Investigating the relationship between infraorbital canal morphology and maxillary sinus size

The purpose of the current study was to investigate relationships between maxillary sinus (MS) dimensions and the bony structures associated with the infraorbital nerve (ION). Computed tomographic scans of 87 adult crania (174 sides) from four morphologically diverse groups (West Africans, East Africans, North Asians, Europeans) were utilized. Seven primary variables were collected: infraorbital canal (IOC) type; infraorbital foramen (IOF) shape; distance from the foramen rotundum to IOF (FR-IOF); distance from the posterior wall of the infraorbital groove to IOF (IOG-IOF); and MS length, breadth, and height. Chi-square analyses indicated a significant association between IOC-type and IOF-shape (Pearson chi-square = 12.710; p-value = .013), with the most common pattern being oval IOFs and Type-I IOCs (45.68% of the sample; 74/162 sides). Analysis of covariance indicated a significant effect of ancestry (F = 8.333; p < .001) and MS length (F = 15.406; p < .001) on IOG-IOF distance. Ordinal regression analyses indicated that MS length (Wald chi-square = 7.103; p = .008) also maintained a significant effect on IOC-type, while multinominal regression analyses indicated that none of the measured parameters had a significant effect on IOF-shape. These results have clinical implications: recognizing IOC-type and IOF-shape relative to the MS is important to avoid ION damage during medical procedures. Overall, this study found most individuals possess Type-I IOCs (housed in the maxillary sinus roof) and oval-shaped IOFs. Most aspects of the ION pathway, including IOC-type and IOF-shape, were not influenced by ancestry or sex. However, antero-posteriorly longer MSs tend to possess Type-III IOCs protruding into the sinus, which could lead to surgical complications.     

磨牙与下颌管、上颌窦的位置关系及临床意义

目的:为牙种植术等临床口腔外科提供解剖学基础.方法:选取新鲜及成人全牙上、下颌骨标本和全牙志愿者,观察下牙槽神经、血管的关系和上颌窦下壁的凸起结构,测量磨牙牙根至下颌管、上颌窦的距离和牙槽窝的深度.结果:下颌管内的下牙槽血管位于下牙槽神经上方,下颌第1磨牙、第2磨牙、第3磨牙牙根至下颌管上壁的距离分别为(3.22±1.40)mm、(2.96±1.54)mm、(3.64±1.72)mm.上颌窦下壁有凸起的骨隔和黏膜隔,上颌第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(2.02±0.91)mm、(2.06±1.04)mm、(3.74±1.73)mm.下颌磨牙的牙槽窝深度均大于上颌磨牙相应的牙槽窝.结论:磨牙牙根至下颌管、上颌窦的距离和牙槽窝的深度对选择适宜长度的牙种植体,避免牙种植体损伤下牙槽神经和误入上颌窦等具有重要意义.     

Clear cell adenocarcinoma of the maxillary sinus: a case report

A variety of salivary gland tumours histologically show the presence of clear cells. Clear cell adenocarcinoma of salivary glands (CCASG) is a distinct clinico-pathologic entity arising in the minor salivary glands of mainly the oral cavity in elderly women and having a low grade malignant potential. A case occurring in the maxillary sinus and extending to the nasal cavity is reported.     

Widely invasive solitary fibrous tumor of the sphenoid sinus,cavernous sinus,and pituitary fossa

Solitary fibrous tumor is a spindle cell tumor first described in the pleura, but also found in multiple extrathoracic sites including the meninges, orbit, nasal and paranasal sinuses. No cases have been previously reported in the cavernous sinus or pituitary fossa. We present the case of a 54-year-old woman who presented with progressive amaurosis. On imaging studies, a widely infiltrative lesion involving the pituitary fossa, sphenoid sinus, cavernous sinus, carotid artery, medial temporal, ethmoid, and pterygoid bones, and extending into the nasopharynx was discovered; impression was a malignant tumor originating in the pituitary fossa. At surgery, the tumor was only partially resectable because of extensive bony invasion and encasement of the carotid artery, and was found to compress but not invade the pituitary gland. Histology showed a spindle cell proliferation with a dense, hyalinized collagenous stroma and dilated vascular spaces, some showing a staghorn-like appearance. Areas of cellular pleomorphism and increased cellularity were present, but few mitoses were identified. Immunohistochemistry showed strong positivity with CD34, factor XIIIa, CD99, and Bcl-2. There was scattered cyclin D1, mib-1, and p53 positivity. Muscle, epithelial, vascular, and melanocytic markers were negative. These results led to the diagnosis of solitary fibrous tumor. The size, extensive invasion, and bony destruction indicated a tumor with at least low malignant potential. The occurrence of solitary fibrous tumors in the pituitary fossa and sinuses of the head and neck is rare, but must be considered in the differential diagnosis of spindle cell lesions in these regions.     

