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Ear, Nose, & Throat Journal May 2024Maxillary sinus pathology is commonly approached through endoscopic middle meatal antrostomy (MMA). However, MMA does not provide full exposure to certain aspects of...
Maxillary sinus pathology is commonly approached through endoscopic middle meatal antrostomy (MMA). However, MMA does not provide full exposure to certain aspects of the maxillary sinus, such as alveolar, zygomatic, and prelacrimal recesses. In these hidden maxillary sinus niches, a combination approach with MMA is required for better exposure and access. In this article, we present a modification of inferior maxillary antrostomy (IMA) to allow for a temporary intraoperative window with no significant postoperative consequences. (1) To describe our modification of IMA. (2) To report the outcome of maxillary sinus disease, postoperative complications, and flap condition. This is a retrospective chart review study. It was performed on 20 patients where submucosal temporary inferior maxillary antrostomy (STIMA) was indicated in the period from January 1, 2020, and July 1, 2023. All patients were assessed for their demographics, diagnosis, indication for STIMA, maxillary disease outcome, presence of postoperative complications, and flap condition. Total of 18 patients fulfilled our inclusion/exclusion criteria; of them, 13 were males while the remaining were females. Mean age of patients was 33 years; most common diagnosis was chronic sinusitis. Status of maxillary sinus mucosa was healthy in all except 4 patients having polypoidal mucosa while flap condition was intact in all patients except 2 patients with pinpoint defects. Postoperative complications assessment demonstrated no neural, orbital, lacrimal, or dental complications in all patients. This retrospective chart review showed promising technique to address challenging maxillary lesions in difficult-to-access locations where combined approaches are necessary.
PubMed: 38770939
DOI: 10.1177/01455613241255727 -
Folia Morphologica May 2024Any intervention to the maxillary posterior teeth (MPT) and alveola pose a risk of sinus perforation. Given the proximity of these structures, this study aimed to...
BACKGROUND
Any intervention to the maxillary posterior teeth (MPT) and alveola pose a risk of sinus perforation. Given the proximity of these structures, this study aimed to investigate the relationship between the maxillary sinus (MS) and MPT.
MATERIALS AND METHODS
CBCT images obtained from 207 patients (mean age, 45 ± 17 years; age range: 18-92 years) including 99 females and 108 males were examined retrospectively. Patients with sinus pathologies affecting the structure of MS and a history of oral and maxillofacial surgery were excluded from the study. On these images, the relationship of maxillary sinus floor (MSF) with 2 premolars and 3 molars was examined bilaterally for each patient using Kwak H. H. et al.'s classification. The presence, number, frequency and location of septa within the MSF were investigated.
RESULTS
Examination of a total of 410 maxillary sinuses on the images of 207 patients with no sinus perforation or pathology revealed that septa were most commonly (48.7%) located in the middle segment (second molars). When the relationship between the MSF and MPT was evaluated, molar teeth were found to have a closer relationship with the MSF than premolars.
CONCLUSIONS
It is believed that the findings of this study may provide further guidance to the dental practitioners and other clinicians for future studies.
PubMed: 38757496
DOI: 10.5603/fm.99268 -
Archives of Medical Science : AMS 2024Our goal was to systematically review the current evidence comparing the relative effectiveness of two maxillary sinus floor elevation (MSFE) approaches (internal and... (Review)
Review
Clinical evaluation of maxillary sinus floor elevation with or without bone grafts: a systematic review and meta-analysis of randomised controlled trials with trial sequential analysis.
INTRODUCTION
Our goal was to systematically review the current evidence comparing the relative effectiveness of two maxillary sinus floor elevation (MSFE) approaches (internal and external) without bone grafts with that of conventional/grafted MSFE in patients undergoing implantation in the posterior maxilla.
MATERIAL AND METHODS
Medical databases (PubMed/Medline, Embase, Web of Science, and Cochrane Library) were searched for randomised controlled trials published between January 1980 and May 2023. A manual search of implant-related journals was also performed. Studies published in English that reported the clinical outcomes of MSFE with or without bone material were included. The risk of bias was assessed using the Cochrane Handbook Risk Assessment Tool. Meta-analyses and trial sequence analyses were performed on the included trials. Meta-regression analysis was performed using pre-selected covariates to account for substantial heterogeneity. The certainty of evidence for clinical outcomes was assessed using GRADEpro GDT online (Guideline Development Tool).
