scholarly journals CLINICAL AND RADIOLOGICAL FEATURES OF THE MAXILLARY SINUS IN PATIENTS AFTER REMOVAL OF FUNGAL BALL AND THEIR IMPACT ON THE FREQUENCY OF SUBANTRAL BONE AUGMENTATION COMPLICATIONS.

2021 ◽  
Vol 3 (17) ◽  
pp. 13-20
Author(s):  
Ya.V. Shkorbotun
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Tissue Injury ◽  
Sinus Surgery ◽  
Middle Meatus ◽  
Bone Augmentation ◽  
Endoscopic Removal ◽  
Fungal Ball ◽  
Dental Implantation ◽  
Maxillary Sinuses

Abstract. The mucoperiostitis and local osteitis are radiological symptoms of the fungal ball of the maxillary sinuses. The condition of the mucoperiosteum and the adjacent bone in the alveolar bay of the maxillary sinus predict the results of dental implantation and subantral augmentation. The endoscopic access to the sinus by the antrostomy in the middle meatus and infraturbinal have been used to avoid excessive tissue injury during the removal of the fungal ball. Aim: To assess the condition of the bone and mucoperiosteum of the maxillary sinus in patients with fungal ball after rhinosurgery by the antrostomy with additional osteoplastic infraturbinal access. Methods and materials: The data of 102 patients who underwent surgery for the fungal ball of the maxillary sinus were analyzed, and subsequently - subantral bone augmentation and dental implantation were performed. In patients of the first group (67 people) - endoscopic intervention was performed by antrostomy in the middle meatus, and in 2nd group (35 people) - additional osteoplastic infraturbinal access was used. Result: Computed tomography data were evaluated before endoscopic sinus surgery and before subantral augmentation. The frequency of signs and severity of osteitis according to Kannedy Osteitis Score, after the intervention did not change significantly, and was established as 0.90 ± 0.07 in patients of group №1 and 0.77 ± 0.08 – group №2. The total frequency of complications with subantral augmentation in the comparison groups was 17.91 ± 4.68% and 17.14 ± 6.37%, respectively. Symptoms of osteitis in patients with fungal ball of the maxillary sinus after endoscopic removal, in the first 4 - 6 months of observation tend to regress, but do not disappear. Conclusions: The incidence of osteitis in computed tomography in patients with maxillary sinuses fungal balls in 4.8 months after endoscopic removal tends to decrease and is 77.61 ± 5.09% when approach through the middle meatus and 74.29 ± 7, 39% in patients with combined infraturbinal approach. The use of additional infraturbinal approach in patients with a fungal ball does not adversely affect the results of subsequent subantral augmentation and dental implantation.

scholarly journals Disease Management in the Fungal Body of the Maxillary Sinus in People with Planned Dental Implantation

2021 ◽  
Vol 6 (3) ◽  
pp. 206-211
Author(s):  
Ya. V. Shkorbotun ◽  
◽  
Keyword(s):  
Maxillary Sinus ◽  
Complete Removal ◽  
Sinus Surgery ◽  
Endoscopic Endonasal ◽  
Main Method ◽  
Maxillary Bone ◽  
Fungal Ball ◽  
Dental Implantation ◽  
Group 2 ◽  
Maxillary Sinuses

