Maxillary sinus cyst as a risk factor for osteomeatal complex block

Introduction: Cysts of the maxillary sinuses are found in about 10% of the population. There is a necessity to clarify indications for cyst removal taking into account its size. The purpose of the study to clarify the indications for surgical treatment of maxillary sinus cysts as a risk factor for sinus drainage disorders in the development of maxillary sinusitis. Methods and materials: 57 people (92 sinuses) were examined. There were 20 patients (40 sinuses) with acute rhinosinusitis, 22 patients (22 sinuses) with post-augmentation sinusitis, and 15 (30 sinuses) almost healthy individuals among them. Prediction of the cyst size, which can lead to blockage of the maxillary sinus ostium, was performed by direct measurement on coronary sections at the ostiomeatal complex level distance from the surface of the mucoperiosteum in the area of the alveolar recessus to the lower surface of the mucosal surface in the area of the ostium. The obtained data were verified by calculation method taking into account the height of the sinus at the level of the osteomeatal complex, the magnitude of possible mucoperiosteum edema in the alveolar recessus and ostium in acute rhinosinusitis and post-augmentation sinusitis, as well as the magnitude of mucoperiosteum elevation due to sinus lift. Results: It was found that the vertical size of the cyst, which can potentially lead to blockage of the maxillary sinus ostium in acute rhinosinusitis is 21.2±0.8 mm, 14.7±1.1 mm in sinusitis after augmentation of the maxilla, and 28.5±0.7 mm in practically healthy individuals. The calculated values are 18.5 mm, 14.0 mm and 24.5 mm, respectively. In case of acute rhinosinusitis, the distance from the apex of the cyst to the surface of the mucous membrane of the ostiomeatal complex area may decrease by 12.8 mm, and in sinusitis after sinus lift it may decrease by 20.4 mm. Conclusions: To assess the potential of the ostiomeatal complex block by a cyst located in the alveolar recessus in acute rhinosinusitis, its vertical size is really important according to coronary sections of at the ostiomeatal complex level corresponding to the location of 5-6 teeth of the upper jaw. The indication for removal of the cyst of the alveolar recessus of the maxillary sinus, as a factor that may worsen the course of acute rhinosinusitis due to the anastomosis block, is its size exceeding 20 mm, and 15 mm for patients who plan to sinus lift.

Silent Sinus Syndrome Secondary to Lymphoma: An Unusual Case With Radiological Evidence of Rapid Progression

Objective: To describe a case of silent sinus syndrome secondary to malignancy and discuss the pertinent clinical findings. Silent Sinus Syndrome (SSS) refers to a rare, asymptomatic condition whereby occlusion of the maxillary sinus ostium results in gradual resorption of air, creation of negative pressure and collapse of the maxillary walls. Methods: Review of medical records and literature review using NCBI/PubMed. Results: We describe a case of a 54-year-old gentleman presenting solely with enophthalmos. He had been diagnosed with stage IVa small lymphocytic lymphoma (SLL) 1.5 years prior to this, which was being managed with active surveillance. CT demonstrated severe bowing of the anterior and posterolateral wall, inferior displacement of the floor of the orbit and right enophthalmos, thus supporting a diagnosis of silent sinus syndrome. Compared to previous staging CT at the time of the lymphoma diagnosis these findings were entirely new, and soft tissue in the pterygomaxillary fissure was found to be enlarged. The patient underwent endoscopic sinus surgery and a right maxillary mega-antrostomy was performed to ventilate the maxillary sinus and prevent progression of eye symptoms. A biopsy was taken from the pterygopalatine fossa, which was confirmed to be chronic lymphocytic leukemia (CLL). Conclusion: This case is unique both in being secondary to malignancy, as well as being rapidly progressive given the presence of radiologically normal appearances 1.5 years prior to presentation. Although a rare condition, prompt recognition of SSS is vital to prevent ophthalmological complications. This report highlights malignancy as a potential cause in cases with focal bony remodeling.

