X线片上推测上颌窦的侧面积

目的:利用多元回归方程式探讨X线颅侧位片上颌窦前后径、高径与侧面积的关系。方法:对18~76岁正常成年人103名(男67人,女36人)的X线颅侧位片进行了上颌窦前后径(X1)、高径(X2)和侧面积(y)的测量。结果:X1、X2与y之间呈正相关关系,相关系数有显著性差异,建立男女共用的多元回归方程式:y(mm2)=27.02X2-5.81X1-65.65。经回代检验,可信率为96.13%。结论:成人上颌窦侧面积可用多元回归方程式推算。     

Anatomic evaluation of maxillary sinus septa: Surgery and radiology

The anatomical structure of the maxillary sinus is fundamental to maxillofacial surgery. The presence of septa, located at the inner surface of the maxillary sinus, increases the risk of sinus membrane perforation during sinus elevation for dental implant surgery. The aim of this study was to evaluate the anatomy of maxillary sinus septa.Data in this study was obtained from a total of 205 cases. One hundred and seventy‐seven patients were partially edentulous (PE) whereas 28 patients had no teeth. Dental computerized tomography (dental CT) was used in the assessment of 410 sinus segments (205 left and 205 right segments). The prevalence of sinus segments with septa was found to be 145/410. Septa were detected in 91 of the 177 PE cases. There were a total of 26 septa in 18 of the 28 completely edentulous (CE) cases. A total of 165 septa were detected in these segments. The prevalence of septa was 46.4% (26/56) in the CE, and 39.2% (139/354) in the PE segments. Thirty septa were found in the anterior, 110 in the middle and 25 in the posterior region. All detected septa were located mediolateral direction. Their relative position: lateral, middle or medial were also noted. The height measurements of the septa varied amongst the different positions. In view of the fact that septa of various heights and courses can develop in all parts of the maxillary sinus, timely and adequate assessment of the inner aspect of the maxillary sinus is essential to avoid complications during sinus augmentation procedures. Clin. Anat. 22:563–570, 2009. © 2009 Wiley‐Liss, Inc.     

上颌窦底骨分隔对内提升术后成骨效果的影响

目的　上颌窦骨分隔被认为是上颌窦内提术的相对禁忌症,文中旨在探讨上颌窦底骨分隔对内提升术后成骨效果的影响。 方法　收集上颌窦底骨分隔需内提升进行种植的患者7例（有分隔组）,另随机选取上颌窦无分隔需进行内提升的患者8例（无分隔组）,共15例,利用CBCT(Cone Beam Computed Tomography)和Simplant软件对植体周围骨高度及骨密度进行测量,采用SPSS19.0软件对数据进行统计分析。 结果　有分隔组及无分隔组的提升高度,植体根尖高度差,颊侧高度差,根尖区骨密度,颊侧骨密度的对比,P值均大于0.05,两组结果差异无统计学意义。 结论　上颌窦底骨分隔内提升术后的成骨效果无明显影响。     

Observation of maxillary sinus septa and bony bridges using dry skulls between Hellman's dental age of IA and IIIC

Maxillary sinus septa and bony bridges were observed using dry skulls in childhood, classified based on Hellman's dental age, to clarify maxillary sinus septum formation. Eighty-eight maxillary sinuses of 44 dry skulls and a cone-beam computed tomography (CBCT) unit were used. The locations of the septum, defined as a pointed bony structure originating from the inferior wall, and bony bridge, defined as a bony structure between the maxillary sinus wall and dental germ, were antero-posteriorly recorded, and the superoinferior distance, distance from the bony palate, and angle to the median palatine suture were measured. The rate of septum presence in the maxillary sinus was high (41.7%) in IIIC, and the septa were located in the deciduous molars, premolars, and molars. Also, all bony bridges were related to the median maxillary sinus wall, and the rate of the maxillary sinus showing a bony bridge was high in IIA and IIIA. Septum presence in the maxillary sinus was observed in IIA, IIC, IIIA, IIIB, and IIIC of Hellman's dental age. Also, bony bridges were observed in IC, IIA, IIC, IIIA, IIIB, and IIIC of Hellman's dental age.     