The fungal ball is the most common clinical form of fungal etiology sinusitis. The main method of treatment of patients with this pathology is surgery. Achieving complete removal of the fungal body is important, especially in patients who will have planned dental implantation. Among the accesses to the maxillary sinus in cases of the fungal body of the sinus, the most common one is through the middle meatus, but it does not provide visual control of the anterior parts of the sinus during the intervention. The use of modified infraturbinal access provides better opportunities for examination of the anterior parts of the maxillary sinus. The purpose of the study is to increase the effectiveness of surgical treatment of patients with fungal bodies of the maxillary sinus by optimizing access during endoscopic endonasal intervention. Materials and methods. The data of 113 patients with fungal ball of maxillary sinuses who underwent sinusotomy in preparation for dental implantation were analyzed. Cone beam computed tomography of paranasal sinuses of patients were performed twice – before functional endoscopic sinus surgery and before subantral augmentation of the maxillary bone. Group 1 included 78 patients to whom the fungal balls were removed from the sinus through the middle nasal meatus, group 2 – 35 patients to whom, in cases when it was impossible to visually confirm the completeness of removal of the fungal ball from the anterior area of the sinus, an additional infraturbinal approach was performed in our modification. Results and discussion. According to tomography before rhinosurgery it was established that "blackout" of more than 60% of the sinus space is observed in 50.5% of patients with fungal bodies, with the vast majority of patients (88.1%) fungal bodies in the maxillary sinus are located in its lower parts and spread forward from the nasolacrimal canal level. During sinus rehabilitation, the need for additional infraturbinal access arose in 5 (14.3%) patients of the second group. As a result of its performance in all 5 operated patients polyposis-altered tissues were found in "blind zones" and in 2 (5.7%) – there were also remains of a fungal body. Residual fungal bodies in the maxillary sinus were detected in 3 (3.9% CI 95% – 0.01; 11.6) patients of the first group, and were not observed in the second group. All cases of residual fungal masses in the sinus were not accompanied by specific complaints. A revision of sinusitis with fungal masses removing was performed on 3 patients due to the appearance of residual fungal bodies by preformed antrostomy with local anesthesia. Conclusion. Anthrostomy using additional endoscopic infraturbinal access when removing the fungal body from the lower anterior maxillary sinus is the optimal combined access that allows maximum visualization of the maxillary sinus and avoid recurrence of the disease

Correlation between bacteriology and computed tomography staging for chronic sinusitis

2005 ◽  
Vol 119 (3) ◽  
pp. 193-197 ◽  
Author(s):  
Rong-San Jiang ◽  
Pzu-Kai Lin ◽  
Jen-Fu Lin
Keyword(s):  
Computed Tomography ◽  
Chronic Sinusitis ◽  
Sinus Surgery ◽  
Ct Scans ◽  
Middle Meatus ◽  
Ostiomeatal Complex ◽  
Highly Correlated ◽  
Endoscope Guidance ◽  
Ethmoid Sinuses ◽  
Maxillary Sinuses

In this study we report on the correlation between bacteriology and disease severity staging by computed tomography (CT) for chronic sinusitis. When patients with chronic sinusitis underwent functional endoscopic sinus surgery (FESS), swab specimens were taken from the ipsilateral middle meati and ethmoid sinuses under endoscope guidance. The severity of chronic sinusitis was evaluated by pre-operative CT scans. The CT scans were staged by the Lund and Mackay system. The scores for the frontal, anterior ethmoid and maxillary sinuses and for the ostiomeatal complex were added. The culture rates were correlated with the added scores. Between November 1998 and January 2003, 79 pairs of specimens were collected from 79 patients whose CT scans were done within a day before FESS. The culture rates of middle-meatus specimens were moderately correlated with the scores, but those of ethmoid sinus specimens were negatively correlated with the scores. If Staphylococcus epidermidis and corynebacteria were considered normal flora, the bacteriology of the middle meatus was highly correlated with the CT scores. This study shows that culture rates of middle-meatal specimens tended to increase with the severity of chronic sinusitis.

