Traumatic subluxation of the globe into the maxillary sinus

We report a case of complete traumatic subluxation of the globe into the maxillary sinus as documented by CT. The cornea sustained a mild epithelial abrasion but the globe was otherwise intact without signs of trauma.     

Inadvertent injection of sodium hypochlorite into the maxillary sinus

A previously undocumented complication of root canal therapy is reported. A dilute solution of 5-10 mls sodium hypochlorite was inadvertently injected into the maxillary sinus during root canal therapy of a right upper second premolar (5). The patient developed acute, sudden, severe facial pain and swelling necessitating emergency admission to hospital and operative intervention under general anaesthesia. A diagnosis of acute chemical sinusitus was made, further management and discussion follow.     

Needle entrance into the maxillary sinus during retrobulbar anesthesia

Three patients are presented to whom an accidental needle entrance into the maxillary sinus occurred during retrobulbar anesthesia. In all cases air was aspirated during the aspiration check at the end of needle advancement, and the patients reported a bitter taste after the injection of a small quantity of anesthetic. After withdrawal and careful reinsertion of the needle, maxillary sinus entrance was avoided and a successful retrobulbar block was achieved. Two of the patients had no history of previous facial trauma or surgery, whereas the third had suffered a recent blowout fracture of the orbital floor. The authors suggest that air aspiration or anesthetic passage into the pharynx during retrobulbar anesthesia should raise the suspicion of maxillary sinus entrance, even in patients without any history of facial trauma or surgery. The early recognition of sinus entrance can prevent retrobulbar block failure and reinjection of a second anesthetic dose.     

Histologic changes in the sinus membrane after maxillary sinus augmentation in goats

PURPOSE: Previous studies have reported on the morphologic aspects of bone regeneration after maxillary sinus grafting. However, no previous studies have examinated the morphology of the maxillary sinus mucosa after grafting. The purpose of this study was to evaluate the histologic changes in the lining membrane after sinus augmentation. MATERIALS AND METHODS: A unilateral osteotomy of the lateral maxillary wall, medial displacement of the bony segments, and elevation of the sinus mucosa were performed in 12 goats. An autogenous bone graft combined with coralline particles was placed on the floor of the sinus in three animals, and coralline particles alone were placed in three other goats. Six goats were not grafted and were used as controls. Samples were harvested at 2.5, 4.5, and 6.5 months. The maxillary sinus mucosa was examined using light microscopy and scanning and transmission electronic microscopy. RESULTS: The coralline particles were surrounded by fibrous connective tissue when used alone. The addition of iliac crest bone to the coralline particles stimulated bone formation. After the sinus augmentation, the mucosal lining showed a lack of glands in the lamina propria, and the epithelium showed an increase in goblet cells. CONCLUSION: It was concluded that the sinus mucosa undergoes physiologic adaptations and remains healthy and free of chronic sinusitis after maxillary sinus grafting.     

Mucocele of maxillary sinus]

The effect of heat on double-strand breaks (dsb) repair was compared with thermal radiosensitization using HeLa S3 cells. Cells were exposed to a combined treatment of X-irradiation followed by heat (44 degrees C, 0.5 h) separated by time intervals up to 8 h. DNA dsb were measured by PFGE and survival by the colony forming assay. In non-heated HeLa S3 cells repair of dsb was biphasic with the majority of breaks being repaired fast with a half-time of 14 min and only a minority were repaired slowly with a half-time of 130 min. Heat applied immediately after irradiation was found to cause an increase in both half-times but mainly to result in an increased fraction of slowly repairable dsb. The latter effect was shown to result from the formation of additional dsb. The number of additional dsb declined when irradiation and heat were separated by an interval at 37 degrees C with a half-time of 120 +/- 30 min. This half-time was similar to the half-time of 100 +/- 20 min found for the loss of thermal radiosensitization studied for the same protocol. Both processes were recently found also to correlate in CHO cells but occurred much faster in rodent cells than in the human HeLa S3 cells used in the current study. These results show that in human cells, unlike previously suggested on the basis of rodent cells, thermal radiosensitization is still a substantial contributor to the killing efficacy of a combined treatment even when irradiation and heat are separated by a time internal of 4 h.     

