Lead Airgun Projectiles Inside the Maxillary Sinuses—Therapeutic Approaches through the Years: A Systematic Review of Case Reports

Background: Shots from commonly available non-gunpowder weapons are a significant cause of facial injuries, especially in pediatric patients. A consequence of such trauma may be the placement of a projectile within the maxillary sinus, which is a therapeutic need with no guidelines for foreign body removal. The purpose of this paper is to discuss the etiology, epidemiology, diagnosis, treatment and prognosis of such cases. Materials and methods: Any cases describing the presence of airgun pellets within the maxillary sinus were included. Animal patients and non-English cases were excluded. The final search using the PubMed, BASE and Google Scholar engines was made on 13 November 2021. The JBI Critical Appraisal Checklist for Case Reports was used to assess the risk of bias. The collected data are presented in tabular form and were subjected to a comparative assessment. Results: In total, reports of seven cases of lead airgun projectiles in the maxillary sinuses were identified, qualified and analyzed. There were no cases of lead intoxication. The bullets were removed by open surgery in the form of antrostomy of the maxillary sinus or with the use of an endoscope. In none of the described cases were complications observed during surgery or postoperative observation. Discussion: This systematic review was based on case reports that differed significantly in quality. The location of the lead foreign body within the maxillary sinuses may be considered favorable over other craniofacial gunshots. The risk of lead intoxication does exist, but such a location of the bullets does not favor it. The removal of projectiles from the maxillary sinuses appears to be easily achievable and does not predispose one to complications.

The enlargement of the maxillary ostium after balloon sinuplasty evaluated by a novel measuring technique from 3D CBCT images

Our aim was to evaluate the effects of balloon sinuplasty on the size of the ostium in the maxillary sinuses in patients with chronic rhinosinusitis from cone beam computer tomography (CBCT) scans of the sinus. This is a blinded retrospective trial in patients who had undergone balloon sinuplasty of the maxillary sinus. CBCT scans were taken and SNOT-22 Quality of Life questionnaire completed before and 12 months after the operation. The size of the maxillary ostium was measured from the CBCT scans three-dimensionally. The association of changes in the SNOT-22 scores of the ostium was analysed. We discovered that the balloon sinuplasty increased the size of the maxillary ostium in all dimensions. The changes were statistically significant (p<0.05) in the axial diameter and the ostium area. The number of patent ostia increased after the intervention. The association between SNOT-22 score and ostium patency were statistically significant before the operation. Our conclusion is that the threedimensional measuring technique provides a reliable method to evaluate ostium dimensions. Balloon sinuplasty increased the size of the maxillary ostium and the result was maintained for 12 months after the operation.

The role of microorganism association in the development of chronic purulent maxillary sinusitis in patients with type 1 diabetes mellitus

Aim – to study the species composition and population level of the microbiota of the content of the maxillary sinuses and the role of associations of microorganisms in the development and course of chronic purulent maxillary sinusitis (CPMS) in patients with type 1 diabetes.Material and methods. A microbiological examination of 97 samples of the contents of the cavity of the maxillary sinuses was carried out. The main group consisted of 50 patients with CPMS with type 1 diabetes at the age of 20-67 years (10 patients at the age of 20-31 years, 14 patients - 31-45 years old and 26 - at the age of 45-67 years). Among the patients of the main group, endocrinologists established the course of type 1 diabetes mellitus of moderate severity in 39 patients, and a severe course in 11 patients. The control group consisted of 47 CPMS patients of the same age without type 1 diabetes mellitus (DM).Results. Bacteriological and mycological methods in the content of maxillary sinuses of patients with maxillary sinusitis associated with type 1 diabetes mellitus (DM) 175 strains of different kinds of microorganisms were isolated and identified, belonging to 24 various taxonomic groups which form different by their qualitative content microbial associations in the biotope which consist of three different kinds in 58% of patients, consist of four kinds – in 34,0% and five various taxa – in 8,0% of patients. Chronic purulent maxillary sinusitis in patients with type 1 DM disrupts microbial associations. In patients with CPMS with type 1 DM in comparison with the control group, the number of associations consist of three kinds increases by 2,7 times, but the number of associations composed of 4 types of microorganisms decreases by 11.76%. The number of associations consisting of 5 types in patients is reduced by 3.5 times. The above may indicate the influence of not only the etiological agent but also a certain association of microorganisms on the severity of the course of CPMS associated with type 1 diabetes. All leading pathogens persist in the biotope in association. Associates, depending on their role in normobiocenosis, can inhibit the pathogenetic activity of the leading pathogen or, conversely, activate its pathogenetic role, which must be taken into account when choosing a therapeutic tactics.Conclusions. Chronic purulent maxillary sinusitis in patients with type 1 diabetes disrupts microbial associations. In the content of the cavity of the maxillary sinuses of patients with chronic purulent maxillary sinusitis, combined with type 1 diabetes mellitus, 175 strains of various types of microorganisms belonging to 24 different taxonomic groups were isolated and identified, which in the biotope form microbial associations of different qualitative composition, consisting of 3 different species in 58% of patients, out of 4 species in 34.0% and from five different taxa - in 8.0% of patients. Among the most numerous associations, consisting of 3 types of pathogenic and opportunistic autochthonous facultative microorganisms, associations of the following representatives are more common: M. catarrhalis, S. aureus and Bacteroides spp.; Prevotella spp., S. viridans and S. salivarius; M. catarrhalis, Prevotella spp. and S. epidermitidis; H. influenzae, Prevotella spp. and S. epidermitidis. Associations consisting of 4 species were found in 34% of patients and consist of S. pneumoniae, M. catarrhalis, S. pyogenes, Fusobacterium spp; S. pneumoniae, E. coli, S. aureus and Candida spp.; S. pneumoniae, E. coli Hly +, S. viridans and Candida spp. In patients with chronic purulent maxillary sinusitis, combined with type 1 diabetes mellitus with a severe course, there were associations consisting of S. pneumoniae, M. catarrhalis, Candida spp. and S. epidermitidis; S. pneumoniae, M. catarrhalis, S. pyogenes, S. epidermitidis; Bacteroides spp., H. influenzae, S. pyogenes, Enterobacter freundii spp.; Bacteroides spp., H. influenzae, S. pyogenes, Candida spp. In patients with chronic purulent maxillary sinusitis, against the background of a severe course of type 1 diabetes mellitus, associations of microorganisms, consisting of 5 types, were found. Their composition was different, but in all the pathogen S. pneumoniae was isolated and identified at a high population level, opportunistic obligate anaerobic bacteria of the genus Bacteroides and Prevotella, Fusobacterium, streptococci, and Staphylococcus aureus. All leading pathogens persist in the biotope in association, which must be taken into account when choosing therapeutic tactics.