Endoscopic anatomy and approaches of the cavernous sinus: cadaver study

Objective  

The objectives of this study were to recognize the endoscopic anatomy of the cavernous sinus and to understand the standard, purely endoscopic endonasal approaches to this anatomic structure. This basic information will facilitate our surgical procedures and decrease the rate of surgical complications.     

Anatomy of greater palatine foramen and canal and pterygopalatine fossa in Thais: considerations for maxillary nerve block

This study aims to investigate the anatomy of the greater palatine foramen (GPF), greater palatine canal (GPC) and pterygopalatine fossa (PPF) with special reference to the blockage of the maxillary nerve. A correlation between the length of GPC and PPF and the heights of the orbit and the maxilla was also studied using simple linear regression analysis. The morphology of the GPF, GPC and PPF as well as heights of the orbit and the maxilla were assessed in 105 Thai skulls. The thickness of the mucosa over the GPF was also measured from the dissection of 55 cadavers. The results showed that most GPF appeared as an oval foramen located at the palatal aspect of the upper third molar. The GPF was 16.2±1.3 mm lateral to the median sagittal plane of the hard palate, 2.1±1.3 mm anterior to the posterior border of the hard palate and 5.1±1.3 mm from the greatest concavity of the distolateral margin of the hard palate. The mean length of GPC and PPF was 29.7±4.2 mm. The mean angles of the GPC in relation to the hard palate and the vertical plane were 57.9±5.8° and 6.7±5.2°, respectively. In attempting to insert a needle to reach the foramen rotundum through the GPF, 31.7% passed into the orbit while 8.7% passed into the brain. The mean thickness of the mucosa over GPF was 6.7±2.3 mm. Two models for estimating the depth of needle injection in maxillary nerve block have been developed as follows: Length of GPC and PPF=19.038+0.314 (orbital height) and length of GPC and PPF=21.204+0.187 (maxillary height). The calculated length combined with the mucosal thickness was the estimated depth of needle injection. In conclusion, our results concerning the GPF, GPC and PPF will provide the useful reference for clinicians to anesthetize the maxillary nerve with a greater degree of success.     

Secondary pneumatization of the maxillary sinus in callitrichid primates: insights from immunohistochemistry and bone cell distribution

The paranasal sinuses remain elusive both in terms of function and in the proximate mechanism of their development. The present study sought to describe the maxillary sinuses (MSs) in three species of callitrichid primates at birth, a time when secondary pneumatization occurs rapidly in humans. The MSs were examined in serially sectioned and stained slides from the heads of two Callithrix jacchus, one Leontopithecus rosalia, and two Saguinus geoffroyi. Specimens were examined microscopically regarding the distribution of osteoclasts and osteoblasts along the osseous boundaries of the MS and other parts of the maxillary bone. Selected sections were immunohistochemically evaluated for the distribution of osteopontin (OPN), which facilitates osteoclast binding. Taken together, OPN immunoreactivity and bone cell distribution suggested trends of bone resorption/deposition that were consistent among species for the superior (roof) and inferior (floor) boundaries of the MS. Expansion at the roof and floor of the MS appeared to correspond to overall vertical midfacial growth in callitrichids. Much more variability was noted for the lateral (alveolar) and medial (nasal walls) of the MS. Unlike the other species, the nasal wall of Saguinus was static and mostly composed of inferior portions of the nasal capsule that were undergoing endochondral ossification. The variation seen in the alveolar walls may relate to the presence or absence of adjacent structures, although it was noted that adjacency of deciduous molars influenced medial drift of the alveolar wall in Saguinus but not Leontopithecus. The results of this study are largely consistent with the "structural" or "architectural" hypothesis of sinus formation with respect to vertical MS enlargement, and the variable cellular/OPN distribution found along the nasal and alveolar walls was evocative of Witmer's (J Vert Paleontol 1997;17:1-73) epithelial hypothesis in revealing that most expansion occurred in regions unopposed by adjacent structures.     

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.     