True carcinosarcoma of the maxillary sinus

A case of true carcinosarcoma primarily arising in the right maxillary sinus is reported in a 60-year-old male. His chief complaints were right nasal obstruction and bleeding. Histological findings of the biopsied primary tumor revealed two components of keratinizing squamous cell carcinoma and osteosarcoma which were intricately intermingled. Despite intensive irradiation and chemotherapy, and total maxillectomy, he finally died of rapid tumor recurrence and widely spreading metastases to lungs, pleurae and brain two months later. At autopsy the recurrent and metastatic tumors consisted entirely of the osteosarcoma component, suggesting the efficiency of the radiotherapy and chemotherapy against the carcinomatous component, but not against the sarcomatous one. As for histogenesis, this case was compatible with a combination tumor judging from histologic, immunohistochemical and electron microscopic findings.     

Cholesterol granuloma of the maxillary sinus

Cholesterol granuloma is usually associated with chronic middle ear disease and is common in the mastoid antrum and air cells of the temporal bone. It has also been reported in other parts of the skull, such as the frontal and maxillary sinuses and orbit. Cholesterol granuloma is rare in the paranasal sinuses. We report a new case of cholesterol granuloma in the maxillary sinus of a 38-year-old man who underwent surgical excision. We also review the literature and discuss the mechanism of development for this lesion. The resected specimen showed fragments of respiratory mucosa with cholesterol clefts surrounded by multinucleated foreign-body giant cells. Some multinucleated foreign-body giant cells showed asteroid bodies. Hemorrhagic areas, hemosiderin-laden macrophages, chronic inflammatory cells, and dilated lymphatics vessels were seen as well. Increased intrasinus pressure due to drainage obstruction may affect venous and lymphatic drainage from the sinus cavity, leading to venule microhemorrhages while still allowing arterial blood into the sinus mucosa and further contributing to a large localized hemorrhage. Lymphatic drainage may be insufficient to completely remove the lipid components of the red blood cells, and the lipid accumulation may contribute to the formation of cholesterol crystals and their esters.     

以有限元法仿真分析闭合式上颌窦提升的黏膜形变

背景：如何避免闭合式上颌窦提升种植治疗中医源性上颌窦黏膜穿孔等并发症成为近年研究的热点。 目的：以有限元法比较闭合式上颌窦提升种植治疗中不同上颌窦黏膜厚度对黏膜穿孔的影响。 方法：在ANSYS有限元分析软件的SHELL63单元中分别建立0.3,0.5,0.8 mm厚度上颌窦黏膜与4.2 mm直径种植体的有限元模型,模拟闭合式上颌窦提升手术抬高黏膜,根据大变形非线性理论计算3种厚度上颌窦黏膜中心Von Mises最大应力值,并进行统计学分析。 结果与结论：通过对3种厚度上颌窦黏膜提升1-5 mm的形变与应力分析,发现上颌窦黏膜高变形区发生在黏膜顶端中心,在黏膜提升1-4 mm时,最大应变值曲线变化温和,在大于4 mm高度后曲线斜率明显增加;在上颌窦黏膜提升5 mm之内,0.3,0.5,0.8 mm 3种厚度黏膜中心最大Von Mises应力值差异无显著性意义(P > 0.05)。提示上颌窦黏膜提升高度大于4 mm之后,黏膜弹性拉伸大幅增加,增大了穿孔的概率;对于上颌窦黏膜厚度为0.3-0.8 mm需要进行闭合式上颌窦提升治疗的患者,其所面对的黏膜穿孔风险是无差别的;而上颌窦黏膜厚度小于0.3 mm的患者,要更加慎重地选择上颌窦提升方案以防止黏膜穿孔的发生。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Shape of the lingula and its localization by panoramic radiograph versus dry mandibular measurement

