Orthopantomography and its significance for the otorhinolaryngologist

Orthopantomography, i.e. a single radiograph producing a panorama-like view of the entire jaw, was originally developed for the diagnosis of dental diseases. Further developments have made this technique useful for routine ENT examination also. The main indications for orthopantomography in otorhinolaryngology are: diseases of the maxillary sinus (especially of the basal parts), fractures of the jaws, sialolithiasis, tumours of the oral cavity invading the jaw, osseous tumours and facial anomalies.     

Stability of grafts and implants after bone grafting of the maxillary sinus. Retrospective analysis of 44 patients

OBJECTIVES: We assessed the reliability of maxillary bone grafting and implant stability, comparing our results with reports in the literature. MATERIAL AND METHODS: This retrospective series included 44 patients who underwent maxillary sinus bone grafting between 1998 and 2002. An analogous graft was used for 31 patients and a combination autologous-bone substitute graft for 13. One hundred twelve dental implants were positioned at the grafting site (2.5 implants per graft). We assessed recipient site morbidity, bone graft integration and stability, and stability of the implants. RESULTS: Bone grafting was successful in 97.8% of patients. There was one failure. Two of the 112 implants failed. DISCUSSION: Our results are comparable with those in the literature. This study demonstrated the reliability of maxillary bone grafting with equivalent results using autologous bone and combination autologous bone-bone substitute.     

Prosthetic rehabilitation with dental implant in cleft lip and palate: a ten-year retrospective study

INTRODUCTION: Two problems need to be faced during cleft lip and palate surgical treatment to gain a functional and esthetic result: restoration of the maxillary bone defect and the missing lateral incisor tooth, which may be replaced by an implant. The aim of our study was to demonstrate that it is possible to successfully place a dental implant after obtaining adequate bone graft volume. PATIENTS AND METHOD: 12 consecutively treated patients were studied, 7 with unilateral and 5 with bilateral clefts, mean age 21.5 years, with an average follow-up of 5.5 years (range: 1-10 years). Various types of autogenous or alogenous bone grafts were performed to provide adequate bone volume for immediate or secondary implant placement. We studied the number of bone grafts needed to reach this target, and the number of implants placed, focusing on lateral incisor tooth replacement. RESULTS: Enough cleft bone volume for the implant was obtained in 9 out of 12 cases (75%). All endosseous implants placed in bone graft were successfully restored, 8 out of them for lateral incisor. Some surgical cases are described. DISCUSSION: Global improving of cleft lip and palate surgical treatment by implantology is now feasible. Maxillary defect bone grafting, often in several stages, is strictly necessary to place an implant but also to obtain a good cosmetic result in cleft repair. Length, direction, and cervical implant position have to be considered too. Reconstruction of mucosal anatomy also contributes to the end result.     

Mikrochirurgischer Beckenkammtransfer nach erfolgter Caldwell-Luc-Operation

The standard Caldwell–Luc procedure includes the removal of most of the maxillary sinus mucosa and the introduction of an inferior meatal antrostomy to promote sinus drainage. Pain, chronic relapsing inflammation and loss of volume are typical sequels of this procedure. Partial maxillary resection and iliac crest bone graft harvesting is a new concept and treatment option in such cases. The case of a 64-year-old woman who had previously undergone several unilateral sinus operations is presented. Fluorescein imaging was used to detect bone areas of low blood perfusion in the sinus walls. All affected bone and granulation tissue were removed. After resection, an iliac crest bone graft with vascular pedicle was performed to reconstruct the maxillary defect. Postoperative CT and scintigraphic imaging revealed a vital transplant. At the 10-month follow-up, no inflammation was observed and chronic pain was significantly reduced. The results clearly demonstrate that maxillary resection and iliac crest bone graft harvesting might be an option to treat severe cases of chronic sinusitis. Further prospective studies are necessary to confirm the advantages of this technique.     

