RESUMEN
OBJECTIVE: A significant cause of infertility is the inability of the embryo to implant. Endometritis is one of the major causes affecting embryo implantation. The present study addressed the diagnosis and effects of chronic endometritis (CE) treatment on pregnancy rates after in vitro fertilization (IVF). PATIENTS AND METHODS: We conducted this retrospective study on 578 infertile couples treated with IVF. In 446 couples, we performed a control hysteroscopy with biopsy before IVF. In addition, we examined the visual aspects of the hysteroscopy and the results of the endometrial biopsies, followed by antibiotic therapy if necessary. Finally, the results of IVF were compared. RESULTS: Of the 446 cases studied, we diagnosed 192 (43%) with chronic endometritis, either by direct observation or based on the histopathological result. In addition, the cases diagnosed with CE we treated with a combination of antibiotics. The group diagnosed at CE and subsequently treated with antibiotic therapy had a significantly higher pregnancy rate after IVF (43.2%) than the group without treatment (27.3%). CONCLUSIONS: Hysteroscopic examination of the uterine cavity was particularly important for the success of IVF. The initial CE diagnosis and treatment were an advantage for the cases in which we performed the IVF procedures.
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Endometritis , Infertilidad Femenina , Embarazo , Femenino , Humanos , Endometritis/diagnóstico , Endometritis/tratamiento farmacológico , Endometritis/patología , Estudios Retrospectivos , Fertilización In Vitro/efectos adversos , Enfermedad Crónica , Histeroscopía , Infertilidad Femenina/terapia , Antibacterianos/uso terapéuticoRESUMEN
The lingual surface of the mandible's body is commonly indicated as presenting the submandibular and sublingual fossae, which are separated by the mylohyoid line. The mylohyoid line attaches to the mylohyoid muscle (MM). Less attention has been paid to the 'mylohyoid boutonnières', which allow the 'sublingual buttons' to pass through the mylohyoid muscle in the submandibular space. The cone-beam computed tomography files of patients were routinely examined for anatomical studies. Two cases were found with unexpected morphologies of the mandible's body - the mylohyoid lines were incomplete anteriorly, and herniated sublingual tissue determined an additional fossa inferior to that line in the premolar region. That fossa was termed the 'accessory submandibular fossa'. It determined on coronal slices a 'sand watch' contour of the mandible's body. With such a peculiar morphology, the mandible is more prone to fracture. Moreover, when inserting endosseous implants, the procedure should be carefully personalised in such rare cases.
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Mandíbula , Arena , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/anatomía & histología , Tomografía Computarizada de Haz Cónico , Músculos del CuelloRESUMEN
The dental pulp stem cells (DPSCs) are mesenchymal stem/stromal cells (MSCs) with multilineage potential of differentiation. Different studies investigated dental pulp stones (PS), the calcified masses in the dental pulp, in regard to their prevalence, topography and structure. The etiology of PS is still unclear and, to our knowledge, the DPSCs were not attributed yet specific roles in PS formation. We report here an immunohistochemical study of a PS-embedding dental pulp from an impacted third mandibular molar of an adult patient, in which we used antibodies against CD34, Ki67, glial fibrillary acidic protein (GFAP), α-smooth muscle actin (α-SMA) and nestin. While endothelial cells expressed CD34 and pericytes or vascular smooth muscle cells expressed α-SMA, DPSCs and the osteoblasts coating the PS were exclusively labeled with nestin antibody. Stromal networks of nestin-expressing DPSCs were regarded as in situ providers of osteogenic progenitors involved in PS formation. Further experimental studies, with larger lots of tissue samples, as well as extended panels of markers, are needed in order to elucidate the DPSC hypothesis in the PS etiology.
