinus floor in the occurrence of incidental sinus pathologies using cone-beam computed tomography (CBCT).

Methodology

CBCT scans of 118 patients of age range 18-77 years were evaluated retrospectively to determine the relationship of maxillary posterior teeth to sinus floor in which vertical relationship was assessed using modified Kwak's classification and periapical status using CBCT periapical index. Statistical analysis was performed using SPSS statistics software.

Results

Of all 227 sinuses examined, 56.8% showed pathological changes, with mucosal thickening being the most common. More than 50% (50.2%) of sinuses were associated with periapical lesions of at least one maxillary posterior tooth based on evidence of pathological mucosal thickening. The presence of pathologic mucosal thickening was also significantly related (P < 0.05) to the presence of periapical pathologies. There was a significant association between tooth position and pathological sinus mucosal thickening, especially with second molars, first molars, and second premolars, respectively (P < 0.05). Second molar involvement was the most significant (P < 0.05).

Conclusion

The present study established a positive association between periapical disease status of maxillary posteriors and maxillary sinus mucosal thickening. Maxillary second premolar and first and second molars pathologies can significantly affect the maxillary sinus compared to other maxillary posterior tooth. CBCT proved to be an efficient imaging modality in detecting these changes.

[Application experience of prelacrimal recess combined with septotomy in resection of recurrent inverted papilloma]

Objective:To investigate the effectiveness of nasal endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum in resecting recurrent nasal inverted papilloma. Methods:Patients with recurrent nasal inverted papilloma who underwent reoperation in our hospital during the past 2 years were included . The nasal septum may hinder full access to and effective treatment of the lesions at the anterior and medial wall of the maxillary sinus by endoscope, aspirator and surgical instrument in the narrow aperture of the prelacrimal recess, although these lesions could be observed by 70° nasal endoscope. Results:The nasal septum is temporarily opened on the basis of the prelacrimal recess approach, and the nasal endoscope and instrument was introduced through trans-septal window, so as to provide a better view of the operative field and the angular range of the instrument's movement. Conclusion:The recurrent nasal inverted papilloma could be successfully managed by re-endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum, and no recurrence was observed during the 2-year follow-up. This surgical approach is recommended for the inverted papilla which originates from the anterior medial wall of the maxillary sinus, as the tumor can be removed completely using this surgical approach.

Malignant Lymphoma with the MRI Findings Mimicking Inflammatory Disease: A Case Report

Magnetic resonance imaging (MRI) is a more useful diagnostic modality for detecting paranasal tumors compared with computed tomography (CT). We encountered a case of malignant lymphoma of the maxillary sinus. Although CT findings suggested malignancy, MRI findings indicated an inflammatory disease. The patient was a 51-year-old man with a chief complaint of right maxillary toothache. Edema in the right middle meatus and bloody rhinorrhea were observed. CT revealed r ight maxillary s inus shadow with partial bone loss, suggesting malignancy. However, MRI performed two weeks later showed an internal homogeneous lesion with neither contrast effect, nor invasion outside the maxillary sinus. The patient also had no fever, weight loss, or night sweats. Additionally, no palpable cervical lymphadenopathy was observed. Endoscopic sinus surgery was performed to confirm the diagnosis. Upon opening the maxillary sinus, highly viscous retention and a large amount of yellowish-white debris were observed. Allergic fungal rhinosinusitis was suspected. However, histopathological analysis of the debris established a diagnosis of malignant lymphoma. The debris exhibited pathological findings of necrosis. The patient remained in remission after undergoing radiochemotherapy. Malignant lymphomas of the paranasal sinuses, which have a minimal tendency for invasion but with considerable predominance of necrosis, may be diagnosed as an inflammatory disease, based on MRI findings. In cases in which a thorough physical examination could not rule out malignant lymphomas, an endoscopic biopsy should be immediately considered.