Species composition and population level of the microbiota of the contents of the maxillary sinuses and oropharynx in patients with chronic purulent maxillary sinusitis with type 1 diabetes mellitus

Aim – to study the species composition and population level of the microbiota of the contents of the maxillary sinuses and oropharynx in patients with chronic purulent maxillary sinusitis (CPMS), which arose on the background of type 1 diabetes mellitus (DM).Material and methods. A microbiological examination of 97 samples of the contents of the maxillary sinus cavity was performed. The main group consisted of 50 patients with CPMS with type 1 diabetes aged 20-67 years (10 patients aged 20-31 years, 14 patients aged 31-45 years and 26 aged 45-67 years). Among patients of the main group, endocrinologists found in 39 patients the course of type 1 diabetes of moderate severity, in 11 - severe course. The control group consisted of 47 people of the same age, who during the last 6 months did not suffer from any diseases and considered themselves practically healthy.Results. The leading pathogens in CPMS in patients with type 1 (DM) are S. pneumoniae (34% of patients), H. influenzae (24%), M. catarrhalis (24%), S. aureus (10.0%), S. pyogenes (6.0%), E. coli Hly + (2.0%). It is established that the purulent-inflammatory process in the maxillary sinuses in patients with type 1 diabetes develops against the background of the formed dysbiosis of the oropharynx: 1st degree in 6.0%, 2nd degree - in 28% of patients and 3rd degree - in 66% of patients, which is characterized by a pronounced deficiency of indigenous obligate anaerobic and aerobic bacteria and contamination of the habitat with pathogenic and opportunistic pathogens and other microorganisms.Conclusions. The leading causative agents of chronic purulent maxillary sinusitis in patients with type 1 diabetes mellitus at the present stage are: S.pneumoniae (32.0%), H.influenzae (26.0%), M.catarrhalis (24.0%), S. pyogenes (10.0%), S. aureus (6.0%) and E. coli Hly + (2.0%). Patients with chronic purulent maxillary sinusitis, which developed on the background of type 1 diabetes mellitus, are eliminated from the habitat of bifidobacteria, lactococci and S. mutans, which are important for their multifunctional role in the microbiocenosis; the number of physiologically useful lactobacilli is significantly reduced by 2 orders of magnitude, salivary streptococci by 92.91%, S.viridans by 25.17%, S.sanguis by 86.17%, S.mitis by 45.33%, M.luteus-25.35%. Against this background, the number of opportunistic pathogens increases significantly by 84.59%, fusobacteria by 69.33%, pyogenic streptococcus - by 50.5%, hemophilic bacteria - by 55.71%, moraxella - by 74.01%, yeast-like fungi of the genus Candida - by 25.63%. Bacteria that contaminate the oropharynx and the contents of the cavities of the maxillary sinuses reach a high population level (from 4.33 ± 0.14 to 5.69 ± 0.09 lg KUO \ ml). In chronic purulent sinusitis in patients with type 1 diabetes mellitus in the contents of the oropharyngeal cavity are associations of autochthonous obligate and facultative opportunistic and allochthonous microorganisms, consisting of 3 types of microorganisms in 3 (6%) patients, out of 4 in 41 ( 82%) and out of 5 in 6 (12%) patients. Chronic purulent process in the maxillary sinus in patients with type 1 diabetes mellitus develops against the background of the formed dysbacteriosis / dysbiosis of the oropharynx I degree in 6.0%, II degree - in 28.0% of patients and III degree - in 66.0% of patients with chronic purulent maxillary sinusitis, characterized by elimination or severe deficiency of autochthonous obligate anaerobic and aerobic bacteria (bacteria of the genus Bifidobacterium, Lactobacillus, Streptococcus (S.salivarius, S.sanguis, S.mitis, S.mutans, L.lactis, M.luteus) biotope contamination by pathogenic and conditionally pathogenic S.pneumoniae, S.pyogenes, H.influenzae, M.catarrhalis, E.coli, E.coli Hly+, Enterobacter freundii., Klebsiella oxytoca, S.aureus and others.