Asunto(s)
Calcificaciones de la Pulpa Dental , Células Endoteliales , Diferenciación Celular , Pulpa Dental , Humanos , Nestina , OsteogénesisRESUMEN
The lateral (temporal) wall of the orbit separates it from the temporal fossa and the anterior part of the temporal muscle. Within this wall, the sphenozygomatic suture joins the greater wing of the sphenoid bone and the zygomatic bone. We retrospectively documented in cone-beam computed tomography the anatomy of the orbit in a 56-year-old female and we found a previously unreported anatomic variant. The greater wing of the sphenoid bone and the zygomatic bone were separated, bilaterally, by a large unossified space which we termed the sphenozygomatic fissure. This was merged inferiorly with the inferior orbital fissure. A possible imbalanced mechanism of membranous ossification of both the zygomatic bone and the orbital surface of the greater wing could be speculated as a possible cause for such sphenozygomatic fissure. This previously undocumented anatomic variant is of high clinical relevance, since it may allow orbital fat to herniate (or bulge) toward the temporal fossa, it may be easily damaged during minor trauma and it should be carefully approached during the surgery of the orbit through the lateral wall.
Asunto(s)
Órbita , Hueso Esfenoides , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Persona de Mediana Edad , Órbita/diagnóstico por imagen , Estudios Retrospectivos , Hueso Esfenoides/diagnóstico por imagenRESUMEN
BACKGROUND: Paradoxical curvature of the middle nasal turbinate (MT) is a common anatomic variant, usually found and reported on coronal CT slices. However, less attention has been paid to the sagittal groove (SG) which is determining it. AIM: The study aimed to determine paradoxical curvatures and bifidities in the sagittal groves of middle nasal turbinate. MATERIAL AND METHOD: A retrospective CBCT study on the archived files of 52 adult patients was performed. RESULTS: Different patterns of MT bifidity were found: (1) unilateral bifid MTs; (2) bifid and trifid MTs and "wandering" single SGs; (3) bilateral bifid middle turbinates and double SGs, (4) bilateral false bifid appearance due to middle and superior turbinates fusion and (5) bifid concha bullosa media. Digital "dissections" of patients' files allowed us to conclude that paradoxical curvature as well as bifidity of MTs relate to the placement and number of the SGs on the MTs. Such SGs were previously documented in prenatal MTs since the 14th week, as well as in pædiatric patients. CONCLUSIONS: It seems reasonable to speculate that paradoxical curvature, as well as bifidity of MT, this later being previously undocumented, are just adult vestiges of the primitive MT morphology. Nevertheless, documentation of the MT morphology should not rely exclusively on coronal CTs, as combined morphologies of that turbinate could occur.
Asunto(s)
Tomografía Computarizada por Rayos X/métodos , Cornetes Nasales/anatomía & histología , Cornetes Nasales/diagnóstico por imagen , Adulto , Variación Anatómica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Nasales/diagnóstico por imagen , Estudios RetrospectivosRESUMEN
BACKGROUND: The inferior alveolar nerve (IAN) courses through the mandibular foramen (MF) to enter the first segment of the mandibular canal (MC) in the mandibular ramus, to further supply with trigeminal fibers the lower teeth of that hemimandible. As the IAN also supplies the mylohyoid nerve, it is a mixed nerve. METHODS: Unusual morphologies of the mandibular ramus were encountered during a retrospective study of archived CBCT files. RESULTS: A previously unreported anatomic variation was found bilaterally in an edentulous mandible, consisting of a lowered position of the MF, with seemingly compensatory lengthening and enlargement of the sulcus colli, thus shortened MCs. Also, a rare neurovascular canal of the neck of the mandible was incidentally found unilaterally in another case and is reported here. CONCLUSIONS: Such possibilities of variation could justify the individual effect of the IAN block.
