Ameloblastoma of the maxillary sinus: conservative surgical management considering high recurrence risk potential

2021 ◽  
Vol 14 (5) ◽  
pp. e241487
Author(s):  
Lukas S Fiedler ◽  
Annette Wunsch
Keyword(s):  
Maxillary Sinus ◽  
Radical Resection ◽  
Recurrence Risk ◽  
Flexible Endoscopy ◽  
Cystic Mass ◽  
High Rate ◽  
Sinus Surgery ◽  
Nasal Passage ◽  
Lateral Sinus ◽  
Sinus Wall

Ameloblastoma (AM) in the maxillary sinus is rare. This benign entity shows locally invasive, destructive and aggressive behaviour and a high rate of recurrence. Therefore, the course of treatment is radical resection. We report the case of a 38-year-old man presenting with signs of recurrent sinusitis in the Ear, Nose and Throat Department. Transnasal flexible endoscopy revealed a cystic mass in the right inferior and middle nasal passage. CT scan showed an obliterated right maxillary sinus with a ballooning effect and pressure atrophy of the lateral sinus wall, without possible differentiation of the middle and low nasal turbinate. The patient was treated with transnasal functional sinus surgery; pathology stated AM. AM in the maxillary sinus is rare, locally destructive and therefore as a gold standard is resected radically to prevent recurrence. We demonstrate a conservative approach; explicitly, we combined a transvestibular and functional endoscopic sinus surgery resection of the AM to maintain function and reduce the possibility of postoperative impairments. Whether the strategy of treatment for AM is conservative, it nonetheless can result in a recurrence-free status. Nevertheless, inclusion into an oncological follow-up-programme with regularly performed MRI and CT is recommended.

Axial Triangle of the Maxillary Sinus, and its Surgical Implication With the Position of Maxillary Sinus Septa During Sinus Floor Elevation: A CBCT Analysis

2020 ◽  
Vol 46 (4) ◽  
pp. 415-422
Author(s):  
Junho Jung ◽  
Jung Soo Park ◽  
Seoung-Jin Hong ◽  
Gyu-Tae Kim ◽  
Yong-Dae Kwon
Keyword(s):  
Maxillary Sinus ◽  
Surgical Techniques ◽  
Lateral Sinus ◽  
Sinus Floor Elevation ◽  
Second Molar ◽  
Sinus Wall ◽  
Posterior Maxilla ◽  
Significant Difference ◽  
Sinus Floor ◽  
Molar Region

The aim of this study was to measure the convexity of the lateral wall of the maxillary (Mx) sinus and identify the locational distribution of antral septa in relation to the zygomaticomaxillary buttress (ZMB), in order to suggest another anatomical consideration and surgical modification of sinus floor elevation procedures. This study was designed as a cross-sectional study, and a total of 134 patients and 161 sinuses containing edentulous alveolar ridges were analyzed. The angle between the anterior and lateral walls of the Mx sinus (lateral sinus angle [LSA]), and the angle between the midpalatal line and the anterior sinus wall (anterior sinus angle [ASA]) were measured. Mean LSAs and ASAs were 105.9° ± 9.86° and 58.4° ± 6.43°, respectively. No significant difference between left and right sides was found (LSA, P = .420; right = 105.5° ± 9.27°; left = 105.5° ± 9.27° and ASA, P = .564; right = 57.9° ± 6.80°; left = 58.8° ± 6.02°). The prevalence of septa was 37.3%, and it was most frequently noted in the second molar region (32.8%), followed by the first molar (20.9%), retromolar (16.4%), and second premolar regions (14.9%). Septa were most frequently located posterior to the ZMB (49.2%), while ZMB was mostly located in the first molar region (66.4%). Narrow LSAs may complicate the surgical approach to the posterior maxilla, especially when sinus elevation should be used in the second molar region. Considering the occasional presence of antral septa, membrane elevation may be complicated when a septum is encountered during the procedure. These results suggest that 3-dimensional examination of the convexity of the Mx sinus should be performed preoperatively to choose proper surgical techniques and minimize surgical complications.

