Investigations of anti-inflammatory activity of Jigrine

We report our experience with five lesions exclusively involving the entire cavernous sinus in which an essentially extradural surgical approach was used. There were two cases of cavernous haemangioma, two cases of meningioma and one case of fungal granuloma. The dural cover of the superior orbital fissure, and mandibular and maxillary divisions of the fifth nerve was dissected along with the dura of the lateral wall of the cavernous sinus. The presence of a relatively large intracavernous bulge due to the tumour assisted in this dissection. The contents of the cavernous sinus were exposed from an anterolateral, lateral and inferior approach. Through the corridor available between the splayed out cranial nerves, a radical resection of the tumour was accomplished in each case. The technical advantages of this approach are discussed in light of the anatomy of the dural configuration of the lateral wall of the cavernous sinus.     

Mean fetal growth curve adjustment]

OBJECTIVE: Three-dimensional models created by milling machines and stereolithography on the basis of 3-dimensional computed tomography scans have become essential in the diagnosis and therapy planning of oral and maxillofacial disorders. The purpose of this study, based on 3 clinical cases, was to examine the advantages of using 3-dimensional computed tomography scans and 3-dimensional milling models of the maxillary sinus before operative sinus elevation and of developing an operative layout with the aid of 3-dimensional models. REPORT DESIGN: Three patients with atrophy of the maxillary alveolar ridge received computed tomography scans before operative sinus elevation with iliac bone transplants and simultaneous dental implantation. These computed tomography data were used to create 3-dimensional graphic and plastic reconstructions of the maxillary sinuses. RESULTS: The 3-dimensional milling models enabled the development of an exact preoperative layout that took into consideration the exact shape of the iliac bone and the selection of dental screw implants. Furthermore, the models offered the possibility of producing an acrylic device for precise implant insertion. Precise planning resulted in good success with implantation 2 years after surgery. CONCLUSION: Three-dimensional diagnosis and treatment layout have become an acknowledge method of operative maxillary sinus floor augmentation combined with simultaneous dental implantation in the upper jaw in difficult cases of sinus lift operations. As far as transplant shape and sinus anatomy are concerned, this has resulted in greater intraoperative precision. A 1-step procedure can thus be performed for augmentation and implantation through use of a well-adapted block transplant and dental screw implants in patients with extensive alveolar ridge atrophy.     

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.     

Extramedullary anaplastic plasmacytoma

A case of extramedullary plasmacytoma of the maxillary sinus, locally aggressive, in a 65 years old man is presented. Clinical diagnosis of adenocarcinoma was suspected but the pathological study showed an anaplastic morphology, with little plasmacytic differentiation and lack of stain with cytokeratins and epithelial membrane antigen (EMA), immunohistochemical marker of plasmatic cells, among others. Definitive diagnosis was based on light chain restriction and lack of multiple myeloma.     

Professional anamnesis and information: considerations on a clinical case]

Although choanal polyps frequently arise from the maxillary sinus, a choanal polyp originating from the sphenoid sinus is a rare entity. In this report, an unusual case of a large choanal polyp taking origin from the sphenoid sinus is presented. The reasons for its development and methods of management are discussed.     

Toothache with a multifactorial etiology: a case report

A case report of orofacial pain originating from both dental and nondental conditions is presented. The spontaneous throbbing pain initiated from the left maxillary second premolar and spread throughout the entire upper part of the face to the frontoparietal area. Root canal treatment of the maxillary second premolar did not resolve the chief complaint. Magnetic resonance imaging examination revealed hypertrophy of the left inferior turbinate and soft tissue haziness in the left maxillary sinus floor. After antrostomy, submucosal turbinectomy, and endodontic treatment, the patient was free from pain. The final diagnosis of this case, in addition to pulpitis, was maxillary sinusitis with chronic rhinitis. The multiple factors associated with the etiology made the diagnosis difficult. The mechanism of referred pain from the maxillary sinus and paranasal mucosa to the maxillary teeth and face is discussed.     

The placebo effect and clinical research in urology

A case of a large dentigerous cyst containing a canine tooth in the maxillary antrum is presented. This case is of interest due because of its extensiveness and the presence of a canine tooth in the roof of the maxillary sinus. In addition, this caused a right-sided epiphora. Enucleation of the cyst containing the ectopic tooth was made.     

