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Oral Surgery, Oral Medicine, Oral... Apr 2024Maxillary sinusitis can be a sequela of medication-related osteonecrosis of the jaw (MRONJ). This study aims to characterize the microbiome of maxillary MRONJ with...
OBJECTIVE
Maxillary sinusitis can be a sequela of medication-related osteonecrosis of the jaw (MRONJ). This study aims to characterize the microbiome of maxillary MRONJ with concurrent maxillary sinusitis and radiographic maxillary sinus opacification to determine if there is a relationship between the microbiome of MRONJ and sinus disease.
STUDY DESIGN
This retrospective case series was conducted using electronic health records from the University of Pennsylvania and affiliated hospitals. The target population was surgically managed maxillary MRONJ patients. The primary predictor variables were tissue culture results. The primary outcomes were maxillary sinusitis or maxillary sinus opacification. Statistical analysis was performed using chi-squared tests at the 95% confidence interval.
RESULTS
Thirty-nine subjects were selected: 25 had sinus opacification and 11 had sinusitis. Resident bacteria were present in 90% of subjects, nonresident bacteria in 74%, and opportunistic organisms in 15%. There were significantly more subjects with chronic sinusitis microbes (79%) than without. There were significantly more gram-positive anaerobes, specifically Propionibacterium, as well as the gram-negative facultative anaerobe, Capnocytophaga, in subjects with concurrent sinusitis.
CONCLUSIONS
Maxillary MRONJ with concurrent maxillary sinusitis may be associated with gram-positive anaerobic species, Propionibacterium, and Capnocytophaga colonization. Maxillary MRONJ patients may benefit from sinus evaluation and concurrent surgical intervention.
Topics: Humans; Maxillary Sinusitis; Maxillary Sinus; Retrospective Studies; Sinusitis; Paranasal Sinus Diseases
PubMed: 38443234
DOI: 10.1016/j.oooo.2023.12.003 -
Indian Journal of Otolaryngology and... Feb 2024Chronic rhino sinusitis (CRS) is a common disease. Maxillary sinusitis not cured by the medicines was addressed by the open surgical procedure namely Caldwell Luc...
Chronic rhino sinusitis (CRS) is a common disease. Maxillary sinusitis not cured by the medicines was addressed by the open surgical procedure namely Caldwell Luc operation. Thereafter introduction of nasal endoscopes in 1970's led to the minimally invasive surgery FESS which preserved the physiology of the nose and sinuses. In the year 2002 balloon sinuplasty was introduced in the western world and subsequently in India. Due to various logistics it was not performed and reintroduced in the year 2015 in India. It can be termed as micro minimally invasive surgery wherein anatomy as well as physiology of the nose and sinuses were preserved in cases of medically non responsive mild to moderate sinusitis. 20 cases were selected for exclusive balloon sinuplasty of maxillary sinus. Balloon sinuplasty is a relatively new procedure which can be termed as micro minimally invasive surgery addressing the CRS without the traditional forms for surgery like incision, cutting or microdebriding. The principle is causing microfractures by inflating the sinus opening and thus facilitating the drainage of the sinus contents. No immediate or late post operative complications were noted. Sinus patency 6 months later was present in 90% of the cases. Balloon sinuplasty is an excellent procedure for medically nonresponsive CRS without polyposis. The success rate is spectacular matching the FESS with almost no immediate post operative and late complication. The recurrence rate of sinusitis is low. We conclude that balloon sinuplasty is a micro invasive procedure which saves operating time, time of hospital stay of the patient and delivers excellent result with almost no complications. We hope it could be incorporated as a routine surgery for mild to moderate sinusitis not responding to medicines.
PubMed: 38440653
DOI: 10.1007/s12070-023-04111-7 -
Indian Journal of Otolaryngology and... Feb 2024Acute invasive fungal sinusitis (AIFS) is a rapidly progressive infection predominantly seen in immunocompromised patients. There is an increasing incidence of AIFS post...