Imaging study of the anatomical variations and the maxillary sinus pathology in patients with missing lateral teeth for the application of dental implants

ORL ro ◽  
2016 ◽  
Vol 1 (1) ◽  
pp. 6-12
Author(s):  
Iulian Damian ◽  
Gheorghe-Ionel Comșa
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Dental Implants ◽  
Preoperative Evaluation ◽  
Anatomical Variations ◽  
Accurate Information ◽  
Maxillary Artery ◽  
Lateral Sinus ◽  
Sinus Wall ◽  
Increased Risk

Preoperative evaluation of maxillary sinus anatomy is very important to avoid surgical complications due to close anatomical relations between the sinus and the posterior maxillary teeth and/or edentulous alveolar ridge. Posterior superior alveolar artery is a branch of the maxillary artery and provides the vascularization of the lateral sinus wall and underlying mucosa. Maxillary artery branches should be taken into consideration during sinus lifting procedures and bone augmentation due to increased risk of bleeding by damaging the artery during the osteotomy. Computed tomography (CT) explores three-dimensional anatomic structures and provides complex and accurate information about them. Cone Beam Computed Tomography (CBCT) offers an accurate view of the teeth and surrounding structures at high resolution, despite low-dose radiation used. In this study, the incidence of anatomical variations and sinus pathology were assessed using CBCT. The aim is to evaluate the presence of sinus pathology (sinus mucosal thickening, oro-antral communications, sinus tumors, cysts, polyps), presence and position of the posterior superior alveolar artery. These issues are important because they are about the limits of the dental implants in the posterior maxillary area. The presence of sinus pathology and anatomical variations may predispose to complications and even failures of implantation therapy.  

Posterior Maxillary Sinus Wall: A Landmark for Identifying the Sphenoid Sinus Ostium

2018 ◽  
Vol 128 (3) ◽  
pp. 215-219 ◽  
Author(s):  
Raj D. Dedhia ◽  
Tsung-yen Hsieh ◽  
Yecenia Rubalcava ◽  
Paul Lee ◽  
Peter Shen ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Endoscopic Sinus Surgery ◽  
Sphenoid Sinus ◽  
Average Distance ◽  
Posterior Wall ◽  
Sinus Surgery ◽  
Endoscopic Endonasal ◽  
Sinus Wall ◽  
Significant Difference ◽  
Sinus Ostium

Importance: Safe entry into sphenoid sinus is critical in endoscopic sinus and skull base surgery. A number of surgical landmarks have been used to identify the sphenoid sinus ostium during endoscopic endonasal surgery with variable reliability and intraoperative feasibility. Objective: To determine if the posterior wall of the maxillary sinus is a reliable landmark to determine the depth of the sphenoid sinus ostium during anterior to posterior dissection. Design, Setting, and Participants: Prospective study of adult patients undergoing endoscopic sinus surgery between August 2016 and September 2017. Measurements were made intraoperatively between the depth of the posterior maxillary sinus wall and sphenoid sinus ostium. Main Outcomes and Measures: The primary measurement is the distance between the depth of the posterior maxillary sinus wall and sphenoid sinus ostium. Additional data points included age, gender, surgical indication, and primary versus revision endoscopic sinus surgery. Results: Forty-five patients (38% male, 62% female) with an average age of 56 were enrolled, resulting in 88 operated sides. The average distance between the depth of the posterior wall of the maxillary sinus and the sphenoid ostium was 1.5 mm ± 1.4 mm. The most common position of the sphenoid sinus ostium was posterior to the level of the posterior maxillary sinus wall (54%), followed by same level (23%) and anterior (23%). There was no significant difference between different disease states ( P = .75) and between primary and revision cases ( P = .13). Conclusions and Relevance: The posterior wall of the maxillary sinus serves as an adjunctive intraoperative landmark to determine the depth of the sphenoid sinus ostium. While the posterior wall of the maxillary sinus approximates the depth of the sphenoid sinus ostium, the relative position is variable and can be anterior or posterior.

scholarly journals TREATMENT OF PATIENTS WITH THE CYCLE OF THE SUPERMONTAL ARM OF THE ONTOGENIC GENESIS

2019 ◽  
pp. 18-24
Author(s):  
Mohammed Rezmak ◽  
Liliya Krynychko ◽  
Alexander Naumenko
Keyword(s):  
Maxillary Sinus ◽  
Pathological Process ◽  
Endoscopic Examination ◽  
Nasal Passage ◽  
Filling Material ◽  
Oroantral Fistula ◽  
Sinus Wall ◽  
Subsequent Revision ◽  
Group 2 ◽  
Group 1