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Variación Anatómica , Mandíbula/anomalías , Nervio Mandibular/anatomía & histología , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Imagenología Tridimensional , Hallazgos Incidentales , Mandíbula/diagnóstico por imagen , Mandíbula/inervación , Nervio Mandibular/diagnóstico por imagen , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: The infraorbital canal (IOC) courses through the roof of the maxillary sinus (MS). Different grading systems concerning the topography of the IOC have been proposed. Further, it has been suggested that a transantral IOC would be morphologically related to Haller's cells (HCs). However, we hypothesized that this is not necessarily the case. Hence, we aimed to study the anatomical possibilities of the air spaces located medially to the IOC. MATERIALS AND METHODS: The cone-beam computed tomography (CBCT) files of 40 adult patients were retrospectively evaluated. RESULTS: The transantral type of IOC was found in 32.5% of patients. The infraorbital recesses of the MS were found medial to the IOC in 20% of patients. As referred to the nasolacrimal canal, these recesses were either prelacrimal (appearing as false isolated air cells) or retrolacrimal (appearing as false HCs). True HCs were found in 10% of patients. They were located medial to the IOC and they drained into the ethmoidal infundibulum (EI), which was distinct from the MS drainage. In 15% of patients, aerated nasolacrimal ducts (NLDs) were found anterior to the EI and medial to the antral angle. They were capable of masquerading either a HC or an infraorbital recess of the MS. CONCLUSION: Previous classifications of the IOC, which related it to HCs, were reviewed and the evidence was found to be insufficient to assess the HC-related topography of the IOC. Therefore, to achieve the accurate anatomical identification of the air spaces neighbouring the IOC, the infraorbital recesses of the MS, the HCs, and the aerated NLDs should be carefully discriminated within the antero-supero-medial antral angle.
Asunto(s)
Seno Maxilar/anatomía & histología , Conducto Nasolagrimal/anatomía & histología , Adulto , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Masculino , Seno Maxilar/diagnóstico por imagen , Conducto Nasolagrimal/diagnóstico por imagenRESUMEN
The transantral or ectopic infraorbital canal (IOC) courses diagonally through the maxillary sinus (MS), thereby being exposed to risk during a number of surgical procedures. A few prior reports have presented evidence of a septa-embedded IOC, albeit only on single-plane slices. We identified this extremely rare variation of the IOC during a retrospective study of the cone-beam computed tomography files of 2 patients. In the first case, which involved a 34-year-old female patient, the canals and septa within the MS were bilaterally asymmetrical. On the right side, the sinus roof was attached to a short transverse septum that was traversed by the IOC, while the left sinus featured an oblique large septum that divided it into antero-superior and posterior chambers. The left IOC was embedded within the septum rather than within the orbital floor above the septum. In the second case, which concerned a 36-year-old male patient, the left MS featured an almost completely oblique/vertical septum that divided it into anterior and posterior chambers and also embedded the respective IOC, which was thus absent from the orbital floor. In both cases, infraorbital recesses in the anterior chambers of the MS were found that, if not documented on three-dimensional (3D) renderisations, could have been misidentified as infraorbital (Haller) cells. To the best of our knowledge, this is the first report to document the 3D anatomy of an extremely rare variant, namely a septum-embedded transantral IOC. Such a variant, if not adequately documented preoperatively, could divert the transmaxillary corridors down false paths or else expose the IOC to damage during surgical procedures involving access to tumours.
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Tomografía Computarizada de Haz Cónico , Imagenología Tridimensional , Órbita/anatomía & histología , Órbita/diagnóstico por imagen , Adulto , Femenino , Humanos , Masculino , Seno Maxilar/diagnóstico por imagenRESUMEN
Bi-allelic mutations in the glucocerebrosidase gene (GBA1) cause Gaucher's disease, the most common human lysosomal storage disease. We previously reported a marked increase in miR-155 transcript levels and early microglial activation in a zebrafish model of Gaucher's disease (gba1-/-). miR-155 is a master regulator of inflammation and has been implicated in a wide range of different neurodegenerative disorders. The observed miR-155 upregulation preceded the subsequent development of widespread pathology with marked neuroinflammation, closely resembling human Gaucher's disease pathology. We now report similar increases of miR-155 expression in mammalian models of GD, confirming that miR-155 upregulation is a shared feature in glucocerebrosidase (GCase) deficiency across different species. Using CRISPR/Cas9 mutagenesis we then generated a miR-155 mutant zebrafish line (miR-155-/-) with completely abolished miR-155 expression. Unexpectedly, loss of miR-155 did not mitigate either the reduced lifespan or the robust inflammatory phenotypes of gba1-/- mutant zebrafish. Our data demonstrate that neither neuroinflammation nor disease progression in GCase deficiency are dependent on miR-155 and suggest that miR-155 inhibition would not be a promising therapeutic target in Gaucher's disease.
