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PubMed2002

Maxillary sinus hypoplasia.

Maxillary sinus hypoplasia (MSH) is an uncommonly encountered condition by otolaryngologists. The computerized tomography (CT) scans provide valuable data about the anatomic details of the paranasal sinuses. MSH may be misdiagnosed as an infection or a neoplasm of the maxillary sinuses. Variations of the other paranasal structures, especially the uncinate process associated with MSH were defined. MSH shows three distinct hypoplasia patterns. Type I MSH characteristics are mild hypoplasia of the maxillary sinus, normal uncinate process and a well-developed infundibular passage. Significant hypoplasia of the maxillary sinus, hypoplastic or absent uncinate process and absent or pathologic infundibular passage are seen in Type II MSH. Type III MSH is characterized by the absence of an uncinate process and cleft-like maxillary sinus hypoplasia. In this study a series of 18 patients with MSH were presented. Twelve cases of unilateral and 6 cases of bilateral maxillary antrum hypoplasia were evaluated and 13 MSH type I, 7 MSH type II and 4 MSH type III were detected. Three ethmomaxillary sinuses, an overpneumatized posterior ethmoid cell into the orbit and the maxillary sinus were determined. Our series showed that the uncinate process anomalies related to MSH may lead to inadvertent orbital complications and therefore should be kept in mind.

Adult↗
PubMed2002

Local anesthesia with EMLA cream for maxillary sinus puncture.

Maxillary sinus puncture is traditionally carried out through the lateral wall of the inferior nasal meatus under local anesthesia. One problem with it is that the insertion of a cotton-tipped applicator soaked in local anesthetic is painful. Patients also dislike waiting for the anesthetic effect with the metallic applicators in the nose. In this study, we present a new, well-tolerated method of topical anesthesia for maxillary sinus puncture via the inferior meatus of the nose. Twenty adult patients with maxillary sinus infection who were undergoing bilateral maxillary sinus puncture were studied. One side of each patient's nose was anesthetized with a cotton-tipped applicator moistened with a lidocaine-adrenaline solution (LA), and the other side was anesthetized with EMLA cream instilled with a suction needle and syringe; the sides were chosen randomly. The mean "application of anesthesia" pain score on a 100-mm visual analog scale was 39.2 for the LA side and 9.1 for the EMLA side (p < .01). The anesthesia required for puncture was reached more quickly on the EMLA side than on the LA side (p = .02). The mean puncture pain score was 25.1 with LA and 8.6 with EMLA (p = .01). Fourteen patients out of the 20 (70%) found EMLA more tolerable, 3 patients (15%) found no difference, and 3 patients (15%) preferred LA (p < .01). We conclude that EMLA is better-tolerated and quicker-acting than LA for local anesthesia in maxillary sinus puncture.

Adult↗
PubMedDate not supplied

[Relations between the maxillary sinus and upper maxillary process. Anatomotopographic study].

The anatomic proximity of the antral floor and superior alveolar processes favors the propagation of infections from teeth to neighboring structures, as was pointed out first by John Hunter. A radiologic and anatomic study was made of these anatomic relations and the bony substance between the alveolar ridge and maxillary sinus was measured. No firm criteria for normality could be established because of the variability of the maxillary sinus. Variations in environmental and developmental conditions easily modify its morphology.

Adult↗
PubMed1995

[Odontogenic diseases of the maxillary sinuses].

Odontogenic maxillary sinusitis is aetiologically different from rhinogenic maxillary sinusitis. Accordingly, there are distinct and--for the oral maxillofacial surgeon--very specific therapeutic consequences. The general clinical diagnostical principles have scarcely changed in the last years. In diagnostic imaging, computed tomography and magnetic resonance tomography are of great importance, especially concerning pre-operative diagnostics. Endoscopical techniques have been enhanced with the introduction of microcamera-supported endoscopy, a technical improvement. Therapeutical principles are: complete treatment of odontogenic factors in the whole quadrant; conservative and operative therapeutical procedures are to be combined. Other than in the ENT field, where the maxillary sinus is approached by an endo-nasal technique--infundibulotomy-in oral and maxillofacial surgery the transalveolar approach through the fossa canina is used when treating odontogenic maxillary sinusitis. However, cautious methods assuring the preservation of tissue in all respects are treatment of choice.

Diagnosis, Differential↗
PubMed2006

Pattern of local relapse of maxillary sinus carcinoma.

