Minimally invasive endoscopic maxillary sinus lifting and immediate implant placement: A case report

BACKGROUND This case report discusses a modified approach for maxillary sinus augmentation,in which platelet-rich fibrin,endoscope,simultaneous implant placement,and sinus floor elevation(PESS)were applied for a maxillary sinus floor lift in a 40-year-old patient.CASE SUMMARY A 40-year-old woman suffered missing upper right first molar.Implant stability quotient and cone-beam computed tomography(CBCT)were used to evaluate the diagnosis.CBCT showed insufficient posterior maxillary bone with a mean residual alveolar bone height of only 3.5 mm.The patient underwent a minimally invasive sinus floor elevation endoscopically.The sinus membrane was elevated in two stages,and a 12-mm implant was placed immediately.At 3 mo postoperatively,the final impressions were accomplished,and a full-ceramic crown was fit-placed.A 6-mo follow-up demonstrated satisfactory aesthetic and functional results.CONCLUSION This is the first report to use an endoscope for maxillary sinus floor lifting in cases with severe and insufficient bone height.This case report demonstrates the advantages of the PESS technique,which include minimal invasiveness with high precision,being applicable in cases with a residual alveolar bone height<4 mm with a promising result,and a shortened treatment period from 12 to 3 mo.     

Minimally invasive maxillary sinus augmentation with simultaneous implantation on an elderly patient: A case report

BACKGROUNDIn this case study, a minimally invasive transalveolar approach using platelet-rich fibrin and bone substitute with simultaneous implantation was carried out in an elderly patient. We analyzed the cone-beam computed tomography (CBCT) findings to evaluate bone regeneration.CASE SUMMARYA 65-year-old female with no contraindications for dental implants and loss of maxillary bilateral molars is described. Examination by CBCT showed the available vertical bone height in the bilateral posterior maxilla was 0.5-6.8 mm in the left and 2.8-6.5 mm in the right. The patient underwent a transalveolar approach using platelet-rich fibrin and bone substitute with simulataneous placement of an implant 10 mm in length. Six months post-surgery, the implant showed excellent osseointegration with the bone graft. Thereafter, full-ceramic crowns were fitted. Follow-up at 2 years demonstrated satisfactory prognosis.CONCLUSIONPlatelet-rich fibrin and bone substitute can be used to augment the maxillary sinus with a vertical bone height less than 4 mm.     

Diverticulum of the buccal mucosa: A case report

BACKGROUND A diverticulum is the medical or biological term for outpouching of a hollow structure in the body.It particularly occurs in the digestive system,but rarely occurs in the oral mucosa.CASE SUMMARY This report describes a rare case of diverticulum presenting in the buccal mucosa in a 44-year-old woman that was initially diagnosed in Stomatology Hospital,Wuhan University.We made our diagnosis under the guidance of imaging data,and the patient underwent surgical resection.CONCLUSION This report is the first confirmed case of buccal mucosal diverticulum.in addition,we elucidated that in general,idiopathic developmental abnormalities caused by succinate muscle defects are responsible for diverticulum development.     

Lung adenocarcinoma metastasis to paranasal sinus: A case report

BACKGROUNDLung cancer is often metastasized to the brain, liver, kidneys, bone, bone marrow, and adrenal glands; however, metastasis of primary lung cancer to the paranasal sinuses is extremely rare.CASE SUMMARYIn this paper, we present a case of metastatic tumors of the sinus secondary to lung adenocarcinoma. The patient was a 46-year-old woman who underwent surgical removal of lung carcinoma. Four months after the surgical removal of the lung tumor, the patient presented with epistaxis, and on investigation, the diagnosis was confirmed to be nasal sinus tumors due to metastasis of lung adenocarcinoma. CONCLUSIONThorough investigation of patients with epistaxis and a history of lung cancer is necessary to diagnose metastatic sinus tumors. We reviewed relevant literature and found that there are no characteristic clinical or radiologic features for metastatic sinus tumors; however, the diagnosis can be confirmed by histopathological examination of biopsied tumor sample.     

Primary intramedullary melanocytoma presenting with lower limbs,defecation, and erectile dysfunction: A case report and review of the literature