Asunto(s)
Encefalitis/metabolismo , Enfermedad de Gaucher/metabolismo , MicroARNs/metabolismo , Degeneración Nerviosa/metabolismo , Animales , Animales Modificados Genéticamente , Repeticiones Palindrómicas Cortas Agrupadas y Regularmente Espaciadas , Citocinas/metabolismo , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Encefalitis/genética , Encefalitis/patología , Enfermedad de Gaucher/genética , Enfermedad de Gaucher/patología , Glucosilceramidasa/genética , Glucosilceramidasa/metabolismo , Ratones , MicroARNs/genética , Mutación , Degeneración Nerviosa/genética , Degeneración Nerviosa/patología , Neuronas/metabolismo , Neuronas/patología , Regulación hacia Arriba , Pez CebraRESUMEN
The lateral nasal wall attaches the nasal turbinates, which could be, either pneumatized, or paradoxically curved. The turbinate pneumatization-concha bullosausually indicates the pneumatization of the middle turbinate. However, concha bullosasuperior (CBS) is also, although rare, anatomic possibility of variation. We report here a case of unilateral giant septated CBS, which was not, to our knowledge, previously reported. The case was documented in Cone Beam Computed Tomography (CBCT). Subtle pneumatizations of inferior turbinates were found bilateral, as also were the middle conchae bullosae. The left concha bullosasuperior was very large (17.43/5.34mm), dropping down between the left middle turbinate and the contralaterally deviated nasal septum, and contacting the paradoxical curvature of the middle turbinate on that side. An incomplete oblique septum divided it incompletely into anterior and posterior chambers, it was communicating with a posterior ethmoid air cell, and was draining in the superior meatus. Care should be taken not to misdiagnose a giant CBS as a middle turbinate pneumatization, in order not to misjudge surgical corridors. Therefore, a careful anatomic CT or CBCT diagnosis would be of use for the plan of treatment.
Asunto(s)
Variación Anatómica , Cráneo/anomalías , Cornetes Nasales/anomalías , Femenino , Humanos , Persona de Mediana Edad , Cráneo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Cornetes Nasales/diagnóstico por imagenRESUMEN
The lateral nasal wall contains the nasal turbinates (conchae) which are used as landmarks during functional endoscopic surgery. Various morphological pos- sibilities of turbinates were reported, such as bifidity of the inferior turbinate and extra middle turbinates, such as the secondary middle turbinate. During a retrospective cone beam computed tomography study of nasal turbinates in a patient we found previously unreported variants of the superior nasal turbina- tes. These had, bilaterally, ethmoidal and sphenoidal insertions. On the right side we found a bifid superior turbinate and on the left side we found a secondary superior turbinate located beneath the normal/principal one, in the superior nasal meatus. These demonstrate that if a variant morphology is possible for a certain turbinate, it could occur in any nasal turbinate but it has not been yet observed or reported.
Asunto(s)
Cornetes Nasales/anomalías , Femenino , Humanos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Common anatomic variants of the middle nasal turbinate include its pneumatization (i.e. concha bullosa media) and its paradoxical curvature. We report here two cases of differently combined variations of the middle turbinate which were documented in cone beam computed tomography (CBCT). The first report presents the vertical combination of a double or septated lamellar concha bullosa with the paradoxical curvature of middle turbinate. This combined variant associated (coincidental findings): ipsilateral paradoxical superior turbinate and contralateral paradoxical middle turbinate, concha bullosa superior and concha bullosa suprema. In the second case was found the sagittal combination of successive anterior concha bullosa media and posterior paradoxical curvature of the middle turbinate. An ethmoidal sinolith was found embedded in lamella basalis. The contralateral superior turbinate was pneumatized. These rare findings demonstrate that sound knowledge of possible anatomical variations, supported by a complete use of the tools available for the CBCT documentation of cases, is able to enrich the picture of human anatomic variations, with a direct impact on clinical and surgical practice. The septa-containing lamellar concha bullosa and paradoxical middle concha combination is a variation that affects surgical practice.
