Application experience of prelacrimal recess combined with septotomy in resection of recurrent inverted papilloma / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the effectiveness of nasal endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum in resecting recurrent nasal inverted papilloma. Methods:Patients with recurrent nasal inverted papilloma who underwent reoperation in our hospital during the past 2 years were included . The nasal septum may hinder full access to and effective treatment of the lesions at the anterior and medial wall of the maxillary sinus by endoscope, aspirator and surgical instrument in the narrow aperture of the prelacrimal recess, although these lesions could be observed by 70° nasal endoscope. Results:The nasal septum is temporarily opened on the basis of the prelacrimal recess approach, and the nasal endoscope and instrument was introduced through trans-septal window, so as to provide a better view of the operative field and the angular range of the instrument's movement. Conclusion:The recurrent nasal inverted papilloma could be successfully managed by re-endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum, and no recurrence was observed during the 2-year follow-up. This surgical approach is recommended for the inverted papilla which originates from the anterior medial wall of the maxillary sinus, as the tumor can be removed completely using this surgical approach.

Remoção de fresa odontológica alojada em seio maxilar: relato de caso / Removal of dental burr localized in the maxillary sinus: case report

Introdução: O seio maxilar é um dos seios paranasais, constituído por cavidade óssea preenchida de ar, localizado bilateralmente na maxila, próximo a região dos dentes posteriores. Dada sua localização, morfologia e fisiologia, o assoalho desse seio possui íntima relação com as raízes dos dentes posteriores. Essa estrutura possui uma membrana de revestimento e que pode ser acometida em processos de exodontia de dentes posteriores no qual existe uma relação de proximidade muito evidenciada. O alvéolo pode tornar-se uma via de comunicação entre cavidade oral e seio maxilar. Relato de Caso: O objetivo desse trabalho é descrever o relato de caso de um paciente que foi encaminhado à clínica de cirurgia Bucomaxilofacial para remoção de um fresa alojada no interior do seio maxilar direito que se deslocou durante ato de odontossecção do dente 26. A remoção do fragmento foi realizada pelo alvéolo onde, inicialmente, foi realizada a cirurgia de exodontia. O paciente em questão apresentou evolução satisfatória com ausências de sinais e sintomas de complicações relacionadas ao corpo estranho. Considerações Finais: conhecer a história é fundamental na conduta de tais casos, assim como investigar as possíveis queixas relacionadas ao quadro, por exemplo, os sinais e sintomas de uma sinusite maxilar... (AU)

Introduction: The maxillary sinus is one of the paranasal sinuses, constituted by a bone cavity filled with air, located bilaterally in the maxilla, close to the region of the posterior teeth. Given its location, morphology and physiology, the floor of this sinus is closely related to the roots of the posterior teeth. This structure has a lining membrane and can be affected in processes of extraction of posterior teeth in which there is a very evident relationship of proximity. The alveolus can become a communication route between the oral cavity and the maxillary sinus. Case Report: The purpose of this paper is to describe the case report of a patient who was referred to oral and maxillofacial surgery clinic for removal of a dental burr located inside the right maxillary sinus that was displaced during the tooth 26 extraction. Removal of the fragment was performed through the socket where, initially, extraction surgery was performed. The patient in question presented a satisfactory evolution with no signs and symptoms of complications related. Final considerations: knowing the history is important in management of these cases, as well as investigating possible complaints related to the condition, for example the signs and symptoms of a maxillary sinusitis... (AU)

Riesgos y complicaciones clínicas asociadas con los injertos de origen bovino / The long-term risks and complications of bovine-derived xenografts

La frecuencia de las cirugías relacionadas con implantes dentales que involucran procedimientos de aumento de tejido blando y hueso han aumentado significativamente. Los sustitutos óseos derivados de bovinos han sido, por mucho, los xenoinjertos más utilizados en odontología. Aunque la literatura está repleta de estudios clínicos a favor de los materiales de injerto derivados de bovinos, los estudios que reportan los riesgos y las complicaciones clínicas son escasos. La impresión clínica y la preocupación por la seguridad del paciente llevaron al informe que hemos proporcionado. El objetivo de esta presentación de una serie de casos es crear conciencia sobre los riesgos a largo plazo y las complicaciones clínicas tardías de los materiales de injerto derivados de bovinos. Los pacientes fueron referidos a un consultorio privado debido a complicaciones asociadas con los procedimientos de injerto óseo. Reportamos los datos demográficos, hallazgos médicos y dentales significativos. Las complicaciones incluyeron: sinusitis y patologías del hueso maxilar, desplazamiento de los materiales del injerto, falla del implante, reacción de cuerpo extraño, encapsulación del material, inflamación crónica, fenestraciones de tejidos blandos y quistes asociados. Los materiales de injerto derivados de bovino no fueron biodegradables. La preocupación de los autores es que la morbilidad del paciente puede no reducirse con los xenoinjertos, debido a los riesgos inherentes y a las complicaciones asociadas. La resolución de las lesiones y los síntomas asociados se logró después de la eliminación/ remoción de los materiales del injerto óseo. La extracción quirúrgica de los materiales de xenoinjerto puede requerir habilidades clínicas avanzadas, debido a las diferentes configuraciones que los cirujanos pueden encontrar en las partículas no resorbidas y migradas. Los médicos que buscan proporcionar resultados funcionales y estéticos deben ser conscientes de las complicaciones de los materiales de injerto derivados de bovinos. La seguridad a largo plazo de los xenoinjertos y su posible asociación con la transmisión de enfermedades son preocupaciones válidas (AU)

