Cholesterol Granuloma of the Maxillary Sinus Encountered during Floor Augmentation Procedure: A Case Report

Background: Cholesterol granuloma (CG) is a foreign‐body reaction to the deposition of cholesterol crystals. Its occurrence in the paranasal sinuses is very rare. Purpose: This report describes a new case of maxillary sinus CG discovered incidentally during sinus‐floor augmentation for dental implant placement in a 60‐year‐old female patient. Materials and Methods: The preoperative clinical and radiological examinations revealed a normal maxillary antrum with no evidence of sinus pathology. After lateral osteotomy, a dark‐green, viscous soft tissue mass appeared through the thin mucous membrane inside the sinus. Enucleation and curettage of the sinus contents including the sinus membrane were performed for histopathologic analysis. The augmentation and implant placement procedures were postponed. Results: Histopathologic analysis showed several fragments of granulation tissue containing diffuse cholesterol clefts surrounded by mixed chronic inflammatory cell infiltrate including plasma cells and lymphocytes. These features were compatible with the diagnosis of CG. The patient was followed up for 3 months after the first procedure, and a second attempt of sinus augmentation and dental implant insertion was then carried out. The inserted dental implants were followed up for 6 months without any complications. Conclusions: CG of maxillary sinus can be an incidental finding. For this reason, the final diagnosis can only be achieved after examination of the material under the microscope.     

Malignant tumor involving paranasal sinuses

Carcinoma of the paranasal sinuses is a very serious disease, but its incidence is lower than that of any other oral malignancy. Failure to diagnose it early because of misleading symptoms resembling sinusitis usually leads to its detection at a stage when it has already destroyed the bony walls of the sinus and has spread to surrounding structures (infratemporal fossa, posterior ethmoid cells, orbit, cribriform plate, nasopharynx, sphenoid sinus or base of the skull). It is uncommon for this cancer to spread to the regional lymph nodes as long as it remains confined within the maxillary sinus. CT scanning provides an accurate assessment of the extent of resection required and is usually used as an indicator of operability. A 56-year-old man with a chief complaint of palatal swelling, pain and pus discharge was referred to Seoul National University Dental Hospital. Orthopantomogram and Waters' view revealed an aggressive bone destruction in the right maxillary molar area, ipsilateral sinus opacification and destruction of the lateral wall of the maxillary sinus. The CT fidding showed that the right maxillary sinus was occupied by a soft tissue mass which represented a central low density, with an irregular shape at some levels. The tumor mass also involved the pterygopalatine fossa, right esthmoid sinus, nasal cavity and hard palate. Incisional biopsy was done and the biopsy report was squamous cell carcinoma. He was transferred to Internal Medicine for chemotheraphy because of inoperability.     

Accidental displacement and migration of endosseous implants into adjacent craniofacial structures: A review and update

Objectives: Accidental displacement of endosseous implants into the maxillary sinus is an unusual but potential complication in implantology procedures due to the special features of the posterior aspect of the maxillary bone; there is also a possibility of migration throughout the upper paranasal sinuses and adjacent structures. The aim of this paper is to review the published literature about accidental displacement and migration of dental implants into the maxillary sinus and other adjacent structures. Study Design: A review has been done based on a search in the main on-line medical databases looking for papers about migration of dental implants published in major oral surgery, periodontal, dental implant and ear-nose-throat journals, using the keywords "implant," "migration," "complication," "foreign body" and "sinus." Results: 24 articles showing displacement or migration to maxillary, ethmoid and sphenoid sinuses, orbit and cranial fossae, with different degrees of associated symptoms, were identified. Techniques found to solve these clinical issues include Cadwell-Luc approach, transoral endoscopy approach via canine fossae and transnasal functional endoscopy surgery. Conclusion: Before removing the foreign body, a correct diagnosis should be done in order to evaluate the functional status of the ostiomeatal complex and the degree of affectation of paranasal sinuses and other involved structures, determining the size and the exact location of the foreign body. After a complete diagnosis, an indicated procedure for every case would be decided.     