BACKGROUND: To evaluate the incidence of lingula shapes in Thai adult mandibles and to compare the accuracy of panoramic radiograph measurement with the dry mandible measurements for localizing the position of the lingula. METHODS: Seventy-two dry adult mandibles (144 sides) from 52 males and 20 females of Thai origin were classified as triangular, truncated, nodular or assimilated. Twenty-three mandibles, composed of both first molar and canine on the same side (33 sides), were selected for distance measurement. The ten distances from the lingula to the anterior, posterior ramus, to the coronoid notch and lower border of the mandible were measured on the dry mandibles and compared with the same distances on panoramic radiographs. The distribution of the lingula shape is described. Paired t test and correlation were used to evaluate the accuracy of panoramic radiographs in localizing the position of the lingula. RESULTS: Truncated lingula were most commonly found (68 sides or 47%). Nodular, triangular and assimilated shapes were found in 33 (23%), 24 (17%) and 19 subjects (13%), respectively. The distance differences between the panoramic radiograph measurement and the dry mandible measurement were statistically significant (P < 0.01). The positive correlations between the panoramic and dry skull measurements were high (0.59-0.91). CONCLUSIONS: The lingula has different shapes in different populations. In adult Thai mandibles, the truncated lingula shape is most common. Panoramic radiographs present not only the position but also the shape and number of lingula and mandibular foramen. There is a high concordance between the measured distances in panoramic radiography and dry mandibles.     

Dermoid cyst of the maxillary sinus.

Dermoid cysts are rare developmental teratomatous lesions composed of ectodermally derived stratified squamous epithelium and mesodermally derived skin adnexal structures. As part of the teratomatous lesion group, dermoid cysts are related to teratoid cysts, true teratomas, and epignathi. Although several theories have been postulated, the pathogenesis of dermoid cysts, and teratomatous lesions in general, is unclear. Most commonly affecting sites within the head and neck, dermoid cysts may be found in the frontotemporal/lateral brow area, central nasal area, oral cavity, lateral neck, and other sites. We present what is believed to be the first reported case arising within the maxillary sinus and briefly discuss the possible pathogenesis.     

Malignant fibrous histiocytoma of the maxillary sinus

A case of malignant fibrous histiocytoma arising primarily in the left maxillary sinus is described. The patient, a 39-year-old male, who had suffered from sinusitis for 20 years, began to have paresthesia or sharp pain of the left side of the face and toothaches of the left maxilla. At operation a white fibrous tumor developing extensively from the lateral wall to the upper and medial walls of the left maxillary sinus and into the ethmoidal sinus was noted. Following a gradual progression of dyspnea, he died approximately one year after the onset in spite of radiation therapy and anticancer chemotherapy. An autopsy revealed recurrence of the tumor in the left maxillary sinus with wide-spread metastases to the lungs, pleurae, pancreas, kidneys and bone marrows. The direct cause of death was respiratory failure due to extensive growths of the pulmonary and pleural metastases.     

Evaluation of the blood and nerve supply patterns in the molar region of the maxillary sinus in Japanese cadavers

The maxillary sinus (MS) in the maxilla bone is located near the orbit, the nasal cavity and the oral cavity; however, the positioning of the constituent bones is complex. The posterior superior alveolar branches of the maxillary artery and nerve are distributed in the lateral wall of the MS. The courses of these blood vessels and nerves are restricted by the morphology of the craniofacial bones, and the landmarks used in dental implant treatment of these courses mainly run along the lateral wall of the MS. In this study, 19 human cadavers with 34 sides of Japanese origin (ranging in age from 59-94 years, mean 77.7 +/- 9.8 years) were prepared for measurement of the MS, the superior alveolar artery and the infraorbital artery using cone beam computed tomography (CBCT). The posterior superior alveolar artery (PSAA) of the lateral wall of the MS can be classified into one of three groups based on the supply pattern. In the greatest number of cadavers, the PSAA ran mainly to the lateral surface of the zone between the superior border of the alveolar foramen and the inferior border of the MS (53.0%, 18/34). In others, the PSAA ran to the zone between the infraorbital foramen and the superior border of the alveolar foramen (17.6%, 6/34); in a third group, the PSAA ran to the zone between the inferior border of the MS and the greater palatine foramen (23.5%, 8/34). The lest of two sides are spread out in this area (5.9%, 2/34). CBCT is the most accurate tool to evaluate important anatomical parameters, such as the distance of the blood supply, for the implant of grafts in the floor of the MS during surgical procedures.     

