Endoscopic Trans-Turbinal Medial Maxillectomy: A Modified Endoscopic Medial Maxillectomy Technique to Preserve the Inferior Turbinate

Endoscopic medial maxillectomy (EMM) and its modifications are surgical techniques are used to treat recalcitrant maxillary sinusitis as well as maxillary sinus tumors. In this report, we propose a simple and efficient modification of EMM, called endoscopic trans-turbinal medial maxillectomy (ETTMM), by which the inferior turbinate (IT), nasolacrimal duct, and anatomical integrity of the nasal valve area are preserved. A total of 10 patients (five tumorous and five nontumorous maxillary diseases) underwent ETTMM. Briefly, a turbinate mucosal flap on the superior aspect of the IT was elevated after middle meatal antrostomy. Then a trans-turbinal window was developed to expose the inferior meatus, after which an extended maxillary antrostomy was generated. Finally, the turbinate mucosal flap was repositioned after complete removal of the antral lesions. All lesions were successfully treated using ETTMM. Our modification was easy to perform, and we achieved good endoscopic visualization and accessibility throughout the whole antrum by creating a trans-turbinal window and extended maxillary antrostomy. We could perform postoperative surveillance easily through the wide antrostomy using rigid endoscopes of various angles. ETTMM is a simple and useful modification of EMM that provides clear visualization and great accessibility to most aspects of the maxillary antrum while preserving the nasal functional units, including the IT and nasal valve area.

Antrochaonal Polyp in a 4 Years Old Child

Antrochoanal polyp (ACP) is a benign, solitary polypoidal lesion arises from the maxillary antral mucosa that traverses through the ostium to the choana extending in a variable extent to the naso/oropharynx. It is usually unilateral and appears mainly in adults and rarely in children. It should be on differential diagnosis of any patients with nasal obstruction and chronic nasal discharge. Nasal endoscopy, computed tomography (CT), cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) are the main diagnostic techniques. Complete endoscopic surgical removal from the antral portionis recommended to prevent recurrence. Here a 4-year-old child of antrochoanal polyp that underwent functional endoscopic sinus surgery (FESS) with complete clearance from the maxillary antrum is presented. Bangladesh J Otorhinolaryngol 2021; 27(2): 188-193

Giant ossifying fibroma of the maxilla: an unusually aggressive presentation in a 21-year-old woman

We present a rare case of a huge aggressive ossifying fibroma of the maxilla in a 21-year-old female patient with involvement of the maxillary antrum, nasal cavity, orbit and the ethmoid sinus with a unique radiologic appearance for documentation.

Maxillary Antrum Carcinoma - A Wolf in Sheep’s Clothing

Maxillary sinus squamous cell carcinoma is an invasive tumour that is usually diagnosed at an advanced stage, where the majority of patients have a very low prognosis and survival rate. We present a case of maxillary sinus carcinoma that affected the entire orbit, resulting in proptosis of the eye and nasal cavity. The patient was recommended for palliative treatment due to the high degree of its involvement and proximity to vital structures. It manifests with very mild to no signs, resulting in a late diagnosis. As a result, physicians must be mindful of maxillary sinus pathologies to make an early diagnosis. Paranasal sinuses are air-filled spaces located close to vital structures such as visual organs and the face. Maxillary, ethmoidal, frontal, and sphenoidal are the 4 paranasal sinuses that are named according to the bones in which they are situated. Nasal cavity and paranasal air sinus malignancies are uncommon. According to the literature, paranasal sinus malignancies account for less than 1 % of all human malignancies and 3 % of the total malignancies of the head and neck region. However, the maxillary sinus is the most frequent site of origin of primary malignant tumours amongst the paranasal sinuses.1 we need to raise general awareness among the oral stomatologists as Asian countries report a very high incidence of maxillary sinus carcinoma.2 The incidence of malignancies in maxillary sinus is high (60 % - 70 %) and less in the nasal cavity (12 % - 25 %), the Ethmoid (10 % - 15 %) and very rare in sphenoid / frontal sinuses (1 %).3 Further, not only the malignancies of maxillary sinuses are common, but they also incur the worst prognosis. Maxillary sinus carcinomas have very few symptoms and are similar to those of chronic paranasal sinusitis. They usually present themselves as locally advanced diseases. 4,5 Paranasal sinus malignancies are difficult to diagnose in the early stages and 90 % of cases are reported in T3 / T4 advanced stage.6 Environmental factors such as industrial pollutants, dust, smoke, and adhesives are the leading causes for the development of disease.7 Thus, sinonasal malignant tumours are rare and pose a challenge in diagnosis as well as treatment. Therefore, maxillofacial specialists should be aware of the signs and symptoms of this rarely occurring disease. This article presents a rare case of a 45-year-old female who reported to our OPD with a complaint of swelling in the right zygomatic area and proptosis of the right eye.

