Anterior Skull Base Analysis from Coronal and Reconstructed Computed Tomography: Radio-Anatomical Study

Endoscopic sinus and skull base Surgery has gained significant improvement widely all over the world. A computerized tomography (CT) scan provides a detailed anatomy of the skull base especially the bone framework. This study aims to analyze the fixed anatomical bony landmarks of the anterior skull base through coronal and reconstructed CT in the context of the Nepalese population and guide the surgeon to perform endoscopic sinus and skull base surgery safely. This Prospective study includes 70 Computerized Tomography scans of Paranasal sinuses. The different measurement from nasal floor to skull base was taken in coronal and reformatted sagittal CT scan. Mean, standard deviation, minimum and maximum values were analyzed using descriptive statistics. Student T-test was applied to compare between right and left side. This study includes 75 patients between 18 to 77 years. The measurement from nasal floor to the cribriform plate and ethmoidal roof in right and left side were, mean± SD (47± 4.1, 45.3±4.3, 47.9±5.1, and 49±8.5 mm) respectively. Mean Take off angle at the cribriform plate was 43.9 ±10.9°on right side and 43 ± 9.4° on the left side. The distance from the nasal spine to the skull base (mean ± SD) at nasofrontal recess, bulla ethmoidalis, and the junction of sphenoethmoid levels at right sides were 51.5 ± 4.7, 52.9 ± 4.1, and 61.2 ±4.7 little higher at left side. This study provides a detailed analysis of the anterior skull base in coronal and sagittal CT scans which helps to reduces complications.

Dental implants survival after nasal floor elevation: a systematic review

Purpose The aim of this work is to assess the clinical outcomes of implants placed after a nasal floor elevation procedure. Methods A systematic review was conducted using four electronic databases; Medline (Pubmed), Cochrane library, DOAJ and SCOPUS, following the PRISMA statement recommendations to answer the PICO question: “In patients undergoing dental implant placement in the maxillary anterior region (P), Do implants placed after nasal floor elevation (I) have a different survival (O) from those implants placed without grafting procedures (C)?. The study was pre-registered in PROSPERO (CRD42021229479). Included articles quality was assessed using the “NIH quality assessment tool”, “The Newcastle-Ottawa scale” and “JBI critical appraisal tools for case reports''. Results Twelve articles were finally selected, including 151 patients and 460 implants. The weighted mean follow-up was 32.2 months, and the weighted survival rate after this period was 97.64% (range 89.2-100%). No statistical differences could be inferred between the treatments performed in one-stage or two-stage, following a lateral approach or a transcrestal approach or using different grafting materials. A great heterogeneity was found in terms of study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible. Conclusion Within the limitations of this study, implants placed after a nasal floor elevation present a good survival and a low range of complications. In absence of randomized studies, the level of evidence was low, attending the GRADE system and based on the study quality level, the strength of evidence attending the SORT taxonomy was B.

Labial-Nasal Evaluation for Nasal Floor Reconstruction With the New Triangular Flap in Unilateral Cleft Lip Repair

In this study, we present a modified technique for primary cleft lip repair with a rotation triangular flap from the cleft lateral side to reconstruct the nasal floor; and evaluate the outcome compared with traditional Millard repair. 40 patients with unilateral cleft lip were included in this research. The patients were divided into 2 groups; 17 patients treated with the Millard technique, and 23 patients treated with the newly modified technique. 14 measurement indexes were employed to evaluate the nose-lip morphology of postoperative patients with UCCL in standardized photographs preoperatively, postoperatively and 1-year follow-up. For lip symmetry, statistical significance was detected in the measurements of the vertical philtral height ratio indicating that the newly modified technique resolve the shortage of lip height on the cleft side 1-year follow-up. ( P < .05). In addition, statistical significance was detected in the 1-year postoperative columellar angle, alar width ratio, nostril width ratio, nostril height ratio, and nostril shape (cleft) ( P < .05), showing more successful repair of the nose compared with the traditional repair. The modified unilateral cleft lip repair with rotation triangle flap from the cleft lateral side was beneficial in the correction of lip and nasal deformity in and had positive effects on labial symmetry.

Septodermoplasty: Make It Easier

Septodermoplasty (SDP) is a technique that presents a surgical option for the treatment of recalcitrant epistaxis from hereditary hemorrhagic telangiectasia. It involves the removal of affected nasal epithelium, replacing it with a split thickness skin graft (STSG). However, the inherent challenges with SDP are that owing to the floppy and unstable nature of the STSG, especially if simultaneously grafting the lateral nasal wall in addition to the septum and nasal floor, there is a risk of inadvertently stripping and displacing the STSG from its intended position. In this article we offer some techniques that utilize microdebrider for addressing mucosal lesions and fixate silastic sheet on floppy STSG as a scaffold to make it firm and easy to handle in order to hold the graft right in place.