A Pediatric Case of High-Grade Secretory Carcinoma of the Maxillary Sinus With ETV6::NTRK3 Gene Fusion, Therapeutic Implications, and Review of the Literature

Secretory carcinoma (SC) is a salivary gland tumor with a generally low grade microscopic appearance, a characteristic immunophenotype, and a recurrent translocation leading to ETV6::NTRK3 fusion gene. Rare cases are reported in children. The maxillary sinus is an unusual localization. SC have an overall favorable prognosis, but cases with high grade morphology have been described in adult population and are related to a more aggressive clinical course. We present a pediatric case of secretory carcinoma involving the maxillary sinus with high grade morphology, with a review of the literature of secretory carcinomas with high grade component.

Highly Aggressive Osteosarcoma of the Ethmoids and Maxillary Sinus-A Case of Successful Surgery and Proton Beam Radiotherapy in a 65-Year-Old Man

Sarcomas in the head and neck area are rare diseases with an incidence of under 1% of all head and neck malignant tumours. Osteosarcomas or osteogenic sarcomas consist of neoplastic cells that produce osteoid bone or immature bone. Sarcomas develop more in the mandible than the maxilla. The exact diagnosis of different types of sarcomas is based on the immunohistochemical investigation. These rare tumours are of mesenchymal origin; osteosarcomas and chondrosarcomas are the most common types—Ewing’s sarcomas. The use of proton beam radiotherapy in the treatment of osteosarcoma of the maxilla is rarely reported in the literature. We present a case of successfully treated (surgery and proton beam radiotherapy) poorly differentiated highly aggressive osteosarcoma in the ethmoids and maxillary sinus and morbidity after the treatment. We were presented with a case of a 65-year-old man with anaesthesia and palsy of the right face. The stomatology department performed the extraction of a tooth. One month later, the wound was still open. The histology showed an osteogenic sarcoma in the area of the wound. The oncologist and maxillofacial surgeons in a catchment hospital recommended a nonsurgical approach. Hence, we performed a radical maxillectomy and ethmoidectomy, after which we continued with proton bean radiotherapy. The patient is now five years after therapy without signs of sarcoma; however, he has blindness in the right eye and reduced vision in the left eye, as well as gliosis of the brain, vertigo, tinnitus, trismus, and ancylostomiases. Head and neck osteosarcomas treatment is considered a complex multidisciplinary task. It is currently argued that there is no clear therapeutic protocol for successful treatment. Innovations in treatment modalities such as proton beam radiotherapy appear to have potential, although their effects on long-term morbidity and survival outcomes are still undetermined. We present a rare case report of an osteosarcoma of the maxilla involving an innovative, successful treatment procedure combining surgical excision followed by proton beam radiotherapy. This treatment approach may enable maximum tumour control. This protocol has not been adequately described in the world literature for this diagnosis.

Modified Endoscopic Denker's Approach for Management of Anterior Maxillary Sinus Tumors: Multicenter Series of 58 Cases

OBJECTIVES

Tumors involving the anterior portion of the maxillary sinus remain technically challenging to access via an endoscopic approach. The modified endoscopic Denker's (MED) procedure was recently introduced to address such lesions. We present a multicenter series of 58 patients with tumors involving the anterior maxillary sinus successfully resected using a MED procedure and present the clinical outcomes and complications.

METHODS

A multi-institution retrospective chart review was performed on patients who underwent the MED approach for the management of tumors involving the anterior maxillary sinus from 2009 to 2020. Demographic data, pathology, surgical outcomes, and complications were reviewed.

RESULTS

Fifty-eight patients were identified, including 34 (58.6%) male and 24 (41.4%) female patients. The most common pathologies included: inverted papilloma (n = 27; 46.6%), adenoid cystic carcinoma (n = 9; 15.5%), and squamous cell carcinoma (n = 8; 13.8%). Thirty-eight patients (65.5%) underwent MED alone, while 20 (34.5%) had combined expanded endonasal approaches for lesions extending beyond the maxillary sinus. All maxillary sinus lesions were successfully accessed with the MED procedure without the need for an additional approach. After a mean follow-up of 30 months (range, 1-127), 8 of 58 (13.8%) patients developed complications related to the MED, including epiphora requiring an additional procedure (n = 4; 6.9%), prolonged facial/palatal numbness (n = 3; 5.2%), severe epistaxis (n = 1; 1.7%), and vestibular stenosis (n = 1; 1.7%), the latter of which occurred following postoperative radiation.