The frequency of dental implant related surgeries that involve soft and bone augmentation procedures has increased significantly. Bovinederived substitutes have been by far the most commonly used xenografts in dentistry. Albeit literature is replete with clinical studies in favor of bovine-derived graft materials, bibliographical data reporting on risks and clinical complications is scarce. Clinical impression and concern for patients' safety led to the report we have provided. The aim of the present case series was to raise awareness on the long-term risks and late clinical complications of bovine-derived graft materials. Patients were referred to a private practice due to bone augmentation complications. Demographics, significant medical and dental findings are reported. The present report was conceived with the safety of patients in mind. Complications included sinus and maxillary bone pathoses, displacement of the graft materials, oro-antral and oro-nasal communications, paresthesia, implant failure, foreign body reactions, encapsulation, chronic inflammation, soft tissue fenestrations and associated cyst. Bovine-derived graft materials were not biodegradable. Resolution of the associated lesions and symptoms was achieved after the removal of the bone graft materials. Clinicians seeking to provide functional and esthetic outcomes should be aware of the complications of the bovine-derived graft materials. The long-term safety of xenografts and their potential association with disease are valid concerns (AU)

Maxillary sinus floor pneumatization and alveolar ridge resorption after tooth loss: a cross-sectional study

Abstract This is a cross-sectional study that aimed to estimate maxillary sinus floor (MSF) pneumatization in single missing tooth of posterior maxilla, by using cone-beam computed tomography (CBCT). CBCT images were analyzed bilaterally and divided into 2 groups: edentulous site (EdS) - edentulous single region of upper second premolar, first or second molars; Tooth site (TS) - contralateral region homologous to the EdS region, with tooth present. Variables evaluated were: sinus height (SH), estimated sinus pneumatization (eSP: ∆ EdS - TS), healed ridge height (HR) and presence of localized sinus pneumatization (LSP) in molars teeth at TS. HR were categorized according to therapeutic option for posterior maxilla. 183 CBCT scans were included and it was observed that EdS presented a higher SH than the TS (p < 0.001) showing an eSP of 0.9 ± 2.93 mm. First molars presented the highest SH for both sides, although significant differences were detected when compared to second molars. First molars were mostly affected by LSP at TS (36 out of 43). Individuals with LSP at TS presented lower HR than the ones without LSP (p < 0.05). 54% of the cases presenting LSP obtained HR < 5 mm, which indicates sinus lift surgery. The present study showed that tooth loss in posterior maxilla favors sinus pneumatization and the identification of LSP at molar roots seems to indicate a greater necessity for sinus lift surgeries.

Bioactive glass added to autogenous bone graft in maxillary sinus augmentation: a prospective histomorphometric, immunohistochemical, and bone graft resorption assessment

Abstract Objective The aim of this study was to compare the bone resorption rate, histomorphometry and immunohistochemical findings of bioactive glass (Biogran; Biomet, Warsaw, IN, USA) mixed with autogenous bone grafts (1:1) and autogenous bone graft isolate in maxillary sinus elevation surgery. Material and Methods A total of 9 maxillary sinuses were grafted with Biogran with autogenous bone graft (group 1) and 12 were mixed with autogenous bone graft (group 2). Postoperative cone beam computed tomography (CBCT) was used to measure the initial graft volume after 15 days (T1), and 6 months later, another CBCT scan was performed to evaluate the final graft volume (T2) and determine the graft resorption rate. The resorption outcomes were 37.9%±18.9% in group 1 and 45.7%±18.5% in group 2 (P=0.82). After 6 months, biopsies were obtained concurrent with the placement of dental implants; these implants were subjected to histomorphometric analysis and immunohistochemical analysis for tartrate-resistant acid phosphatase (TRAP). Results The average bone formation in group 1 was 36.6%±12.9 in the pristine bone region, 33.2%±13.3 in the intermediate region, and 45.8%±13.8 in the apical region; in group 2, the values were 34.4%±14.4, 35.0%±13.9, and 42.0%±16.6 of new bone formation in the pristine bone, intermediate, and apical regions, respectively. Immunostaining for TRAP showed poor clastic activity in both groups, which can indicate that those were in the remodeling phase. Conclusions The similarity between the groups in the formation and maintenance of the graft volume after 6 months suggests that the bioactive glass mixed with autogenous bone (1:1) can be used safely as a bone substitute for the maxillary sinus lift.