A Case Report of 41-Year-Old Female with Fibrous Dysplasia Combined with Ethmoid Mucocele

Fibrous dysplasia (FD) is a non-malignant progressive condition, which replaces normal bone and marrow with fibrous tissue and woven bone. Sinus mucocele is a cystic, expansile, and destructive lesion that occurs as a result of obstruction of the sinus ostium secondary to inflammation, trauma, anatomical variation, previous sinus surgery, tumor or FD. Among them, FD combined with mucocele has been rarely reported. Here we report the first case of FD combined with ethmoid mucocele. The patient underwent endoscopic debulking of FD and marsupialization of mucocele. The mucocele was successfully marsupialized, and the patient’s symptoms were completely resolved. We propose a new hypothesis that nasal mucosa invaginates into FD and forms a mucocele. For the treatment of ethmoid FD combined with mucocele, we recommend an endoscopic transnasal approach for debulking and marsupialization.

Anatomical Variations Associated With Maxillary Sinus Fungal Ball

Objective: We investigated the anatomical and dental factors associated with unilateral maxillary sinus fungal ball (MSFB). Also, we evaluated the effect of combinations of those factors on the incidence of MSFB. Methods: Three hundred patients were divided into MSFB, normal, and chronic rhinosinusitis (CRS) groups. We reviewed paranasal computed tomography scans for the presence of deviated nasal septum, concha bullosa (CB), Haller cells, and various dental factors. Also, we measured the ethmoid infundibulum, maxillary natural ostium, and CB. Results: Maxillary sinus fungal ball showed a more significant association with CB compared to the other 2 groups (37%, P < .05). The MSFB group had a lower rate of Haller cells than the normal group (10% vs 22%, respectively; P < .05). Also, the MSFB group had a wider maxillary sinus ostium than the normal group (7.07 ± 1.8 vs 5.48 ± 1.3 mm; P < .01). Moreover, the combination of CB and Haller cells was significantly associated with a decreased rate of the fungal ball ( P = .047, odds ratio = 0.694). The dental factors were more prevalent in the MSFB and CRS groups (73% and 75%, respectively) than in the normal group (32%, P < .001). Conclusions: Maxillary sinus fungal ball is significantly associated with CB, Haller cells, an increased maxillary sinus ostium size, and dental factors.

Frontoethmoid mucocele: a case report

<p>Mucoceles are cystic lesions of the paranasal sinuses that develop as a result of mucous secretion accumulation due to sinus ostium obstruction, Mucoceles are most common in the frontal and ethmoidal sinuses, and they affect both men and women equally in may become infected and spread to the orbital cavity, compressing the orbit by eroding the orbital cavity's bony walls. In surgical treatment, endoscopic approach we are used, we present a case of a complicated ethmoid mucocele that eroded the orbital wall and spread into the orbital cavity, and we discuss surgical treatment options in light of the existing literature.</p>

A Numerical Model of the Influence of Maxillary Sinus Ostium Size on the Distribution of Nitric Oxide Concentration in the Nasal Cavity and Sinuses.

ObjectiveUsing a numerical model, we aimed to study the influence of maxillary sinus ostium size variation on nitric oxide (NO) concentration distribution in the nasal cavity and sinuses and to determine the impact of differing sinus ostium size on sinusitis development and recurrence following sinus ostium opening surgery.MethodsWe obtained high-resolution computed tomography images of the nasal sinuses of a volunteer, following which we established a numerical model, determined NO concentration and air volume in the maxillary sinus on one side, then changed the maxillary sinus ostium size on that side, and finally established five models of sinus ostium of different sizes. Two sizes of sinus numerical models were established to determine effect of differing ostium size on the maxillary sinus cavity NO concentration distributions.ResultsA smaller sinus ostia size corresponded to lower NO concentration in nasal cavity and exhaled air; moreover, a concentration gradient was formed from sinus ostium to nasal cavity. A larger sinus ostia size demonstrated a lower NO concentration surrounding sinus ostium in the sinus cavity and formed a concentration gradient from ostium to cavity.ConclusionConstriction of the sinus cavity can lead to changes in NO concentration. Detection of NO concentration in nasally exhaled air can be used as an index to detect the patency of the maxillary sinus ostium. An excessive opening of sinus ostium leads to a decrease in NO concentration around sinus ostium, which is one of the main causes of persistent or recurrent inflammation in the maxillary sinus