CONCLUSION

The MED procedure is a safe and highly effective approach for benign and malignant tumors involving the anterior maxillary sinus. However, patients should be counseled preoperatively on potential complications including the risk of facial numbness and epiphora.

Endoscopic Endonasal Prelacrimal Approach: Radiological Considerations, Morbidity, and Outcomes

OBJECTIVE/HYPOTHESIS

This study describes a multicentric experience with the use of prelacrimal approach (PLA), focusing on preoperative radiological parameters potentially associated with surgical outcomes and postoperative morbidity.

STUDY DESIGN

Retrospective case-series.

METHODS

A retrospective review of patients undergoing PLA in three European referral centers was performed. The post-operative morbidity was analyzed in relation to two radiological parameters: width of prelacrimal recess (WPR) and internal angle of pyriform notch (APN).

RESULTS

The study included 28 patients affected by Schneiderian papilloma (20 cases), inflammatory disease (6 cases), schwannoma (1 case), and osteoma (1 case). The most reported sequela was paresthesia of ipsilateral anterior superior alveolar process (25% of the cases). An association between post-operative morbidity and APN was observed (P = .047).

CONCLUSIONS

Preoperative radiological evaluation of WPR is crucial in understanding the feasibility of the approach, while APN measurement may predict postoperative morbidity, which is paramount in the patients' counseling.

LEVEL OF EVIDENCE

4 case-series Laryngoscope, 131:1715-1721, 2021.

Histological, radiological, and clinical outcomes of sinus floor elevation using a lateral approach for pre-/post-extraction of the severely compromised maxillary molars: a study protocol for a randomized controlled trial

BACKGROUND

The volume of residual alveolar bone is critical to the survival of dental implants. When the volume of alveolar bone in the posterior maxillary region is less than 4 mm, maxillary sinus floor elevation (MSFE) with the lateral approach is an effective option. Traditionally, this standard approach is usually conducted at 4-6 months after tooth extraction (standard MSFE). However, defective dentition due to extraction can impair mastication during the period of bone remodeling, especially if the molars on both sides are severely compromised and must be extracted. MSFE before extraction (modified MSFE) can take full advantage of residual tooth strength. However, the effectiveness and practicability of the modified MSFE procedure remain unknown. Therefore, the aim of this study was to compare the clinical outcomes of modified vs. standard MSFE, in order to provide references to periodontists.

METHODS/DESIGN

The study cohort included 25 adult patients (50 surgery sites) recruited from Peking University Hospital and School of Stomatology who met the inclusion criteria. The two sides of each patient will be randomly divided into two groups: a test group-modified MSFE or a control group-standard MSFE. The surgical duration and patient-reported outcomes (visual analog scale for discomfort) will be documented. Clinical indicators, including implant survival rates, mucosal conditions, and complications, will be recorded every 6 months during the 5-year follow-up period. The volume of the alveolar bone and marginal bone level will be assessed radiographically (cone-beam CT and periapical films) every 6 months. Histological analysis of biopsy samples retrieved from both sides will be performed to evaluate the biological features of the bone.

DISCUSSION

The current study will explore the implant survival rates, safety, reliability, effectiveness, and practicability of the modified MSFE procedure. Moreover, the extent of osteogenesis on the sinus floor will also be assessed. The results of this trial will provide strategies for the modified MSFE procedure to achieve ideal clinical outcomes.

TRIAL REGISTRATION

International Clinical Trials Registry Platform ChiCTR1900020648 . Registered on 1 January 2019.