The maxillary sinus cysts are a fairly common pathology of the paranasal sinus system, which has a multifactorial etiology that continues to be actively investigated. In recent years, particular attention of researchers has focused on the role of chronic inflammation of the root of the teeth, which are directly adjacent to the lower wall of the maxillary sinus, and accordingly involve the surrounding structures in the pathological process. One of the objective indicators of the severity of inflammation is the level of matrix metalloproteinases, in particular matrix metalloproteinase 9 (MMP-9). Аs follows, the purpose of the study is to study of efficiency of treatment of patients with cystic sinus cysts of odontogenic origin in the long term. Materials and methods. The study included 150 patients. Group 1 - 125 people (age 20-69 years, men - 58, women - 67), group 2 - 25 patients (age 21-59 years, 11 men and 14 women). All patients from the examined groups underwent surgical treatment - removal of the cyst of the maxillary sinus through the lower nasal passage, with subsequent conservative treatment; patients of the first group in the postoperative period were audited channels of the teeth of the upper jaw with replacement of the filling material, and patients of the second group this intervention was not carried out. The inclusion criterion is an increase in the level of ММП-9 in saliva. The exclusion criteria were the presence of acute disease 3 months before surgery, treatment with the dentist 3 months before surgery, normal level of MMP-9 in saliva. In the course of preoperative preparation, all patients underwent CT scan of the paranasal sinuses, endoscopic examination of the nasal cavity and nasopharynx, rhinopneumometry, determination of the index of mucociliary clearance, activity of MMP-9 in saliva. The study of MMP-9 activity in saliva was performed using ELISA kit. Statistical data processing was performed using IBM SPSS Statistics 22. Conclusion. The level of ММР-9 in the saliva of patients of the first group was 1347 (± 328) ng / ml, the second - 1410 (± 220) ng / ml. The number of recurrences of sinus cyst in group 1 was 8, accounting for 6.4% of the total. Other complications include sinus mycetoma - 4 oroantral fistula - 1, hoonal polyp - 2.. The number of relapses of the sinus cyst in group 2 was 9 cases (36%), mycetoma of the sinus cyst - 3 cases, oroantral fistula - 1, hoonal polyp - 1. Conclusion. The results obtained indicate a higher likelihood of recurrence of the maxillary sinus cyst in the absence of a subsequent revision of the root of the teeth and around the root areas immediately adjacent to the lower sinus wall.

scholarly journals A Case of Nasopalatine Duct Cyst with Cholesterol Granuloma in Maxillary Sinus

2020 ◽  
Vol 63 (11) ◽  
pp. 528-532
Author(s):  
Ju Chang Kang ◽  
Kyu Ha Shin ◽  
Eun Mee Han ◽  
Sang Hyeon Ahn
Keyword(s):  
Maxillary Sinus ◽  
Cystic Mass ◽  
Sinus Surgery ◽  
Odontogenic Cysts ◽  
Cholesterol Granuloma ◽  
Transnasal Approach ◽  
Duct Cyst ◽  
Middle Ear Disease ◽  
Nasopalatine Duct Cyst ◽  
The Right

Nasopalatine duct cysts are the most common non-odontogenic cysts that occur in the maxilla. Cholesterol granulomas, on the other hand, are commonly found in patients with chronic middle ear disease, but rarely occur in the paranasal sinuses. We report a rare case of a 30-year-old woman who was treated for a nasopalatine duct cyst and cholesterol granuloma at the same time. The patient complained of sudden nasolabial pressure and right nasal obstruction from three weeks ago. A 3 cm sized cystic mass, diagnosed as a nasopalatine duct cyst, was observed in the maxilla and haziness of the right maxillary sinus suspected of chronic rhinosinusitis was detected by computerized tomography. Marsupialization of the nasopalatine duct cyst was performed through the endoscopic transnasal approach. Solid mass in the maxillary sinus, diagnosed with cholesterol granuloma by pathology after surgery, was completely removed by endoscopic sinus surgery. The patient was followed up for 18 months without any recurrence or complications.