Elevación de piso de seno maxilar con técnica de ventana lateral y colocación simultánea de implantes: reporte de un caso / Sinus floor elevation with a lateral window technique and simultaneous dental implants placement: case report

RESUMEN: La colocación de implantes en la zona posterior maxilar resulta en numerosos desafíos para la rehabilitación fija implanto-soportada debido a la falta de reborde residual. La disponibilidad ósea de la región posterior del maxilar se ve reducida por varios factores, entre ellos, la pérdida prematura de dientes, presencia de enfermedad periodontal, o hiperneumatización de las cavidades sinusales, posterior a exodoncias de la zona posterior. El presente artículo reporta un caso de una paciente femenina de 51 años, con disminución de altura del reborde alveolar en la zona de premolares, describiendo la técnica de elevación de piso de seno maxilar por medio de la realización de una ventana lateral y la colocación simultánea de 2 implantes.

ABSTRACT: The edentulous posterior maxillary implant presents numerous challenges that are unique to this region. The bone availability of the posterior maxilla is reduced, among other things, because of the premature loss of teeth, presence of periodontal disease, or hiperpneumatization of the sinus cavities after extractions of posterior teeth. This article presents a case report of a 51 years old female patient with the alveolar ridge diminished at premolars zone, describing the surgical technique of sinus floor elevation with a lateral window and the simultaneous colocation of 2 dental implants.

Tumor odontogénico queratoquístico en seno maxilar: reporte de un caso clínico / Keratocystic odontogenic tumor in the maxillary sinus: report of a clinical case

El tumor odontogénico queratoquístico, es una patología que se encuentra asociada a la retención de un órgano dentario, en especial al tercer molar, es reconocido por su potencial destructivo y extenso, erosionando placas corticales que envuelven mucosa y tejidos blandos, la etiología del tumor odontogénico queratoquístico está probablemente relacionada con el desarrollo de la lámina dental (o restos de Serres) y con una mayor recidiva dentro de los tumores odontogénicos, siendo motivo de su reclasificación en el 2005 por la OMS. Se presenta casoclínico de un tumor odontogénico queratoquístico en el seno maxilarderecho, se exponen los métodos utilizados para la exploración clínica,radiológica y el tratamiento quirúrgico elegido.

The keratocystic odontogenic tumor is a condition associated withtooth retention, particularly of the third molar. It is recognized as beingpotentially highly destructive, by eroding cortical plates overlying theoral mucosa and soft tissues. The etiology of keratocystic odontogenictumor is probably related to the development of the dental lamina (orremains of Serres) and the recurrence rate is high compared to that ofother odontogenic tumors, the reason for their reclassifi cation by theWHO in 2005. We present a clinical case of a keratocystic odontogenictumor in the right maxillary sinus, including an explanation of themethods used for clinical and radiological examination, and the chosensurgical treatment.

Association between maxillary sinus mucosal thickening and periapical pathology - a CBCT study

Aim: Association between maxillary sinus mucosa/ thickening and periapical pathology - A CBCT study

Objective: To assess the relation between sinus mucosa/ thickening and periapical lesion, to assess anatomic position of root tips with periapical lesion and to correlate age and prevalence of maxillary sinus mucosa/ thickening

Study Design: This retrospective study analysed 100 CBCT scans of patients between 25-75 years enrolled at a CBCT centre in Bhopal, India. The images were acquired using Sirona's Orthophos SL [70 Kv and 8 mA]. Two oral and maxillofacial radiologists examined all images to evaluate the objectives of the study

Results: The gap or space between the lesion and sinus floor was seen in 48% patients, the lesion contact with the sinus floor was seen in 36% patients, the lesion entered the sinus floor was seen in 16% patients. The prevalence of maxillary sinus mucosa/ thickening in our study increased dramatically as the degree of periapical pathology increased. The relationship between position of root tips with periapical lesion, was also assessed