Massive pleomorphic adenoma of the maxillary sinus. A case report

A case of pleomorphic adenoma of the maxillary sinus in a 78-year-old man with associated mucocele is reported. The diagnosis and treatment of this rare lesion is discussed.     

Calcifying odontogenic cyst (Gorlin's cyst) of the maxillary sinus

Occasionally the maxillary sinus is invaded by a cyst or tumor of odontogenic origin. Though usually benign, these lesions may be locally aggressive. A recent case involving bone destruction and sinus opacification is presented.     

The importance of panographic and dental evaluation for lesions of the antrum

A large dentigerous cyst which displaced the antrum and partly eroded its bony walls was interpreted as a malignant neoplasm in routine sinus films. The true nature of the process was readily apparent in a panographic view which showed an unerupted third molar lying horizontally above the apices of the first and second molars. This case is an excellent demonstration of the important role of panographic views in the differential diagnosis of maxillary sinus lesions.     

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.     

The maxillary sinus and odontogenic cysts

An unilateral maxillary sinusitis is frequently caused by dental pathology. An odontogenic cyst in the maxillary sinus usually lacks accompanying symptoms of infection. In three patients, a 35-year-old man and two women aged 16 and 28, an odontogenic cyst in the maxillary sinus was diagnosed. Consultation of a maxillofacial surgeon is needed because orthopantomographic imaging is diagnostically most helpful. In these patients combined treatment by an ENT surgeon and a maxillofacial surgeon is important.     

The sinus lift graft: basic technique and variations

Following an early controversy concerning its efficacy, the sinus lift and graft technique is now considered to be a state-of-the-art surgery. In 1975, Tatum introduced the technique that increased maxillary bone height by placing graft material under the maxillary sinus and Schneiderian membrane; by the early 1990s, a modification of Tatum's original technique had become a standard procedure. This article describes and illustrates three variations of the basic sinus lift surgery and graft operation--the hinge osteotomy, the elevated osteotomy, and the complete osteotomy. Additional considerations affecting the surgical outcome are also discussed as is the management of possible complications. The learning objective of this article is to obtain up-to-date information regarding the basic technique and variations of the sinus lift procedure to the general practitioner as well as the specialist.     

Dystocia: is it a major indication for caesarean section?

An unusual case of rhinocerebral zygomycosis with its clinical and histopathological features are presented. A good response was observed with oral itraconazole at a dose of 200 mg day-1 for a period of 3 months. To our knowledge, it is the first case report of this infection, involving the maxillary sinus, eye and the brain, from Madras, Tamilnadu, India.     

Variation in labial shoulder geometry of metal ceramic crown preparations: a finite element analysis

BACKGROUND: The anatomic variation of the frontal sinus and frontal recess can create both a diagnostic and therapeutic challenge. Most cases of frontal sinus disease can now be treated by endoscopic approaches. For refractory cases or those with severe pathology, the microscopically controlled drainage (MCD) operation has at times been successful and spared the patient the morbidity of an external approach. The aim of this study was to evaluate microscopically controlled frontal sinus surgery in these difficult cases. MATERIAL AND METHODS: Prospective analysis was performed on the efficacy of MCD in patients for whom endoscopic sinus surgery had failed or in primary cases with severe pathology or unfavorable anatomy. The technique employs a self-retaining endonasal retractor and a diamond bur under microscopic visualization to remove solid bone (frontal spine) obstructing the sinus drainage and allow a wide opening of the frontal recess while causing minimal mucosal damage. Unilateral drainage (extended frontal sinus drainage operation), and in some cases bilateral drainage (median drainage procedure) is employed. RESULTS: With an average of 23 months of follow-up, over 90% of patients were either free of symptoms or substantially improved after the MCD procedure. Three patients required revision surgery (extend the opening into a median drainage procedure) for adequate relief of symptoms. CONCLUSIONS: The MCD procedure is highly successful in the treatment of frontal recess disease, particularly in those cases of severe pathology or difficult anatomy. It may be used in those cases refractory to standard endoscopic sinus surgery where an external approach and frontal sinus obliteration are contemplated. As with endoscopic sinus surgery, precise knowledge of the frontal recess and neighboring landmarks is critical, and adequate drainage with minimal mucosal disruption should be the goal.     