Frontal sinus pneumocele caused by a maxillary sinus mucocele

2021 ◽  
Vol 14 (4) ◽  
pp. e242477
Author(s):  
Spyridon Potamianos ◽  
Eftychia Kanioura ◽  
Georgios Chrysovitsiotis ◽  
Evangelos Giotakis
Keyword(s):  
Maxillary Sinus ◽  
Paranasal Sinus ◽  
Frontal Sinus ◽  
Sinus Surgery ◽  
Valve Mechanism ◽  
Patient Reports ◽  
Full Resolution ◽  
Sinus Wall ◽  
The Face ◽  
The Right

A sinus pneumocele is a rare entity caused by obstruction of a paranasal sinus ostium. It is characterised by dilation and expansion of the sinus, with subsequent bony erosion. The most probable mechanism is air trapping in the paranasal sinus, via a one-way valve mechanism. The case presented concerns a 68-year-old Caucasian man, with recurrent episodes of acute rhinosinusitis. Clinical examination and subsequent imaging of the face, revealed a large pneumocele of the right frontal sinus that significantly eroded the posterior sinus wall. A large mucocele of the right maxillary sinus was also noted, extending to the middle meatus, causing full obstruction of the ostiomeatal complex. Endoscopic sinus surgery was performed, the mucocele was removed and the pneumatisation pathway of the frontal sinus was restored. The patient reports full resolution of symptoms and shows no evidence of recurrence, 6 months postoperatively.

scholarly journals Modified Endoscopic-Assisted Approach for Removal of Ectopic Third Molar in the Maxillary Sinus

2021 ◽  
Vol 11 (18) ◽  
pp. 8446
Author(s):  
Mi-Hyun Seo ◽  
Ju-Young Lee ◽  
Paul Frimpong ◽  
Mi-Young Eo ◽  
Soung-Min Kim
Keyword(s):  
Maxillary Sinus ◽  
Third Molar ◽  
Case Series ◽  
Sinus Surgery ◽  
Surgical Removal ◽  
Effective Technique ◽  
Sinus Wall ◽  
Alternative Approach ◽  
Ectopic Tooth ◽  
Ectopic Third Molar

This case series describes an alternative approach for removing ectopically erupted tooth in the maxillary sinus using an improved endoscopic approach known as modified endoscopic-assisted sinus surgery (MESS). We reviewed medical charts and radiographs of patients who underwent surgical removal of an ectopic tooth in the maxillary sinus using MESS. The surgical technique consisted of creating a bony window in the maxillary sinus wall with a pre-adapted microplate, which was repositioned after the tooth was removed. For all the patients included in this study, there were no postoperative complications clinically and radiographically. At the time of microplate removal, satisfactory bone regeneration was observed around the bony window margins of the maxillary sinus wall. MESS is an effective technique that modifies and integrates the techniques of the conventional Caldwell-Luc procedure (CLP) and functional endoscopic sinus surgery (FESS) and can be used to remove ectopic tooth in the maxillary sinus by avoiding the risk of postoperative sinus-related complications.

scholarly journals Long-Term Clinical Study of Implants Placed in Maxillary Sinus Floor Augmentation Using Beta-Tricalcium Phosphate

2021 ◽  
Vol 18 (19) ◽  
pp. 9975
Author(s):  
Eugenio Velasco-Ortega ◽  
Angela Sierra-Baztan ◽  
Alvaro Jiménez-Guerra ◽  
Antonio España-López ◽  
Iván Ortiz-Garcia ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Tricalcium Phosphate ◽  
Sinus Surgery ◽  
Lateral Sinus ◽  
Beta Tricalcium Phosphate ◽  
Sinus Floor Augmentation ◽  
Maxillary Sinus Floor ◽  
Sinus Floor ◽  
Maxillary Sinus Floor Augmentation

Introduction. The aim of this study was to show the long-term clinical outcomes of implants placed in maxillary sinus floor augmentation (MFSA) using beta-tricalcium phosphate (β-TCP). Patients and methods. Maxillary patients were diagnosed for MFSA and used beta- β-TCP. After the lateral sinus surgery, implants were loaded at 6 months with restorations. The clinical follow-up was at 10 years. Results. One hundred and one patients (58 females and 43 males) were treated with MFSA. Twenty-nine patients (28.7%) had a history of periodontitis. Thirty-three patients (32.7%) were smokers. One hundred and twenty-one MFSA, 81 unilateral and 20 bilateral sites, with 234 implants were performed. The average vertical bone height available was 4.92 ± 1.83 mm. The average vertical bone gain obtained was 6.95 ± 2.19 mm following MFSA. The implant cumulative survival rate was 97.2%. Three implants (1.3%) were lost during the healing period. Six implants (2.6%) were lost by peri-implantitis. One hundred and fifteen restorations were placed in the patients. Mean marginal bone loss was 1.93 mm ± 1.03 mm. Six patients (27.3%) showed technical complications. Thirty-six implants (15.3%) in 14 patients (13.9%) were associated with peri-implantitis. Conclusions. This study indicates that treatment with implant-supported restoration by MFSA using β-TCP constitutes a successful implant approach.

