ABSTRACT
INTRODUCTION: Surgical ciliated cyst (SCC) is a type of true epithelial lined antral cysts, which mostly occurs in maxilla from the sinonasal mucosa and gland, comprising 20% of all oral cysts in Japan. It is also called as postoperative maxillary cyst or postoperative paranasal cyst. The etiology is believed to be post trauma or surgery in the region of maxillary antrum. PATIENT CONCERNS: Patient's concern is less evident in this cystic pathology, because this cyst even though an aggressive cyst, presents with fewer symptoms that can be uncomfortable to the patient or push them to seek medical attention. Often, this becomes an incidental finding during routine postoperative follow-up. RATIONALE: The rationale behind this report is to emphasize even a traumatic extraction of tooth can damage the floor of the sinus and lead to the cyst formation. REPORT: We report a case of SCC in a 76-year-old female of the left maxillary sinus possibly after a traumatic extraction of the tooth, for which enucleation of the cyst was done as a primary modality of treatment. DIAGNOSIS: Diagnosis was made after a computed tomography (CT) scan and incisional biopsy. Diagnosis of such rare cases poses a great challenge due to its paucity in etiology, and it often requires a CT scan that becomes an essential gold standard investigation. OUTCOMES: Patient is currently under one year follow up and without any signs of recurrence. LESSONS: It should be acknowledged that tampering trauma or with sinus mucosa can trigger the formation of a SCC of the maxilla, and it should always be considered as a possible sequel after any procedure of such potential in the maxilla.
ABSTRACT
BACKGROUND: Orthognathic surgery involves movement of jaws in all three planes, and this being a part of airway complex, displacement of jaws can influence the dimension of airway at all levels. Lefort one osteotomy surgery with superior repositioning is a common procedure done for patients with vertical maxillary excess. PURPOSE: The purpose of this study was to evaluate the three-dimensional volumetric changes in airway after lefort one impaction surgery using three-dimensional cone beam computed tomography (3D-CBCT) in patients with vertical maxillary excess (VME). METHODS: A prospective analysis of 15 patients who underwent isolated lefort one impaction surgery was done with pre-operative (T0) and 3-months (T1) post-operative 3D-CBCT scans. Airway was divided into three segments, nasopharyngeal, velopharyngeal and oropharyngeal. Volumetric analysis of all these segments was done before and after surgery. Paired 't test' was used to assess the mean difference in airway volume and area between T0 and T1. One-way ANOVA was used to check the mean percentage difference in airway volume and area among the three segments. RESULTS: The mean percentage of nasopharyngeal volume difference was - 0.6299 ± 0.9146%, velopharyngeal volume difference was - 0.5205 ± 1.107%, oropharyngeal volume difference was - 1.492 ± 2.745%. Though volume and area of pharyngeal airway were decreased after maxillary impaction surgery in all three segments of airway studied, they were not statistically significant. CONCLUSION: Among the three segments of airway studied, oropharyngeal airway volume has shown the highest post-surgical reduction though statistically insignificant. ESS scores were within normal limits. Hence, we are of the opinion that there is lack of evidence to conclude that the patients undergoing lefort one superior repositioning for the treatment of VME might develop significant narrowing of PAS that may predispose the patient to breathing disorders.
ABSTRACT
OBJECTIVE: The aim of this retrospective study was to identify the significant risk factors that contribute towards postoperative infection in patients recovering from orthognathic surgery. METHODS: Retrospective records of 522 patients who underwent orthognathic surgery over 9 year period were evaluated for postoperative infection within 3 months of surgery and after 3 months of surgery. The variables of interest included age, gender, habits like smoking and alcohol consumption and incidence of postoperative infection. RESULTS: The overall infection rate was 4.60%. Patients who underwent bilateral sagittal split osteotomy to advance the mandible had an infection rate of 10.4%. Statistically significant predictor variables (P < 0.05) included patients who had the smoking habit, and those that received bone grafts in both the time periods. CONCLUSION: In conclusion, the occurrence of infection after orthognathic surgery is influenced by multiple factors, among which are the type of osteotomy, smoking habit and bone grafting procedures.