Acute invasive fungal sinusitis (AIFS) is a rapidly progressive infection predominantly seen in immunocompromised patients. There is an increasing incidence of AIFS post COVID-19 infection. Yet, there is sparse literature regarding spectrum of cross-sectional imaging findings (CT and MRI) in these patients, which is prudent for appropriate timely surgical intervention. This study aims to highlight spectrum of imaging findings in patients with post-COVID-19 AIFS integrating the clinical details from presentation to follow-up. We retrospectively reviewed the demographics, clinical details and radiological imaging of 31 histopathological proven cases of post COVID-19 AIFS. MR and CT images of these patients were retrieved from the PACS and analysed. 90-day follow-up of these patients was obtained. Statistical analysis was performed using descriptive statistics. Cross-sectional imaging showed nasal cavity involvement in all patients, bilateral in (15, 48%) cases; predominant involvement of maxillary (31, 100%) followed by ethmoid sinuses (29, 93.5%) was seen. MR showed patchy/complete loss of normal mucosal enhancement in the turbinates and sinuses as predominant imaging finding. Maxillary sinus walls erosions were seen in 28 cases (90%). Rhino-orbital and rhino-orbito-cerebral mycosis was seen in 24 (77%) and 14 (45%) respectively. Optic nerve-sheath complex was involved in 15 (48%) cases. Cerebral involvement was seen in form of meningeal enhancement, cerebritis, ischemic changes, cavernous sinus and intracranial arterial thrombosis and aneurysms. Comprehensive knowledge of imaging features of AIFS and recognition of extent of their spread allows radiologists to play pivotal role in alerting the clinician for appropriate therapy to avoid protracted and fatal outcome.
PubMed: 38440560
DOI: 10.1007/s12070-023-04171-9 -
Indian Journal of Otolaryngology and... Feb 2024To determine the prevalence of tonsilloliths in CT PNS (Computed Tomography ParaNasal Sinuses) of patients with and without features of chronic rhinosinusitis. 97 CT PNS...
To determine the prevalence of tonsilloliths in CT PNS (Computed Tomography ParaNasal Sinuses) of patients with and without features of chronic rhinosinusitis. 97 CT PNS of the patients with features of chronic rhinosinusitis were included in the study group, and 124 CT PNS of cases without features of chronic rhinosinusitis were taken as the control group. All 221 CT PNS were then evaluated for the presence of tonsillar calcifications indicative of tonsilloliths and the prevalence of the same in the study and control groups. 97 of the 221 CT PNS evaluated showed features of chronic rhinosinusitis. 60 of these 97 CT PNS showed features of tonsillolith in one or both tonsils. Of these 60 cases, 58 had maxillary sinusitis, and 17 had pansinusitis. Most of the cases had small tonsilloliths (1-3 mm), and only one case had a large tonsillolith (> 6 mm). At the same time, 27 out of the remaining 124 CT PNS without chronic rhinosinusitis showed the presence of tonsilloliths in one or both tonsils. The prevalence of tonsilloliths is significantly higher in patients with chronic rhinosinusitis than in the control group. The presence of tonsilloliths in patients with chronic rhinosinusitis indicates repeated inflammation of the tonsils due to sinusitis. Such chronic inflammation of the mucosa of the pharynx should prompt more aggressive treatment of chronic rhinosinusitis.
PubMed: 38440553
DOI: 10.1007/s12070-023-04087-4 -
Indian Journal of Otolaryngology and... Feb 2024Anatomical variations in the maxillary sinus pneumatisation are limited unlike the ethmoids. We present rare variations of the maxillary sinus along its floor other than...
Anatomical variations in the maxillary sinus pneumatisation are limited unlike the ethmoids. We present rare variations of the maxillary sinus along its floor other than septations and includes wide pneumatisation of alveolar and palatal recess with cell formation. An intra-maxillary cell that opens into the maxillary infundibulum well within the sinus is described here and our senior author has coined the new term-alveolar recess cell. Its involvement in the sinus pathologies and additional surgical approaches for the disease clearance is discussed here.
PubMed: 38440486
DOI: 10.1007/s12070-023-04189-z -
Indian Journal of Otolaryngology and... Feb 2024Chronic rhinosinusitis (CRS) is a syndrome with multifactorial aetiology. Amongst which, anatomical variations studied by computed tomography of paranasal sinuses (CT...
BACKGROUND
Chronic rhinosinusitis (CRS) is a syndrome with multifactorial aetiology. Amongst which, anatomical variations studied by computed tomography of paranasal sinuses (CT PNS) had a high incidence which varied between 64.0% and 99.8%. Due to such high incidence, this study is undertaken to assess the various anatomical variations and their significant association in CRS.
