Retrieval-of-displaced-root-fragment-associated-with-fungal-ball-in-the-maxillary-sinus-using-functional-endoscopic-sinus-surgery-a-case-report

Introduction: Fungal ball is a non-invasive sinus disease and the incidence of this disease has increased in recent years and also several case reports and case series have suggested a relationship with the accidental displacement of root into maxillary sinus. We report a case where fungal ball was removed along with the dental root fragment which was accidentally displaced into the maxillary sinus following traumatic dental extraction. A 32-years-oldCase Report: female patient presented to Maxillofacial Surgery Department with complaint of pain in the left orofacial region for one month. The patient had a history of traumatic extraction of posterior maxillary teeth 4 years back. On examination, no dental cause of pain was detected. On further evaluation, a foreign body within the left maxillary sinus was seen in the panoramic radiograph. Computed tomography images revealed displaced root in the left maxillary sinus with surrounding heterogenous soft tissue opacity. Following the detection of foreign body, patient underwent Functional Endoscopic Sinus Surgery (FESS) and the root was retrieved and the adjacent soft tissue specimen was sent for histopathological examination. The presence of fungus consistent with the Aspergillus species was confirmed. Conclusion: This article emphasizes the importance of atraumatic dental extraction, the association of fungal ball with displaced root and the utility of FESS in clearing the same.

Role of High-Resolution Computed Tomography in the Evaluation of Anatomical Variations of Sphenoid Sinus and Its Clinical Importance in FESS.

Sphenoid sinus of all sinuses is generally the most inaccessible sinus to the surgeons. The trans-sphenoid route is considered to be the standard approach for surgery of pituitary adenomas. Knowing the details of the anatomy of sphenoid sinus and the extent of pneumatization can guide the surgeon through difficult corners of the approach. We wanted to evaluate the incidence of the different anatomical variations of sphenoid sinus as detected by HRCT scan and their impact on related neurovascular structures for the safe removal of inter sphenoid and pituitary lesions.METHODSThis prospective study was conducted in Sree Gokulam Medical College & Research Foundation, Trivandrum. Study population included 150 cases who were referred for HRCT of the paranasal sinuses to the Department of Radiodiagnosis, over a period of 12 months (from November 2018 to October 2019). After obtaining a written informed consent and history, all the patients underwent HRCT axial section of PNS. Once the axial sections were obtained through the paranasal sinuses, these images were reconstructed into coronal sections by multiplanar reconstruction (MPR) technique without exposing the patient.RESULTSOnodi cells were found predominantly in female patients with male:female ratio 2:7. Optic nerve protrusion and dehiscence had male predominance. Rest of the variations had no significant gender difference and few variations were seen equally distributed among both males and females. The most common variation observed in our study was pterygoid process pneumatization. Of the total 150 patients, pterygoid process pneumatization was identified in 76 patients including bilateral in 54 patients. Next common variation observed was vidian nerve protrusion, identified in 62 patients along with dehiscence of wall in 38 patients. Maxillary nerve protrusion was present in 42 patients and its dehiscence of wall in 10 patients. Optic nerve protrusion was identified in 41 patients and dehiscence of wall was noted in only 6 patients.CONCLUSIONSSphenoid sinuses are the most inaccessible paranasal sinuses and are surrounded by significant anatomical structures such as the orbit and its contents, cavernous sinus, internal carotid artery (ICA) and the anterior cranial fossa. HRCT of sphenoid sinus for the demonstration of the anatomical variations and its relation to the vital adjacent crucial anatomical structures helps in reducing the complications during trans-sphenoidal surgeries and functional endoscopic sinus surgery. Our study of HRCT findings delineates most of the anatomical variations in sphenoid sinus and thus helps the surgeons in appropriate surgical planning and helps them to reduce the intraoperative complications.

Measurements Of Maxillary Sinus In Correlation To Age And Gender By Computed Tomography

Introduction: The sinonasal region is often imaged because of infectious and allergic diseases of the nasal cavityand paranasal sinuses. Improved knowledge of normal pneumatization and development of paranasal sinusesis important to allow sinus diseases to be evaluated and an adequate treatment to be proposed.Materials and methods: 100 patients (72 males and 28 females) undergoing coronal and axial sections of computedtomography scan of maxillary sinus of head and neck aged between 1year to 90 years at the Radiology Department,Vydehi Institute of Medical Science & Research Centre Bangalore for reasons other than due to craniofacialabnormalities or sinus problem were taken for the study. Volume and dimensions of the maxillary sinuses withits anatomical variations were obtained. Mean, SD, significant difference between age & gender was calculated.Results: Maxillary sinuses in Males on both sides have higher values in mean height, depth and volume thanfemales except right side width which was lesser in value than females. All the mean parameters were more onleft sinus both in male and females, except mean height of right sinus in males, on side comparison all the meanparameters were more on right side in females. There is a significant difference in mean height of right and leftmaxillary sinus in between male and female. There is a significant difference on right and left side widthbetween male and female in the age group 51-60 yrs and 61-70 yrs. The maximum age growth in males was during11-20 yrs and 41-50 yrs in height, width and volume, in 21-30 yrs and 31-40 yrs in depth, later dimensions weredecreasing in growth by 61-70 yrs in height and 81-90 yrs both in depth, width and volume. In females maximumgrowth was in 21-30 yrs and 51-70 yrs for height, depth, volume, 11-20 yrs and 51-60 yrs for width dimensions, laterdecreases by 61-70 yrs onwards in height, width and 11-20 yrs in depth and volume.Conclusion: These results will be helpful in understanding normal and pathological conditions of the maxillarysinuses and useful in clinical planning of medical or surgical interventions of the maxillary sinuses