RESULTS
Seventeen studies, including 547 sinuses and 696 implants, were pooled for the meta-analysis. The meta-analysis showed no statistically significant difference between MSFE without bone grafts and conventional MSFE in terms of the implant survival rate in the short term ( = 11, = 0%, risk difference (RD): 0.03, 95% confidence intervals (CI): -0.01-0.07, = 0.17, required information size (RIS) = 307). Although conventional MSFE had a higher endo-sinus bone gain ( = 13, = 89%, weighted mean difference (WMD): -1.24, 95% CI: -1.91- -0.57, = 0.0003, RIS = 461), this was not a determining factor in implant survival. No difference in perforation ( = 13, = 0%, RD = 0.03, 95% CI: -0.02-0.09, = 0.99, RIS = 223) and marginal bone loss ( = 4, = 0%, WMD = 0.05, 95% CI: -0.14-0.23, = 0.62, no RIS) was detected between the two groups using meta-analysis. The pooled results of the implant stability quotient between the two groups were not robust on sensitivity analysis. Because of the limited studies reporting on the visual analogue scale, surgical time, treatment costs, and bone density, qualitative analysis was conducted for these outcomes.
CONCLUSIONS
This systematic review revealed that both non-graft and grafted MSFE had high implant survival rates. Owing to the moderate strength of the evidence and short-term follow-up, the results should be interpreted with caution.
PubMed: 38757030
DOI: 10.5114/aoms/174648 -
Rare Tumors 2024Sino-nasal respiratory epithelial adenomatoid hamartomas (REAHs) are rare entity. They are benign tumors with excellent results after complete excision. We report a case...
Sino-nasal respiratory epithelial adenomatoid hamartomas (REAHs) are rare entity. They are benign tumors with excellent results after complete excision. We report a case of a 57-year-old male with a history of endoscopic surgery for right nasal polyps 20 years ago. The patient presented nasal obstruction that persisted for 10 years without anosmia nor epistaxis. Nasal endoscopy found a tissular mass filling the right nasal cavity extending to the nasopharynx. CT scan and MRI demonstrated soft tissue opacification of the right maxillary sinus and the homolateral anterior ethmoid cells with extension to the nasal cavity. The suspected diagnosis on imaging was an Inverted papilloma with a wide implantation base on the posterior part of the nasal septum. No endocranial or orbital extension was noted. The patient underwent endoscopic sinus surgery with complete extirpation of the tumor and a right ethmoidectomy. Histopathological assessment showed features consistent with REAH. No recurrence was noted at 1 year follow-up.
PubMed: 38756436
DOI: 10.1177/20363613241255567 -
Clinical Oral Implants Research May 2024The objective of this study is to investigate the association of peri-implantitis (PI) and sinus membrane thickening and to assess the resolution of membrane thickening...
OBJECTIVE
The objective of this study is to investigate the association of peri-implantitis (PI) and sinus membrane thickening and to assess the resolution of membrane thickening following intervention (implant removal or peri-implantitis treatment) aimed at arresting PI.
MATERIALS AND METHODS
Forty-five patients with 61 implants in the posterior maxillary region were retrospectively included in the study. Twenty-four patients were diagnosed with peri-implantitis (PI) and 21 had peri-implant health (PH). Cone-beam computed tomography (CBCT) scans were evaluated to assess maxillary sinus characteristics, including membrane thickening, sinus occupancy and ostium patency. The CBCT scans taken 6 months after intervention aimed at arresting disease (implant removal or treatment of PI) in the PI group were also appraised and compared to baseline scans.
RESULTS
At baseline, all parameters evaluating membrane thickness disorders yielded significant differences between groups (p < .001). Patients with posterior maxillary implants diagnosed with PI were 7× more likely to present membrane thickening compatible with pathology when compared to patients with healthy implants (OR = 7.14; p = .005). Furthermore, the likelihood was 6x greater in implants diagnosed with PI to exhibit moderate membrane thickening (OR = 6.75, p = .001). The patients receiving interventions aimed at arresting PI experienced significant enhancement in all radiographic parameters related to the sinus cavity at the 6-month follow-up (p < .001), though these variations were similarly independent of whether treatment consisted of PI treatment or implant removal.
CONCLUSIONS
Maxillary sinus membrane thickening and the permeability/obstruction of the ostium are frequently associated with the presence of PI in posterior implants. Interventions targeting disease resolution effectively reduce membrane thickness to levels compatible with maxillary sinus health.
PubMed: 38747485
DOI: 10.1111/clr.14282 -
Medicine and Pharmacy Reports Apr 2024Maxillary lateral sinus floor elevation, or external sinus lift, is a widespread surgical intervention in the dental field. Insertion of implants in the posterior region...
Autologous leucocyte and platelet rich in fibrin (L-PRF) - is it a competitive solution for bone augmentation in maxillary sinus lift? A 6-month radiological comparison between xenografts and L-PRF.
UNLABELLED
Maxillary lateral sinus floor elevation, or external sinus lift, is a widespread surgical intervention in the dental field. Insertion of implants in the posterior region of the maxilla often requires reconstruction of the remaining native bone that has insufficient volume.