METHOD
A prospective observational study was conducted in 70 CRS patients and were subjected to CT PNS. CT PNS is studied to know the various anatomical variations & other CT findings causing CRS and then findings noted down, tabulated and statistical analysis done.
RESULTS
All 70 CRS patients evaluated by CT PNS had one or more anatomical variations along with other findings like fungal sinusitis in 6 patients, dentigerous cyst and inverted papilloma in 1 case each. The anatomical variations observed in our study were septal deviation(62.8%), concha bullosa(52.8%), agger nasi(51.4%), pneumatized crista galli(47.1%), hyperpneumatized bulla(40%), suprabullar cells(37%), septal spur(34.3%), paradoxically curved middle turbinate(34.2%), supra orbital cells(32.8%), haller cells(31.4%), septal pneumatization(17.1%), pneumatized uncinate(13%), interfrontal septal pneumatization(13%), maxillary septations(10%), maxillary sinus hypoplasia(7.1%), frontal hypoplasia(5.7%), uncinate attached to lamina papyracea(40%), uncinate to middle turbinate(11%), uncinate to skull base(7.9%), free uncinate(41%), frontal cells type 1;2;3;4 (36%);(30%);(20%);(38.5%), onodi cells(27.1%), pneumatized anterior clinoid process(18.5%), lateral recess(15.7%), sphenoid septations attached to optic nerve(10%) and carotid(2.8%), pneumatized superior turbinate(1.4%), Sellar; Pre sellar; Post sellar sphenoid(42.8%);(5.7%);(51.4%). In our study only anatomical variations around the maxillary & Frontal sinus showed significant association with CRS.
CONCLUSION
Anatomical variations around the anterior group of sinuses have a significant association with CRS.
PubMed: 38440475
DOI: 10.1007/s12070-023-04320-0 -
Acta Otorhinolaryngologica Italica :... Apr 2024To investigate the clinical efficacy of dental treatment and endoscopic sinus surgery (ESS), each primary/combined treatment modality, in patients with odontogenic...
OBJECTIVES
To investigate the clinical efficacy of dental treatment and endoscopic sinus surgery (ESS), each primary/combined treatment modality, in patients with odontogenic sinusitis (ODS), according to its phase, acute or chronic.
MATERIALS AND METHODS
We retrospectively reviewed clinical data on 172 patients diagnosed with ODS. They were divided into two groups: acute (≤ 3 months; 90 patients) and chronic (> 3 months; 82 patients) ODS. The success rate and time to resolution of each primary/combined treatment modality were compared between the two groups.
RESULTS
In both ODS groups, the success rate was highest with combined ESS and dental therapy, followed by ESS alone and dental therapy alone. ESS outperformed dental therapy (96.6% 65.5% for acute ODS, p = 0.011; 80.6% 56.5% for chronic ODS, p = 0.046) and led to quicker resolution of symptoms for acute ODS than dental therapy (0.9 1.7 months, p = 0.012). In the comparison between ESS alone and combined therapy, no significant difference was observed for acute ODS, whereas combined therapy demonstrated a superior success rate for chronic ODS (100% 80.6%, p = 0.046).
CONCLUSIONS
In our study, the clinical utility of dental treatment and/or ESS depended on the morbidity period of ODS. For chronic ODS, combined ESS and dental treatment seems to be an effective first-line treatment.
PubMed: 38420842
DOI: 10.14639/0392-100X-N2648 -
The International Journal of Oral &... Feb 2024To evaluate the impact of different approaches to sinus membrane perforation (SMP) repair on bone formation, postoperative complications, and implant loss risk. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the impact of different approaches to sinus membrane perforation (SMP) repair on bone formation, postoperative complications, and implant loss risk.
MATERIALS AND METHODS
Electronic searches on PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases were conducted for publications up to February 2021. All included articles reported SMPs submitted for repair. The proportion of implant loss in repaired SMP sites was calculated using a random-effects model meta-analysis.
