Reconstruction of defects of maxillary sinus wall after removal of a huge odontogenic lesion using prebended 3D titanium-mesh and CAD/CAM technique

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.

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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 ◽

10.26416/orl.30.1.2016.517 ◽

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.

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Evaluating Endoscopic Ipsilateral Endonasal Corridor Approaches to the Anterolateral Wall of the Maxillary Sinus: A Computerized Tomography Study

International Archives of Otorhinolaryngology ◽

10.1055/s-0041-1724092 ◽

2021 ◽

Author(s):

Navarat Vatcharayothin ◽

Pornthep Kasemsiri ◽

Sanguansak Thanaviratananich ◽

Cattleya Thongrong

Keyword(s):

Confidence Interval ◽

Maxillary Sinus ◽

Inferior Turbinate ◽

Radial Access ◽

Sinus Wall ◽

Nasal Floor ◽

Significant Difference ◽

Anterolateral Wall ◽

The Mean ◽

Maxillary Sinuses

Abstract Introduction The endoscopic access to lesions in the anterolateral wall of the maxillary sinus is a challenging issue; therefore, the evaluation of access should be performed. Objective To assess the accessibility of three endoscopic ipsilateral endonasal corridors. Methods Three corridors were created in each of the 30 maxillary sinuses from 19 head cadavers. Accessing the anterolateral wall of the maxillary sinus was documented with a straight stereotactic navigator probe at the level of the nasal floor and of the axilla of the inferior turbinate. Results At level of the nasal floor, the prelacrimal approach, the modified endoscopic Denker approach, and the endoscopic Denker approach allowed mean radial access to the anterolateral maxillary sinus wall of 42.6 ± 7.3 (95% confidence interval [CI]: 39.9–45.3), 56.0 ± 6.1 (95%CI: 53.7–58.3), and 60.1 ± 6.2 (95%CI: 57.8–62.4), respectively. Furthermore, these approaches provided more lateral access to the maxillary sinus at the level of the axilla of the inferior turbinate, with mean radial access of 45.8 ± 6.9 (95%CI: 43.3–48.4) for the prelacrimal approach, 59.8 ± 4.7 (95% CI:58.1–61.6) for the modified endoscopic Denker approach, and 63.6 ± 5.5 (95%CI: 61.6–65.7) for the endoscopic Denker approach. The mean radial access in each corridor, either at the level of the nasal floor or the axilla of the inferior turbinate, showed a statistically significant difference in all comparison approaches (p < 0.05). Conclusions The prelacrimal approach provided a narrow radial access, which allows access to anteromedial lesions of the maxillary sinus, whereas the modified endoscopic Denker and the endoscopic Denker approaches provided more lateral radial access and improved operational feasibility on far anterolateral maxillary sinus lesions.

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Virtual Surgical Planning, Stereolitographic Models and CAD/CAM Titanium Mesh for Three-Dimensional Reconstruction of Fibula Flap with Iliac Crest Graft and Dental Implants

Journal of Clinical Medicine ◽

10.3390/jcm10091922 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1922

Author(s):

Carlos Navarro Cuéllar ◽

Manuel Tousidonis Rial ◽

Raúl Antúnez-Conde ◽

Santiago Ochandiano Caicoya ◽

Ignacio Navarro Cuéllar ◽

...

Keyword(s):

Bone Resorption ◽

Surgical Planning ◽

Iliac Crest ◽

Three Dimensional ◽

Titanium Mesh ◽

Iliac Crest Graft ◽

Virtual Surgical Planning ◽

Fibula Flap ◽

Dimensional Reconstruction ◽

Cad Cam

Mandibular reconstruction with fibula flap shows a 3D discrepancy between the fibula and the remnant mandible. Eight patients underwent three-dimensional reconstruction of the fibula flap with iliac crest graft and dental implants through virtual surgical planning (VSP), stereolitographic models (STL) and CAD/CAM titanium mesh. Vertical ridge augmentation and horizontal dimensions of the fibula, peri-implant bone resorption of the iliac crest graft, implant success rate and functional and aesthetic results were evaluated. Vertical reconstruction ranged from 13.4 mm to 10.1 mm, with an average of 12.22 mm. Iliac crest graft and titanium mesh were able to preserve the width of the fibula, which ranged from 8.9 mm to 11.7 mm, with an average of 10.1 mm. A total of 38 implants were placed in the new mandible, with an average of 4.75 ± 0.4 implants per patient and an osseointegration success rate of 94.7%. Two implants were lost during the osseointegration period (5.3%). Bone resorption was measured as peri-implant bone resorption at the mesial and distal level of each implant, with a variation between 0.5 mm and 2.4 mm, and with a mean of 1.43 mm. All patients were rehabilitated with a fixed implant prosthesis with good aesthetic and functional results.

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3D Volumetric Analysis and Anatomical Considerations for Sinus Bone Graft

Applied Sciences ◽

10.3390/app11030951 ◽

2021 ◽

Vol 11 (3) ◽

pp. 951

Author(s):

Ji Hyoung Kim ◽

Hyo Joon Kim ◽

Ye Joon Jo ◽

Jun Seok Choi ◽

Seong Yong Moon

Keyword(s):

Bone Graft ◽

Maxillary Sinus ◽

Alveolar Bone ◽

Lateral Wall ◽

Volumetric Analysis ◽

Ct Scans ◽

Sinus Floor Elevation ◽

Sinus Wall ◽

Sinus Floor ◽

The Mean

The aim of this study is to evaluate anatomical considerations and assess the volume of the maxillary sinus bone graft. There were sixty-three patients (eighty-three sinuses) who had taken CT scans for implant surgery. Patients included those whose height of the residual alveolar bone was less than 5 mm. The position of posterior superior alveolar artery, the thickness of the maxillary sinus wall, and the volume of the maxillary sinus according to the amount of sinus floor elevation were measured. The mean vertical distance of posterior superior alveolar artery was 11.91 ± 4.79 mm from 3.03 mm to 24.05 mm. The mean thickness of the lateral wall was 1.71 ± 0.55 mm in the range of 0.74 mm to 3.93 mm. The volume of 3 mm, 5 mm, 7 mm, and 10 mm from the sinus floor was 0.173 ± 0.11 cm3, 0.526 ± 0.25 cm3, 1.068 ± 0.43 cm3, and 2.184 ± 0.74 cm3 on average, respectively. The knowledge of the posterior superior alveolar artery position, the lateral wall thickness, and the volume of the maxillary sinus can help the clinician for sinus bone graft.

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

BMJ Case Reports ◽

10.1136/bcr-2020-241487 ◽

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.

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