Definition and management of odontogenic maxillary sinusitis / 대한악안면성형재건외과학회지

BACKGROUND: Maxillary sinusitis of odontogenic origin, also known as maxillary sinusitis of dental origin or odontogenic maxillary sinusitis (OMS), is a common disease in dental, otorhinolaryngologic, allergic, general, and maxillofacial contexts. Despite being a well-known disease entity, many cases are referred to otorhinolaryngologists by both doctors and dentists. Thus, early detection and initial diagnosis often fail to detect its odontogenic origin. MAIN BODY: We searched recent databases including MEDLINE (PubMed), Embase, and the Cochrane Library using keyword combinations of “odontogenic,” “odontogenic infection,” “dental origin,” “tooth origin,” “sinusitis,” “maxillary sinus,” “maxillary sinusitis,” “odontogenic maxillary sinusitis,” “Caldwell Luc Procedure (CLP),” “rhinosinusitis,” “functional endoscopic sinus surgery (FESS),” “modified endoscopy-assisted maxillary sinus surgery (MESS),” and “paranasal sinus.” Aside from the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) trial, there have been very few randomized controlled trials examining OMS. We summarized the resulting data based on our diverse clinical experiences. CONCLUSION: To promote the most efficient and accurate management of OMS, this article summarizes the clinical features of rhinosinusitis compared with OMS and the pathogenesis, microbiology, diagnosis, and results of prompt consolidated management of OMS that prevent anticipated complications. The true origin of odontogenic infections is also reviewed.

Quality of Life after Functional Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis at Tertiary Care Hospital

Background: Chronic rhinosinusitis (CRS) is a pathogenic disease of infection commonly affected the ear, nose and throat. Chronic Rhinosinusitis (CRS) has a serious negatively impact over quality of life of patients. Quality of life, nature of job and environmental conditions are the primary reasons of spread of rhinosinusitis. Most of the symptoms of CRS are not life threatening but generally these leads to poor quality of life by affecting the efficiency of individuals. Methods: This prospective study was conducted in the department of ENT in tertiary care hospital among the 50 patients with clinical presentation, endoscopy examination and CT-scan changes of chronic rhinosinusitis (CRS) without a polyp. The history of the patients were taken and then the different ENT examinations were done like endoscopic examination of the nose and CT-scan imaging. All the surgeries like uncinectomy, middle meatal antrostomy, anterior and posterior ethmoidectomy, or opening of the sphenoid sinus were performed under general anesthesia with orotracheal intubation and hypotensive technique. All the patients were regularly given the postoperative antibiotic and nasal steroid treatments and reviewed regularly. Sinonasal Assessment Questionnaire - 11 (SNAQ-11) were used for the collection of data because this questionnaire contains 11 questions covering most of the symptoms of sinonasal diseases. Results: ‘Total 50 patients were included in this study among them 32 (64%) were male and 18 (36%) were females. All the patients was between 18-60 years among them 16 (32%) were the age group 25-35 years, followed by age group 35-45 years 14 (28%). The most common preoperative complaint of the patients was nasal obstruction (100%) patients, followed by nasal congestion (96%), facial pain (94%), running nose (90%), anterior nasal discharge (76%), and least complaint was sneezing (28%) and earache (28%). Conclusion: The study concludes, this study shows the significant outcome of improvement in the quality of life of patients in all the three subgroups of chronic rhinosinusitis which can be assessed by using SNOT-11 questionnaire. The Functional endoscopic sinus surgery performed in patients with chronic rhinosinusitis has statistically significant with the association of improvement in the QoL after twenty 24 month follow up. There is paucity of data so more studies are required to the scientific evidence gathered on the effectiveness of surgery offered to our population, as seen in studies performed in other countries.

Quality of life after FESS among patients with nasal polyps using the NOSE questionnaire translated in Filipino (NOSE-Ph)

@#<p><strong>OBJECTIVE:</strong> To evaluate the quality of life before, and after Functional Endoscopic Sinus Surgery (FESS) among patients with nasal obstruction due to nasal polyposis using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire translated in Filipino (NOSE-Ph) in a tertiary government hospital in Metro Manila.</p> <p><strong>METHODS:</strong></p> <p><strong>Design:</strong>Cross-Sectional QOL Study</p> <p><strong>Setting:</strong>Tertiary Government Hospital</p> <p><strong>Participants:</strong>  40 patients with nasal polyposis who underwent FESS from April 2014 to June 2015 were included in the study. Patients who underwent FESS due to other nasal tumors other than nasal polyp were excluded. The subjects answered the previously-validated NOSE-Ph questionnaire pre- and post-operatively and the scores were gathered and analyzed.</p> <p><strong>RESULTS:</strong>Based on the pre and post-operative scores, there was a statistically significant improvement in all 5 parameters (1. nasal congestion, 2. nasal obstruction, 3. trouble breathing, 4.  trouble sleeping, and 5. inability to get enough air through the nose during exercise).</p> <p><strong>CONCLUSION:</strong>There was a statistically significant improvement in the quality of life of patients who underwent FESS based on the pre and post-operative scores using the NOSE-Ph questionnaire translated in Filipino.  </p>