Aggressive fibrous dysplasia of the maxillary sinus

Fibrous dysplasia is usually a slowly progressive, benign disease that develops over several years and presents with deformity or mild symptomatology. Five of 34 patients (ages 4-21 years), who were subsequently diagnosed histologically as having fibrous dysplasia of the maxillary sinus, rapidly developed soft tissue masses of the malar region over a period of less than 4 months with accompanying pain (2 patients) and nasal obstruction and exophthalmos (2 patients). Each was clinically suspected of having a sarcoma; two had been thought to have an "osteofibrosarcoma" on initial biopsy at outside hospitals. After resection, all lesions developed regrowth. At histopathologic examination, both initial and recurrent masses proved to be typical fibrous dysplasia with spicules of woven bone in cellular, sometimes vascular, fibrous tissue. No malignant degeneration was found. On conventional radiography, aggressive fibrous dysplasia produced opacification and expansion of the maxillary sinus and apparent disruption of its wall with an associated soft tissue mass. Computed tomography (CT) demonstrated voluminous heterogeneous masses with "ground glass appearance", calcifications, areas of enhancement, low attenuation, cystic areas, and a thinned, sometimes interrupted, maxillary wall. Despite the aggressive clinical course for both initial and recurrent lesions, the CT findings of a "ground glass" mass with calcifications surrounded by a maxillary sinus wall, even if incomplete, can suggest the diagnosis of aggressive fibrous dysplasia.     

Unusual metastasis of hypernephroma in the maxillary sinus

OBJECTIVES: To determine the predictive value of intraoperative threshold stimulus for facial nerve outcome and the prevalence and prognostic value of persistent trains of activity and frequent spontaneous or mechanically induced contractions during acoustic neuroma surgery. STUDY DESIGN: Prospective recording and subsequent review of facial nerve activity. SETTING: Tertiary referral centre. PATIENTS AND METHODS: Consecutive patients undergoing acoustic neuroma surgery. Intraoperative facial nerve activity was digitised and stored on a personal computer for future analysis. Operative events were flagged. Recordings were available in 27 patients. MAIN OUTCOME MEASURES: Frequent mechanically induced contractions (< 20), prolonged trains of facial nerve activity (total time > 199 seconds), and facial nerve brainstem stimulus threshold were correlated with facial nerve outcome. RESULTS: A brainstem stimulus threshold > 0.1 mA was significantly associated with intermediate or poor facial nerve function (House-Brackmann grade > 2) on the sixth postoperative day, at 1 month and 6 months. Patients with normal or near-normal facial function on the first day and a threshold of > 0.1 mA were significantly more likely to develop a delayed facial nerve palsy. Frequent contractions were noted in 74% of patients and persistent train activity in 59%. Neither was predictive of facial nerve outcome. CONCLUSIONS: An elevated brainstem threshold is helpful in predicting delayed facial nerve palsy and suboptimal facial nerve outcome. Persistent train activity and frequent contractions, do not have major prognostic significance.     

Effects of functional endoscopic sinus surgery on maxillary sinus mucosa

OBJECTIVE: To compare the preoperative and postoperative changes on ciliary surface of maxillary sinus mucosa in patients treated with functional endoscopic sinus surgery. DESIGN: The maxillary mucosa of both the superolateral wall and the ostium were sampled during the operation and 6 to 12 months (mean duration, 7.6 months) after the operation. Ciliary surface was determined using scanning electron microscopy in combination with an image analyzer and was expressed in terms of ciliary area, which is the percentage of mucosal surface occupied by cilia. SETTING: The samples were taken at a hospital-based clinic. An electron microscopic study was performed at Mie University School of Medicine, Mie, Japan. PATIENTS: Sixteen patients (20 maxillary sinuses) undergoing functional endoscopic sinus surgery for treatment of chronic sinusitis. RESULTS: The mean (+/-SD) ciliary area before the surgery was 60.7%+/-28.8% and 39.9%+/-21.5% in the superolateral wall of the maxillary sinus and the ostium of the maxillary sinus, respectively. The ciliary area of the superolateral wall was significantly higher than that of the ostium (P<.001). The mean (+/-SD) postoperative ciliary area value was 74.3%+/-22.6% in the superolateral wall and 51.3%+/-16.1% in the ostium. These postoperative values were significantly higher than the preoperative values (P<.001). CONCLUSIONS: This study showed that the maxillary sinus mucosa in chronic sinusitis is capable of regeneration, and the damaged ciliated epithelium could return toward normal with the improvement of ventilation and drainage of the maxillary sinus following functional endoscopic sinus surgery.     