Asunto(s)
Cornetes Nasales/anatomía & histología , Cornetes Nasales/diagnóstico por imagen , Variación Anatómica , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Nasal anatomic variations are relevant during nasal surgical and endoscopic procedures. The extent of imaging methods, such as the cone beam computed tomography (CBCT), allows a better characterization of such peculiar anatomic traits. The bifid inferior turbinate (BIT) is a rare finding, being previously reported less than ten times. It was found and described on CT scans of patients, being usually associated with the absence of the uncinate process (UP). We hereby report for the first time a bilateral true BIT which differs from the previously reported BITs by the fact that the UPs were present and the bifidity was oriented laterally. In the light of this new find, we consider that the variant resulted from UP displacement should be regarded as a false bifid, or double, inferior turbinate. Bifidity of the inferior turbinate was not previously evaluated in CBCT, as well as in three-dimensional volume renderizations. So, CBCT proves as an efficient tool to investigate prevalence of rare anatomical variants. Noteworthy, CT studies of patients on a case-by-case basis allows a better performance of surgical and endoscopic procedures.
Asunto(s)
Tomografía Computarizada de Haz Cónico , Cornetes Nasales/anatomía & histología , Adulto , Variación Anatómica , Endoscopía , Femenino , Humanos , Programas Informáticos , Cornetes Nasales/diagnóstico por imagen , Cornetes Nasales/cirugíaRESUMEN
The study of anatomical variations is important not only for collecting anthropometric data, but also for improving clinical protocols and understanding why a particular clinical procedure sometimes does not yield the expected results. We report the case of a 74 year-old patient, in which we observed combined anatomical variants of the mandible and maxillary bone. One of these was the unilateral mylohyoid bridge (MB) of the uncommon, lingular type. This MB extended posteriorly to the spine of Spix, over the sulcus colli behind the spine. It thus formed a common mandibular canal (MC) which further divided into a retromolar canal and the MC proper. This combination of variants in the mandible has not, to our knowledge, previously been reported, at least in studies using cone beam computed tomography (CBCT). Additionally we found multiple accessory canals (ACs) deriving from the canalis sinuosus, which opened opposite to each frontal tooth, presumably carrying either dental fibers of the palatine nerves, or palatine fibers of the anterior superior alveolar nerve. Although the ACs in the anterior palate are well established anatomical variants, the MB appears in publications rather as an anthropological identifier. However, when present, it can impede anaesthesia of the lower teeth and thus deserves to be included in anatomical descriptions. The evaluation of patients in CBCT should observe the anatomical features on a case-by-case basis and it also provide data for studies of MB prevalence in large numbers of patients.
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Anomalías Múltiples/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico/métodos , Mandíbula/anomalías , Mandíbula/diagnóstico por imagen , Maxilar/anomalías , Maxilar/diagnóstico por imagen , Anomalías Múltiples/patología , Anciano , Femenino , Humanos , Mandíbula/patología , Maxilar/patologíaRESUMEN
Bulges of the most posterior ethmoid air cells into the maxillary sinus were termed maxillary bullæ by Onodi. With few exceptions, they have since been ignored by anatomists through time. Likewise, Sieur cells-the spheno-ethmoido-maxillary air cells-are uncommonly found in anatomical texts. We therefore aimed to perform a retrospective cone beam computed tomography study on 50 patients to document the possibilities of anatomic variation in the situs of the orbital process of palatine bone-a variation related anatomically with the pterygopalatine fossa (PPF) and the respective angle of the maxillary sinus. Commonly occurring pneumatizations in this situs were the Sieur cell (58 %/64 % right/left side), and the maxillary recess of the sphenoidal sinus (20 %/22 % right/left side). Alone or in combination, these determined, but not exclusively, the maxillary bullæ. Uncommon pneumatizations in the anterior wall of the PPF were also found, such as a sphenoidal recess of the maxillary sinus, and lateral (maxillary, or pterygopalatine) recesses of the middle and superior, respectively, nasal meatuses. In two different cases, non-Haller, and non-Sieur posterior ethmoid air cells were found extruded posterior to the maxillary sinus. Significant statistical association indicated bilateral symmetry of Sieur's cell and of the maxillary recess of the sphenoidal sinus. It is important to identify such variant pneumatizations on a case-by-case basis in different surgical procedures and endoscopic corridors.