Aneurysmal bone cyst of the maxillary sinus

Aneurysmal bone cyst is a cystic vascular osseous tumour which destroys and expands bone. The skeleton may be affected, the femur, tibia and the vertebral column being most commonly involved. It has previously been reported in the sphenoid sinus, this is the first reported case of such pathology in the maxillary sinus.     

正常成人上颌窦锥形束CT的影像学研究

目的：本研究将锥形束CT应用于上颌窦影像学参数的测量,并比较不同性别、左右侧上颌窦间不同参数的差异性。方法选择200例正常成人的头颅锥形束CT影像,导入InVivo Dental软件进行三维重建,测量上颌窦前后径、左右径、上下径、容积和眶下壁骨质厚度,并使用SPSS 11.5统计软件进行分析。结果双侧上颌窦组间比较,上颌窦左右径、前后径、上下径、容积和眶下壁骨质厚度的差异均无统计学意义（P均＞0.05）;在不同性别组间比较,双侧上颌窦上下径、右侧上颌窦左右径和双侧上颌窦容积的差异均有统计学意义（P均＜0.05）。而左侧上颌窦的左右径、双侧上颌窦的前后径和双侧眶下壁骨质厚度的差异均无统计学意义（P均＞0.05）。结论锥形束CT可用来测量上颌窦的影像学参数,为临床提供影像学解剖数据。     

Management of the orbital floor in silent sinus syndrome

BACKGROUND: Enophthalmos in a patient with an opacified hypoplastic maxillary sinus, without sinus symptomatology, describes the silent sinus syndrome. A current trend is to perform endoscopic maxillary antrostomy and orbital floor reconstruction as a single-staged operation. A two-staged approach is performed at our institution to avoid placement of an orbital floor implant in the midst of potential infection and allow for the possibility that enophthalmos and global ptosis may resolve with endoscopic antrostomy alone, obviating the need for orbital floor reconstruction. METHODS: A retrospective review identified four patients with silent sinus syndrome evaluated between June 1999 and August 2001. Patients presented to our ophthalmology department with ocular asymmetry, and computerized tomography (CT) scanning confirmed the diagnosis in each case. RESULTS: There were three men and one woman, with ages ranging from 27 to 40 years. All patients underwent endoscopic maxillary antrostomy. Preoperative enophthalmos determined by Hertel's measurements ranged from 3 to 4 mm. After endoscopic maxillary antrostomy, the range of reduction in enophthalmos was 1-2 mm. Case 2 had a preoperative CT scan and a CT scan 9 months after left endoscopic maxillary antrostomy. Volumetric analysis of the left maxillary sinus revealed a preoperative volume of 16.85 +/- 0.06 cm3 and a postoperative volume of 19.56 +/- 0.07 cm3. This represented a 16% increase in maxillary sinus volume postoperatively. Orbital floor augmentation was avoided in two patients because of satisfactory improvement in enophthalmos. In the other two patients, orbital reconstruction was performed as a second-stage procedure. There were no complications. CONCLUSION: Orbital floor augmentation can be offered as a second-stage procedure for patients with silent sinus syndrome. Some patients' enophthalmos may improve with endoscopic antrostomy alone.     

Tibial bone harvesting technique for filling maxillary bone gaps in implantology

We present an easy and quick technique of tibial bone grafting that can be used in maxillary bone losses, specially in implantology. The surgical technique is performed under general anaesthesia. A 1.5 cm skin incision is made on the anteromedial side of the tibia. Then the bone marrow can be approached through a cortical window drilled with a motorized trephine. At this stage, a disposable bone aspirator is used to collect the cancellous bone. At the end of the procedure, the periosteum, the subcutaneous tissues and the skin are sutured in three layers. The quantity of harvested cancellous bone varies from 18 to 30 cc. The procedure duration is about twenty minutes. The complication rate is low and the patients are able to walk a few hours after the procedure. They leave the hospital on the day after. Tibial bone harvesting is an alternative technique that can be chosen in cases with large bone defects. This tibial graft can be recommended because of its low morbidity, the quality of the bone and the short time duration of the procedure. Some details must be pointed out. A medial tibial surgical approach is for us better than a lateral approach because of its lower morbidity and because the bone is more superficial. The use of a motorized trephine is important to lift precisely the cortical bone window and because it is less traumatic than the hand trephine. The disposable bone aspirator is an excellent option to pick-up bone marrow with a minimum loss of bone material and in a shorter time.     