Nasofrontal Mucocele Following after Craniotomy Procedure

Introduction : Mucocele is a chronic, expanding, mucosa-lined lesion of the paranasal sinus characterized by mucous retention that can be infected becoming a mucopyocele. They originate from obstruction of the sinus ostium by congenital anomalies, infection, inflammation, allergy, trauma (including surgery) or a benign or malignant tumor. The frontal sinuses are most commonly affected, and subsequently ethmoidal sinuses. Case Report : A 56 years old man, presented with a lump on the left and right forehead accompanied by a protruding left eye since 6 months and is getting wors. Patient with a history of craniectomy debridement surgery indicated for open depressed fracture due to an accident 12 years ago, then underwent a titanium mesh cranioplasty 11 years ago. From examination of the head CT scan revealed a solid mass lesion filling the left and right frontal sinuses expands into the left orbital cavity. Bifrontal craniotomy was performed on the patient. Discussion : Mucoceles are mucous-secreting expansive pseudocystic formations, and capable of expansion by virtue of a dynamic process of bone resorption and new bone formation. They result from obstruction of a sinus ostium and frequently are related to a previous condition as chronic sinusitis, trauma, surgery or expansible lesion. With continued secretion and accumulation mucus, the increasing pressure causes atrophy or erosion of the bone of the sinus, allowing the mucocele to expand in the path of less resistance. This may be into the orbit, adjacent sinuses, nasal cavity, intracranial or through the skin; intracranial and orbital extension were demonstrated in this patient. Conclusion : Frontal mucoceles are benign and curable, but early diagnosis and treatment of them is important. Open surgery remains a valid procedure in frontal mucoceles with orbital and/or intracranial extension and in cases where the district anatomy is unfavourable for a purely endonasal approach.

Paranasal sinus mucoceles, therapeutic solution through external surgical approach

Mucoceles are benign, expansive, cystic tumors, affecting especially the adult, with development in the paranasal sinuses. Clinical symptoms are not specific. These are rare conditions that originate within the sinusal mucosa, favoured by the obstruction of the sinus ostium. Due to the inflammation and the expansive character of the tumor, with the erosion of the bony walls, combined forms can develop, with the involvement of two or more sinuses, most frequently with fronto-ethmoidal localization.The authors carry out a clinical retrospective study on 25 cases of mucoceles of the paranasal sinuses, diagnosed and treated in the ENT Clinic of the “Sfantul Spiridon” Emergency Clinical Hospital Iasi, during 2015-2019. The authors insist on aspects related to clinical and radiological diagnosis (CT scanner), as well as surgical treatment by external approach.The postoperative evolution is generally simple, with full recovery, without complications or recurrences.The diagnosis of the mucoceles of the paranasal sinuses consists in radiologic techniques by preoperative CT scan examination, intraoperative macroscopic aspect and histopathological result.Surgical approach with complete excision of the tumor and creating a new sinusal drainage path prevents the occurrence of recurrences.

Evaluation of the Prevalence of Concha Bullosa in Cone-Beam Computed Tomography Images

Background: The ostiomeatal complex (OMC) is not a separate anatomical structure although it is a functional unit of structures, including the middle meatus, uncinate process, infundibulum, maxillary sinus ostium, ethmoidal bulla, anterior ethmoid sinus ostium, and frontal recess. Concha bullosa is the pneumatization of the concha, which is one of the most common anatomical variations in the middle turbinate. Methods: This study was conducted using the cone-beam computed tomography (CBCT) images of 172 patients in the archives of the Department of Oral and Maxillofacial Radiology, Dentistry School, Ahvaz Jundishapur. Patient information including age and gender, presence or absence of concha bullosa, the involved side (left or right), and its type (i.e., extensive, lamellar, and bulbous) were collected in the information form. Finally, the chi-square test (with SPSS, version 22) was used to analyze the data, and P value less than 0.05 was considered statistically significant. Results: Patients with and without concha bullosa were 39.1 and 41.7 years, respectively, but it was no significant difference in terms of age (P = 0.321). Out of 52 patients with concha bullosa, 19 (36.5%) cases were males and 33 (63.5%) of them were females. The prevalence of concha bullosa was higher for the bilateral side (20 patients, 38.5%, P = 0.000). The prevalence of bulbulsand lamellar-shape was nearly the same (32.7% and 30.8%, respectively). Eventually, the extensive shape with 36.5% was more frequent for the shape of concha bullosa (P = 0.000). Conclusions: The prevalence of concha bullosa was high. There was no significant difference in terms of age (P = 0.321) and gender (P = 0.058) of patients with concha bullosa. The extensive type and the bilateral appearance of concha bullosa were more significant (P = 0.000).