Nasal Floor Slanting and Its Association With Nasofacial Structures

Background and Objectives Nasal floor slanting (NFS) is an incidental radiographic finding of asymmetry in the nasal floor level. Despite its frequent appearance, however, NFS has never been properly defined, neither has its correlation with the asymmetry of the adjacent nasofacial structures been investigated. We evaluated the incidence of NFS in patients with sinonasal symptoms and its correlation with the nasofacial skeletal structures.Subjects and Method We investigated patients who underwent preoperative ostiomeatal unit (OMU) CT and facial photography. We measured the incidence of NFS and its angle in the 265 patient images, and analyzed the relationships between NFS and radiologically detected asymmetries of the adjacent nasofacial skeleton and facial asymmetry visible on a photograph.Results NFS was found in 51% of the study subjects (136/265), who were defined as the slanted group. The mean NFS angle in the slanted group was 7.7° with a standard deviation (SD) of 4.4°, ranging from 2.4° to 22.4°. The slanted group showed a higher incidence of nasal septal deviation, asymmetry in the orbit and maxillary sinus, and a larger maxillary cavity (p<0.001) than the non-slanted group. Asymmetry of the face showed a higher incidence in the slanted group (p<0.01), whereas an external nasal deviation did not show an association with NFS.Conclusion NFS is evident in about 50% of patients complaining of nasal symptoms and is associated with nasofacial skeletal asymmetry as well as asymmetry in the face.

AN IMPACTED, INVERTED AND ROTATED MAXILLARY CENTRAL INCISORS AND ITS SURGICAL MANAGEMENT: A CASE REPORT.

A female patient aged 13 years was referred to the Department of Oral and Maxillofacial Surgery, CSMSS Dental College, Aurangabad, Maharashtra, India with a complaint of a missing tooth in the upper anterior region of the jaw. The patient was apparently healthy with no relevant family, medical and dental history. This case is peculiar due to the fact that the impacted maxillary central incisors are not frequently reported in our routine dental practice. Here, a case of impacted maxillary left permanent central incisors, with only a few reported cases in the literature, is presented. On radio diagnosis, it was observed that the tooth was sprawling in an inverted position in the anterior region of the maxilla with mild dilaceration. Moreover, the tooth was located beneath the remnants of the root stumps of the deciduous maxillary central incisors and lateral incisors. The treatment for this case was planned with mutual efforts of the orthodontists, the oral surgeon, and the patient with his parents. The most appropriate treatment of choice for this case was the Surgical extraction of the impacted maxillary central incisor along with the root stumps of deciduous teeth that were performed under local anaesthesia without any hindrance to the nasal floor

Have conventional dental radiographs lost its charm to modern techniques?

For any dental implant procedure that is being carried out, the success will depend on a thorough pre-operative investigation. The quality, quantity and the volume of available bone at the planned implant site has to be assessed properly when planning a dental implant placement. When we speak of the fore-mentioned aspects pre-surgical imaging and its co-relation to clinical findings help assess the relation to the amount of bone available from underlying vital parts namely the sinus cavities, nasal floor, nerves, teeth and vessels. Different radiographic modalities have been advocated for its assessment. Intra Oral Peri-apical radiograph (two-dimensional) is one such modality that has lost its importance after the introduction of more advanced techniques like Cone Beam Tomography (three-dimensional). This article will help us understand how two-dimensional and three-dimensional imaging modalities go hand in hand while treating dental patients. It will also explain why the conventional imaging technologies are still required in this era of modern methods of imaging.

A large radiolucent lesion in anterior maxilla: A case report

Cystic lesions of the jaw are a common occurrence. We present a case of a large unilocular cystic lesion in maxilla associated with an impacted tooth, impinging on the nasal floor. The uniqueness of the case is the high probability of a dual pathology; a cystic pathology associated with the impacted tooth (likely dentigerous cyst) and a large radicular cyst involving the apices of teeth from 21 to 26. The patient presented with a rare finding of a palatal swelling rather than a buccal swelling associated with cystic lesions involving maxillary posterior teeth. Enucleation of the cyst and extraction of the impacted tooth were performed, no other teeth were extracted. The report describes the treatment and follow up of the patient.

A large radiolucent lesion in anterior maxilla: A case report

Cystic lesions of the jaw are a common occurrence. We present a case of a large unilocular cystic lesion in maxilla associated with an impacted tooth, impinging on the nasal floor. The uniqueness of the case is the high probability of a dual pathology; a cystic pathology associated with the impacted tooth (likely dentigerous cyst) and a large radicular cyst involving the apices of teeth from 21 to 26. The patient presented with a rare finding of a palatal swelling rather than a buccal swelling associated with cystic lesions involving maxillary posterior teeth. Enucleation of the cyst and extraction of the impacted tooth were performed, no other teeth were extracted. The report describes the treatment and follow up of the patient.