Variação da técnica de drenagem do seio maxilar após remoção de corpo estranho pela abordagem descrita por Caldwel-Luc

In this paper, an improvement of the maxillary sinus drainage after the remotion of foreign bodies by Caldwell-Luc surgery is developed. Three patients with tooth or radicular apex introduced into the maxillary antrum during dental extraction were submitted to the surgery. In contrast to the opening to the nasal cavity, two probes were installed to perform the irrigation and aspiration of the antrum after the surgery. The conclusions are that the use of the probes is an advance in the Caldwell-Luc surgery. With the irrigation and aspiration, the opening to the nasal cavity is not necessary and the result is a comfortable recovery to the patient. The Caldwell-Luc surgery is a safe and simple procedure to remove foreign bodies from the maxillary sinus.

A study on the association between accessory maxillary ostium and maxillary sinus mucosal thickening using cone beam computed tomography

Background Accessory maxillary ostium (AMO) has a major role to play in the aetiology of maxillary sinusitis. Mucosal thickening is one of the key radiographic features of chronic maxillary sinusitis. The aim of this study was to identify the location of the AMOs and investigate the association between Mucosal Thickening [MT] and AMO using Cone Beam Computed Tomography [CBCT]. Methods CBCT scans of 400 maxillary sinuses from the records of 200 patients who seeked various dental treatments at the Thumbay Dental Hospital, Gulf Medical University, Ajman, United Arab Emirates were evaluated. The incidence, anatomical position and maximal length of accessory maxillary ostia (AMO) in the maxillary antrum were reviewed using CBCT by two examiners. The association between MTs and AMOs were also analysed. Results Among the 200 CBCT scans, 131 belonged to male patients and 69 scans belonged to female subjects within the age group of 18–65 years (mean age 41.32 years). AMOs were found in 142 maxillary antra (35.5 %). The inter-observer reliability for using CBCT to detect AMO was (k = 0.83). There was no significant difference in the frequency of AMOs when the age (P = 0.19) and gender (P = 0.54) distribution were considered. Sinuses with AMOs, showed significantly greater frequency of MTs (p = 0.001). AMOs with maximal length of less than 1mm were most commonly observed (51.40 %). AMOs with larger greater maximal length were associated with higher degrees of MT. The location of the AMOs, were not affected by the degree of MT. Conclusions The study demonstrates a clear association between degree of MT and occurrence of AMO in the maxillary sinus. However, the location of the AMO is independent of the degree of the MT. There is a greater probability of finding an AMO in the maxillary sinus if the MT in the sinus is more than 3 mm.

Not all swellings are dental abscesses: A cautionary tale

Carcinomas of the maxillary antrum are rare and tend to present late, leading to poor survival rates. Two-thirds of cases will present with oral symptoms or facial swelling. Dentists should be aware of suspicious clinical and radiographic signs, which may help in early detection and treatment. We present the case of a 48-year-old female complaining of facial swelling. In preceding months, she had visited her GP and dentist numerous times, receiving antibiotics from each for suspected sinusitis and a dental abscess, respectively. Subsequent investigations confirmed an SCC of the right maxillary antrum, which unfortunately, could only be treated palliatively. CPD/Clinical Relevance: The reader should understand the classic findings for a maxillary antrum carcinoma. They should also increase their confidence and awareness in identifying red flag signs and symptoms.

Sino-Maxillary Mucormycosis of Iatrogenic Etiology in an Immunocompetent Patient - Importance of Early Diagnosis and Prompt Management

Sino-maxillary mucormycosis is an opportunistic, aggressive, invasive and fulminant fungal infection, which has the ability to rapidly cross anatomical barriers, causing extensive hard and soft tissue destruction, leading to significant cosmetic deformity, functional debility and morbidity. It usually affects susceptible, debilitated or immunocompromised individuals. A descriptive report of an unusual case involving the dentoalveolar complex and thereafter invading the maxillary antrum, in an otherwise healthy, adult patient with nil comorbidities, is presented. A probable intraoral portal of entry, and a likely iatrogenic etiopathogenesis resulting from inoculation of the fungus or its spores during dental extractions carried out in an unsterile setting, has been considered and elucidated. An emphasis has been placed on according a high index of suspicion in diagnosis of this fungal infection even in immunocompetent and healthy adults, presenting with a seemingly simple, deceptively indolent odontogenic infection. The importance of careful, albeit rapid differential diagnosis, and a prompt and aggressive medical-surgical treatment protocol instituted immediately following a confirmatory diagnosis, helps in limiting the spread and degree of destruction which can be caused by this potentially lethal fungal infection.

Maxillary Sinus Lobular Capillary Hemangioma in a 15-Year-Old Boy

Lobular capillary hemangioma (LCH) is a benign capillary proliferation with a microscopically distinctive lobular architecture, composed of small to medium-sized vessels of capillary type. Rarely, it originates from the mucosa of the nasal cavity, most frequently from the anterior nasal septum, turbinates, and nasal vestibule. Etiology is unclear, but previous investigations suggest that this lesion is associated with injury, hormonal factors, some viral infections, and therapy with some drugs. We present a case of LCH arising from the medial wall of the maxillary sinus in a 15-year-old boy, which was completely excised by preoperative embolization and endoscopic sinus surgery. To our knowledge, this is the second reported case of an LCH originating from the maxillary antrum. Etiology, pathogenesis, diagnosis, and treatment modalities of LCH were also discussed.