Atelectasis of the maxillary sinus: report of a case of acute onset

INTRODUCTION: Maxillary sinus atelectasis is a rare pathology, characterized by a retraction of the maxillary sinus walls associated with tenacious mucus secretions filling the antrum. The disease usually develops in a chronic fashion, leading progressively to enophthalmos. This is sometimes associated with diplopia and midfacial depression. In these typical forms, maxillary sinus ventilation (via a middle meatal antrostomy) stops progression to retraction, but usually cannot reverse the phenomenon, resulting in a specific surgical procedure on the orbital floor or on the anterior wall of the sinus. MATERIALS & METHODS: We describe a case of maxillary sinus atelectasis with enophthalmos and midfacial depression, which appeared suddenly in one week, without nasal or sinus related symptoms. A middle meatal antrostomy performed rapidly enabled us to observe a reversal of the atelectatic process with recovery of the sinus volume, correction of the enophthalmos and disappearance of the associated diplopia, without the necessity for an additional surgical procedure. It is, to our knowledge, the first case described with such a rapid evolution.     

A rare case of metastases to the maxillary sinus from sigmoid colon adenocarcinoma

Metastases of malignant tumors to the nasal cavity and paranasal sinuses are rare. A review of the world's literature reports only four cases of antral metastases from carcinoma of gastrointestinal tract. We present a case of a stenosing adenocarcinoma of the sigmoid colon with metastases within the maxillary sinus. The ENT physical examination revealed a mass involving the right alveolar ridge, the right hard palate. CT scan of the head and the neck showed a large and irregular mass involving the right maxillary sinus, the infratemporal fossa and the pterygoid muscles with resorption of the bone of the posterior portion of the right alveolar ridge and of the posterior wall of the right maxillary sinus. The neoplastic tissue showed marked positivity for CEA and expressed cytokeratin 20, confirming the diagnosis of metastases to the maxillary sinus from colorectal adenocarcinoma. When a differential diagnosis between a second primary tumor of the maxillary sinus and a metastasis has to be carried out, the gastrointestinal tract should be taken into account and detailed immunohistochemical should be performed.     

上颌窦三维立体形态与上颌窦炎关系的研究

目的:通过螺旋CT影像学研究,重建上颌窦的三维立体形态,探讨上颌窦炎症与上颌窦三维立体形态、容积和气化系数之间的关系。方法:对双侧上颌窦正常者、单侧上颌窦炎症及双侧上颌窦炎症者各50例(均为成年人)行鼻-鼻窦螺旋CT扫描,重建上颌窦的三维立体形态;测量并计算上颌窦的容积和气化系数,分析上颌窦三维立体形态、容积和气化系数与上颌窦炎的关系。结果:上颌窦炎组上颌窦形态不规则(凹陷、变形),容积为(14 971.86±360.93)mm3,气化系数为0.252±0.057;正常组上颌窦形态规则,容积为(15 018.64±473.36)mm3,气化系数为0.345±0.071;两组之间容积比较差异无统计学意义,气化系数比较差异有统计学意义。结论:上颌窦三维重建更加直观地描述了上颌窦的三维结构和立体形态;上颌窦炎症与上颌窦容积无相关性,而主要与上颌窦的三维立体形态及气化系数有关;上颌窦三维立体形态规则,气化系数>0.300,上颌窦发生炎症的概率较低;反之机会增大。成人炎症上颌窦可能来源于儿童及青少年期一个较大的上颌窦。     