Sinusitis in the Intensive Care Unit Patient

1997 ◽  
Vol 117 (4) ◽  
pp. 362-366 ◽  
Author(s):  
Stilianos E. Kountakis ◽  
Luke Burke ◽  
Jean-Jacques Rafie ◽  
Benjamin Bassichis ◽  
Alberto A. J. Maillard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Physical Examination ◽  
Maxillary Sinus ◽  
Middle Meatus ◽  
Sinus Disease ◽  
Plain Films ◽  
Chi Squared ◽  
Maxillary Sinuses

A retrospective study was undertaken to determine the incidence of sinusitis as a source of fever in the intensive care unit (ICU) patient, evaluate the effectiveness of radiologic studies in diagnosing sinusitis, and develop guidelines that may help predict the result of antral levage. Sixteen of 52 (30.7%) lavages in patients studied with plain films and 27 of 67 (40.3%) lavages in patients studied with computed tomography of the sinuses revealed purulence in the maxillary sinuses. Conversely, 23 of 30 (76.7%) of the cases with purulence in the middle meatus had purulence in the maxillary sinus (chi-squared = 27.1). If no purulence was seen, the results of the antral lavage were negative in 68 of 89 cases (76.4%). When physical examination was used in conjunction with computed tomography, 92.3% of lavages confirmed purulence in the maxillary sinus (chi-squared = 16.6). In conclusion, the most important factor in predicting a positive result with antral lavage is the presence of purulence in the middle meatus on physical examination in conjunction with the presence of sinus disease on computed tomography of the sinuses.

scholarly journals Comparison of the Frequency of Detection of Some Radiological Signs in Chronic Maxillary Sinusіtis of Fungal and Non-Fungal Origin

2020 ◽  
Vol 5 (6) ◽  
pp. 202-207
Author(s):  
Ya. V. Shkorbotun ◽  
◽  
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Chronic Rhinosinusitis ◽  
Chronic Sinusitis ◽  
Maxillary Sinusitis ◽  
Biologically Active ◽  
Differential Diagnostics ◽  
Diagnostic Significance ◽  
Fungal Ball ◽  
The One

The one of the most informative method of preoperative diagnosis of fungal paranasal sinuses is computed tomography. The radiological marker that allows to identify chronic sinusitis of fungal origin is an eclipse with hyperintensive inclusions. The sensitivity of this criterion for fungal ball is about 80%. In addition, a sign of recalcitrant chronic sinusitis is the presence of reactive changes in the bone wall of the sinus – "osteitis". The purpose of the work was to study the frequency of radiological signs of osteitis and areas of increased radiological density in the maxillary sinuses of the patients with chronic sinusitis of fungal and non-fungal etiology, to clarify the diagnostic significance of these symptoms in the differential diagnostics. Material and methods. The results of a retrospective study of computer tomography data of 60 people with chronic rhinosinusitis (intraoperative was verified fungal ball in the maxillary sinus space of 30 patients, other 30 patient had no signs of fungal etiology). Results and discussion. In patients with chronic rhinosinusitis of non-fungal nature, hyperintensive inclusions in the sinus were found in 13.3%, and signs of osteitis were detected in 36.7%, which was significantly less common than in patients with fungal processes, 83.3% and 80,0% respectively (p <0,05). The presence of both of the radiological symptoms was observed in 63.3% of patients from the group of chronic rhinosinusitis in the presence of a fungal body in the space of the sinus and in 6.7% of cases the chronic rhinosinusitis of non-fungal etiology. The severity of osteitis according to KOS, in patients with a fungal body in the sinus was 0.71 ± 0.15 points, and 0.55 ± 0.2 points in patients without a fungus. The pathogenesis of osteitis in the cases of sinusitis with fungal origin is a violation of bone trophism, which develops due to periostitis after the influence of biologically active substances secreted by the fungus. The increase of radiation density in areas of osteitis indicates the predominance of osteogenesis over osteolysis in the inflammatory focus of the bone wall of the maxillary sinus. Conclusion. The frequency of detecting radiological signs of osteitis in patients with chronic rhinosinusitis of the maxillary sinus with fungal bodies was 80%, that was comparable to the frequency of detecting hyperintense inclusions in the lumen of the sinus in these patients (83.3%), and was significantly more than in patients with chronic sinusitis nonfungal etiology. The presence of radiological signs of osteitis of the bone wall of the maxillary sinus in computed tomography should be regarded as an additional symptom in the differential diagnosis of maxillary sinusitis of fungal origin

scholarly journals A study on maxillary sinus dimensions by computed tomography in population of Tamil Nadu