Results of definitive radiotherapy with concurrent chemotherapy for maxillary sinus carcinomas with neck lymph node metastasis

The purpose of this study was to describe the results of definitive radiotherapy (RT) with concurrent chemotherapy for maxillary sinus carcinomas (MSCs) with neck lymph node metastasis to clarify its limitation. Local control (LC), progression-free survival (PFS) and overall survival (OS) rates were calculated using the Kaplan-Meier method and were compared between subgroups using the log rank test. Toxicity was classified using common terminology criteria of adverse events version 5.0. Eighteen patients with inoperable MSC with neck lymph node metastasis including 12 men and 6 women with a median age of 67 years were analyzed. The histologic diagnoses were as follows: 16 patients had squamous cell carcinomas and 2 had other histology. Four patients had stage T3 MSC, 6 had T4a and 8 had T4b. Among 18 patients, 7 received concurrent systemic chemotherapy and 11 received selective arterial chemo-infusion. The median follow-up period was 17 months. The 2-year LC, PFS and OS rates for the entire cohort were 34, 31 and 46%, respectively. No significant differences were observed for LC, PFS and OS rates between systemic chemotherapy and selective arterial chemo-infusion cohorts. Grade 3 or higher acute toxicity, including both non-hematological and hematological, was observed in nine patients (50%), while no grade 3 or higher late toxicity was observed. In conclusion, we described the results of definitive RT for MSCs with neck lymph node metastasis. Local recurrence of primary tumor was a frequent pattern of failure and it should be addressed in future study.

Osseous mass in a maxillary sinus of an adult male from the 16th-17th-century Spain: Differential diagnosis

OBJECTIVE

To undertake a differential diagnosis of a large mass found in the left maxillary sinus of a cranium dated to the 16th-17th-century, and to expand knowledge of the diagnosis of osseous tissue formation in osteoarchaeological studies.

MATERIAL

A cranium recovered from the cemetery of San Salvador de Palat de Rey church, León (Spain).

METHODS

Macroscopic analysis, CT scanning.

RESULTS

Macroscopic analysis indicated that the individual was probably a male over 30 years old with an ossified mass in the left maxillary sinus, measuring 24 × 19 × 24 mm, occupying approximately 27 % of the maxillary antrum. Computed tomography revealed a well-demarcated radiolucent unilocular mass with some radiopaque areas, with no communication with the alveoli of the premolars or molars. No erosive lesions or signs of inflammation were found.

CONCLUSIONS

Neither the macroscopic, nor the radiological characteristics are compatible with inflammatory or malignant pathology, favoring a diagnosis of ossifying fibroma.

SIGNIFICANCE

This case adds to the few reported cases in the osteoarchaeological literature, especially since there is limited relevant reference data to assist diagnosis. The CT scans and 3D reconstruction presented here facilitate differential diagnosis in future paleopathological studies.

LIMITATIONS

Destructive methods were not authorized.

SUGGESTIONS FOR FURTHER RESEARCH

In the future, micro-CT analysis, which was not performed in the current study, may add new and valuable information.

Zygomatic implants supported rehabilitations in atrophic maxilla: sinus complications, radiological, periodontal and prosthodontic evaluations: a one year follow up retrospective longitudinal study

The rehabilitation of maxillary bone atrophy represents one of the main challenges of modern oral implantology. The use of zygomatic implants in the prosthetic rehabilitation of the patient affected by severe maxillary bone atrophy is another therapeutic alternative, not exempt from complications. The present study included 19 patients with edentulous maxillae who were treated between 2013 to 2015 with at least two zygomatic implants at the Department of Maxillofacial Surgery, Verona, Italy. The purpose of this retrospective longitudinal study was to evaluate sinus complications and radiological, periodontal and prosthetic evaluations of zygomatic implants technique in severe atrophic. Implant-prosthetic rehabilitation of the upper jaw edentulous severely atrophic using zygomatic implants represents one safe and repeatable technique. In terms of implant survival from our study showed an implant CRS (common reporting standard) of 98.5% and a prosthetic CRS 100% with a mean follow-up period of 19.2 months (range). Both recorded data are superimposed on major reported studies in literature.

