Ameloblastoma of the maxilla. Case report

A basal cell maxillary ameloblastoma became obvious as an asymptomatic swelling of the left buccal sulcus and alveolar process, although a large extension into the maxillary sinus up to the nasal conchae and the orbital floor had already occurred. The painless and slow growth of the lesion, the thin bone of the upper jaws, the adjacent cavities and the vital structures are the main factors for delay in recognition and thus the potentially lethal result of a maxillary ameloblastoma. A review of location, age, sex and race predilection, clinical course, radiographic appearance, histological types and treatment methods in made.     

Image features of aspergillosis arising from the pterygopalatine fossa: a case report and literature review

Aspergillosis of the skull base is an unusual disease entity, mainly found in immunocompromised patients. Aspergillosis originating in the pterygopalatine fossa (PPF) without contiguous spread from the sinuses is extremely rare. A 79-year-old woman complained of having suffered pain in her left cheek and headaches for 4 months. Computed tomography (CT) scans revealed soft tissue filling the left PPF with sclerotic change and erosion of the adjacent bone. A follow-up CT scan 1 month later after supportive care showed an increase in the extent of the soft tissue lesion in the left PPF with progressive erosion of the posterior wall of the left maxillary sinus. Magnetic resonance imaging revealed a low-signal-intensity mass in the PPF on T2-weighted images; the mass displayed strong enhancement on contrast-enhanced T1-weighted images and extended into the left maxillary sinus, infratemporal fossa, and cavernous sinus. The patient underwent a Caldwell-Luc operation with debridement of the PPF; the histopathological diagnosis was aspergillosis. The patient eventually died from cerebral ischemic change and brain edema during the postoperative period.     

Solid variant of odontogenic keratocyst

A case of an unusual lesion from the maxilla is presented. Macroscopically, the lesion was solid and histologically consisted of 'multiple separate keratocysts' of varying size that infiltrated into the surrounding bone and soft tissues. Panoramic image and CT scans showed a multilocular honeycomb ill-defined radiolucency with infiltration into the maxillary sinus and floor of orbit. This lesion should be differentiated from similar odontogenic lesions, such as keratoameloblastoma and papilliferous keratoameloblastoma. As there was no evidence of follicles, islands of ameloblastoma, or papilliferous structures in the entire specimen, the lesion could not be diagnosed as either a keratoameloblastoma or a papilliferous keratoameloblastoma. The invasive and destructive growth behavior, the histopathological features, and the histochemical pattern of the collagen stroma imply that this solid lesion is a neoplasia. It is suggested that the proper term for this lesion is solid variant of odontogenic keratocyst.     

Toothache with a multifactorial etiology: a case report

Abstract A case report of orofacial pain originating from both dental and nondental conditions is presented. The spontaneous throbbing pain initiated from the left maxillary second premolar and spread throughout the entire upper part of the lace to the frontoparietal area. Root canal treatment of the maxillary second premolar did not resolve the chief complaint. Magnetic resonance imaging examination revealed hypertrophy of the left inferior turbinate and soft tissue haziness in the left maxillary sinus floor. After antrostomy, submucosal turbinectomy; and endodontic treatment, the patient was free from pain. The final diagnosis of this case, in addition to pulpitis, was maxillary sinusitis with chronic rhinitis. The multiple factors associated with the etiology made the diagnosis difficult. The mechanism of referred pain from the maxillary sinus and paranasal nuicosa to the maxillary teeth and face is discussed.     

Endoscopic minimally invasive management of a periradicular lesion invading the maxillary sinus

A referred patient presented with a lesion of endodontic origin located at the apex of tooth #27. The tooth had been endodontically treated and re-treated. A periapical radiograph revealed a close relationship between the lesion and the maxillary sinus. A cone-beam computed tomography scan confirmed that the lesion had invaded the sinus cavity. The treatment plan consisted of periapical surgery using an endoscope as a magnification device. Due to a sinus membrane perforation, a new sinus membrane repair technique was performed. Twelve months after surgery, a cone-beam computed tomography scan revealed successful healing of the lesion. The continuous preservation of the sinus physiology was also observed. The use of an endoscope as a magnification device and a tailored technique for sinus membrane management allowed us to achieve a successful treatment outcome in the case of an endodontic lesion invading the maxillary sinus.     