Accidental displacement and migration of endosseous implants into adjacent craniofacial structures: A review and update

Objectives: Accidental displacement of endosseous implants into the maxillary sinus is an unusual but potential complication in implantology procedures due to the special features of the posterior aspect of the maxillary bone; there is also a possibility of migration throughout the upper paranasal sinuses and adjacent structures. The aim of this paper is to review the published literature about accidental displacement and migration of dental implants into the maxillary sinus and other adjacent structures. Study Design: A review has been done based on a search in the main on-line medical databases looking for papers about migration of dental implants published in major oral surgery, periodontal, dental implant and ear-nose-throat journals, using the keywords “implant,” “migration,” “complication,” “foreign body” and “sinus.” Results: 24 articles showing displacement or migration to maxillary, ethmoid and sphenoid sinuses, orbit and cranial fossae, with different degrees of associated symptoms, were identified. Techniques found to solve these clinical issues include Cadwell-Luc approach, transoral endoscopy approach via canine fossae and transnasal functional endoscopy surgery. Conclusion: Before removing the foreign body, a correct diagnosis should be done in order to evaluate the functional status of the ostiomeatal complex and the degree of affectation of paranasal sinuses and other involved structures, determining the size and the exact location of the foreign body. After a complete diagnosis, an indicated procedure for every case would be decided. Key words:Implant, oral surgery, foreign body, paranasal sinuses, displacement, migration.     

Usefulness of CT images for diagnosis of odontogenic maxillary sinusitis

To assess the usefulness of CT images for the diagnosis of suspected odontogenic maxillary sinusitis, 52 patients with maxillary sinusitis who had received CT examination were retrospectively analyzed. maxillary sinus ostium was established on coronal CT image in 20 out of 55 lesions in those 52 patients. However, a considerable number of patients who had inflammatory disease not only in the maxillary sinus but also in other paranasal sinuses (38/55) or in the nasal meatus (34/55) were included in those 52 patients. Concerning the opening of the ostium, the clinical diagnosis is frequently different from the diagnosis made using CT. The CT findings of the maxillary sinus ostium, nasal meatus and other paranasal sinuses were thus important in planning the treatment for patients with maxillary sinusitis in dentistry, as in otorhinolaryngology.     

An interesting reason for chronic sinusitis: firearms injury

Various kinds of etiological factors play a role in chronic sinusitis, and foreign bodies in the sinuses are one of the etiological factors. A 44-year-old man attended our outpatient clinic with complaints of headache, nasal congestion, and postnasal drainage. He had a history of gunshot accident 1 year ago, and his paranasal computed tomography revealed a bullet-shaped, radiopaque foreign body in the right maxillary sinus floor. With the patient under general anesthesia, the foreign body was removed endoscopically. One year after the surgical removal, the patient became free of nasal symptoms.     

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.     

The management of complications following displacement of oral implants in the paranasal sinuses: a multicenter clinical report and proposed treatment protocols

This study retrospectively analyses paranasal sinus complications following displacement of oral implants in the maxillary sinus treated according to clinical situation by functional endoscopic sinus surgery (FESS), an intraoral approach, or a combination of both procedures. Over 5 years, 27 patients (13 male; 14 female), aged 27–73 years (mean 53.9 years), underwent treatment for postoperative complications involving the paranasal sinuses following displacement of oral implants in the maxillary sinuses. According to the complication (implant displacement, implant displacement with or without reactive sinusitis and/or with or without associated oro-antral communication), patients were treated with FESS, intraoral approach to the sinus, or FESS associated with an intraoral approach. Follow up lasted for at least 1 year with clinical and radiographic controls. 26 patients recovered completely; one patient underwent re-intervention with FESS and an intraoral approach 2 years after implant removal, due to persistent signs and symptoms of maxillary sinusitis and oro-antral communication. Postoperative recovery after the second procedure was followed by complete recovery. The results demonstrate that a rational choice of surgical protocol for the treatment of complications involving the paranasal sinuses following displacement of implants in the maxillary sinuses may lead to reliable results.     

Outpatient Endoscopic Removal of Gutta-Percha From the Maxillary Sinus Using a Sublabial Antroscopy: A Rare Entity

Any foreign body in the paranasal sinuses can cause chronic complications. It is therefore important to remove these foreign bodies meticulously. Various approaches are available to accomplish this. This article is a case report of a patient who had gutta-percha as a foreign body in left maxillary sinus, after a gutta-percha point had been used to trace a sinus to confirm that it was an oroantral fistula. Traditional surgical approaches to the maxillary sinus require invasive techniques, such as radical antrostomy and the Caldwell–Luc approach. These may result in further complications and morbidity. The gutta-percha point in this case report was removed endoscopically in an otolaryngology clinic with local anaesthesia using a sublabial antroscopy. There is only one case reported in the dental literature regarding the endoscopically-assisted technique for removal of displaced gutta-percha using the sublabial antroscopy approach (Yura S, Ohga N, Ooi K, Izumiyama Y. Procedure of endoscopic removal of a gutta-percha point in maxillary sinus mucosa by ultrathin arthroscope. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;104:e58–60).     