Kieferh?hlenuntersuchung nach Sinusbodenelevation kombiniert mit autologer Onlay-Osteoplastik

BACKGROUND: Complication rates after sinus floor augmentation of up to 10% are mentioned in literature, often when heterologous bone implants are used. The aim of our retrospective study was to determine the complication rate involving the maxillary sinus of patients treated with autologous spongiosa. PATIENTS AND METHODS: In 46 patients with an absolute maxillary atrophy (61% female, 39% male, mean age 49 years), a sinus floor augmentation, if necessary combined with an onlay bone graft of the iliac crest, was performed. Implants (Br?nemark) were placed in a two-stage procedure after 3-6 months. Prior to surgery, a panoramic film was made for diagnosis and treatment planning; in addition, a sinus X-ray was taken when disease of the maxillary sinus was suspected. panoramic radiography was routinely taken after surgery. A clinical and radiological follow-up examination was performed after 6-12 months, and the patients answered a questionnaire. This study also included evaluation of operation reports and case histories. Ultrasound as well as magnetic resonance imaging to prevent radiation exposure were performed additionally. RESULTS: In spite of perforation of the maxillary sinus mucosa in about 25%, removal of the bone graft due to inflammation was not necessary. A transient sinusitis developed in 2%. The implant loss rate (3 out of 154) may be called small. DISCUSSION: Even though alternative heterologous graft materials exist, maxillary sinus floor elevation with autologous bone graft is still a safe option. Changes of the maxillary sinus are detectable in a small percentage, relatively often due to preexisting unrecognized or subclinical diseases of the maxillary sinus. Magnetic resonance imaging is, in spite of the high financial and technical effort required, a serious alternative to computed tomography. The combination of autologous bone graft with calcium phosphate ceramics, platelet-rich plasma, or synthetic bone growth factors should be tested as an alternative treatment method.     

Endoscopic sinus surgery for unilateral chronic sinusitis]

Functional endoscopic sinus surgery has become an increasingly popular treatment for chronic sinusitis. This approach is aimed at re-establishment of ventilation and mucociliary clearance of the sinuses. However, some otolaryngologists believe that the Caldwell-Luc procedure should be routinely used for unilateral chronic sinusitis, because it is often associated with the maxillary sinus carcinomas. To evaluate the state of endoscopic sinus surgery for the diagnosis and treatment of unilateral chronic sinusitis, we analyzed the cases of 39 patients with unilateral chronic sinusitis who underwent endoscopic sinus procedures. These patients were unresponsive to appropriate antibiotic management for more than 6 months. Generally, endoscopic ethmoidectomy and antrostomy were performed with preservation of the middle turbinate. After the ostium was enlarged, the maxillary sinus was cleaned and carefully inspected for the presence of associated neoplasms using 30 and 70 degree endoscopes. Preoperative computed tomography (CT), postoperatve pathologic diagnosis, fiberscopic findings of the maxillary sinus, and symptomatic improvement were evaluated. Three patients had CT evidence of bone destruction of the lateral nasal wall. Pathological diagnosis demonstrated that three patients had maxillary sinus mycoses caused by Aspergillus species, one patient had inverted papilloma, and the other 35 patients had chronic sinusits. No associated malignancy was found. Eighty-one percent of the patients had almost normal endoscopic findings of the maxillary sinus by postoperative fiberscopic examination 4 to 8 months following surgery. With an average follow-up of 26 months, 88% of the patients were judged as having significantly improved in their presenting complaints of mucopurulent rhinorrhea, nasal obstruction, and facial pain. The results of this series suggest that endoscopic sinus surgery is an effective procedure for the diagnosis and treatment of unilateral chronic sinusitis.     