RESULTS
A total of 130 studies reporting SMP repair protocols were included in the systematic review, with 20 selected for meta-analysis. A total of 1,972 sinuses that were perforated and repaired during sinus elevation using different approaches were included in the qualitative analysis. The resorbable collagen membrane was the most commonly reported treatment. The presence of sinusitis was the most frequently described complication. Regarding bone parameters, the majority of studies described no differences between perforated and repaired sinuses and intact membranes. No difference in the implant loss proportion was observed between sites with repaired SMP compared to undetected SMP. The proportion of implant loss in repaired sinuses membrane sites (independent of the material or implant placement time) was 4% (95% CI: 2.0 to 8.0). In meta-regression analysis, no association was observed between the SMP size and implant loss proportion (P = .86).
CONCLUSIONS
The materials and techniques indicated for SMP management seem to securely seal the maxillary sinus, without a negative effect on the ultimate survival of the implants placed in the affected sinuses.
Topics: Humans; Maxillary Sinus; Membranes; Postoperative Complications; Osteogenesis
PubMed: 38416004
DOI: 10.11607/jomi.10180 -
Medicina (Kaunas, Lithuania) Jan 2024: Chronic sinusitis is a commonly encountered diagnosis for otorhinolaryngologists. The profound negative effect of rhinosinusitis on patients' quality of life is...
: Chronic sinusitis is a commonly encountered diagnosis for otorhinolaryngologists. The profound negative effect of rhinosinusitis on patients' quality of life is frequently overlooked, and surgical lines of treatment are numerous. The aim of the study was to assess the comparative efficacy of endoscopic middle meatal antrostomy with the endoscopic prelacrimal recess approach, combined with middle meatal antrostomy in the treatment of unilateral chronic maxillary sinus lesion. : Thirty patients with unilateral chronic maxillary sinus lesions enrolled in the study at Alahsa hospital. Patients were divided into two groups: 15 treated through a middle meatal antrostomy and 15 treated via a combined middle meatal antrostomy and prelacrimal recess approach. Demographic and clinical information of the patients, including the medical history, CT scan findings, diagnosis, recurrence, and complications, were gathered and analyzed. Pre- and postoperative clinical findings were graded utilizing the Lund-Kennedy Endoscopic Scoring System. : The enrolled patients varied in age from 18 to 56, with 60% being male and 40% being female. Antrochoanal polyp, maxillary sinus mucocele, and unilateral allergic fungal sinusitis were among the pathological diagnoses. The follow-up period averaged 14.3 months. Following surgery, two patients in Group II encountered nasal discomfort, which included synechia and epiphora. The success rate for preserving a patient's disease-free condition was 86.7%. A statistically significant difference in disease-free incidence was observed among the patients in group II. In group I, recurrence was identified in 26.7% of the patients. The postoperative symptoms diminished considerably, and the VAS score was reduced substantially. In Group II patients, however, there was no significant difference in scarring. Clinically significant differences were observed in the mean total Lund-Kennedy Endoscopic scores when compared to their preoperative values. : Achieving endoscopic access to the sinus's anterior, lateral, inferior, and inferomedial regions is facilitated by operating via the prelacrimal recess, which is the most advantageous approach. This approach facilitates rapid mucosal healing by maintaining the integrity of the nasolacrimal duct and mucosal covering. The specific pathology, surgical objectives, surgeon expertise, and equipment accessibility influence the choice of endoscopic surgical technique.
Topics: Humans; Male; Female; Maxillary Sinus; Quality of Life; Nasal Polyps; Sinusitis; Endoscopy; Retrospective Studies
PubMed: 38399510
DOI: 10.3390/medicina60020222 -
Malawi Medical Journal : the Journal of... Dec 2023Odontogenic keratocyst is a benign intraosseous lesion of odontogenic origin which is characterized by its aggressive nature. It is usually present in the mandibular...
Odontogenic keratocyst is a benign intraosseous lesion of odontogenic origin which is characterized by its aggressive nature. It is usually present in the mandibular posterior area, although it can also be found in the maxilla, particularly in the canine region. We discuss a unique example of OKC in the maxillary sinus involving the 27&28 region. Due to comparable clinical signs, this lesion is more prone to be mistaken for other lesions of the maxillary sinus, such as sinusitis or polyps. On the other side, this benign disease has the potential to develop into Ameloblastoma or squamous cell carcinoma. A favorable prognosis thus depends on early identification, precise diagnosis, appropriate treatment, and follow-ups.
Topics: Humans; Animals; Dogs; Maxillary Sinus; Odontogenic Cysts; Carcinoma, Squamous Cell
PubMed: 38362567
DOI: 10.4314/mmj.v35i4.6