BACKGROUND AND AIMS
Much of the research published involves using artificial products, like xenografts and resorbable collagen membranes, after a prior Cone Beam Computer Tomography (CBCT) investigation. Nowadays, more accessible access, less financial costs, a biological approach, and faster healing are objectives that surround this procedure. Leucocytes and platelets rich in Fibrin (L-PRF) are a natural component with a high concentration of growth factors. Due to its regenerative properties and lack of complications, it is used in several medical fields, like orthopedics, dermatology, and oral surgery. This retrospective study aims to compare results in bone height and volume obtained through external sinus lift, either by using xenografts or autologous plasma rich in fibrin, by evaluating the quantity of new bone formation from a radiological point of view.
METHODS
Fifty-eight Caucasian patients were included in this retrospective study; 48 were submitted to xenograft procedure, and 10 were selected for L-PRF grafting material with simultaneous implant placement. Lack of clinical and histological studies performed on patients with L-PRF surgeries limited us in choosing a larger group for the radiological analysis. CBCT evaluation was performed before surgery and 6 months after. All patients selected for the study presented good general and oral health, acute oral and sinus infections excluded; smoking and periodontal disease were also criteria of exclusion. Two operators performed the measurements in pre-established landmarks in different time frames. The two independent groups were compared with the Wilcoxon rank-sum test for quantitative data. Qualitative characteristics were described as counts and percentages. All analyses were performed in an R environment for statistical computing and graphics.
RESULTS
Mean bone height gain in the xenograft group in the regions was as follows: 7.44 for the anterior landmark, 12.14 for the median and 8.28 for the distal. The mean group height gained for the L-PRF group was 0.1 anteriorly, -0.18 for the median measurement, and 0.23 distally. We obtained excellent overall reliability for all the height measurements between the two operators.
CONCLUSIONS
Further studies must be conducted to establish new sets of surgical protocols in case L-PRF alone is found to be a reliable, stable, biological alternative to the well-documented xenografts in external sinus lifts. Radiological results, although promising, must be further applied in long term clinical survival of the implants in the grafted sites. Also, studies combining L-PRF in conjunction with xenograft might bring improved clinical results in terms of reduced postoperative complications and accelerated healing.
PubMed: 38746034
DOI: 10.15386/mpr-2719 -
Iranian Journal of Otorhinolaryngology May 2024Upper respiratory tract infections and sinusitis are more prevalent in children than in adults. Unilateral sinusitis is not uncommon disease. Our aim was to analyze the...
INTRODUCTION
Upper respiratory tract infections and sinusitis are more prevalent in children than in adults. Unilateral sinusitis is not uncommon disease. Our aim was to analyze the disease characteristics in children with unilateral sinusitis and compare them with those of adults.
MATERIALS AND METHODS
This study included 124 patients with unilateral chronic sinusitis divided according to age into two groups: pediatric group ≤18 years (66 cases) and adult group >18 years (58 cases). The groups were compared in terms of demographic data, side, clinical manifestations and radiological findings.
RESULTS
In pediatric patients, the most common inflammatory pathology was antrochoanal polyps, followed by allergic fungal sinusitis. On the other hand, chronic sinusitis without nasal polyps is the most common in adults, followed by antrochoanal polyps. The mean duration of clinical manifestations before diagnosis in pediatric patients was significantly shorter than that in adults (P=0.001). The most common symptoms in both pediatric and adult patients were anterior nasal discharge and nasal obstruction. Proptosis was significantly higher in pediatric group than in adult group (P=0.015). On computed tomography (CT), the most commonly affected sinus in both pediatric and adult patients was the maxillary sinus followed by the anterior ethmoid sinus. Bone expansion, erosion and involvement of adjacent structures were significantly higher in pediatric patients (P=0.028, 0.027 respectively).
CONCLUSION
Pediatric patients have a high incidence of antrochoanal polyps and allergic fungal sinusitis as unilateral inflammatory lesions. These lesions require surgical management. Inflammatory paranasal sinus lesions in pediatric patients have a shorter duration of clinical manifestations and a higher incidence of bone erosion and involvement of adjacent structures; therefore, early diagnosis and management prevent complications.
PubMed: 38745689
DOI: 10.22038/IJORL.2024.75788.3539 -
SAGE Open Medical Case Reports 2024Head and neck mucosal melanoma is a rare but highly aggressive malignant tumor that usually has a poor prognosis. We describe a 53-year-old male patient, having no any...
From apparent pseudoprogression to durable complete remission of expansile destructive sinonasal mucosal melanoma under pembrolizumab after primary endoscopic resection: A case report.