Endoscopic removal of a dental implant through a middle meatal antrostomy

Ear nose and throat surgeons use endoscopic operations on the sinuses not only for chronic paranasal sinusitis but also for other operations. We report the case of a 52-year-old woman in whom we used an endoscopic technique to remove a dental implant that had been displaced into the maxillary sinus. We approached the sinus through the natural ostium, and the foreign body was removed through the widened ostium.     

Removal of displaced foreign body from the maxillary sinus using replaceable bony windows and saline irrigation, followed by suctioning of the foreign body

Various surgical techniques for the removal of a foreign body from maxillary sinuses have been reported. However, the access window in the lateral wall of the maxillary sinus cavity is not replaced by a bony wall when sinus grafting is not performed. The replaceable bony window provides an access window into the sinus cavity and maintains the integrity of the lateral wall of the sinus cavity after the removal of a foreign body from the sinus. Saline irrigation and suction are simple and quick techniques to remove foreign bodies from the sinus. This technique does not require special equipment, including that of endoscopy.     

Aspergillus mycetoma of the maxillary sinus secondary to overfilling of a root canal

In nonimmunocompromised patients aspergillosis of the paranasal sinuses is a relatively rare disease. Root canal treated teeth with overextension of the root canal sealer or solid materials such as gutta-percha or silver cones into the sinus might be the main etiological factor for aspergillosis of the maxillary sinus in healthy patients. Root-filling materials based zinc oxide-eugenol is considered to be a growth factor for aspergillus. Aspergillus fumigatus needs heavy metals such as zinc oxide for proliferation and metabolism. Prognostic and histological studies showed that instrumentation and obturation should not extend beyond the apical foramen. When the sealer and/or gutta-percha is extruded within the sinus, this produce an inflammatory reaction and then Aspergillus growth. We report one case of healthy 60-yr-old male with overextension of root canal sealer in maxillary sinus. After surgical procedure, microscopic examination revealed aspergillosis. Overextension into the maxillary sinus with root canal cements has to be avoided.     

Respiratory epithelial adenomatoid hamartoma of the maxillary sinus presenting as a periapical radiolucency: a case report and review of the literature

We report a case of respiratory epithelial adenomatoid hamartoma of the left maxillary sinus that initially presented as a periapical radiolucency involving the left maxillary first molar. Respiratory epithelial adenomatoid hamartoma is a rare lesion that occurs in the nasal cavity, paranasal sinuses, and nasopharynx. Most cases are found in the nasal cavity associated with the posterior nasal septum. Involvement of the maxillary sinus is very unusual, and only one other report of a respiratory epithelial adenomatoid hamartoma involving the maxillary antrum was found in a search of the literature. The current case is additionally unique as it was initially detected in the course of a dental examination. Awareness of this lesion is important because inverted schneiderian papilloma and adenocarcinoma may be included in the histopathological differential diagnosis. Conservative surgical removal is curative and recurrence has not been reported.     

Fremdkörper in den Nasennebenhöhlen

Aims. All cases of the last 5 years requiring foreign bodies to be removed from the paranasal sinuses were investigated as to causes, special aspects in diagnostics and therapy, occurrence of pathologic germs and possible sequels. Patients. 68 cases were evaluated: 43 patients were male, 25 female. Average age was 29 years in males and 37 years in females. Results. In our patients foreign bodies in the paranasal sinuses were in more than 60% the result of medical or dental procedures followed by industrial accidents (25%). The maxillary sinus was affected in 75%, the frontal sinus in about 18%. Involvement of the ethmoid or sphenoid sinus was rare. The spectrum of pathologic microbes was dominated by mixed infections, the share of actinomyces and aspergillus was unexpected high. Most important acute complications were bleeding, compression of the optic nerve and liquorrhoe. Late complications consisted mainly of pain – often associated with disturbances of sensibility- and infections. Conclusions. A smear should be taken whenever the foreign body remained in the sinus for more than 4 days. Foreign bodies jammed in the posterior wall of the sinus require a sufficiently open view since the risk of heavy bleeding is especially high.     