Conclusion: It can be concluded that there is a strong correlation between maxillary sinus mucosa/ thickening due to periapical pathology

Alteraciones estéticas faciales en el síndrome de seno silente / Facial aesthetic alterations in silent sinus syndrome / Alterações estéticas faciais na síndrome do seio silencioso

Introducción: el Síndrome de Seno Silente (SSS) es una entidad rara, siendo poco frecuente el hundimiento del maxilar superior como motivo de consulta. El trabajo pretende realizar una revisión de la bibliografía del SSS con el hundimiento del maxilar superior como principal manifestación. Material y método: Se realizó una revisión bibliográfica de artículos publicados desde el año 2008 a la actualidad. Se revisaron las historias clínicas de los pacientes diagnosticados con SSS, intervenidos quirúrgicamente. Como criterios diagnósticos se tuvieron en cuenta: asimetría facial, ausencia de síntomas rinosinusales, tomografía de macizo cráneo facial (TC MCF) con velamiento del seno maxilar y disminución de su volumen, y aumento del volumen orbitario. Se evaluó el seguimiento postoperatorio y sus resultados. Resultados: El SSS se debe a un proceso inflamatorio en el seno maxilar que genera aumento de las presiones negativas. Clínicamente se caracteriza por asimetría facial. El diagnóstico se confirma por tomografía, siendo lo más característico la presencia, en el plano coronal, de un seno maxilar ocupado y atelectásico y el descenso del piso orbitario con disminución del volumen del mismo y aumento del volumen de la órbita. El tratamiento quirúrgico se basa en mejorar las presiones dentro del seno maxilar, reservando el tratamiento del piso de la órbita a aquellos pacientes en los que persisten las alteraciones estéticas. Conclusiones: La asimetría facial es el principal motivo de consulta del paciente. Sin embargo el hundimiento del seno maxilar no es la causa más frecuente de asimetría.

Introduction: silent Sinus Syndrome (SSS) is a rare entity, and the subsidence of the upper jaw is rare. The paper aims to review the SSS literature with the upper jaw collapse as the main manifestation. Material and method: A bibliographic review of articles published from the year 2008 to the present time was carried out. Were viewed the medical records of patients diagnosed with SSS, whounder went surgery. As diagnostic criteria were taken into account: facial asymmetry, absence of rhinosinusal symptoms, massive facial cranial tomography with maxillary sinus veil and diminished volume, and increased orbital volume. Postoperative follow-up and results were evaluated. Results: The SSS is due to an inflammatory process in the maxillary sinus that generates an increase of the negative pressures. Clinically it is characterized by facial asymmetry. The diagnosis is confirmed by tomography being the most characteristic the presence, in the coronal plane, of a occupied maxillary sinus and atelectatic and the descent of the orbital floor with decrease of the volume of the same and increase of the volume of the orbit. The surgical treatment is based on improving the pressure inside the maxillary sinus, reserving the treatment of the floor of the orbit to those patients who persist the aesthetic alterations. Conclusions: Facial asymmetry is the main reason for patient consultation. However, sagging of the maxillary sinus is not the most frequent cause of asymmetry.

Introdução: síndrome do Sinus Silencioso (SSS) é uma entidade rara, e o maxilar inferior não é freqüente como motivo de consulta. O artigo pretende rever a literatura SSS com o colapso do maxilar superior como principal manifestação. Material e método: Foi realizada uma revisão bibliográfica de artigos publicados de 2008 para o presente. Revisamos os registros médicos de pacientes diagnosticados com SSS, que foram submetidos a cirurgia. Como critérios de diagnóstico foram tidos em conta: assimetria facial, ausência de sintomas rinossinusais, tomografia craniana facial maciça com velamento maxilar superior e volume diminuído e aumento do volume orbital. O acompanhamento pós-operatório e os resultados foram avaliados. Resultados: SSS é devido a um processo inflamató- rio no seio maxilar que gera um aumento nas pressões negativas. Clinicamente, é caracterizada por assimetria facial. O diagnóstico é confirmado pela tomografia sendo a mais característica a presença, no plano coronal, de um seio maxilar ocupado e atelectásico e a descida do piso orbital com diminuição do volume do mesmo e aumento do volume da órbita. O tratamento cirúrgico baseia-se na melhoria da pressão dentro do seio maxilar, reservando o tratamento do piso da órbita aos pacientes que persistem as alterações estéticas. Conclusões: A assimetria facial é o principal motivo para a consulta do paciente. No entanto, a flacidez do seio maxilar não é a causa mais frequente de assimetria.