2016 ◽  
Vol 05 (02) ◽  
pp. 091-096
Author(s):  
N Muthukumaravel ◽  
K.Y Manjunath
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Tamil Nadu ◽  
Maximum Width ◽  
Average Width ◽  
Computed Tomographic ◽  
Significant Difference ◽  
The Difference ◽  
The Right ◽  
Maxillary Sinuses

Abstract Background and aims: Maxillary sinuses are the largest of the paranasal sinuses known for variability in their dimensions. The maxillary sinus dimensions can be better ascertained in living by using computed tomography instead of plain radiography. This study was planned for highlighting the variations in the dimensions of the maxillary sinuses of population of Tamil Nadu region. The aims of the present study were to estimate dimensions of the maxillary sinuses on computed tomographic (CT) scan of the head of patients from Tamil Nadu and to compare the data gender wise and sidewise. Material and methods: Maximum width, height and depth of maxillary sinus of both sides were measured in CT - head images of 100 males and 100 females of 20-50 years of age in Tamil Nadu. Comparison of data between genders and sides by applying unpaired student "t" test was done. Results : The mean depth, height and width of both right and left maxillary sinuses were comparatively less in females than the males and the difference was found to be statistically significant ( P <.0001). On comparison between the sides of maxillary sinuses, the depth and the height of maxillary sinus did not show any significant difference in the measurements (p >.05), whereas the width of the left side (23.96 mm) was higher than that of the right side (23.69) and the difference was found to be statistically significant (P<.05). The combined average maxillary sinus dimensions (in mm) for both genders in the study population of Tamil Nadu are as follows: Right side depth: 33.71 ± 1.00; Left side depth : 33.65 ± 1.22; Right side height: 34.66 ± 2.71; Left side height: 34.74± 2.48; Right side width: 23.69 ± 0.78 and Left side width: 23.96 ± 0.86. Conclusion: The dimensions of maxillary sinuses in males were found to be larger than those of females and this difference was statistically significant. The average width of the maxillary sinuses on the left side is significantly more than that of right sided sinuses. Computed tomography measurements of maxillary sinuses may be useful in gender determination.

Polyps originating from accessory middle turbinate and secondary middle turbinate

2012 ◽  
Vol 126 (7) ◽  
pp. 729-732 ◽  
Author(s):  
H Jung ◽  
S K Park ◽  
J-R Kim
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
World Literature ◽  
Middle Turbinate ◽  
Anatomical Variations ◽  
Sinus Surgery ◽  
Histopathological Analysis ◽  
Middle Meatus ◽  
The World ◽  
Paranasal Sinus Computed Tomography

AbstractObjective:We report two extremely rare cases of polyps from unilateral accessory middle turbinates, one of which coexisted with a polyp from an inferomedially projecting, pneumatised, secondary middle turbinate.Methods:Case report and literature review concerning accessory middle turbinate and secondary middle turbinate.Results:Two patients presented with unilateral nasal obstruction. In both patients, nasal endoscopy revealed polypoid masses originating from the middle meatus. Paranasal sinus computed tomography and histopathological analysis confirmed the presence of polyps originating from an accessory middle turbinate and secondary middle turbinate, which were resected uneventfully via endoscopic sinus surgery.Conclusion:To our knowledge, this is the first report in the world literature of polyps originating from a unilateral accessory middle turbinate and secondary middle turbinate. Pre-operative recognition of these rare anatomical variations is of particular importance in avoiding intra-operative complication.