Age- and sex-related changes of the volume of maxillary sinuses quantified via cone beam computed tomography

Anatomical studies found in cone beam computed tomography (CBCT) an optimal resource for the three-dimensional (3D) assessment of the head and neck. When it comes to the maxillary sinuses, CBCT enables a life-size reliable volumetric analysis. This study aimed to assess the age and sex-related changes of the maxillary sinuses using volumetric CBCT analysis. The sample consisted of CBCT scans of 112 male (n = 57) and female (n = 55) individuals (224 maxillary sinuses) distributed in 5 age categories: 20 |— 30, 31 |— 40, 41 |— 50, 51 |— 60 and > 60 years. Image acquisition was accomplished with the i-CAT Next Generation device set with voxel size of 0.25 mm and field of view that included the maxillary sinuses (retrospective sample collection from an existing database). Image segmentation was performed in itk-SNAP (www.itksnap.org) software. The volume (mm3) of the segmented sinuses was quantified and compared pairwise based on side (left and right), sex (male and female) and age (five groups). Differences between left and right sides volume were not statistically significant (p > 0.05). The mean volume of maxillary sinuses in males was 22% higher than females (p = 0.0001). Volumetric differences were not statistically significant between age categories for males and females (p > 0.05). The discriminant power of sinuses’ volume may support customized and patient-specific treatment planning based on sex.

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.

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.

Optimization of Local Anesthesia during Radical Maxillary Sinusotomy in Dental Patients

The purpose of the study was to give a clinical evaluation of the effectiveness of endonasal blockade of the nasopalatine nerve in different ways during radical maxillary sinusotomy in dental patients. Materials and methods. Clinical observations were performed in 50 patients diagnosed with chronic odontogenic maxillary sinusitis. Radical maxillary sinusotomy was performed under local potentiated anesthesia. All patients underwent anesthesia on the maxilla according to classical methods. Patients, depending on the methods of endonasal blockade of the nasopalatine nerve, were divided into two clinical groups: the main (24 people) and the comparison group (26 people). Patients of the main group underwent endonasal blockade of the nasopalatine nerve at the site of its branch from the pterygopalatine ganglion. In patients of the comparison group, the blockade of this nerve was performed before its entry into the incisal canal. The effectiveness of anesthesia was evaluated for clinical and autonomic manifestations of pain stress. Results and discussion. During the removal of polyps and pathological granulations from the mucous membrane of the maxillary sinus in patients of the main group there was no pain, no emotional-motor and autonomic manifestations of pain stress, which confirmed the effectiveness of the endonasal method of anesthesia of the nasopalatine nerve. In patients of the comparison group during similar surgical manipulations the full effect of local anesthesia was achieved in 50.0% of cases (χ2 – 8.065, р = 0.005). These were patients who had hypopneumatized or moderately pneumatized types of maxillary sinuses. The rest of the patients during the operation had emotional – motor and autonomic manifestations of pain stress during the removal of pathologically altered mucous membrane located on the medial wall of the maxillary sinus. Conclusion. Complete anesthesia of the mucous membrane, maxillary sinus, regardless of the degree of its pneumatization is achieved during the usage of endonasal blockade of the nasopalatine nerve at the site of its branch from the pterygopalatine ganglion during radical maxillary sinusotomy in dental patients. Anesthesia of the nasopalatine nerve in the lower nasal passage, before its entry into the incisal canal, allows painless surgery only in patients with hypopneumatized maxillary sinuses and in most patients with moderate pneumatization

Bilateral ectopic third molar in the maxillary sinuses associated with dentigerous cyst: a case report

A dentigerous cyst is an epithelial-lined odontogenic cyst formed by an accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth. About 70% of dentigerous cysts occur in the mandible and 30% in the maxilla and the most involved teeth are maxillary canines and maxillary third molar. Dentigerous cysts often displace the related tooth into an ectopic position. In the maxilla when the cyst expands into the sinus, usually causes total or partial occupation of the sinus cavity and can extend to the nose. We report a rare case of a 24-year-old female with bilateral maxillary third molars inside the maxillary sinuses attached to a dentigerous cyst and treated with a minimally invasive endoscopic surgery through the middle meatal meatotomy.