The dimensions of the tarsal sinus and canal in different foot positions and its clinical implications

This study presents a reference for the dimensions of the tarsal sinus and canal in healthy adults in different foot positions to facilitate understanding of the kinematics of the subtalar joint, the effect of an implant, and other clinical issues. In a 3D CT stress test on 20 subjects, the right foot was forced into a neutral and eight different extreme foot positions while CT scans were obtained. The bones were segmented in the neutral foot position. The kinematics of the bones in the extreme positions were determined relative to the neutral position. The dimensions of the tarsal sinus and canal were calculated by determining the radii of the maximal inscribed spheres at 20 equidistant locations along an axis in 3D surface models of the tali and calcanei in each foot position. The radii were small on the medial side and increased laterally. Medial from the middle, the radii were small and not significantly different among the various foot positions. At the lateral side, the dimensions were affected mainly by eversion or inversion and less by dorsiflexion or plantarflexion. The pattern was reproducible among subjects, but there were between‐subject differences. The dimensions are mostly determined by rotation in the frontal plane. A pivot point was found medial from the middle. These data serve as a reference and model for predicting the effect of sinus implants and understanding such clinical problems as sinus tarsi syndrome. Between‐subjects differences have to be taken into account. Clin. Anat. 30:1049–1057, 2017. © 2017 Wiley Periodicals, Inc.     

GIST: particular aspects related to cell cultures, xenografts, and cytogenetics

In less than half a decade, gastrointestinal stromal tumors (GIST) have emerged from historical anonymity to become a model of kinase-targeted therapies. Approximately 80% to 85% of GISTs harbor activating mutations of the KIT or PDGFRA tyrosine kinase genes, and such mutations have predictive and prognostic value. In this regard, the in vitro and in vivo models have provided valuable tools for understanding the molecular pathology of this interesting neoplasm. This review charts particular aspects in the field of cell cultures and tumor xenografts in nude mice in GIST and their implication in the establishment of appropriate models for discovering and testing therapy. The cytogenetic features of these tumors are also discussed. Classic karyotyping, loss of heterozygosity, fluorescent in situ hybridization, comparative genomic hybridization (CGH), and CGH-array analyses have shown that chromosomal numerical abnormalities and loss of genetic material at chromosomes 1p, 9p, 14q, and 22q are significantly associated with GIST malignancy and response to treatment. Furthermore, these regions constitute "hot" areas for finding candidate genes involved in the pathogenesis of GISTs. A deeper knowledge of these genetic aspects of GIST will provide a better understanding of this neoplasm that could translate into clinical practice.     

Primary small cell carcinoma of the maxillary sinus: a case report with immunohistochemical and molecular genetic study involving KIT and PDGFRA

Primary small cell carcinoma of the nose and paranasal sinuses is very rare; only a few reports are present in the English literature. The author herein reports a very rare case of primary small cell carcinoma of the maxillary sinus with an emphasis on immunohistochemistry and on KIT and PDGFRA. A 64-year-old man was admitted to our hospital because of left nasal obstruction. Endoscopy revealed three nasal polyps, and imaging modalities revealed an infiltrative tumor (45 x 45 mm) in the left maxillary sinus with invasion into nasal cavity. Multiple biopsies are taken from the nasal lesions. Histologically, the tumor consists of proliferation of malignant small epithelioid cells with hyperchromatic nuclei, fine chromatin, scant cytoplasm, molded nuclei, and absent nucleoli. Immunohistochemically, the malignant cells were positive for cytokeratin (CK) 18, synaptophysin, CD56, p53, Ki-67 (labeling=95%), bcl-2, KIT, and PDGFRA. However, they were negative for pancytokeratins, high molecular weight CK, CK5/6, CK7, CK 14, CK 19, CK20, vimentin, neuron-specific enolase, chromogranin, CD15, CD45, S100 protein, CEA, CA19-9, glial fibrillary acidic protein, neurofilaments, neuroblastoma, CD99, surfactant apoprotein A, melanosome, and TTF-1. The pathologic diagnosis was small cell carcinoma. A molecular genetic analysis using PCR-direct sequencing was performed using paraffin sections, and it showed no mutations of KIT (exons 9, 11, 13, and 17) and PDGFRA (exons 12 and 18) genes. Imaging modalities including CT, MRI and PET did not reveal any tumors, including the lung, other than the maxillary sinus tumor. The present case is the first of small cell carcinoma of the maxillary sinus with a comprehensive immunohistochemical examination and a gene analysis of KIT and PDGFRA.     

A new superfamily of cell surface proteins related to the nerve growth factor receptor.

In this article Susan Mallett and Neil Barclay discuss the molecular and functional features of a new superfamily of membrane proteins defined by the presence of cysteine-rich motifs originally identified in the low-affinity nerve growth factor receptor. This superfamily includes two lymphocyte proteins of unknown function and two receptors for tumor necrosis factor.     