Radioanatomic Study of the Greater Palatine Canal Relevant to Endoscopic Endonasal Surgical Landmarks

2017 ◽  
Vol 157 (4) ◽  
pp. 731-736
Author(s):  
Noel Ayoub ◽  
Andrew Thamboo ◽  
Peter H. Hwang ◽  
Evan S. Walgama
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Sagittal Plane ◽  
Inferior Turbinate ◽  
Posterior Wall ◽  
University Hospital ◽  
Ct Scans ◽  
Endoscopic Endonasal ◽  
Greater Palatine Canal ◽  
Maxillary Sinuses

Objective A radioanatomic study of surgically relevant variations in the greater palatine canal (GPC) on computed tomography (CT) was performed to determine susceptibility during endoscopic endonasal procedures. Study Design Blinded radioanatomic analysis. Setting Tertiary university hospital. Subjects and Methods Fifty consecutive paranasal CT scans (100 sides) were analyzed. Measurements were standardized to landmarks such as the inferior turbinate (IT) and floor of the nasal cavity (FNC) to assess variability and vulnerability of the nerve. Measurements included (1) incidence of maxillary sinus pneumatization posterior to the GPC, (2) distance from the posterior wall of the maxillary sinus to the GPC at the IT and FNC, (3) width of bone containing the GPC, (4) incidence of medial GPC dehiscence, and (5) angle of the GPC extending from the IT to FNC. Results Ninety-one percent of maxillary sinuses were pneumatized posterior to the GPC. The distance from the posterior wall of the maxillary sinus to the GPC was 2.8 ± 1.7 mm (range, –2.3 to 5.9) at the posterior attachment of the IT and 4.1 ± 3.1 mm (range, –6.3 to 11.9) at the FNC. The width of bone containing the GPC was 3.3 ± 1.3 mm (range, 1-8.9), and the medial bony GPC was dehiscent in 38% of cases. In the sagittal plane, the angle of the GPC between the IT and the FNC was 31.9 ± 6.9 degrees (range, 10.8-45). Conclusion The GPC has considerable anatomic variability relative to important surgical landmarks in endoscopic procedures. Preoperative review of CTs to assess vulnerability may prevent postoperative complications.

scholarly journals Evaluation of Anatomical Variations in Maxillary Sinus and Management of Chronic Sinonasal Disease

2021 ◽  
Vol 10 (38) ◽  
pp. 3351-3355
Author(s):  
Ganesh Manohar Vihapure ◽  
Akshay Sorade ◽  
Kaenat Ahmed ◽  
Lakshmi Sravya Yarlagadda ◽  
Khaleel Basha Munnaru
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Paranasal Sinuses ◽  
Endoscopic Sinus Surgery ◽  
Anatomical Variations ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Successful Outcome ◽  
Operative Care ◽  
Number Of Patients

BACKGROUND The paranasal sinuses (PNS) have various anatomical difference. Computed tomography (CT) is an excellent means of providing anatomical information of this region, disease extent, assisting endoscopic evaluation and guiding treatment. Functional endoscopic sinus surgery (FESS) has become an increasingly popular treatment for chronic sinus diseases. CT of the paranasal sinuses has become a roadmap for FESS. The present study focuses on the assessment of the efficacy, safety and benefits of functional endoscopic sinus surgery in cases of maxillary pathologies and also study the anatomical variations in maxillary sinus in computed tomography and its usefulness in planning and management of chronic sinonasal diseases. METHODS It was a prospective study and a total of 80 patients were included in this study from July 2019 to June 2020 in the Otolaryngology Department, KIMS, Karad. Standard surgical steps were applied in each case according to the extent of disease. All patients underwent standard post-operative care. All findings were recorded and studied. RESULTS Total number of patients were 80. Of which, 31 (38.75 %) patients were operated for ethmoidal polyp, 24 (30 %) for chronic rhinosinusitis, 10 (12.5 %) for antrochoanal polyp, 9 (11.25 %) for rhinosporidiosis and 6 (7.5 %) for inverted papilloma. Postoperative complications were periorbital echymoses (13 %), synechiae (2.5 %), epiphora (2.5 %), infection (2.5 %), hemorrhage (4 %). Complete relief of symptoms were noted in 81.67 % cases. CONCLUSIONS Successful outcome and patient satisfaction post treatment can be obtained by careful evaluation and patient selection by history, examination and most importantly, proper imaging of the sinuses. KEY WORDS Maxillary Sinus, Sinusitis, Nasal Polyp, Paranasal Sinus Disease, Computed Tomography (CT)

scholarly journals Adenoid hypertrophy is a common finding in children with antrochoanal polyp