Arterial blood supply of the maxillary sinus.

Knowledge of the arterial supply of the maxillary sinus region is essential for surgical treatment in this area (e.g., implantation of grafting materials, repair of injuries, sinus floor elevation). The goal of this study was to describe the arterial architecture of the maxillary sinus region in respect to sinus lift procedures. In 18 unfixed human cadavers, the arterial vessels of the head were injected with a mixture of latex and barium sulfate. Afterward, the arteries entering the maxilla were prepared. The number and calibers as well as anastomoses were carefully documented. In addition, we measured the distance between the alveolar ridge and the lower main branches. The arterial supply of the maxilla originated from the posterior superior alveolar artery as well as from the infraorbital artery. In all specimens we found an intraosseous anastomosis between these two vessels. The oral mucosa in the area of interest is supplied by the posterior superior alveolar artery and the infraorbital artery, and an extraosseous anastomosis was found in 44% of our cases. The two anastomoses build up a double arterial arcade, supplying the lateral wall of the antrum and parts of the alveolar process.     

Ectopic primary olfactory neuroblastoma of the maxillary sinus

Olfactory neuroblastoma (ONB) is a rare malignant tumor. Although the vast majority of cases arise in the nasal cavity, ONB is rarely reported in ectopic locations. We report a case of ONB in the maxillary sinus. A 63-year-old woman presented with left-sided nasal obstruction and epistaxis. Magnetic resonance imaging showed a nonenhancing left maxillary sinus tumor. Histologic sections showed ONB, Hyams grade IV, invading bone, skeletal muscle, and adjacent fibroadipose tissue. It is essential to be accurate when diagnosing sinonasal tumors because the differential diagnosis is broad, and one must consider the possibility of ectopic ONB, although it is rare. The behavior of ONB and other neuroendocrine tumors of the sinonasal region is quite different, and there are varied approaches to treatment. Therefore, an accurate diagnosis as well as correct grade and stage must be assigned.     

上颌窦与上颌后牙的位置关系及临床意义

目的为上颌牙种植术等临床口腔外科提供解剖学基础。方法选取新鲜上颌骨标本10例20侧、成人全牙上颌骨标本18例36侧和20名全牙志愿者,分别暴露出上颌窦粘膜、上颌窦与上颌后牙牙根和CT连续扫描后进行三维重建。观察上颌窦的形态及其下壁的骨性和粘膜结构,用游标卡尺和CT三维重建工作站分别测量上颌后牙牙根至上颌窦下壁的距离。结果上颌窦呈三边形或四边形的锥体形腔隙,其下壁常有凸起的骨隔和粘膜隔。上颌磨牙的近中颊根至上颌窦的距离均较舌根、远中颊根近,由近及远依次为近中颊根、舌根和远中颊根。在标本及影像上的第1前磨牙、第2前磨牙、第1磨牙、第2磨牙、第3磨牙牙根至上颌窦下壁的距离分别为(9.30±2.64)mm和(9.50±2.72)mm、(4.50±1.98)mm和(4.60±1.95)mm、(2.02±0.91)mm和(2.18±0.96)mm、(2.06±1.04)mm和(2.26±1.20)mm、(3.74±1.73)mm和(3.82±1.84)mm。结论(1)上颌后牙至上颌窦的距离以第1磨牙最近,由近及远依次为第1磨牙、第2磨牙、第3磨牙、第2前磨牙和第1前磨牙。(2)对选择适宜长度的牙种植体,避免牙种植体误入上颌窦等具有重要意义。     