Computerized 3-D reconstruction of two "double teeth"

"Double teeth" is a root malformation in the dentition and the purpose of this study was to reconstruct three-dimensionally the external and internal morphology of two "double teeth". The first set of "double teeth" was formed by the conjunction of a mandibular molar and a premolar, and the second by a conjunction of a maxillary molar and a supernumerary tooth. The process of 3-D reconstruction included serial cross-sectioning, photographs of the sections, digitization of the photographs, extraction of the boundaries of interest for each section, surface representation using triangulation and, finally, surface rendering using photorealistic effects. The resulting three-dimensional representations of the two teeth helped us visualize their external and internal anatomy. The results showed: a) in the first case, fusion of the radical and coronal dentin, as well as fusion of the pulp chambers; and b) in the second case, fusion only of the radical dentin and the pulp chambers.     

Needs assessment of non-traditional students in physical and occupational therapy programs

A technique of combined functional endoscopic sinus surgery (FESS) was carried out through the nose to clear up the ostiomeatal complex. A small window was then created in the canine fossa to remove the maxillary sinus pathology under endoscopic control. It aims at the complete removal of maxillary sinus pathology, which cannot be safely removed via the middle meatus while preserving the rest of the mucosa to ensure sinus rehabilitation. It also helps the surgeon in case of difficulty in locating the ostium during FESS. A series of 36 patients was studied over a period of two years, with a follow up, up to two years, post operatively. The present technique proved to be complementary to FESS with no serious complications. It is recommended for cases of recurrent antrochoanal polyps, oroantral fistula, sinusitis of dental origin or fungal infection of the nose and sinuses.     

Treatment of oroantral communications after tooth extraction. Is drainage into the nose necessary or not?

Seventy-six patients with oroantral communications after tooth extraction and chronic maxillary sinusitis were treated as follows: bacterial cultures were taken in all of them and maxillary sinuses were irrigated with an antibiotic from the cephalosporin group. Then, in 36 patients, drainage using the Caldwell Luc procedure was performed, including a naso-antral window. In all patients operations were completed by closing oroantral communications with flaps of the mucosa of the alveolar process close to the fistula. Antibiotics according to antibiogram were administered to all patients at least 10 days after surgery. Retrospective comparison between the results obtained in the first group and those in the second group 1, 3 and 6 months after operation was based on objective findings (condition of the oroantral communication, maxillary sinusitis), side effects (pain, numbness of the operated area, headache) and control radiographs (clear maxillary sinus or with mucosal thickening). The study suggests that transnasal drainage is not required in maxillary sinus surgery and in the closure of oroantral communications. Equally good results are achieved by treating with antibiotics and without drainage of the maxillary sinus into the nose.     

Ovarian surgery in premenarchal girls

OBJECTIVES: Evaluate causes of surgical failure at time of revision endoscopic sinus surgery. STUDY DESIGN: Prospective review of 682 cases that had endoscopic sinus surgery performed between 1991 and 1995. METHODS: In all cases, variables of age, sex, asthma, allergy, computed tomography stage, associated procedures, complications, and operative findings were collected. Those cases that had a failure after a previous endoscopic sinus procedure and not an intranasal procedure or an external procedure were evaluated. RESULTS: Fifty-two patients (7.6%) were identified. The age range was 24 to 70 years. The most common cause of failure was residual air cells and adhesions in the ethmoid area (30.7%), followed by maxillary sinus ostium stenosis in 27%, frontal sinus ostium stenosis in 25%, and a separate maxillary sinus ostium stenosis in 15% of the cases. CONCLUSION: Review of surgical causes of failure in endoscopic sinus surgery patients revealed that residual air cells and stenotic maxillary or frontal sinus ostium were the most common causes of failures.     

1H and 15N resonance assignment of neural cell adhesion molecule module-2

This article presents a simple, inexpensive method for precisely locating the floor of the maxillary sinus, as well as the presence of any septa, at the time of sinus augmentation surgery. Using an anesthesia light wand placed transnasally to illuminate the sinus, the surgeon can reliably elevate the lateral maxillary wall overlying the sinus with relative ease without fear of placing the osteotomy cuts too far from the sinus floor. The same procedure can be used postoperatively to evaluate the density of the bone graft placed into the sinus prior to closure.