Digital design of functional surgery for odontogenic cyst intruding into maxillary sinus / Desenho digital de cirurgia funcional para cisto odontogênico intrusivo em seio maxilar

Abstract Introduction Traditional Caldwell-Luc approach needs modifications for odontogenic cysts intruding into the maxillary sinus, to preserve sinus mucosa and bony contour. Recently, digital technology has been widely applied to the field of maxillofacial surgery, guiding the surgical plan and improving its accuracy. Objective This study attempted to present and evaluate the functional surgery of odontogenic cysts intruding into the maxillary sinus using a computer-assisted pre-surgical design. Methods Consecutive patients with odontogenic cysts intruding into the posterior part of the maxillary sinus were enrolled. Method I "Bony wall reimplantation method" was performed for large lesions exceeding the zygomatic alveolar crest but without apparent bone destruction of the anterior wall of the sinus, while Method II "bone removal method" was more convenient for small lesions near to the zygomatic alveolar crest. The gap was filled with a pedicled buccal fat pad after lesion removal and all cases were without inferior meatal antrostomy. Results A total of 45 cases were included in the study. 22 were operated using method I while 23 were operated with method II. Operations were completed in 20 min. Pain disappeared in 3.62 days on average, and swelling 6.47 days. Nasal bleeding occurred in 8 patients lasting 1-3 days. Suppurative inflammation was observed in 1 patient, and infection occurred after bone reposition. Other repositioned free bony wall was without resorption in CT images. Conclusions Sinus mucosa and bony wall should be conserved. Preoperative digital design can guide osteotomy effectively during the surgery. Bone reposition is not suitable for suppurative inflammation. The pedicled buccal fat pad is enough for drainage and inferior meatal antrostomy is not necessary.

Resumo Introdução A abordagem tradicional de Caldwell-Luc precisa de modificações para os cistos odontogênicos que se introduzem no seio maxilar, para preservar a mucosa sinusal e o contorno ósseo. Recentemente, a tecnologia digital tem sido amplamente aplicada ao campo da cirurgia maxilofacial, orienta o plano cirúrgico e melhora sua precisão. Objetivo Esse estudo teve como objetivo apresentar e avaliar a cirurgia funcional de cistos odontogênicos intrusivos no seio maxilar utilizando um desenho pré-cirúrgico assistido por computador. Método Foram recrutados pacientes consecutivos com cistos odontogênicos intrusivos na parte posterior do seio maxilar. O método I, "método de reimplante de parede óssea", foi feito em lesões grandes que excediam a crista zigomático-alveolar, mas sem destruição óssea aparente da parede anterior do seio, enquanto o método II, "método de remoção óssea", foi mais conveniente para pequenas lesões próximas à crista zigomático-alveolar. O espaço foi preenchido com um retalho pediculado do corpo adiposo bucal após a remoção da lesão e todos os casos foram feitos sem antrostomia meatal inferior. Resultados Um total de 45 casos foram incluídos no estudo. Vinte e dois foram submetidos à cirurgia utilizando-se o método I, enquanto que 23 foram submetidos ao método II. As operações foram concluídas em 20 minutos. A dor desapareceu em média após 3,62 dias, e o edema, depois de 6,47 dias. Hemorragia nasal ocorreu em 8 pacientes com duração de 1 a 3 dias. Processo supurativa foi observado em 1 paciente ocorrendo após a reposição óssea. Outros retalhos reposicionados livres da parede óssea não mostraram reabsorção em imagens de TC. Conclusões A mucosa sinusal e a parede óssea devem ser preservadas; o desenho digital pré-operatório pode orientar a osteotomia de forma eficaz durante a cirurgia; a reposição óssea não é adequada em processos supurativos. O retalho pediculado de corpo adiposo bucal é suficiente para a drenagem e antrostomia meatal inferior não é necessária.

Study of therapeutic effect and mechanism of Sihuang powder treating acute synovitis in experimental rabbit induced by papain injection / 中国骨伤

<p><b>OBJECTIVE</b>To prove the therapeutic effects of Sihuang powder (composed by four traditional Chinese herbs: root of baikal skullcap, bark of amur corktree, root of sorrel rhubarb, fruit of cape jasmine, which were mixed with wild Chrysanthemum flower solution)in treating acute synovitis in experimental rabbit knee osteoarthritic models induced by papain injection and to explore its mechanism.</p><p><b>METHODS</b>Thirty-two New-Zealand white rabbits were divided into 6 groups: blank group, model group, Sihuang powder with high dosage group (2 g/kg), Sihuang powder with low dosage group (1 g/kg), Yingtaiqing group and wild Chrysanthemum flower group. The latter four groups were treated respectively with low and high dose Sihuang powder synovium and cartilage were tested concentrations of nitrogen monoxide (NO) and IL-1 level and then were prepared for pathologic and histologic observation 10 days later. Cartilage pathologic changes were record and synovium pathologic changes were valued by means of Mankin's value system.</p><p><b>RESULTS</b>The NO concentration of synovium in Sihuang powder with high dosage group was lower than that of model group, and there was significantly differences between the two groups (P < 0.01). The IL-1 level of synovium was failed after treated with Sihuang powder with high dosage (P < 0.05). Sihuang powder with low dosage and Yingtaiqing also could restrain IL-1's release (P < 0.05). In Mankin's value system, Sihuang powder with high dosage almost eliminated inflammatory cells infiltrating in synovium, which was seldom found in other groups. The value of Sihuang powder with high dosage group was the lowest in treatment groups (P < 0.005). Sihuang powder with low dosage group and wild Chrysanthemum flower group also decreased the degree of inflammatory in synovium (P < 0.05).</p><p><b>CONCLUSION</b>Sihuang powder can reduce the concentration of NO and IL-1 and improve inflammatory cell infiltrate in lining cells of synovium. Moreover, it can alleviate swelling and pain of joint, improve joint movement and postpone degeneration of the cartilage.</p>