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The American Journal of Case Reports Sep 2023BACKGROUND The maxillary third molar is considered one of the most impacted teeth and can present in different types based on the direction and depth of the impaction....
BACKGROUND The maxillary third molar is considered one of the most impacted teeth and can present in different types based on the direction and depth of the impaction. However, the inverted type of maxillary third molar impaction is a rare condition, with few reported cases in the current literature. CASE REPORT We report an extremely rare case of a 48-year-old man with an inverted maxillary third molar situated in the maxillary sinus in direct contact with the posterior wall of the sinus, with a portion of the coronal part perforating the infratemporal fossa. Because of the anatomical and structural complexity of the impaction and because the tooth has never been symptomatic, the case was conservatively managed after weighing the risks and benefits of surgical intervention. A 2-year follow-up was made to ensure no changes in the impaction location, confirming the validity of the conservative approach. CONCLUSIONS This case is the first reported inverted maxillary third molar impacted in such an anatomical location. This reported case contributes to existing knowledge regarding this rare type of impaction and that this rare impaction location can present congenitally with a non-iatrogenic origin. A thorough dental history and clinical and radiographical examinations will aid dental professionals in their clinical decision making for patients with similar presentations.
Topics: Male; Humans; Middle Aged; Maxillary Sinus; Tooth, Impacted; Molar, Third; Rare Diseases
PubMed: 37689968
DOI: 10.12659/AJCR.941859 -
Diagnostics (Basel, Switzerland) Sep 2023Ectopic teeth in the maxillary sinus are a rare finding and pose a diagnostic challenge due to their unusual location and clinical management. A 28-year-old man...
Ectopic teeth in the maxillary sinus are a rare finding and pose a diagnostic challenge due to their unusual location and clinical management. A 28-year-old man presented with complaints of discomfort and pressure in the maxillary sinus region. A CT scan and cinematic rendering revealed the presence of ectopic teeth in the maxillary sinus bilaterally. The use of cinematic rendering provided a more detailed and accurate visualization of the ectopic teeth and surrounding anatomical structures. A CT scan is the primary imaging modality used for the diagnosis and visualization of ectopic teeth in the maxillary sinus. In addition, the use of cinematic rendering can improve diagnostic accuracy and reduce the need for further imaging studies. The use of CT and cinematic rendering can help in the diagnosis and visualization of ectopic teeth in the maxillary sinus, aiding in the planning of surgical interventions.
PubMed: 37835826
DOI: 10.3390/diagnostics13193084 -
Bioengineering (Basel, Switzerland) Aug 2023Recombinant human bone morphogenetic protein-2 (rhBMP-2) has shown potential in maxillofacial surgery owing to its osteoinductive properties. However, concerns about its... (Review)
Review
Recombinant human bone morphogenetic protein-2 (rhBMP-2) has shown potential in maxillofacial surgery owing to its osteoinductive properties. However, concerns about its safety and high cost have limited its widespread use. This review presents the status of rhBMP-2 use in maxillofacial surgery, focusing on its clinical application, efficacy, safety, and limitations. Studies have demonstrated rhBMP-2's potential to reduce donor site morbidity and increase bone height in sinus and ridge augmentation; however, it may not outperform autogenous bone grafts. In medication-related osteonecrosis of the jaw treatment, rhBMP-2 has been applied adjunctively with promising results, although its long-term safety requires further investigation. However, in maxillofacial trauma, its application is limited to the restoration of large defects. Safety concerns include postoperative edema and the theoretical risk of carcinogenesis. Although postoperative edema is manageable, the link between rhBMP-2 and cancer remains unclear. The limitations include the lack of an ideal carrier, the high cost of rhBMP-2, and the absence of an optimal dosing regimen. In conclusion, rhBMP-2 is a promising graft material for maxillofacial surgery. However, it has not yet become the gold standard owing to safety and cost concerns. Further research is required to establish long-term safety, optimize dosing, and develop better carriers.
PubMed: 37760107
DOI: 10.3390/bioengineering10091005 -
Cureus Sep 2023Background This study aimed to describe the morphometric differences of maxillary alveolar bone's height, width, and densitometric differences in the posterior region...