Clinicopathological features of 214 maxillary sinus pathologies. A ten-year single-centre retrospective clinical study

BACKGROUND

Diagnosis of maxillary sinus pathology must include the clinical radiological study (CRS) and histopathological analysis. The aim of this study is 1) to describe the clinicopathological features of maxillary sinus lesions, obtained successively in a single medical centre over the last 10 years and 2) to determine the sensitivity and specificity for the diagnosis of malignant lesions based exclusively on the CRS.

METHODS

It is a single-centre observational retrospective clinical study on patients who attended the University Hospital Complex of Santiago de Compostela (CHUS) with sinus pathologies during the period of 2009-2019.

RESULTS

The sample consisted of 133 men (62.1%) and 81 women (37.9%), with an average age of 46.9 years (SD = 18.8). In terms of frequency, the most frequent pathology was the unspecified sinusitis (44.4%), followed by polyps (18.2%), malignant tumours (9.8%), inverting papilloma (7.5%), fungal sinusitis (4.7%), cysts (3.7%), benign tumours (2.3%), mucocele (2.3%) and other lesions (1.9%). Cysts and benign tumours were diagnosed earliest Vs malignant tumours (65.2 years (SD = 16.1)) were diagnosed the latest (p < 0.001). Based only on the CRS for malignancies, diagnostic indexes were 71.4% sensitivity and 97.9% specificity, with a Kappa value of 0.68 with (p < 0.001).

CONCLUSION

Maxillary sinus pathology is very varied with therapeutic and prognostic repercussions. CRS is sometimes insufficient and histopathological confirmation is essential.

Volumetric study of the maxillary sinus in patients with sinus pathology

Objectives

The aim of this study is 1) to obtain the area and volumes of the maxillary sinuses in patients affected by clinically unilateral sinus pathology by comparing the results to the contralateral sinus and 2) to determine the importance of the volumetric measures when diagnosing the percentage of sinus obliteration.

Materials and methods

A single-centre observational retrospective clinical study was conducted in 214 patients with clinically unilateral sinus pathologies. Linear (mm), area (mm2) and volume (mm3) measurements were taken from Cone Beam Computed Tomography (CBCT) images of the affected sinus as well as from the contralateral ones. Histopathological study was performed using haematoxylin/eosin and PAS or Groccot stains. The lesions were classified into non-specific sinusitis, polyps, inverted papilloma, fungal sinusitis, cysts, mucocele and other lesions. Chi-squared test, ANOVA for independent samples and Pearson test were used for the statistical analysis.

Results

A total of 100 sinuses were measured in 50 patients (28 men and 22 women, with an age of 43.6 years (SD = 18.3), 50 pathological and 50 healthy contralateral sinuses. The three-dimensional occupation volume of the affected sinuses was 97.1 mm³ (62.5%) vs. 40.6 mm³ (22.8%) in the healthy ones (p<0.0001). The medial-lateral width of the sinus in the frontal plane was significantly higher in the cysts group (32.4 mm, CI: 23–41.8 mm).

Conclusion

In medical terms, the global percentage of occupation determined using the classic manual determination method does not differ from the three-dimensional percentage calculated using specific complex software.

Process of ectopic tooth formation in the maxillary sinus: follow-up observation of one case

Objective

This study was performed to investigate the process of ectopic tooth formation.

Methods

A patient with an ectopic tooth was followed for 6 years. The tooth size and mineralization were evaluated by paranasal sinus computed tomography every 3 years.

Results

The ectopic tooth was present in the nasal crest of the maxilla and did not change significantly during the 6-year follow-up period. However, the patient developed a new ectopic tooth in the maxillary sinus (ETm). This tooth, located in the posterior wall of the left maxillary sinus, initially appeared as a small region of soft tissue on computed tomography. After 3 years, the area of mixed density had significantly increased, and some of it had significantly mineralized to form an ETm. After 6 years, the ETm had further mineralized and enlarged in situ. The width between the left and right sides of the ETm in 2018 (9.08 ± 2.09 mm) was significantly larger than that in 2015 (7.51 ± 2.18 mm), indicating that ETm formation is a gradual process of mineralization.