Auto-CAD计算机辅助设计软件定点测量儿童上颌窦前壁及上颌结节位置变化

BACKGROUND: To make a better preparation for orthodontic tooth, we investigate the changes in the localization of the anterior wall of the maxillary sinus and maxillary tuberosity, analyze the development of the maxilla, and detect the bone mass of the maxilla and development timing. However, the use of Auto-CAD software has not been reported to localize the anterior wall of the maxillary sinus and maxillary tuberosity. OBJECTIVE: To investigate the localization and growth of the anterior wall of the maxillary sinus and maxillary tuberosity in 300 children aged 4-14 years from the Han ethic group in Urumqi, Xinjiang Uygur Autonomous Region, China. METHODS: Totally 300 children, 4-14 years of age, admitted at the Stomatological Hospital of Urumqi, Xinjiang Uygur Autonomous Region, China, were enrolled. According to Hellman’s dental developmental staging, these children were divided into five groups: groups IIA, IIC, IIIA, IIIB, IIIC. Auto-CAD software was used to analyze the panoramic radiographs of the maxilla and mandible. The tracing of each radiograph was digitized by translating the reference points onto an X-Y coordinate system. The straight line that passed the point where the nasal septum intersected with the hard palate (point O) and the point where the medial wall of maxillary sinus intersected with the hard palate (point PA) was designated as the X axis. The straight line that was vertical to the X axis and passed through the point O at a right angle was designated as the Y axis. The X and Y coordinate values of reference point were calculated. And then O point was set as (0, 0), and the point where the posterior wall of maxillary tuberosity intersected with the hard palate (PP) was set as (PPX, PPY). Collected data were analyzed statistically to understand the changes in the localization of PA and PP at different stages of dental development. RESULTS AND CONCLUSION: The change of point PA had on significant differences between the five groups (α > 0.05). Point PP grew obviously in a horizontal rearward and vertical downward manner from stage IIA to IIIA; this point only presented a horizontal rearward growth from stage IIIA to IIIB and only a vertical downward growth from stage IIIB to IIIC. This period was the time of the second molar eruption, indicating that the second molar eruption is helpful to the vertical growth of the maxilla.       

Evaluation of the relationship between the maxillary posterior teeth and the sinus floor using cone-beam computed tomography

Aim

The aim of this study was to evaluate the relationship between each root of maxillary premolars and molars and the maxillary sinus floor according to sex, sinus position, and age by decade in a Turkish population by using cone-beam computed tomography (CBCT) scanning.

Methodology

We evaluated a database of 5,166 (2,680 maxillary premolars and 2,486 maxillary molars) CBCT scans obtained from 849 patients. The vertical relationship between each root of the molar and premolar teeth to the sinus floor was classified into three types: type 1, the roots penetrated into the sinus floor; type 2, the roots contacted the sinus floor; and type 3, the roots extended below the sinus floor.

Results

The results of the classification of each root in relationship to the sinus floor were as follows: type 3 occurred most frequently in the first (92.4 %) and second (71.6 %) premolar teeth, type 1 (34.2 %) occurred most frequently in the palatinal roots of the first molar teeth, type 3 occurred most frequently in the mesiobuccal (39.9 %) and distobuccal (39.7 %) roots of the first molar teeth, and type 2 (36.7 %) occurred most frequently in the mesiobuccal roots of the second molar teeth. No significant differences were found between the left and right sides, but several differences were found between males and females. The relationship between the posterior teeth and the sinus floor differed according to the age decade interval (p < 0.05).

Conclusions

The maxillary first premolars have no relationship with the maxillary sinus floor, but the maxillary second molars are closer to the sinus floor. Also the second decade and males were most susceptible to undesirable results.