BACKGROUNDPrimary intramedullary melanocytoma is an exceedingly rare type of primary melanocytic tumor in the central nervous system. Unfortunately, primary intramedullary melanocytoma lacks specificity in clinical symptoms and imaging features and there is currently no standard strategy for diagnosis or treatment.CASE SUMMARYA 52-year-old male patient suffered from weakness and numbness involving the bilateral lower limbs for 18 mo, and defecation and erectile dysfunction for 6 mo. Furthermore, these symptoms started to worsen for the last 3 mo. Preoperative magnetic resonance imaging (MRI) revealed an intramedullary tumor located at the T9-T10 level. In subsequently surgery, the maximal safe resection extent approached to 98%. The lesion was confirmed to be melanocytoma by pathological examination. In addition, the possibility of original melanocytoma outside the spinal cord was excluded after the examination of the whole body. Therefore, a diagnosis of primary intramedullary melanocytoma was established. The patient refused to accept radiotherapy or Gamma Knife, but MRI examination on July 28, 2020 showed no sign of development. In addition, on April 10, 2021, the recent review showed that the disorder of defecation and lower limbs improved further but erectile dysfunction benefited a little from the surgery.CONCLUSIONAfter diagnosing intramedullary melanocytoma by postoperative pathology, the inspection of the whole body contributed to excluding the possibility of metastasis from other regions and further suggested a diagnosis of primary intramedullary melanocytoma. Complete resection, adjuvant radiation, and regular review are critical. In addition, maximal safe resection also benefits prognosis while the tumor is difficult to be resected totally.     

Paranasal sinus pathologies in patients presenting with headache as the primary symptom

Headache is a frequent symptom of lesions in the paranasal sinuses. Although some inflammatory symptoms are suggestive of pathologies of the paranasal sinuses, occasional headache is sometimes the major presenting symptom. In a retrospective study, we examined the chart histories of 36 patients presenting for treatment at our hospital from 1 January 1992 to 30 June 2001 who were diagnosed as having pathologies of the paranasal sinuses with the primary symptom being headache. All patients had been evaluated with complete otolaryngological and neurological examinations, diagnostic nasal endoscopy, and sinus computed tomographic (CT) scans. Sinus surgery was arranged after failure in performing appropriate medical treatment. Among the 36 patients, 33 showed significant improvement after sinus operation (92%). A paranasal sinus aetiology of headache is an important factor in the differential diagnosis of chronic headache. Those patients who are clinically suspected of having headaches arising from paranasal sinus pathology should receive comprehensive otorhinolaryngological examination and evaluation. Nasal endoscopy and sinus CT scans are good diagnostic tools. Surgical management may be beneficial in those for whom medical treatment fails to resolve the problem.     

Primary intestinal lymphangiectasia presenting as limb convulsions: A case report

BACKGROUNDPrimary intestinal lymphangiectasia (PIL) is a rare protein-losing enteropathy characterized by abnormally dilated lymphatic structures, resulting in leakage of lymph (rich in protein, lymphocytes, and fat) from the intestinal mucosal and submucosal layers and thus hypoproteinemia, lymphopenia, hypolipidemia, and pleural effusion.CASE SUMMARYA 19-year-old Chinese male patient complained of recurrent limb convulsions for the last 1 year. Laboratory investigations revealed low levels of calcium and magnesium along with hypoproteinemia and high parathyroid hormone levels, whereas gastroscopy exhibited chronic non-atrophic gastritis and duodenal lymphatic dilatation. Subsequent gastric biopsy showed moderate chronic inflammatory cell infiltration distributed around a small mucosal patch in the descending duodenum followed by lymphatic dilatation in the mucosal lamina propria, which was later diagnosed as PIL. The following appropriate medium-chain triglycerides nutritional support significantly improved the patient’s symptoms. CONCLUSIONSince several diseases mimic the clinical symptoms displayed by PIL, like limb convulsions, low calcium and magnesium, and loss of plasma proteins, it is imperative to conduct a detailed analysis to avoid any misdiagnosis while pinpointing the correct clinical diagnosis and simultaneously ruling out other clinical aspects in the reported cases without any past disease history. A careful assessment should always be made to ensure an accurate diagnosis in a timely manner so that the patient can be delivered quality health services for a positive health outcome.     

Coronary sinus endocarditis in a hemodialysis patient: A case report and review of literature

BACKGROUNDInfective endocarditis is more common in hemodialysis patients than in the general population and is sometimes difficult to diagnose. Isolated coronary sinus (CS) vegetation is extremely rare and has a good prognosis, but complicated CS vegetation may have a poorer clinical course. We report a case of CS vegetation accidentally found via echocardiography in a hemodialysis patient with undifferentiated shock. The CS vegetation may have been caused by endocardial denudation due to tricuspid regurgitant jet and subsequent bacteremia.CASE SUMMARYA 91-year-old man with dyspnea and hypotension was transferred from a nursing hospital. He was on regular hemodialysis and had a history of severe grade of tricuspid regurgitation. There was no leukocytosis or fever upon admission. Repetitive and sequential blood cultures revealed absence of microorganism growth. Chest computed tomography showed lung consolidation and a large pleural effusion. A mobile band-like mass on the CS, suggestive of vegetation, was observed on echocardiography. We diagnosed him with infective endocarditis involving the CS, pneumonia, and septic shock based on echocardiographic, radiographic, and clinical findings. Infusion of broad-spectrum antibiotics, fluid resuscitation, inotropic support, and ventilator care were performed. However, the patient died from uncontrolled infection and septic shock. CONCLUSIONCS vegetation can be fatal in hemodialysis patients with impaired immune systems, especially when it delays the diagnosis.