Mucocele maxilar secundario a cirugía ortognática: reporte de un caso / Maxillary mucocele after an orthognathic surgery: case report

El mucocele es un tumor pseudoquístico poco frecuente en el seno maxilar y una rara complicación de la cirugía ortognática. El caso reportado describe la presentación de un mucocele que afecta parcialmente el seno maxilar y se presenta clínicamente como un tumor nasal. Se trata de una mujer de 44 años que, luego de 12 años de realizarse cirugías ortognáticas, presenta dolor facial y obstrucción de la fosa nasal derecha. La tomografía axial computarizada de senos paranasales revela una masa de contenido líquido que ocupa la mitad inferior del seno maxilar derecho, extendiéndose a la fosa nasal ipsilateral. La paciente es intervenida por vía endoscópica realizándose una marsupialización intranasal y meatotomía media, evolucionando satisfactoriamente en un seguimiento de dos años.

Mucoceles are not often found in the maxillary sinus, and is a rare surgery complication, in this case, orthognathic. This review describes a mucocele that partially occupies the right maxillary sinus, causing a chronic nasal obstruction. This is the case of a 44 year-old female patient, which after 12 years of several orthognathic surgeries, presents facial pain and right nasal obstruction. The paranasal sinus computed tomography reveals a mass with liquid content that occupies the lower part of the right maxillary sinus and compromises the right nasal cavity. The patient was treated with an intranasal marsupialization and a middle meatotomy with endoscopic nasal approach. Evolution was satisfactory two years after the intervention.

Bone formation in maxillary sinus lift using autogenous bone graft at 2 and 6 months / Formación ósea en elevación de seno maxilar usando injerto óseo autógeno a los 2 y 6 meses

The aim of this study is to compare the bone formation in maxillary sinus lift with an autogenous bone graft in histological evaluation at 2 or 6 months. A comparative study was designed where 10 patients with missing teeth bilaterally in the posterior zone of the maxilla were selected. Patients received a particulate autogenous bone graft under the same surgical conditions, selecting a site to collect a biopsy and histological study at two months and another at six months postoperatively. Histomorphometry was performed and were used Kolmogorov-Smirnov test, student's t-test and Spearman's correlation coefficient, considering a value of p<0.05. Differences were observed in inflammatory infiltrate and vascularization characteristics; however, the group analyzed at two months presented 38.12% ± 6.64 % of mineralized tissue, whereas the group studied at 6 months presented an average of 38.45 ± 9.27 %. There were no statistical differences between the groups. It is concluded that the bone formation may be similar in intrasinus particulate autogenous bone grafts in evaluations at two or six months; under these conditions, early installation of implants is viable.

El objetivo de este estudio es comparar la formación ósea en técnicas de elevación de seno maxilar utilizando injerto óseo autógeno en evaluaciónhistológica a las 2 y 6 meses. Un estudio comparativo fue diseñado donde 10 pacientes con dientes perdidos de forma bilateral en el sector posterior de maxila fueron incluidos. Los pacientes recibieron injerto óseo particulado bajo las mismas condiciones quirúrgicas, seleccionando el sitio para tomar la biopsia y el análisis histológico respectivo a los 2 meses en un lado y 6 meses en el lado contralateral. La histomorfometría se realizó y fueron utilizadas la prueba de Kolmogorov-Smirnov, la prueba t de student y la prueba de Spearman, considerando un valor de p<0,05. Fueron observadas diferencias en infiltrado inflamatorio y características de vascularización; sin embargo, los grupos analizados a los dos meses presentaron 38.12% ± 6.64% de tejido mineralizado, mientras que los grupos de estudio a los 6 meses presentaron en promedio 38.45 ± 9.27%. No se observo diferencias significativas entre los grupos. Se concluye que la formación ósea puede ser similar en elevaciones de seno maxila realizada con hueso autógeno particulado a los dos o seis meses; en estas condiciones, la instalación temprana de implantes puede ser viable.

Mucocele de seno maxilar: revisión a propósito de un caso / Maxillary Sinus Mucocele: Review of case report

El Mucocele del seno maxilar es una formación quística benigna originada en el interior del mismo, limitado por un epitelio (mucosa sinusal) con un contenido de moco. Es una patología poco frecuente que puede causar grandes dificultades a la hora de resolver su terapéutica, sobre todo en aquellos casos que invaden la órbita llevando a una exoftalmia. El presente estudio reporta el caso de un mucocele de seno maxilar derecho, en una paciente de sexo femenino de 68 años. Al examen clínico se visualizaba una deformación por vestibular desde el área de la pieza dentaria 12 a la 16. Al examen imagenológico se observaba el seno maxilar ocupado con límites cercanos a la órbita. Se realizó una biopsia exéresis, con resultado histopatológico de Mucocele de seno maxilar. Se discute su presentación y tratamiento clásico...