The Impact of Maxillary Sinus Pneumatization on the Quality of the Alveolar Bone in Dentated and Edentulous Patients: A Cone-Beam Computed Tomography Radiographic Analysis.
Background This study aimed to describe the morphometric differences of maxillary alveolar bone's height, width, and densitometric differences in the posterior region where maxillary sinus pneumatization occurred. Methodology A cross-sectional, cone-beam computed tomography (CBCT) study used 123 CBCT images as a non-randomized convenient sample of sinus pneumatized cases. Bone height, bone width (in mm), and average density of the remaining ridge of all patients were used as study variables. Analysis of the qualitative variables were as frequency and percentages. Parametric Student's t-test and non-parametric chi-squared tests were used to compare the groups. The significance level was set at a p-value ≤0.05. Results The sample included CBCT radiographs for patients who had a mean age of 42.79 ± 12.32 with males constituting 69 (56.1%) of the patients. There was no gender difference between the present and missing teeth at the measured sites of the first premolar, second premolar, first molar, and second molar (p > 0.05). The mean measurements of height and average bone density were significantly higher in the dentate sites; however, the mean width was higher in the edentulous sites (p = 0.001). Conclusions Average bone height and density were significantly decreased at the edentulous sites of sinus pneumatized cases than the dentate sites with no gender difference.
PubMed: 37900530
DOI: 10.7759/cureus.46005 -
Journal of Clinical Medicine Jun 2024Bimaxillary surgery is an elemental procedure in the field of cranio-maxillofacial surgery. It allows for the correction of even the most challenging cases of...
Bimaxillary surgery is an elemental procedure in the field of cranio-maxillofacial surgery. It allows for the correction of even the most challenging cases of maxillomandibular disorders, malocclusion, facial asymmetry, and disproportion. The osteotomies and maneuvers carried out during the procedure result in changes to the surrounding tissues, including the maxillary sinuses (MS). The aim of this study was to assess the change in the maxillary sinus volume and the thickness of the mucosa after maxillomandibular advancement (MMA) surgeries. A group of 25 patients who underwent MMA surgery were included in the study. Computed tomography (CT) of the head and neck region was performed 2 weeks preoperatively and 6 months postoperatively. Acquired Digital Imaging and Communications in Medicine (DICOM) files were analyzed using different software programs to calculate the medium MS mucosa thickness and MS volume. A statistically significant reduction in MS volume was observed ( = 0.015). The change in the median thickness of the MS mucosa was not statistically significant. The median sella-nasion-A point angle (SNA angle) value of the group increased from 80.2 to 83.4 degrees. A weak negative correlation between the SNA delta and the MS volume delta was observed. Spearman's rank coefficient: (ρ s = -0.381, = 0.060). The MMA surgery results in a reduction in the MS volume. The amount of forward movement of the maxilla may be correlated with the extent of the MS volume reduction.
PubMed: 38929953
DOI: 10.3390/jcm13123425 -
Journal of Orthodontic Science 2023Three-dimensional evaluation of maxillary sinus volume using VR mesh and correlate it with the volume of maxillary canine, lateral incisor, and dentoalveolar and...
Three-dimensional evaluation of maxillary sinus volume, skeletal and dentoalveolar maxillary anterior region, in unilateral palatally impacted maxillary canine (Cross-sectional study).
OBJECTIVES
Three-dimensional evaluation of maxillary sinus volume using VR mesh and correlate it with the volume of maxillary canine, lateral incisor, and dentoalveolar and skeletal dimensions in both impacted and non-impacted sites.
MATERIALS AND METHODS
In a retrospective cross-sectional study, cone beam computed tomography scans of 100 patients with unilateral palatally impacted maxillary canine were analyzed. Canine, lateral incisor, and maxillary sinus volumes on the impaction and non-impaction sides were measured using DICOM files, with three-dimensional softwares (MIMICS) and VR mesh to accomplish this assessment.
RESULTS
There were no significant differences in canine and lateral incisors volumes between male and female patients in the impacted side at ( > 0.05) while the maxillary sinuses volume revealed a statistical difference ( = 0.022) between male (12642 ± 810) and female (12481 ± 650) patients in the impacted side. A strong positive correlation was found between canine and lateral incisor volume for male patients in the non-impacted ( = 0.420**, = 0.008) and impacted sides ( = 0.334*, = 0.038).