Conclusion

Ectopic teeth can gradually form by in situ mineralization after adolescence, suggesting that ectopic teeth are genetically regulated and result from a programmed formation process occurring at a specific time point.

Maxillary sinus floor elevation using Beta-Tricalcium-Phosphate (beta-TCP) or natural bone: same inflammatory response

Sinus elevation is a common procedure to increase bone volume in the atrophic maxilla to allow placement of dental implants. Autogenous bone is the gold standard but is limited in quantity and causes morbidity at the donor site. β-TCP is a synthetic biomaterial commonly used in that purpose. It appears to induce a poor inflammatory response. This study aimed to evaluate the degree of edema of the sinus mucosa after sinus lift surgery according to the type of biomaterial. Forty sinuses (20 patients) were included retrospectively and divided into 2 groups according to the biomaterial that was used: synthetic biomaterial (BTCP group), natural bone (BONE group). A control group (CTRL group) was constituted by the non-grafted maxillary sinuses. Twelve measurements per sinus were realized on pre- and post-operative computed tomography and averaged to provide the sinus membrane thickness value (SM.Th). SM.Th was thicker post-operatively in the BTCP and BONE groups in comparison with the CTRL group and in comparison with pre-operative measurements. No difference was found post operatively between the BTCP and BONE groups. We found that a synthetic biomaterial (β-TCP) induced the same degree of edema, and thus of inflammation, as natural bone. It constitutes therefore an interesting alternative to autogenous bone for maxillary sinus lifts.

Histomorphometric Analysis of Maxillary Sinus Grafts: A Pilot Study

PURPOSE

This pilot study evaluated and compared the degree of new bone formation following maxillary sinus graft (MSG) using three different bone graft materials.

MATERIAL AND METHODS

Patients with an edentulous posterior maxilla (unilateral or bilateral) were included in this study and underwent a two-stage procedure. Each sinus was randomly assigned one of the three graft materials: anorganic bovine bone mineral (ABBM), anorganic equine bone mineral (AEBM), or mineralized cancellous bone allograft (MCBA). Bone core samples were obtained from the lateral wall of the grafted sites at least 8 months after MSG. Bone quality was evaluated during bone core retrieval. The samples were histomorphometrically analyzed using Kruskal-Wallis and Dunn-Bonferroni tests at the significance level of α = .05.

RESULTS

A total of 28 sinuses (14 unilateral and 7 bilateral) from 21 subjects, with a mean age of 61.5 (range, 33-75) years, were included in the study. Twenty-eight bone cores (ABBM [n = 9], AEBM [n = 9], and MCBA [n = 10]) were obtained at a mean healing time of 9.1 (range, 8-12) months. Six maxillary sinus membrane perforations (≤ 5 mm) were noted and repaired during surgery (21.4%). Histomorphometric analysis of the harvested bone cores revealed statistically significant differences in the percentage of vital bone (VB%), residual bone materials (RBM%), and connective tissue/marrow (CT%) among the different graft materials (Kruskal-Wallis; P < .05). The VB% in the MCBA group (32.0% ± 12.4%) was significantly greater than those in the ABBM (10.9% ± 8.9%) and AEBM (9.1% ± 5.9%) groups (P < .05). The RBM% in the MCBA group (5.5% ± 5.7%) was, however, significantly less than those in the ABBM (34.3% ± 12.1%) and AEBM (38.9% ± 5.3%) groups (P < .05). There were no significant differences in VB% and RBM% between ABBM and AEBM (P = 1.0). Newly formed bone and residual graft materials were integrated into the surrounding tissue with no sign of inflammation or foreign-body reaction.

CONCLUSION

Within the confines of the study, MCBA has significantly greater new bone formation than ABBM and AEBM. AEBM showed comparable histomorphometric results in all parameters (VB%, RBM%, CT%) to ABBM.