Foreign body (alginate impression paste) in the maxillary sinus: a case report

A tumor-like foreign body in the maxillary sinus is reported. Examination of the paranasal sinuses by computerized tomography revealed a dense and well defined lesion equal to that of bone in the left maxillary sinus. After surgery, the lesion was found to be alginate used for impression-taking before fitting of a prosthesis, and not a tumor.     

螺旋CT在上颌窦底壁分型及内提升术风险评估中的应用

目的 通过上颌窦螺旋CT扫描,初步对上颌窦底壁进行分型,并为种植牙上颌窦内提升术的风险评估提供理论依据。方法 选取55例（110侧）健康成人的鼻窦CT影象,对上颌窦进行螺旋CT连续容积扫描、三维重建,在选取的截面上观察上颌窦底的形态。结果 110侧上颌窦底中,平坦型、凹面型、凸面型各有50侧、53侧、7侧,所占比例分别为45.5%、48.2%、6.3%。其中平坦型与凹面型之间无显著性差异（P<0.05）,而凸面型与另两种分型之间有显著性差异（P>0.05）。性别、左右侧以及不同年龄之间均无显著性差异（P<0.05）。结论 上颌窦内提升术前,进行螺旋CT扫描,观察窦底形态对评估手术风险有重要的临床指导意义。     

Ameloblastoma, desmoplastic type: a case report with characteristic radiological presentation

Ameloblastoma, desmoplastic type, is a rare lesion for which radiographic images are even less common, and such lesions are sometimes considered to be variant types. It is defined as a variant of ameloblastoma with specific imaging and histological features. This lesion occurs with the same frequency in the maxilla and mandible, although the predominant site is the anterior-premolar site in both the mandible and maxilla. For our case of ameloblastoma, desmoplastic type, resected from the right anterior to premolar maxilla, the radiographic appearance and histopathological findings were compared. Computed tomography images revealed that the lesion had a multilocular structure with many smaller septa at its periphery. Although expansion toward the maxillary sinus was suggested radiologically, invasion of the mucosa into the floor of the maxillary sinus was found on histopathological examination.     

Solitary plasmacytoma of the maxilla--a case report and review of the literature

Plasma cell neoplasms have been classified as multiple myeloma, solitary plasmacytoma, and extramedullary plasmacytoma. The solitary plasmacytoma of the maxilla is a rare condition that focuses solely on myelomatous tissue and is not disseminated to other parts of the skeleton. Some lesions appear to be benign and do not recur after complete removal, while others are locally invasive. The dense plasma cell infiltration that commonly is associated with inflammatory lesions within the oral tissues makes diagnosing plasmacytoma at this site problematic. This article presents a case of solitary plasmacytoma in the maxilla. Radiographic examination revealed an osteolytic lesion over the right maxillary bone, invading the maxillary sinus. A CT scan showed that the tumor mass occupied the right maxillary sinus and the lateral wall of the nasal cavity. The tumor cells were composed of densely packed, round, polygonal cell structures that were scattered in relatively sparse stoma. The neoplastic cells had a large, single eccentric nucleus, resembling typical plasma cells. The clinical, histopathological, and radiological features of solitary plasmacytoma are discussed.     

Inflammatory myofibroblastic tumor of the maxillary sinus related with pulp necrosis of maxillary teeth: case report

Inflammatory myofibroblastic tumor (IMT) is a benign lesion composed of myofibroblasts accompanied by varying numbers of inflammatory cells. Various pathogenetic factors have been proposed, but the etiology of most IMTs remains unknown. This article presents a case of IMT occurring in the left maxillary sinus. A 24-year-old man complained of throbbing pain in the maxillary left molars and swelling of the left cheek. His maxillary left second molar was diagnosed as pulp necrosis and root canal treatment performed. After that, his symptoms continued and he was referred to the Department of Otolaryngology. Computerized tomography disclosed compact soft tissue masses in the left maxillary sinus with obstruction of maxillary ostium. Under general anesthesia, the lesions were fully excised. Histopathologically, the lesions were composed of plump or spindled myofibroblasts. Cells were immunoreactive for smooth muscle actin and β-catenin, and were negative for ALK1, CD34, and EMA. The diagnosis was IMT of left maxillary sinus. Although it is very rare, IMT should be included as a differential diagnosis in patients with compact masses in maxillary sinus.     