CONCLUSIONS
There were no significant differences in the canine volume, the height of the anterior alveolar ridge (AARHMLI), and anterior dentoalveolar (ADAHMLI) of maxillary lateral incisors in the impacted/non-impacted side, but it showed a statistically significant difference for the lateral incisors volume in the impacted and non-impacted sides for male and female patients. The maxillary sinus volumes revealed a statistical difference between males and females in impacted and non-impacted sides.
PubMed: 38234640
DOI: 10.4103/jos.jos_101_22 -
Annals of Medicine and Surgery (2012) Oct 2023Rhino-orbital-cerebral mucormycosis (ROCM) is a life-threatening condition caused by a saprophytic fungus that predominately affecting immune-compromised patients. Early...
BACKGROUND
Rhino-orbital-cerebral mucormycosis (ROCM) is a life-threatening condition caused by a saprophytic fungus that predominately affecting immune-compromised patients. Early diagnosis of ROCM is of utmost importance to start the treatment as early as possible to prevent early and horrible complications of the disease.
MATERIALS AND METHODS
This retrospective study evaluated the imaging findings of 21 patients with biopsy and KOH mount-based evidence of invasive ROCM. The imaging was obtained from a Siemens Magnetom Amira 1.5T system with a strength of 1.5T or more. The spectrum of findings was evaluated for the sites of involvement, signal intensity, contrast characteristics, necrotic component as well as orbital, infratemporal, and intracranial extensions, especially cavernous sinuses, Meckel's cave, and the brain parenchyma.
RESULTS
The mean age of the patients was 55.8±10.9 years and included 71% male. All the patients were positive for COVID-19 and the majority were diabetic. MRI showed predominant involvement of the maxillary sinus (17, 81%) and the ethmoidal sinus (15, 71.4%). The orbital extension was present in 18 cases (86%). T1-weighted imaging showed iso to low signal intensity in involved sinuses in the majority of the patients (9, 42.9%). Heterogeneously high signal intensity was observed in T2-weighted and short tau inversion recovery images in all the patients. Heterogenous contrast enhancement was present in 20 (95.2%) patients.
CONCLUSION
The imaging spectrum of ROCM is variable. Multiplanar MRI with postcontrast images is a very useful complementary tool to the clinical evaluation to assess the extent of disease and its complications, which has a high mortality. Clinicians and radiologists should be aware of the imaging spectrums of ROCM.
PubMed: 37811078
DOI: 10.1097/MS9.0000000000001169 -
Bioengineering (Basel, Switzerland) Sep 2023Maxillary sinus augmentation with a lateral approach (MSA) is a well-established treatment. In this prospective study, we evaluated risk factors for postoperative bone...
The Effectiveness and Practicality of a Novel Barrier Membrane for the Open Window in Maxillary Sinus Augmentation with a Lateral Approach, with Risk Indicators for Bone Graft Displacement and Bone Height Decrease: A Prospective Study in Humans.
Maxillary sinus augmentation with a lateral approach (MSA) is a well-established treatment. In this prospective study, we evaluated risk factors for postoperative bone graft displacement and reported the clinical application of long-term resorbable L-lactic acid/-caprolactone (PLA/PCL) as a barrier membrane to cover the open window in the lateral wall in MSA. Twenty-four patients underwent MSA according to the relevant criteria; CT data obtained before and 1 week (1 w) and 5-6 months (5 m) post-MSA, bone height changes, bone height reduction rates at 1 w and 5 m post-MSA, bone graft displacement measurements, and risk factors were examined. All patients showed bone height increments ( < 0.005). However, no difference was observed between 1 w and 5 m post-MSA. Bone graft displacement was observed in eight patients; the reduction rate from 1 w to 5 m post-MSA was 8.38% ± 4.88%. Sex, septa, maxillary sinus floor-palatal bone distance, and maxillary sinus floor-maxillary ostium distance were associated with bone graft displacement ( < 0.05). The height from the maxillary sinus floor to the palatal bone and the sinus angle influenced the augmentation degree ( < 0.05). The PLA/PCL membrane is compared favorably with other membranes and may be useful as a barrier membrane for the MSA open window.