Evaluation of Health or Pathology of Bilateral Maxillary Sinuses in Patients Referred for Cone Beam Computed Tomography Using a Low-Dose Protocol

The aim of this study was to evaluate the health or pathology of bilateral maxillary sinuses using cone beam computed tomography (CBCT) with a low-dose protocol, and to analyze potential influencing factors. The study included only CBCT scans with complete visualization of bilateral maxillary sinuses. The scans were taken using a medium to large field of view and a low-dose protocol, as indicated by the manufacturer. CBCT images were analyzed with regard to the morphology of the sinus membrane and surrounding bone twice by one observer. Influencing factors such as age, sex, or status of the remaining dentition in the posterior maxilla, including periodontal and endodontic parameters, were evaluated. The study included 134 CBCT scans (268 maxillary sinuses). Using a low-dose protocol, intraobserver reliability of the measurements was almost perfect (kappa value range 0.875 to 1). More than half the sinuses evaluated (63.1%) did not show visible morphologic changes. The most frequently identified pathologic appearance was a flat, shallow thickening of the sinus membrane of > 2 mm (47 positive findings [17.5%]). Only 15 (5.6%) sinuses were associated with teeth with endodontic treatment and/or pathology, and 10 (3.7%) with teeth exhibiting periodontal pathology. CBCT scans with a low-dose protocol can be recommended as a feasible adjunctive tool to evaluate health or pathology of the maxillary sinuses prior to surgical interventions such as sinus floor augmentation. Of all morphologic changes seen, only a small portion of the cases were considered to need further medical diagnosis/treatment.

The Relationship between Maxillary Sinus Lateral Wall Thickness, Alveolar Bone Loss, and Demographic Variables: A Cross-Sectional Cone-Beam Computerized Tomography Study

OBJECTIVES

Sinus floor elevation and augmentation surgery is widely used as a reliable procedure to increase insufficient bone height in the posterior maxillary area. The purpose of the present clinical study was to determine the associations between periodontal bone loss (PBL), maxillary sinus lateral bone wall thickness, age, and gender using cone-beam computerized tomography (CBCT).

MATERIALS AND METHODS

The current retrospective study consists of 716 maxillary sinus CBCT images of 358 patients. The CBCT scans were assessed to detect the relationship between lateral wall thickness and PBL. ANOVA and Student t test analysis were used to determine the influence of PBL on sinus lateral wall thickness.

RESULTS

Sinus lateral wall thickness was significantly associated with PBL (p < 0.05) at 3, 13, and 15 mm height. There was no significant association between lateral wall thickness and gender (p > 0.05). However, there was a significant association between lateral wall thickness at 3 and 13 mm and age (p < 0.05). There were significant associations between PBL and age (p < 0.001), and PBL and gender (p < 0.05).

CONCLUSIONS

PBL might have an association with maxillary sinus lateral bone wall thickness. Further studies are needed to confirm this possible relationship.

20-Year Follow-up in Maxillary Sinus Floor Elevation Using Bovine-Derived Bone Mineral: A Case Report with Histologic and Histomorphometric Evaluation

Bovine-derived bone mineral demonstrated good osteoconductive properties as grating material for maxillary sinus floor elevation, but the long-term behavior of this material has not been reported. The purpose of this report was to analyze and compare histomorphometric measurements of new bone, bone graft, and medullar spaces 6 months, 12 months, and 20 years after grafting. In the grafted area, the amount of mineralized bone was 16.96% at 6 months, 22.53% at 12 months, and 22.05% at 20 years, respectively. The amount of bovine-derived bone mineral ranged from 35.87% to 4.85% in the same period. The volume of the newly formed mineralized bone does not increase over time, conversely to nonmineralized bone.