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Mosaad Abdel-Aziz ◽  
Ahmed Nassar ◽  
Omar Sabry
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sinus Surgery ◽  
Pathological Finding ◽  
Sinus Surgery ◽  
Common Finding ◽  
Antrochoanal Polyp ◽  
Adenoid Hypertrophy ◽  
Pathological Findings ◽  
Endoscopic Removal ◽  
Nasal Pathology

Abstract Background Many nasal pathological findings have been described with antrochoanal polyp (ACP). We aimed in this study to assess the prevalence of adenoid hypertrophy among children presented with ACP and to evaluate the efficacy of concomitant adenoidectomy on the outcome of endoscopic removal of the lesion. Results Forty-three children with ACP were included in this study. Preoperative nasal endoscopy and computed tomography were performed for all patients. Endoscopic sinus surgery (ESS) with widening the maxillary ostium was used for removal of ACP in all patients. Associated nasal pathology was recorded and managed accordingly. The patients were followed up for at least 3 years postoperatively. Coexistent nasal pathology with ACP was detected in 39 patients (90.7%); adenoid hypertrophy was found to be the commonest concomitant lesion (83.7%). Adenoidectomy was performed during ESS for those who had adenoid hypertrophy. Postoperatively, no patients developed adenoid regrowth; however, recurrence of ACP was detected in five patients (11.6%). Conclusion Adenoid hypertrophy is a common pathological finding in children presented with ACP. Endoscopic removal of ACP with concomitant adenoidectomy is an effective procedure and has a favorable outcome.

scholarly journals Computed tomography findings after endoscopic sinus surgery with preserving or enlarging maxillary sinus ostium surgery

2011 ◽  
Vol 49 (4) ◽  
pp. 438-444
Author(s):  
J. Myller ◽  
P. Dastidar ◽  
T. Torkkeli ◽  
M. Rautiainen ◽  
S. Toppila-Salmi
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Endoscopic Sinus Surgery ◽  
Symptom Relief ◽  
Sinus Surgery ◽  
Ct Scans ◽  
Ct Findings ◽  
Middle Meatal Antrostomy ◽  
Sinus Ostium ◽  
Subjective Outcomes

Endoscopic sinus surgery (ESS) is the main surgical approach in the treatment of chronic rhinosinusitis (CRS) after failure of medical treatment. ESS is based on the theory that obstruction of the maxillary sinus ostium is mainly behind the pathogenesis of CRS. Controversy remains concerning the enlargement of the natural maxillary sinus ostium. The aim of this study was to compare computed tomography (CT) findings after preservation or enlargement of the maxillary sinus ostium. Thirty patients with non-polypous CRS underwent randomized endoscopic sinus surgery with uncinectomy on one side and additional middle meatal antrostomy on the other side. Lund-Mackay (LM) scores and the ostium diameters were analysed from CT scans taken preoperatively and nine months postoperatively, and were used for comparison of the two operative techniques. In addition, the correlation between CT findings and subjective outcomes was studied. Comparison of the preoperative and postoperative CT scans revealed that significant reduction of LM score was achieved on both sides, regardless of the type of procedure performed. The postoperative area of the ostium remained significantly larger on the antrostomy side compared to the uncinectomy side. A large maxillary sinus ostium size seems to associate with lower postoperative LM score, but does not seem to provide superior symptom relief.

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