A rare complication of functional endoscopic sinus surgery: maxillary atelectasis-induced spontaneous enophthalmos

BACKGROUND: The first case report of spontaneous enophthalmos due to maxillary atelectasis as a late complication of FESS is presented. METHODS: Chart review of a 24-year-old male who developed a left progressive enophthalmos within three months post bilateral functional endoscopic sinus surgery. RESULTS: The preoperative computed tomography showed a normal left maxillary sinus. The postoperative computed tomography revealed a left maxillary atelectasis with a descending orbital floor. The subject received revised endoscopic sinus surgery and his enophthalmos was stable without further progression after the operation. CONCLUSIONS: This may have been caused by an ostium occlusion with retention of secretions inducing sinus inflammation, osteolytic activity, and osseous remodeling of the sinus walls. A negative pressure may develop. When the pressure gradient exceeds the sinus wall tension, maxillary atelectasis and enophthalmos occur. Prevention of this complication of FESS should include making a patent naso-antral window, minimizing mucosal trauma, and careful postoperative sinoscopic treatment. A "functional" sinus is the goal.     

Unilateral pathological lesions of paranasal sinuses removed by endoscopic surgery

Introduction

The aim of this study was to analyze the incidence and nature of unilateral pathological lesions of paranasal sinuses in patients who had endoscopic sinus surgery performed in ENT. Materials and methods: In the years 2006–2011 endoscopic sinus surgery for unilateral pathological lesions of paranasal sinuses was performed in 1847 patients (838 women and 1009 men). The enrollment of patients was based on the findings of otolaryngological clinical and subjective examinations, assessment of the paranasal sinuses on three-dimensional CT scans, and laboratory examinations. Based on the analysis of medical history data, including gender, age, the type of surgical procedure performed, and histopathological findings the cases were finally analyzed.

Results

Pathological lesions of the paranasal sinuses were localized on the left side in 132 (57%) patients, and on the right side in 100 (43%) patients. Of the 232 patients with unilateral pathological changes, 41.8% subjects underwent endoscopic sinus surgery for polypotic changes in the ethmoid and maxillary sinuses; 28.4% for the maxillary sinus; 10.8% for the ethmoid, maxillary and frontal sinuses; and 8.6% patients for all paranasal sinuses on one side. The number of operations of only one sinus was considerably lower: sphenoid sinus, 4.7%; ethmoid sinus, 2.2%; and frontal sinus, 1.7% patients. The histopathological analysis of unilateral pathological lesions removed by endoscopic surgery showed chronic paranasal sinusitis with polyps in 56.5% patients; chronic paranasal sinusitis in 22.8% patients; and maxillary sinus cyst was confirmed in 11.6% patients. In 5.1% patients inverted papilloma was diagnosed and in 2.2% patients the presence of osteoma was found.

Conclusions

Unilateral paranasal pathological lesions, leaving aside rather typical maxillary sinus cysts, require a particularly thorough pre-operative diagnosis and a precise histopathological assessment.     

Endoscopic endonasal surgery for paranasal sinus mucoceles

Paranasal sinus mucoceles are benign, space-occupying, cystic lesions that require a surgical treatment. An endoscopic endonasal marsupialisation is nowadays the surgical approach of choice in most of the cases. The aim of the present study is to validate this option and to determine the clinical characteristics of paranasal sinus mucoceles. A retrospective study based on the clinical experience of several ENT surgeons was performed using a standardised questionnaire. The respondents participate to a report on endoscopic endonasal surgery for non-inflammatory disease in Belgium. One hundred and fourty patients presenting 178 mucoceles were included in this study. Primitive mucoceles were reported in 35% of the patients, posttraumatic mucoceles in 2.1% and postoperative mucoceles in 62.9%. The time interval between first rhinologic procedure and the mucocele diagnosis was respectively 24.4 months after FESS and 108.3 months after an external procedure. Paranasal sinus mucoceles predominantly occur in the fronto-ethmoidal region (64%), followed by the maxillary sinus (18.6%), the sphenoid sinus (8.4%) and the posterior ethmoid sinus (6.7%). Uncommon locations were also reported in 2.3% (Inferior turbinate, middle turbinate, pterygomaxillary space). Endoscopic endonasal marsupialisation (combined with an external procedure for 8 patients) was successful in 97.9% of the patients. Only 3 patients showed recurrence. Endoscopic endonasal marsupialisation of paranasal sinus mucoceles is a reliable therapeutic option with favorable results and is supported by the questioned ENT surgeons in Belgium.     