Aneurysmal Bone Cyst of the Maxillary Sinus with USP6 Rearrangement: Case Report of a Rare Entity and Review of the Literature

Aneurysmal bone cysts (ABCs) are benign lesions which most frequently occur in the long bones of pediatric patients. Long thought to be reactive, recent molecular advances have demonstrated that the majority of primary ABCs harbor rearrangements of the USP6 gene, confirming their neoplastic nature. Secondary ABCs arising from other lesions do not demonstrate this recurrent genetic anomaly. ABCs rarely occur in the craniofacial bones, and sinonasal ABCs are exceedingly rare. We report a case of a primary ABC arising the maxillary sinus of a 14-year-old female, which was found to harbor USP6 rearrangement. We describe the clinical, radiologic, and pathologic features of this case, and review the current literature on craniofacial ABCs. Careful histologic evaluation and genetic studies are warranted in order to confirm the rare occurrence of a primary sinonasal ABC.

One-year survivor of adult alveolar rhabdomyosarcoma of the maxillary sinus with orbital extension: Case report

INTRODUCTION

Rhabdomyosarcoma is uncommon in adults. Adult and maxillary rhabomyosarcoma with direct orbital extension has been rarely reported. To our knowledge, there is no reported case about adult patient with alveolar maxillary rhabdomyosarcoma and orbital extension survived 1 year with intact ocular function.

CASE PRESENTATION

A 21-year-old female presented with protrusion of the right eye and an obstructed nasal passage for the past month. Her symptoms were not relieved by oral antibiotic or irrigation. She was referred to our clinic. Computed tomography and magnetic resonance imaging showed a large homogenous well-enhanced mass with surrounding bony erosion and remodeling. The mass extended to the ipsilateral nasal cavity and orbit. Endoscopic biopsy of the nasal cavity confirmed alveolar rhabdomyosarcoma. The maxillary mass was excised using the Caldwell-Luc approach, and the orbital mass was excised using a transconjuctival and transcaruncular approach. A systemic work-up confirmed ipsilateral lymph node metastasis. The patient received 6 cycles of chemotherapy with vincristine, dactinomycin, and cyclophosphamide, as well as 5120 cGy radiotherapy. Her ocular function was intact 1 year after treatment, and magnetic resonance imaging showed complete regression of the tumor.

CONCLUSION

Rhabdomyosarcoma, which is usually an aggressive malignancy, should be considered in the differential diagnosis of a rapidly growing orbital mass. Aggressive treatment, including surgery, chemotherapy, and radiation therapy, can increase local remission rates and improve the prognosis.

Is the pneumatisation of the maxillary sinus following tooth loss a reality? A retrospective analysis using cone beam computed tomography and a customised software program

OBJECTIVES

To compare the dimensions of maxillary sinuses in dentate and edentulous patients using cone beam computed tomography (CBCT) scans and a customised software program.

MATERIALS AND METHODS

This study comprised CBCTs of 50 dentate and 50 edentulous posterior maxillae. The observers drew two planar curves in all included sinuses in the frontal, sagittal and axial planes of the respective CBCT scans. The volume (mm³), surface (mm²) and maximum diameter (mm) of the sinuses were calculated using a custom-made software program. The variables analysed were the influence of the state of dentition on sinus dimensions (primary outcome) and the influence of age, gender and side on sinus dimensions; the time needed for analysis; and the intra- and inter-observer agreement (secondary outcomes).

RESULTS

There was no difference in sinus dimensions between dentate and edentulous posterior maxillae. Males had significantly (p < 0.05) greater volume, surface and diameter than females. Strong intra- and inter-observer agreement (Pearson correlation) was found for the calculated sinus dimensions. The time needed per analysis was less than 4 min for both observers.

CONCLUSIONS

Being edentulous did not have an impact on the sinus dimensions, suggesting that there is no ongoing pneumatisation in the sinus after tooth loss. Males had larger sinuses than females in a population older than 30 years.

CLINICAL RELEVANCE

Following tooth loss in the posterior maxilla, vertical bone height is primarily lost due to resorption of the alveolar crest, and not due to pneumatisation of the maxillary sinus. The customised software program was found to be user-friendly and efficient.