Maxillary sinus mucocele is a benign cyst formation that originates within the sinus and is lined by epithelium (sinus mucosa) containing mucus. It is a rare condition for which it might be very difficult to find a suitable therapeutic approach, especially when it involves the orbit, leading to exophthalmos.This study reports the case of a right maxillary sinus mucocele in a 68-year-old female patient. Through clinical examination, vestibular deformation from tooth 12 to tooth 16 was determined. Radiologic examination showed that the maxillary sinus was affected, with borders near the orbit. An excision biopsy was performed, which showed histopathological findings of maxillary sinus mucocele. Presentation and classic treatment are discussed...

Prevalência de septos sinusais maxilares em pacientes parcial e totalmente desdentados, baseada em 150 exames de tomografias feixe cônico (TCFC) / Prevalence of maxillary sinus septa for partial and totally edentulous patients based on 150 cone beam computerized tomographic (CBCT) exams

Objetivo: avaliar a prevalência, localização e o número dos septos sinusais através de tomografi as computadorizadas de feixe cônico (TCFC), correlacionando com o sexo, a idade e o lado acometido nos pacientes parcialmente ou totalmente desdentados. Material e métodos: cada seio maxilar foi dividido em três regiões: anterior, média e posterior, utilizando-se um gráfico de linhas verticais e horizontais, considerando-se a parede lateral da cavidade nasal com a parede posterior do seio maxilar, e os septos com altura igual ou superior a 2 mm. As imagens foram obtidas por meio do tomógrafo modelo 3D (i-CAT, Kavo, Gendex CB-500, OP 300; voxel = 0,125 mm). Resultados: 150 exames foram selecionados igualmente entre pacientes parcial ou totalmente desdentados. Os septos foram encontrados em 74 pacientes (49,3%), sendo 38 pacientes desdentados parciais (50,06%) e 36 desdentados totais (48%). 46,2% dos exames correspondiam ao sexo feminino, e 53,8% ao masculino. Com relação à localização, 48,65% dos septos foram localizados no terço médio do seio maxilar, e 25,68% nas regiões anterior e posterior. A altura média dos septos foi 7,4 mm nos pacientes desdentados parciais, e 6,18 mm nos desdentados totais. Não houve correlação estatisticamente significante entre a prevalência dos septos sinusais com o sexo, a idade e o lado acometido. Conclusão: os septos foram identificados em todos os terços da cavidade sinusal, mas com dimensões menores em pacientes totalmente desdentados. Desta forma, o plano tridimensional é fundamental para a eleição da melhor técnica cirúrgica e prevenir complicações transoperatórias, como a fenestração da membrana sinusal.

Objective: to evaluate the prevalence, number, and location of sinus septa through cone beam computerized tomograms (CBCT) according to gender, age, and site for partial and totally edentulous patients. Material and methods: each maxillary sinus was divided into three regions (anterior, middle, and posterior) using horizontal and vertical plotted lines, considering the lateral and posterior walls of the maxillary sinuses, and septa with > 2 mm in height. All images were obtained by volumetric 3D (i-CAT, Kavo, Gendex CB-500, OP 300; voxel = 0.125 mm). Results: 150 exams were selected for partial and totally edentulous patients. The septa were found in 74 patients (49.3%), being 38 partial (50.06%) and 36 completely edentulous (48%). From these, 46.2% of exams were from female and 53.8% from male patients. Regarding the site, 48.65% of septa were found at the middle and 25.68% at the anterior and posterior regions. The mean septal height was 7.4 mm for partial and 6.18 mm for totally edentulous. No statistically significant correlations were found between septa prevalence and gender, age, and affected site. Conclusion: the septa were found at all sinus cavity thirds, but with reduced dimensions in totally edentulous patients. In this way, a 3D planning is fundamental to elect the best surgical technique to avoid complications and prevent perioperative problems, such as the sinus membrane fenestration.

Senos maxilares vs. implantes dentales / Maxillary sinuses vs. dental implants

Los senos maxilares son, hoy en día, parte del diagnóstico en odontología, por lo que el conocimiento de los mismos es fundamental a la hora de su observación por parte de las imágenes radiológicas y la clínica. El propósito de este trabajo es mostrar los límites de la radiología convencional en el diagnóstico sinusal y los avances que ofrece la tomografía computada en la visualización de los mismos en sus mínimos detalles, tanto en patologías como en la contemplación de los distintos tipos de rellenos en las técnicas de elevación de piso...