Maxillary sinus carcinoma (MSC) is a rare disease with a variety of treatment options. The present study was undertaken to review the outcome of patients with treated MSC in order to clarify the factors related to local recurrence by analyzing CT findings. The study group comprised of 47 cases, 40 males and 7 females with a median age of 61 years (range, 40- 84 years) treated between 1988 to 1996 at the department of radiotherapy. CT was taken with a slice thickness of 5 mm and contrast material was routinely used. The mean follow-up period for the group was 45.0 months (range, 3-125 months). The treatment policy was either preoperative radiotherapy of 40Gy/16fr followed by maxillectomy or radical radiotherapy of 65Gy/26fr with partial maxillectomy during the course of radiotherapy. By using CT-simulation, wedge pair techniques were used in most patients with Cobalt or 6MV X-ray machines as treatment sources. Tumor extension was categorized into the following anatomical sites: orbital contents, other paranasal sinuses, posterior wall of the maxillary sinus, pterygoid plate/muscle, nasopharynx, infra-temporal fossa, base of the skull, anterior wall of the maxillary sinus, subcutaneous tissue, cheek mucosa, hard palate and alveolar bone. Local control was computed by using the Kaplan-Meier method and p value was measured by using Chi-squared test. The 5-year overall local control rates for all patients were 56%. The local recurrence was found in 19 of 47 patients (40.4%). Tumors extending to pterygoid plates (n=13) and pterygoid muscles (n=10) showed higher rate of local recurrences as compared to those without extensions (9/13 [69%] vs 10/34 [29%], p<0.02 and 7/10 [70%] vs 12/37 [32%], p<0.05, respectively). Extensions to nasopharynx (6/9, 66%) and base of skull (4/6, 66%) also showed higher rates of recurrence; however, those were not statistically significant. More than 80% of the relapse became manifest within 12 months of diagnosis and isolated local failure was the most common pattern. This analysis indicates that tumor extension to pterygoid plate/muscles, results in higher rates of recurrences. This may due to the difficult surgical accessibility of the tumor. During radiotherapy planning, special emphasis should be given to this sites of tumor extension to avoid possible local recurrence.

Adult↗
PubMed1976

[Tomography of the maxillary sinus].

The maxillary sinuses were studied roentgenographically and tomographically in 108 patients (with intact sinuses) and in 16 anatomical preparations of the cranium. It has been established that the main features of the laminar picture of the maxillary sinuses can be determined by two main properties of tomography as a method: the possibility to lead the portions of the sinus osseous walls of greater-length as compared with conventional roentgenography out to the edge-forming zone due to oblique course of the ray beam, and vise versa, disappearance of outlines of these walls in those sections where they are considerably inclined in relation to the roentgen film plane. A description of the laminar roentgen-anatomical picture of the maxillary sinuses in naso-frontal, nasomental and lateral projections is presented. It is stresses that in each of these projections several main types of the laminar picture of the maxillary sinuses can be detected, characterizing different depth of sections.

Humans↗
PubMedDate not supplied

[Study of proteolytic enzymes and their inhibitors in maxillary sinus exudates in patients with chronic suppurative maxillary sinusitis].

Specific proteolytic and antitryptic activities were measured in the sinus exudate of 27 patients with chronic suppurative maxillary sinusitis. Most patients showed a shift in the proteinase-inhibitor system with proteolytic activity being predominant. In the course of treatment antitryptic activity in the exudate increased. It was found that biochemical data were correlated with clinical manifestations. It is concluded that patients with the above pathology should be prescribed proteolytic enzymes on an individual basis and that natural proteinase inhibitors should be included into the combined therapy.

Adolescent↗
PubMed1985

Comparative study of standard radiology, sinuscopy and sinusomanometry in the maxillary sinus of the adult (about 465 maxillary sinuses).

The authors examine the correlations among standard X-ray, sinuscopy and sinusomanometry for 465 maxillary sinuses in the adult. Good overall correspondence does exist between radiography and sinuscopy (51.59 to 90.91%) but there is no real correlation between sinusomanometry and a sinuscopy that fails to visualize the ostium. Correlation is excellent when the morphologic appearance of the ostium is studied in conjunction with the sinusomanometric findings (82.09%). This study demonstrates the morphologic and the functional examinations to be rigorously complementary and indissociable.

Adolescent↗
PubMed1997

Mucoceles of the maxillary sinus.

The maxillary sinus is an uncommon site for mucoceles within the paranasal sinuses. In this study nine patients with maxillary sinus mucoceles are presented. Six of these patients were treated by open approaches, and three were treated by endoscopic drainage alone. For uncomplicated maxillary sinus mucoceles, endoscopic drainage appears to be a reasonable approach, whereas for more complicated cases extending outside the sinus, open approaches may be required.

Adult↗
PubMed2001

[Venous drainage and innervation of the maxillary sinus].

The maxillary sinus, or "Highmore's antrum", is a cavity of the facial structure buried in the body of the maxillary body joined to the nasal fossae with which it communicates via the maxillary ostium. The dissection of 25 maxillary sinuses has enabled us to study its venous drainage and innervation. The venous system is collected either by a single trunk, which is a continuation of the spheno-palatine vein, or by three venous plexus: the anterior and posterior pterygoid plexus, and the alveolar plexus. The anterior and posterior pterygoid plexus converge through the lateral pterygoid muscle and connects with the alveolar plexus which drains partly into the maxillary vein and partly into the facial vein. The innervation of the maxillary sinus is ensured by the maxillary nerve (V2): the second branch of the trigeminal nerve and its collateral branches. During the course of its track the maxillary nerve becomes successively the spheno-palatine nerve and the anterior orbital nerve, and gives rise to some collateral branches: the posterior and superior alveolar ramus, the medium and superior alveolar nexus and the anterior and superior alveolar ramus.