Head and neck mucosal melanoma is a rare but highly aggressive malignant tumor that usually has a poor prognosis. We describe a 53-year-old male patient, having no any medical history, with left maxillary sinus mucosal melanoma causing bilateral lung metastasis. Rapid tumor regrowth was observed on the 49th day after radical tumor resection. Subsequent pembrolizumab immunotherapy initially elicited pseudoprogression, for which add-on radiation therapy was carried out during maintenance pembrolizumab. A gradual decrease in tumor volume and complete remission were observed by a series of magnetic resonance imaging scans and lung windows of a computer tomography scan of chest. At the 29-month follow-up, the patient was rendered disease-free. In conclusion, head and neck mucosal melanoma may regrow rapidly after surgical resection and pseudoprogression could be frightening during immunotherapy. Subsequent single-agent pembrolizumab plus localized radiation therapy aiming to release more tumor antigens may offer the possibility of long-term remission.
PubMed: 38741602
DOI: 10.1177/2050313X241253471 -
Cureus Apr 2024B-cell lymphoblastic lymphoma (B-LBL) is an abnormal proliferation of lymphocyte precursor cells located primarily outside of the bone marrow and peripheral blood,...
B-cell lymphoblastic lymphoma (B-LBL) is an abnormal proliferation of lymphocyte precursor cells located primarily outside of the bone marrow and peripheral blood, typically in the mediastinum or other lymph nodes. It is often a disease of childhood that presents with lymphadenopathy, fatigue, pallor, bone pain, and weight loss with laboratory findings of anemia and thrombocytopenia. Initial presentations prompted by head and neck manifestations are exceedingly rare. A five-year-old girl with no significant past medical history presented with right facial swelling and mild proptosis on ophthalmologic evaluation. She was referred to a tertiary care facility by her local otolaryngologist for further management after computed tomographic imaging revealed right maxillary sinus opacification and erosion of the anterior maxillary bone. Her symptoms were initially responsive to prednisone and amoxicillin-clavulanate, and only right unilateral nasal discharge persisted with a near-complete resolution of other sinonasal symptoms. Notably, laboratory values, including complete blood count, were within normal limits. Given concern for the etiology of the bony erosion, the patient presented for a second opinion, where imaging and biopsy resulted in flow cytometry findings consistent with B-ALL/LBL. After a bone marrow biopsy, the ultimate diagnosis was Murphy's stage III B-cell lymphoblastic lymphoma. Malignant neoplasms of the sinonasal region are rare in children, where primary sinonasal B-LBL is a unique occurrence. Clinical features of sinonasal B-LBL in the paranasal sinuses may masquerade as pathologies such as acute sinusitis, orbital cellulitis, and benign tumors or polyps that can lead to a confounding diagnosis. In this case presentation, an initial response to steroids and antibiotics should not provide false reassurance when other features and signs, such as maxillary bone erosion, may suggest the presence of malignancy.
PubMed: 38738089
DOI: 10.7759/cureus.58132 -
Advantages and caveats of endoscopic to the infratemporal fossa as isolated and combined techniques.Laryngoscope Investigative... Jun 2024Identify the benefits and caveats of combining minimal access approaches to the infratemporal fossa (ITF), such as the endoscopic transnasal, endoscopic transorbital,...
OBJECTIVE
Identify the benefits and caveats of combining minimal access approaches to the infratemporal fossa (ITF), such as the endoscopic transnasal, endoscopic transorbital, endoscopic transoral, and endoscopic sublabial transmaxillary approaches to address extensive lesions not amenable to a single approach. The study provides anatomical metrics including area of exposure and degree of surgical freedom.
METHODS
Five human cadaveric specimens (10 sides) were dissected to expose and methodically analyze the anatomical intricacies of the ITF using the following minimal access approaches: endoscopic transnasal transpterygoid (EETA), endoscopic sublabial transmaxillary, endoscopic transorbital via infraorbital foramen, and endoscopic transoral techniques. Area of exposure at the pterygopalatine fossa and surgical freedom at the ITF were obtained for each approach.
RESULTS
The endoscopic sublabial transmaxillary sinus and the combined approach afford a significantly greater exposure than an isolated EETA. The difference in exposure (mean) between the endoscopic sublabial transmaxillary and EETA was 1.62 ± 0.85 cm ( < 0.001), and the difference between the combined approach and EETA was 4.25 ± 0.85 cm ( < 0.001).
CONCLUSIONS
Combining minimal access endoscopic approaches to the ITF can provide significantly greater exposure than an isolated EETA; thus, providing enhanced access to address lesions with extensive involvement of the ITF, especially those with superolateral and inferolateral extensions. In addition, some approaches may have an adjunctive role to the resection, such as the endoscopic transoral approach offering the potential for early control of the internal maxillary artery and its branches, some of which may be supplying the tumor in the ITF; or the endoscopic transorbital approach yielding a direct line of sight to the superior ITF and middle cranial fossa.
LEVEL OF EVIDENCE
NA.
PubMed: 38736945
DOI: 10.1002/lio2.1242