Correlation of Fractal Dimension with Histomorphometry in Maxillary Sinus Lifting Using Autogenous Bone Graft

The aim of this study was to determine the pattern of bone remodeling after maxillary sinus lifting in humans by means of fractal dimension (FD) and histomorphometric analysis. Therefore, the correlation between FD and the histomorphometric findings was evaluated. Sixteen patients with posterior edentulous maxilla were enrolled in this study. Maxillary sinus lifting was performed using autogenous bone grafted from the mandibular retromolar area. Three direct digital panoramic radiographs were obtained: before surgery (Group 1), immediately postoperatively (Group 2) and after 6 months of healing (Group 3) for FD analysis. Biopsies were taken after 6 months, processed and submitted to histological and histomorphometric analysis. Data were analyzed by Shapiro-Wilk test and ANOVA test followed by a Tukey test (a=0.05). The bone volume fraction of newly trabecular bone (TB) and medullary area (MA) was measured as 62.75%±17.16% and 37.25±17.16%, respectively. Significant difference in FD analysis was measured between Group 1 and Group 3. No significant difference was found in the correlation between FD and histomorphometric analysis for TB and MA (p=0.84). In conclusion, all performed analyses were effective in assessing the bone-remodeling pattern in the maxillary sinus, offering complementary information about healing and predictable outcomes. There were no correlations between FD and histomorphometric analysis.

O objetivo deste estudo foi determinar o padrão de remodelação óssea após levantamento de seio maxilar in humanos por meio de analise de dimensão fractal (FD) e histomorfometria. Além disso, a correlação entre FD e histomorfometria foi avaliada. Dezesseis pacientes com edentulismo na região posterior da maxila foram relacionados para este estudo. Levantamento de seio maxilar foi realizado utilizando-se enxerto de osso autógeno coletado da região retro molar da mandíbula. Três radiografias panorâmicas digitais foram obtidas: antes da cirurgia (Grupo 1), imediatamente após o levantamento de seio (Grupo 2) e após 6 meses de cicatrização (Grupo 3) para analise de FD. Biopsias foram coletadas após 6 meses, processadas e submetidas para analise histológica e histomorfométrica. Os dados foram analisados utilizando-se o teste Shapiro-Wilk e ANOVA seguido pelo pós teste de Tukey (a=0.05). A fração de volume de ósseo neoformado para o osso trabecular (TB) e para a área medular (MA) foi mensurado como 65,75%±17,16% and 37,25±17,16%, respectivamente. Diferença significante na analise FD foi observada entre os grupos 1 e 3. Nenhuma diferença estatística foi encontrada para correlação entre FD e histomorfometria para TB e MA (p=0,84). Em conclusão, todas as análises realizadas foram efetivas em acessar o padrão de remodelação ósseo no seio maxilar, oferecendo informações complementares sobre cicatrização e previsibilidade de resultados. Não houve correlação entre FD e histomorfometria.

Avaliação da relação entre as raízes dos dentes posteriores e o assoalho do seio maxilar em pessoas sem e com fissura labiopalatina / Relationship evaluation between the posterior teeth roots and the maxillary sinus floor in patients with and without cleft lip and palate

O seio maxilar apresenta formato distinto e volume variável entre as pessoas e seu assoalho pode ser encontrado em íntimo contato com as raízes dos dentes posteriores, podendo haver protrusão dessas raízes em seu interior. Tal proximidade é de grande relevância frente aos casos de comunicação bucossinusal em potencial ou pela possibilidade de desenvolvimento de um quadro infeccioso de origem odontogênica, em que esse pode vir a se estender para o interior do seio maxilar. Existe uma ausência de trabalhos na literatura acerca da relação estabelecida entre dentes posteriores e o seio maxilar em pessoas com fissura labiopalatina. O objetivo do presente estudo foi identificar e comparar a relação entre o assoalho do seio maxilar e os ápices radiculares dos dentes posteriores em imagens de tomografia computadorizada de feixe cônico em pessoas sem fissura labiopalatina e com fissura transforame incisivo unilateral e bilateral. Foram avaliados 100 indivíduos sem anomalias craniofaciais e 112 com fissura transforame incisivo unilateral ou bilateral, não sindrômicos, utilizando o programa i-CAT® Vision, onde a relação estabelecida pelas estruturas foi convencionada sendo, tipo 0 ou ausência de contato entre as estruturas, tipo 1 ou relação de íntimo contato entre as estruturas sem protrusão radicular no interior do seio maxilar e tipo 2 ou relação de íntimo contato entre as estruturas com protrusão radicular no interior do seio maxilar. Foi utilizado o teste do qui-quadrado para comparar os achados entre os grupos estudados, considerando valor estatisticamente significante quando p≤ 0,05. Foi avaliada a relação do assoalho do seio maxilar com 1679 dentes, totalizando 3664 raízes onde 1883 (51,3%) foram classificadas como tipo 0, 1456 (39,7%) tipo 1 e 325 (8,8%) do tipo 2. Houve diferença estatisticamente significante para a raiz palatina do dente 18 entre os grupos com fissura unilateral e bilateral (p = 0,011), para a raiz mesiovestibular do dente 18...