Acanthomatous ameloblastoma of anterior maxilla

The unusual case of acanthomatous ameloblastoma occurring in maxillary left anterior region in a 13-year-old female child is presented with chief complaint of swelling in the upper left anterior region since one year and spacing between maxillary left central incisor and canine. Microscopic examination of surgically excised specimen revealed solid epithelial cell nests with peripheral palisading ameloblastic cells and the central squamous cell assemblage that was consistent with the findings of acanthomatous ameloblastoma type. Acanthomatous ameloblastoma is the extremely rare variant. The present report discusses issues related to the incidence of such formations in the target tissues.     

Malignant lymphoma of the maxillary sinus manifesting as a persistent toothache.

Many teeth have been mistakenly extracted or endodontically treated because of an incorrect diagnosis of orofacial pain, including toothache. A case of persistent toothache originating from a malignant lymphoma of the left maxillary sinus is presented. Root canal therapy and extraction of the upper left quadrant teeth from the canine to the second molar did not resolve the chief complaint. The patient was referred to a neurologist and received a diagnosis of a malignant lymphoma, a rare lesion of the maxillary sinus. This case stresses the importance of considering malignant neoplasm of the maxillary sinus as a potential etiologic factor in the differential diagnosis of orofacial pain.     

应用颌面专用CT显示上颌窦与上颌后牙区关系

目的：探讨应用颌面专用CT（QR—DVT 9000 NEWTOM）成像技术，显示上颌窦与上颌后牙区关系的意义。方法：对上颌牙齿拔除、种植牙、肿瘤等需要显示上颌窦与上颌后牙区关系的患者，进行颌面专用CT扫描和重建成像。结果：颌面专用CT成像技术能够分别以水平位、矢状位、冠状位、曲面以及3D影像，清楚地显示出上颌窦与上颌后牙区的解剖关系等信息。结论：应用颌面专用CT显示上颌窦与上颌后牙区的关系具有重要的临床意义，更能有效地指导临床手术。     

Osteoradionecrosis of sphenoid and temporal bones in a patient with maxillary sinus carcinoma: a case report

A case of radionecrosis of sphenoid and temporal bones is reported. The patient received a combination of surgery, radiotherapy, and chemotherapy for his left maxillary sinus carcinoma. After the combined therapy, necrosis accompanying inflammation developed in the maxillary and temporal regions. Excision of the necrotic tissues was done, and the left ascending ramus of the mandible was resected because of persistent tumor mass at the left infratemporal fossa. Although the excision wound of the maxilla healed by epithelialization, an area of nonvital bone remained exposed in the temporal region, where progressive osteonecrosis with infection led to breakdown of the skin. The necrotic bones of the zygomatic arch and the sphenotemporal sutural region became visible through the skin defect, and computerized tomography scan revealed bone necrosis involving the inferolateral area and the base of the skull. Excision of the necrotic bone and reconstruction with sternocleidomastoid myocutaneous flap were performed.     

Maxillary ameloblastoma. Case report and review of the literature

A case of maxillary ameloblastoma is presented. A non-healing, asymptomatic ulcerative lesion in the maxillary tuberosity region did not respond following relief of physical irritation. The clinical appearance of the lesion was compatible with that of a malignant tumour, but the histopathology was consistent with a diagnosis of ameloblastoma of the maxilla.     

Epidermal nevus syndrome with development of a mandibular ameloblastoma

Epidermal nevus syndrome (ENS) is a hamartoneoplastic syndrome characterized by the association of epidermal nevi with abnormalities in other organ systems. We report a 32-year-old woman with ENS that, in addition to cutaneous manifestations, showed red plaques on the maxillary and mandibular labial alveolar mucosa and a papillomatous lesion of the midline posterior hard palate. Radiographic examination of the jaws was noncontributory. Approximately 5 years later, a follicular ameloblastoma developed in the mandible. The tumor showed duct-like cystic spaces, continuity with the overlying epithelium, and globular myxomatous areas in the connective tissue. The palatal lesion was diagnosed as papilloma, whereas the maxillary plaques showed nonspecific mucositis. The association of ameloblastoma with ENS is discussed. This is the second case of ENS associated with ameloblastoma reported in the medical literature.     