Follicular adenocarcinoma of the thyroid in the maxillary sinus

No reports of metastatic thyroid carcinoma in the maxillary, ethmoid, or sphenoid sinuses can be found in the literature. A woman with severe posterior epistaxis was examined recently. She had undergone a partial lobectomy for a thyroid tumor 16 years previously. Hemorrhagic thyroid tissue was in the maxillary sinus. The results of subsequent examinations indicated thyroid deposits in the lung and spine. The patient received radioactive iodine, 100 MCi. Her lung and spine deposits lysed, and she experienced no further epistaxis. Thyroid carcinoma's ability to metastasize to a paranasal sinus is documented here. Epistaxis after a thyroidectomy for cancer now must be considered an unusual clinical manifestation of metastatic spread, unless otherwise proved. The differential diagnosis of epistaxis must now include thyroid carcinoma metastatic to the sinonasal tract.     

Dislocation structures ahead of advancing cracks

Previous transmission electron microscope (TEM) observations of the dislocation structure in the vicinity of a crack suggested that the region immediately ahead of a crack is devoid of dislocations. In the present paper, the results ofin situ TEM deformation experiments in numerous systems are described. The dislocation configurations are generally complex, with dislocations extending from the crack tip(i.e., no dislocation-free zone (DFZ)) and forming complex arrangements in the plastic region in front of the crack tip. Crack advance was accompanied by the emission of dislocations from both the crack tip and nearby sources. These observations are summarized, and the theory of dislocation configurations in front of a crack is reconsidered. This paper is based on a presentation made in the symposium “Interface Science and Engineering” presented during the 1988 World Materials Congress and the TMS Fall Meeting, Chicago, IL, September 26–29, 1988, under the auspices of the ASM-MSD Surfaces and Interfaces Committee and the TMS Electronic Device Materials Committee.     

Gallium-67 scanning in the differentiation of maxillary sinus carcinoma from chronic maxillary sinusitis

Gallium-67 scans of 25 patients in whom the clinical symptoms and radiographic findings were suggestive of either maxillary sinus carcinoma or chronic sinusitis proved to be valuable in the differentiation between the two disease processes. Those patients with carcinoma had positive scans, while those with sinusitis had either negative or only weakly positive scans.     

Vascularized bone flap for access to the maxillary sinus

PURPOSE: This article describes a vascularized bony window for access to the maxillary sinus and reports the clinical results. PATIENTS AND METHODS: A bony U-shaped window in the anterior sinus wall was pedicled on the surrounding soft tissue and periosteum. After the described sinus was cleared of disease, the window was repositioned in its original site either using resorbable sutures or not. The method was used in 47 maxillary sinus operations in 45 patients. Twenty-four patients were followed-up for more than 48 months. RESULTS: The vascularized bony window technique showed uneventful healing in all patients and none of the 24 patients reported any problems. CONCLUSIONS: The vascularized bony window technique provides a large antrostomy, which gives good access and visibility and results in satisfactory postoperative healing.     

Leiomyosarcoma of the maxillary sinus: CT and MRI findings

This report describes the CT and MRI appearances of a leiomyosarcoma of the maxillary sinus. CT showed frank bony destruction, no calcification and a low attenuation area within the mass. MRI showed intermediate intensity on T1 weighted images, intermediate to slightly high signal intensity on T2 weighted images and moderate inhomogeneous enhancement. Precise identification of the extent of the tumour, especially of orbital invasion, is of utmost importance because local recurrence is common after the resection of leiomyosarcomas.     

How to prevent the various neuralgic complaints after operation of maxillary sinus? (author's transl)

In order to avoid multiple neuralgic complaints after operations of maxillary sinus the following advice for cautions operative procedures is as follows: 1. A vertical incision in the mucosa of the fossa canine behind the eye-tooth instead of the usual horizontal section. 2. A small dorsolateral fenestration in a part of less nervous ramification in the facial bone layer of the antrum of High-more. 3. The limitation of resection of the mucous membrane in pathological areas of the sinus. 450 operations of the maxillary sinus were done in this way, which resulted in a lower rate of postoperative neuralgic complaints. Another advantage was the minimized intraoperative bleeding and the absence of postoperative swelling and haematoma formation of the cheek.     

Blood supply of the Le Fort I maxillary segment: an anatomic study

The oral efficacy of chicken egg yolk immunoglobulins (yIg) specific for bovine rotavirus (BRV) serotypes G6 and G10 in protecting neonatal calves was examined in a herd of cattle under field conditions. In one of the three trials, yIg-treated calves tested under high relative humidity (RH) showed a significantly increased mean body weight (P < 0.05) and a decrease in number of calves shedding high titer of BRV (G6) in stool compared to control calves (P < 0.01), suggesting that our yIg product was effective in a field condition with an epidemic outbreak of BRV diarrhea.