scholarly journals Partial Preservation of the Inferior Turbinate in Endoscopic Medial Maxillectomy: A Computational Fluid Dynamics Study

2020 ◽  
Vol 34 (3) ◽  
pp. 409-416 ◽  
Author(s):  
Alberto M. Saibene ◽  
Giovanni Felisati ◽  
Carlotta Pipolo ◽  
Antonio Mario Bulfamante ◽  
Maurizio Quadrio ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Maxillary Sinus ◽  
Flow Rate ◽  
Theoretical Basis ◽  
Inferior Turbinate ◽  
Sinus Surgery ◽  
Anterior Portion ◽  
Sinus Wall ◽  
Medial Maxillectomy

Background Endoscopic medial maxillectomy (EMM) is a workhorse for multiple sinonasal conditions. To reduce its burden on the sinonasal physiology, several modified EMM (M-EMM) have been proposed. Objective: In order to provide a theoretical basis for EMM and its modifications, this study introduces a computational fluid dynamics (CFD) model, based on a time-resolved direct numerical simulation, describing EMM and assessing the role of the M-EMM in preserving the overall fluid dynamics of the sinonasal cavities. Methods A normal sinonasal CT scan was converted into a geometrical model and used as a reference; 2 anatomies were then created by virtual surgery, mimicking EMM and M-EMM, with the latter sparing the anterior portion of inferior turbinate and medial maxillary sinus wall. The airflow was simulated in the models via the OpenFOAM CFD software and compared in terms of flow rate, mean and fluctuating velocity, vorticity, and turbulent structures. Results The analysis shows that EMM induces a massive flow rate increase in the operated side, which becomes less obvious in the M-EMM model. In contrast to M-EMM, EMM induces higher velocity fields that reach the maxillary sinus. Velocity and vorticity fluctuations are negligible in the baseline model, but become increasingly evident and widespread in the M-EMM and EMM models. Conclusions A significant disruption of the nasal fluid dynamics is observed in EMM, while M-EMM minimizes variations and reduces interference with nasal air conditioning. Our analysis provides insights into the pathophysiology of radical sinus surgery and provides a theoretical basis for the ability of M-EMM to reduce the temporary surgery-related changes on both healthy and operated sides.

scholarly journals Position of posterior superior alveolar artery in relation to the maxillary sinus using cone beam computed tomography in Indian sub-population

2021 ◽  
Vol 27 (3) ◽  
pp. 34
Author(s):  
Aamir Zahid Godil ◽  
Trupti Jagannath Devadiga ◽  
Shraddha Chandrashekhar Supnekar ◽  
Arshi Ilyas Kazi ◽  
Sanaa Akhlaq Wadwan ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Radiographic Measurement ◽  
Vertical Position ◽  
Lateral Sinus ◽  
Outer Cortex ◽  
Linear Measurements ◽  
Lower Border ◽  
Alveolar Crest ◽  
Sinus Wall ◽  
The Mean

Purpose: To assess the location of posterior superior alveolar artery (PSAA) using CBCT in relevance to sinus lift procedure for implant placement. Patients and Methods: A retrospective study was conducted using the CBCT data of 500 patients (n = 500). Linear measurements were carried out to localize the medio-lateral and vertical position of posterior superior alveolar artery in postero-lateral wall of maxillary sinus and its proximity to the floor of maxillary sinus using CS 3D imaging 3.7.0 software program. The relative position of PSAA was determined as; (a) intra-osseous, (b) below the membrane and (c) outer-cortex of lateral sinus wall. The location of PSAA was assessed in molar region bilaterally by using following radiographic measurement; (1) distance between the lower border of posterior superior alveolar artery and alveolar crest, (2) height from the floor of maxillary sinus to alveolar crest and (3) distance from the posterior superior alveolar artery to medial wall of maxillary sinus. Results: The prevalence of the artery was observed in 99.4% of the sinuses and was mostly intraosseous (84.2%).The mean distance between the lower border of the artery and alveolar crest is significantly higher in males compared to females (P < 0.01). The distribution of artery location did not differ significantly across various age groups (P > 0.05). Discussion/Conclusion: The most common variant of PSAA was identified in the intra-osseous region and the mean distance of the vessel to crest of the residual ridge differs significantly with gender and not with age.

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