The sinus nerve and baroreceptor input to the medulla of the cat.

Electrical stimulation within the medulla of cats revealed that myelinated primary afferent fibres of the sinus nerve terminated within the immediate vicinity of the tractus solitarius and its nucleus. 2. The activity of neurones within this area was also evoked on sinus nerve stimulation, although few (17%) were activated within a latency compatible with monosynaptic excitation. Additional projections over polysynaptic pathways have been shown to the parahypoglossal area and to the area of the nucleus ambiguus. 3. These three areas were shown to contain neurones whose activity was enhanced by stimulation of the baroreceptor endings of the ipsilateral carotid sinus. 4. No evidence for a projection of sinus nerve afferents to the medial reticular formation (an area extending medially from the hypoglossal nucleus and nerve tract and including the paramedian reticular nucleus) was obtained in either antidromic or orthodromic studies. 5. The organization of the central pathway of the carotid sinus baroreceptor reflex is discussed in the light of these results.     

Multiple IgG4-related sclerosing lesions in the maxillary sinus, parotid gland and nasal septum

IgG4-related sclerosing disease is recognized as a distinct clinicopathological entity. It is well known that this disease can occur in the salivary, lacrimal and pituitary glands, in the head and neck region. The nasal cavity is an extremely rare site of involvement of IgG4-related sclerosing disease. Herein is reported a case of multiple IgG4-related sclerosing lesions in the maxillary sinus, parotid gland and nasal septum. A 73-year-old Japanese man presented with nasal obstruction and tumors of the right maxillary sinus and parotid gland were detected, after which resections of these tumors were performed. One year after the last surgery, he noted swelling of the nasal septum, and the tumor was resected. These three tumors had similar histopathology, such as conspicuous fibrosclerotic changes with dense lymphoplasmacytic infiltration and occasional obliterative phlebitis. Immunohistochemistry indicated abundant IgG4-positive plasma cell infiltration and high ratios of IgG4-positive/IgG-positive plasma cells (>70%) in all three lesions. The diagnosis of multiple IgG4-related sclerosing lesions was made. The present case suggests that IgG4-related sclerosing lesion can occur in the maxillary sinus and nasal septum, and represents an extension of the spectrum of IgG4-related sclerosing disease.     

Connections between the facial, vestibular and cochlear nerve bundles within the internal auditory canal

The vestibular, cochlear and facial nerves have a common course in the internal auditory canal (IAC). In this study we investigated the average number of nerve fibres, the average cross-sectional areas of the nerves and nerve fibres, and the apparent connections between the facial, cochlear and vestibular nerve bundles within the IAC, using light and scanning electron microscopy. The anatomical localization of the nerves within the IAC was not straightforward. The general course showed that the nerves rotated anticlockwise in the right ear from the inner ear end towards the brainstem end and vice versa for the left ear. The average number of fibres forming vestibular, cochlear, and facial nerves was not constant during their courses within the IAC. The superior and the inferior vestibular nerves showed an increase in the number of nerve fibres from the inner ear end towards the brainstem end of the IAC, whereas the facial and the cochlear nerves showed a reduction in the number of fibres. This suggests that some of the superior and inferior vestibular nerve bundles may receive fibres from the facial and/or cochlear nerves. Scanning electron microscopic evaluations showed superior vestibular-facial and inferior vestibular-cochlear connections within the IAC, but no facial-cochlear connections were observed. Connections between the nerves of the IAC can explain the unexpected vestibular disturbances in facial paralysis or persistence of tinnitus after cochlear neurectomy in intractable tinnitus cases. The present study offers morphometric and scanning electron microscopic data on the fibre connections of the nerves of the IAC.     

与蝶窦冲洗及内窥镜术有关的蝶窦口应用解剖

目的：为蝶窦冲洗及内窥镜术提供解剖学基础。方法：在６０侧成人头部正中矢状切面标本上解剖、观测了蝶窦口等结构。结果：蝶窦口内径２．１±０．３ｍｍ，距鼻小柱前下缘５８．６±３．８ｍｍ，距鼻腔底３５．１±４．３ｍｍ，距颈内动脉海绵体部中段１８．９±２．０ｍｍ，距视神经１５．９±１．８ｍｍ。结论：进行蝶窦冲洗时应注意蝶窦口的位置、角度；进行蝶窦内窥镜手术时应注意蝶窦口与周围结构的关系。