Entzündungsübertragung zwischen Kieferhöhle und Endokranium

BACKGROUND: Rhinogenous brain abscesses usually originate from a frontal sinusitis, rarely from the ethmoidal system or the maxillary sinus. However, there are different pathways that can lead to the transfer of a maxillary infection to the endocranial compartment. PATIENT: A patient with frontal brain abscesses originating from a maxillary sinus infection is presented and diagnostic steps, therapy as well as pathophysiology are discussed. PATHOPHYSIOLOGY: The venous plexus of the maxillary sinus drains through the posterior wall of the antrum of Highmore into the deep facial vein that leads into the pterygoid plexus and then through the rete foraminis ovalis into the cavernous sinus. In addition, numerous small veins perforate the osseous roof of the maxillary sinus and enter the orbit joining the superior or inferior ophthalmic vein. They are also connected to the cavernous sinus or the pterygoid plexus. A number of veins perforate the anterior wall of the maxillary sinus communicating with the angular vein that drains into the superior ophthalmic vein and into the cavernous sinus. From the cavernous sinus, the blood arrives at the deep middle cerebral vein that usually communicates through the white substance towards the brain's superficial venous system. CONCLUSION: The presence of these maxillo-cerebral venous anastomoses explains the spread of infection from the maxillary sinus to the white substance of the brain without any direct association with the base of the skull.     

Presentation and diagnosis of unilateral maxillary swelling in children

Facial asymmetry secondary to pathologic processes involving the maxillary sinus and its surrounding structures presents a challenge for the clinician. An organized approach to evaluate these patients is essential in order to differentiate inflammatory sinus pathology from disease processes primarily involving the surrounding maxilla, parotid gland, orbital contents, and dental structures. In addition to a thorough history and physical examination, appropriate imaging studies must be obtained to localize the pathologic processes and develop a meaningful differential diagnosis. Once this is accomplished, specific treatment modalities can be developed. Representative cases will be presented to illustrate this organized approach to unilateral maxillary swelling, including soft tissue and osseous masses, fibro-osseous lesions, osseous cysts and inflammatory lesions.     

家族性鼻腔底额外牙含牙囊肿1例及文献复习

患者，男，11岁。左上唇部及鼻旁隆起1个月余，伴鼻塞，无鼻出血．无头痛及牙痛。曾在外院以“鼻前庭炎”药物治疗效果不佳，于2012年1月12日来我院就诊。     

导航鼻内镜下上颌窦良性骨性病变的治疗体会

目的 探讨经导航鼻内镜下切除上颌窦良性骨性病变的治疗体会。方法 回顾分析2005年10月至2010年1月治疗的上颌窦良性骨性病变8例的临床资料,术前行64排CT并三维重建,全部病例采用导航引导下手术切除,包括鼻内镜联合柯-陆氏径路及鼻内镜下经鼻下鼻道开窗径路。结果 3例为上颌窦内骨纤维异常增生症,5例为骨瘤,均在导航引导鼻内镜下成功切除了病变,其中6例经柯-陆氏径路切除病变,2例经鼻下鼻道开窗切除病变。随访半年以上,7例术后头痛、鼻塞、流脓涕、面部不适等症状逐渐消失,1例上颌窦内骨纤维异常增生症患者术后2月再次出现面部肿胀疼痛,保守治疗效果不佳,再次手术,发现上颌窦内有大量死骨,考虑为第1次手术后术腔未冲洗干净,导致上颌窦口堵塞,再次手术后症状消失。患者术后均未见复发。结论 影像导航系统可以准确迅速的确定病变位置,导航鼻内镜下上颌窦良性骨性病变切除是准确、安全、微创的手术方式。