New York State Ear,Nose, and Throat Specialists' Views on Pre–Sinus Lift Referral

Background: Dental implant surgery in the posterior maxilla often involves the maxillary sinuses. Sinus surgery for dental implants is highly successful, but the preoperative risk is difficult to assess because a routine preoperative evaluation does not include an intranasal examination by an otolaryngologist. The purpose of the present study is to obtain the opinions of ear, nose, and throat (ENT) specialists located within New York state in an effort to establish a referral protocol before performing a maxillary sinus elevation. This study assesses the need to consult an ENT specialist for evaluation and treatment recommendations in the pretreatment workup. Methods: A questionnaire and a stamped, return envelope with an identification number was mailed to 302 physicians who maintained a current ENT‐specialty practice or practiced that specialty in a hospital or clinic setting in New York state. The requirement criteria included a valid address and specialty designation. Up to two follow‐up phone calls were made, and another questionnaire was mailed 30 days after the initial mailing. The questionnaire included eight computerized tomography (CT)–scan images that represented different sinus configurations. Answers to the five questions were statistically evaluated and analyzed. A total of 63 recipients returned the questionnaire and were included in the study. Results: A majority of 58.7% (95% confidence interval: 46.9% to 71.1%) of respondents recommended that a maxillary sinus CT scan should be routinely prescribed before a sinus‐lift surgery. Patient symptoms that ENT specialists suggested indicated referral included nose complications/problems (40.1%) and sinus issues (23.6%). Of the eight CT‐scan images, referral suggestions were >50% for the following: an occluded sinus with septum, inflammation at the base of the sinus only, a sinus with a generalized thickened membrane, an oroantral fistula, a thickened sinus membrane in association with teeth that had endodontic and/or periodontic involvement, and a nearly completely occluded sinus that was missing palatal bone. For patients with seasonal allergies, ENT specialists suggested delaying surgery (20.6%) or controlling symptoms before surgery (41.3%). Concerns included a past history of a sinus surgery (87.3%), chronic sinusitis (85.7%), presence of ostium stenosis (68.3%), nasal or sinus obstruction (82.5%), and oroantral fistulation (74.6%). Conclusions: Within the limits of the study, an attempt is made to develop a preoperative protocol, and 63 responses from ENT specialists suggested that the majority (58.7%) would recommend a maxillary CT scan before a sinus‐lift surgery. Their greatest concerns were a prior sinus surgery, severe sinus inflammation, nasal/sinus obstruction, and oroantral fistulation.     

Maxillary sinus unilateral aplasia as an incidental finding following cone‐beam computed (volumetric) tomography

This paper presents a case of maxillary sinus unilateral aplasia, an uncommon condition in adults, diagnosed as an incidental finding during cone‐beam computed tomography (CBCT) examination for an endodontic case analysis. The patient was referred to a specialist endodontic practice for management of an upper right central incisor tooth. A CBCT scan was performed. The images of the left maxillary sinus showed a total lack of pneumatisation, prompting the diagnosis of aplasia. The patient's otolaryngologist was made aware of the findings. Clinical evaluation of volumetric images should be performed by an adequately trained dentist or radiologist so the maximum amount of information is gathered for the patient. This requires a systematic approach to ensure that no relevant information is missed and should include the paranasal sinuses and other surrounding structures as incidental findings can be observed during CBCT analysis.     

92例上颌骨成釉细胞瘤不同手术方式的效果评价

目的:探讨上颌骨各型成釉细胞瘤合适的手术治疗方法.方法:回顾分析92例上颌骨成釉细胞瘤患者的临床资料,所有患者病理诊断明确,术后随访3～8年,定期拍摄颌面部CT、全景片,观察手术治疗效果.采用SPSS 22.0软件包对数据进行统计学分析.结果:上颌骨成釉细胞瘤男女比例为3∶1,男性较多,平均年龄为45.77岁.92例患...     

Odontogenic orbital abscess: a case report and review of literature

Odontogenic orbital abscess is a rare but well-documented complication of sinusitis and infections spreading from dental apical lesion. We report a case of orbital abscess with periorbital cellulitis, in a 35-year-old man with positive recent dental history of a periapical dental infection arising from the second upper left premolar spread into maxillary sinus. The patient has shown facial edema, ocular pain, ophthalmoplegia, proptosis, and initial visual symptoms. A surgical intervention to drain the abscess and a revision of the dental lesion and maxillary sinus were required. A review of literature is also reported focusing on etiology and treatment options dealing with odontogenic orbital abscess and cellulitis.