PubMed: 37892840
DOI: 10.3390/bioengineering10101110 -
BMC Oral Health Jul 2023Maxillary sinus septa increase perforation risk of Schneiderian membrane during the sinus floor elevation (SFE). Cone Beam Computed Tomography (CBCT) allows for a more...
BACKGROUND
Maxillary sinus septa increase perforation risk of Schneiderian membrane during the sinus floor elevation (SFE). Cone Beam Computed Tomography (CBCT) allows for a more precise assessment of the septal position; thus, preoperative CBCT analysis is substantial to avoid possible complications. This study aims to investigate the 3D characteristics of the maxillary sinus septa based on CBCT images. To our knowledge, no study reported the CBCT-based investigation for the sinus septa among Yemeni population.
MATERIALS AND METHODS
This is a retrospective cross-sectional analysis of 880 sinus CBCT images 440 patients. The septa prevalence, locations, orientations, morphology, and associated factors were analyzed. The effect of age, gender, and dental status on the sinus septa and the relationship between sinus membrane pathology and sinus septa were also analyzed. Anatomage (Invivo version 6) was used for CBCT images analysis. Descriptive and analytical statistics were performed, and a P-value < 0.05 was significantly considered.
RESULTS
The maxillary sinus septa were found among 63.9% of patients and 47% of sinuses. The average septa height was 5.2 mm. 15.7% of patients had septa in the right maxilla, 18% in the left, and 30.2% in both. Gender, age, and dental condition had no influence on the presence of septa, and septa presence did not influence sinus membrane pathology. Many septa originated from the floor (54.5%), located in the middle (43%), with coronal orientation (66%) and complete configuration (58.2%).
CONCLUSION
Based on our findings, the septa prevalence, locations, orientations, and morphology were significant and equivalent to the highest recorded in the literature yet. Thus, when sinus floor elevation is planned, CBCT imaging of the maxillary sinus is recommended for safe dental implantation.
Topics: Humans; Cross-Sectional Studies; Maxillary Sinus; Retrospective Studies; Sinus Floor Augmentation; Cone-Beam Computed Tomography
PubMed: 37422645
DOI: 10.1186/s12903-023-03124-6 -
Journal of Asthma and Allergy 2024This study aimed to determine indices to diagnose and predict eosinophilic chronic rhinosinusitis (ECRS) during the initial clinic visit.
PURPOSE
This study aimed to determine indices to diagnose and predict eosinophilic chronic rhinosinusitis (ECRS) during the initial clinic visit.
PATIENTS AND METHODS
We retrospectively analyzed 116 patients with chronic rhinosinusitis who underwent endoscopic sinus surgery and were classified according to the postoperative pathological diagnosis. General data and various clinical indicators were analyzed, and indicators with statistically significant differences between groups were further incorporated into a multivariate logistic regression to establish a comprehensive prediction model. The receiver operating characteristic (ROC) curve was used to compare the two significant valuable single factors from previous studies, the difference in CT scores between the ethmoid sinus and the sum difference of the maxillary sinus (EM difference) and the absolute value of peripheral blood eosinophil (bEOS), with a comprehensive prediction model.
RESULTS
There were significant differences in history of allergic asthma (p < 0.001), visual analog scale (VAS) score (p=0.005), sino-nasal outcome test-22(SNOT-22) scale score (p=0.004), Lund-Mackay scale score (p=0.017), EM difference (p=0.002), percentage of bEOS (%)(p=0.001), and absolute value of bEOS (×109/L) (p=0.000) between the two groups (p< 0.05). The history of allergic disease, VAS and bEOS were screened out and included in the comprehensive prediction model. The area under the curve (AUC) of the comprehensive prediction model (0.804)> the AUC of the absolute value of the bEOS (0.764)>the AUC of the EM difference (0.655). The AUC of the EM difference and the comprehensive prediction model were statistically different (P=0.025). There was no statistical difference between the absolute value of bEOS and the AUC of the comprehensive prediction model.
CONCLUSION
The comprehensive prediction model covering the three aspects of allergic asthma history, VAS score, and bEOS count had the highest AUC compared to the other predictors and had good predictive power for the diagnosis of ECRS.
PubMed: 38434218
DOI: 10.2147/JAA.S450514