Cadaver↗
PubMed1995

Mucociliary activity and histopathology of sinus mucosa in experimental maxillary sinusitis: a comparison of systemic administration of antibiotic and antibiotic delivery by polylactic acid polymer.

To evaluate the efficacy of antibiotic delivered by polyactic acid (PLA) polymer in sinusitis, we induced maxillary sinusitis in 32 New Zealand white rabbits by occluding the sinus ostium and inoculating the sinus cavity with Streptococcus pneumoniae. The rabbits were divided into three groups consisting of group 1 (control group, 8 rabbits), which was treated only by reopening the ostium; group 2, which was treated by both reopening the ostium and injecting ampicillin intramuscularly (40 mg/kg/day in three divided doses, 12 rabbits); and group 3 (12 rabbits) in which a piece of PLA-polymer ampicillin (0.326 mg) sheet (1.5 x 1.5 cm) was placed within the sinus after re-establishing ostial patency. The light microscopic findings such as epithelial ulceration, loss of cilia, infiltration of inflammatory cells, and edema were less pronounced in group 2 and minimal in group 3. The electron microscopic findings such as swelling of mitochondria and endoplasmic reticulum and protruded cytoplasm were severest in the control group, followed by groups 2 and 3. The mucociliary transport speed measured at the medial wall of the maxillary sinus was highest in group 3. The results of this study suggest that treatment with PLA-polymer ampicillin may have a better efficacy in maxillary sinusitis than that with systemic administration of ampicillin.

Ampicillin↗
PubMed2005

Effect of treatment on maxillary sinus and nasal nitric oxide concentrations in patients with nosocomial maxillary sinusitis.

STUDY OBJECTIVES: In maxillary nosocomial sinusitis (MNS) related to severe sepsis, nitric oxide (NO) concentration in the maxillary sinuses is drastically reduced secondarily to a downregulation of type-2 NO synthase. NO plays a major role in nonspecific immune defense of sinuses. We therefore aimed to study maxillary NO concentration during the treatment of MNS with drainage, daily lavage, and removal of any nasally introduced tube. PATIENTS AND METHODS: Nine patients were studied during the first 4 days of treatment of MNS. We measured the concentration of NO gas in the maxillary sinus and in the nasal cavity, and the NO metabolite levels (nitrites/nitrates [NOx]) in the sinus lavages. MEASUREMENTS AND RESULTS: Maxillary NO concentration (median [25 to 75 percentile]) increased from 70 parts per billion (ppb) [40 to 100 ppb] to 2,050 ppb (1,700 to 3,000 ppb) after 4 days of treatment of MNS (p < 0.0001). In the meantime, nasal NO increased from a median of 100 ppb (98 to 148 ppb) to 180 ppb (180 to 188 ppb) [p < 0.001]. At any time, there was a correlation between maxillary NO (logarithmic value) and nasal NO (r2 = 0.57, p < 0.0001). NOx levels remained stable in the lavages. CONCLUSIONS: We conclude that the treatment of the sinusitis with drainage, daily lavage, and removal of the gastric tube lead to a spectacular increase of maxillary and nasal NO concentrations.

Adult↗
PubMed1994

[Endoscopic treatment of maxillary sinus cysts].

Maxillary sinus cysts are common lesions usually found in routine x-rays of the teeth and sinuses. Although most patients are asymptomatic, there may be headache or periorbital or facial pain. Traditionally, these cysts have been treated by puncture and aspiration, or excision via intranasal antrostomy or Caldwell-Luc operation 23 patients with maxillary sinus cysts who presented with facial pain were treated by endoscopic surgery. During followup of 1 year the cyst recurred in only 1 of the patients (after 2 months). We recommend endoscopic removal of maxillary sinus cysts as the treatment of choice.

Cysts↗
PubMed1983

[Cefotiam passage into the maxillary sinus tissues].

Clinical study was made on cefotiam (CTM) and the following results were obtained. Tissue concentrations of CTM were determined 1 hour after intravenous injection (CTM 1 g) in chronic sinusitis and maxillary cyst. Concentrations of CTM were 16.53 micrograms/g, 13.26 micrograms/g in mucosa of the maxillary sinus, maxillary cyst, respectively. Antibacterial activity of CTM was measured on Escherichia coli, Staphylococcus epidermidis, Aerococcus, Acidaminococcus fermentans, Peptostreptococcus anaerobius; that were isolated from pus of maxillary sinus. The highest MIC on them was 3.13 micrograms/ml.

Adolescent↗