Incidental maxillary sinus findings in patients referred for head and neck CT angiography

BackgroundMaxillary sinus pathology is a common finding on routine CT scans of the head and neck. The purpose of this study was to assess the incidental findings in the maxillary sinus on CT scans in patients who presented for head and neck CT angiography.Study designImages of patients referred for head and neck CT angiography were reviewed over a 5-month period. All maxillary sinus incidental findings were recorded and categorised into mucosal thickening, polypoid mucosal thickening, partial and total opacification. The age and gender of the patients and the side of mucosal pathology was also recorded.ResultsA total of 262 CT scans were reviewed (524 maxillary sinuses). Seventy-two patients had pathological changes (27.5%), 44 (16.8%) had mucosal thickening, 20 (8.0%) had polypoid thickening, 6 (2.3%) had partial and another 7 (2.7%) had complete opacification.ConclusionsThere is a high rate of undiagnosed maxillary sinus pathology incidentally found on CT scans. Clinicians reviewing head and neck CT scans such as dentists, general medical practitioners, maxillofacial and ENT surgeons should be vigilant and aware of maxillary sinus disease when interpreting CT scans of the maxilla and patients should be followed up appropriately.     

Mesenchymal phosphaturic neoplasm in the maxillary sinus: a case report

The authors describe a case of oncogenic osteomalacia due to a mesenchymal phosphaturic tumour in the maxillary sinus. This is a paraneoplastic syndrome in which a tumour produces a peptide hormone-like substance (phosphatonin) that causes a urinary loss of phosphates resulting in a debilitating systemic condition. In this case, the patient experienced muscle stiffness, reduction of muscle tone, loss of weight and pathological fractures. Clinical and radiological examination revealed a tumour in the right maxillary sinus; all other results were negative. The diagnosis following pathology examination was mesenchymal phosphaturic tumour with a haemangiopericytoma-like vascular pattern. Different histological types of mesenchymal tumours can be associated with paraneoplastic syndrome, but their localization in the paranasal sinuses is rare. The correct diagnosis allows the appropriate therapeutic approach, which can lead to an almost immediate resolution of the clinical situation after surgical removal of the neoplasm as in the present case. Oncogenic osteomalacia is rare, particularly in the maxillofacial region, and only a few cases have been reported.     

Foreign body in the sphenoid sinus.

Foreign bodies in the paranasal sinuses, especially in the sphenoid sinus are uncommon. We report a rare case of a foreign body in the sphenoid sinus after an occupational accident.     

Traumatic subcutaneous emphysema of the face associated with paranasal sinus fractures: a prospective study.

PURPOSE: The purpose of this report was to review and analyze the epidemiologic features of traumatic subcutaneous emphysema (TSE) originating from frontal, nasoethmoidal, and maxillary facial injuries with sinusal involvement in the emergency room setting. PATIENTS AND METHODS: All patients with a fracture involving the paranasal sinuses were evaluated with regard to TSE occurrence. Data analysis extended to gender, age, etiology, fracture sites, TSE location, sinus involvement, treatment, and complications from April 1999 to December 2003. Evaluation methods included computed tomography scan and clinical evaluation. RESULTS: A total of 390 patients sustaining 458 paranasal sinus fractures were included. TSE was observed in 29 patients (7.43%) patients (male-female ratio of 3.83:1, with a mean age of 36.71 +/- 15.71 years). The main etiologies were vehicle accidents and assaults. Isolated maxillary sinuses fractures were found in 17 cases (58.62%). Ethmoidal and maxillary fractures were associated with 9 cases (31.03%), and 1 (3.45%) case had maxillary and frontal fractures together. Ethmoidal, maxillary, and frontal fractures were found concomitantly in 2 (6.90%) cases. Periorbital emphysema was the most prevalent site of presentation, and edema (86.21%) and bone deformities (79.31%) were the most frequent findings associated with TSE. Conservative treatment was the prevalent treatment choice (55.17%), and 1 complication because of persistent pain was noted. CONCLUSION: The results suggest that TSE of the face associated with paranasal sinus fractures maintained the clinical features of its fractures of origin. The ethmoidal sinuses were considered as the most prevalent etiologic site, and the periorbital region was responsible for addressing the higher incidence of SE following paranasal sinus fractures.     

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.     

Carcinoma of the maxillary sinus: report of case.

A well-documented case of undifferentiated carcinoma of the right maxillary sinus has been presented. Results of initial evaluation and examination were consistent with an acute ulcer, but complete resolution did not occur when the denture was removed. Expansion of the buccal vestibule became evident, and biopsy was done. The expansion probably caused increased pressure under the denture flange, resulting in ulceration. As is so common in malignancy of the maxillary sinus, symptoms did not appear until late in the course of the disease and diagnosis was not made until the tumor was inoperable. Moreover, the initial symptoms were unusual for a tumor of the maxillary sinus. Conventional panoramic radiographs did not show any significance changes, although an advanced tumor had destroyed the lateral wall of the maxilla as confirmed on the Waters projection. We suggest that the panoramic oral radiograph is a valuable tool in evaluating disease of the maxillary sinus but that it does not replace the conventional views used to evaluate the paranasal sinuses.