The maxillary sinus has a remarkable feature and a variable volume among people where the inferior wall may be found in an intimate relation with the posterior teeth roots protruding or not inside the antrum. This proximity is of great relevance considering a potential oroantral communication or the spreading of an odontogenic infection into the maxillary sinus. There is a lack of evidence into the literature regarding the relationship between posterior teeth roots and the maxillary sinus in non-syndromic complete cleft lip and palate patients. This study aimed to evaluate and compare cone beam computed tomography images regarding the relationship between the posterior teeth roots and the maxillary sinus floor in non-cleft lip and palate patients and non-syndromic complete unilateral and bilateral cleft lip and palate patients. Images were interpreted using the i-CAT® Vision software including 100 noncleft patients and 112 presenting non-syndromic complete unilateral and bilateral cleft lip and palate. The relationship between teeth roots and the maxillary sinus floor was established as type 0 or no contact between these structures, type 1 or close contact without root protrusion into the sinus and type 2 or close contact with root protrusion into the sinus. The chi-square test, considering a statistically significant value where p≤0,05, was used to compare data between different groups. The sample included 1679 teeth and 3664 roots where 1883 (51,3%) were classified as type 0, 1456 (39,7%) as type 1 and 325 (8,8%) as type 2. There were statistically significant differences for tooth 18 palatine root between both complete cleft lip and palate groups (p = 0,011), for tooth 18 mesiobuccal root between noncleft and the bilateral groups (p = 0,046) and between both complete cleft lip and palate groups (p = 0,016) and for tooth 24 buccal root between non-cleft and the bilateral group (p = 0,001). Complete unilateral and bilateral cleft lip and palate...

An experimental model of chronic rhinosinusitis in rabbits without bacterial inoculation

PURPOSE: Evaluate and compare two different experimental techniques of maxillary sinus ostium occlusion using N-butyl cyanoacrylate in developing chronic histological findings without the inoculation of pathogenic bacteria among rabbits. METHODS: In a randomized study, sixteen New Zealand rabbits were assigned for occlusion of the right maxillary sinus through a transmaxillary approach or through the roof of the nasal cavity. The contralateral sinus served as a control. After 12 weeks, the animals were sacrificed for blinded histopathological analysis of the maxillary sinus mucosa. RESULTS: Histopathological changes consistent with CRS were found in eight (100%) of the maxillary sinuses approached transmaxillary and three of those through the roof of the nasal cavity (37.5%), p 0.008 and 0.250, respectively, comparing with the control side. Chronic mucosal changes were significantly better induced using the transmaxillary approach (p 0.026). CONCLUSION: It is possible to induce a model of chronic sinusitis among rabbits with transmaxillary sinus occlusion without bacterial inoculation. This model can be replicated for future cellular studies. .

Herniación de quiste de seno maxilar a través de fístula oroantral: reporte de un caso / Hermiation of a maxillary sinus cyst through an oroantral fistula: report of a case

Los quistes de retención mucosa y los mucoceles son las lesiones máscomunes de los senos paranasales. Éstos comparten características muysimilares y su diferencia estará determinada por su etiología. A diferencia del quiste de retención mucosa, cuyo comportamiento es mucho más sutil, el mucocele causa fenómenos infl amatorios locales, y algunas veces,reabsorción ósea de las estructuras adyacentes. El tratamiento será laenucleación quirúrgica. En el caso clínico que presentamos a continuación,se evidencia una lesión quística que se expone a través del alvéolo no cicatrizal de extracción traumática realizada semanas atrás, además se presenta la técnica que utilizamos para el cierre de fístula oroantral.

Mucus retention cysts and mucoceles are the most common lesions of the paranasal sinuses. They share very similar characteristics and the difference between them depends on their etiology. Unlike mucous reten-tion cysts, whose behavior is much more subtle, mucoceles cause local infl ammatory phenomena and sometimes bone resorption of adjacent structures. The treatment called for is surgical enucleation. The clinical case presented deals with a cystic lesion protruding through the non-cicatricial alveolus following a traumatic extraction performed weeks earlier. We also present the technique used to close the oroantral fi stula.