Asunto(s)
Variación Anatómica , Seno Maxilar/anatomía & histología , Seno Maxilar/diagnóstico por imagen , Fosa Pterigopalatina/anatomía & histología , Fosa Pterigopalatina/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
The pneumatizations surrounding the pterygopalatine fossa (PPF) and closely related to the sphenopalatine foramen are anatomically variable. During the assessment of a cone beam computed tomography of a 64-year-old male patient, we found bilaterally a previously unreported anatomic variant. This was represented by a lateral or pterygopalatine recess (PPR) of the superior nasal meatus which extended in the anterior wall of the PPF and protruded within the maxillary sinus to determine a maxillary bulla. The PPR was antero-superior to the sphenopalatine foramen. Additionally were found a right nasal septal deviation, seemingly compensated by a left middle concha bullosa and a left prominent ethmoidal bulla. The superior turbinates were also pneumatized. Such anatomic variants related to the pterygopalatine angle of the maxillary sinus should be explored prior to surgical or endoscopic procedures which target the maxillary sinus, the pterygopalatine fossa, or the skull base.
Asunto(s)
Fosa Pterigopalatina/anomalías , Variación Anatómica , Tomografía Computarizada de Haz Cónico , Humanos , Masculino , Persona de Mediana Edad , Fosa Pterigopalatina/diagnóstico por imagenRESUMEN
The infraorbital canal (IOC) normally courses above the maxillary sinus in the orbit floor. During a retrospective study of cone beam computed tomography (CBCT) scans, we found a previously unknown variant of the IOC. The IOCs were absent, being replaced by lateroantral canals coursing around and not above the maxillary sinus to open at infraorbital foramina which were located above the second upper premolar teeth. On coronal multiplanar reconstructions, the lateroantral canals were located anatomically at the outer limit of the zygomatic recess of each maxillary sinus, while the upper wall of the sinus was devoid of any canal. Such rare variant should be kept in mind by dental practitioners and surgeons, as it can determine modifications of common procedures. In this regard, the anatomy of maxilla, as well as mandible, should be evaluated in CBCT on a case-by-case basis.
Asunto(s)
Tomografía Computarizada de Haz Cónico , Seno Maxilar/anomalías , Seno Maxilar/diagnóstico por imagen , Órbita/anomalías , Órbita/diagnóstico por imagen , Adulto , Femenino , Humanos , Seno Maxilar/inervación , Órbita/inervaciónRESUMEN
There are very few evidences on the extramandibular course (EMC) of the inferior alveolar nerve (IAN). We report here two such cases. The first one was encountered at dissection, in a human adult female cadaver where the right IAN terminal division was identified in the premolar region, above a severely atrophied mandibular body. The second case was a patient evaluated by cone-beam CT, who presented with an extremely atrophic mandible with bilateral extramandibular courses of the IANs. Such severe atrophy of the mandible may be considered as residual ridge class 7 along with the existing Atwood classes. EMCs of the IAN may not only occur in extreme mandibular atrophy, but also in dentate mandibles. In edentulous mandibles, an extramandibular IAN may complicate local surgical procedures or hamper denture wearing.
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Nervio Mandibular/anatomía & histología , Anciano , Atrofia/diagnóstico por imagen , Atrofia/patología , Femenino , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/patología , RadiografíaRESUMEN
The sphenoid sinus is one of the most morphologically variable and surgically important structures of the skull base. Located below the sella turcica, neighbored by parasellar regions, such as the orbital apex, pterygopalatine fossa and lateral sellar region (cavernous sinus), it is clinically related to these and surgically relevant as corridor for various approaches. Moreover, at the sphenoethmoidal junction, important variations occur, most of these related to the presence of the Onodi cells and the intrasinusal protrusions of the optic nerve. That is why any identified and previously undescribed morphological variation at that level must be added to the well-established protocols, clinical and surgical. During a retrospective CT study of the sphenoid sinus anatomical features a previously unreported morphology was encountered and is reported here. It refers to a unilateral sphenoethmoid cell (SEC), Onodi-positive, not only overriding the superior aspect of the sphenoid but also its lateral side to get intimately related to the maxillary nerve. As that SEC expanded medially to the cavernous sinus apex, it altered the usual endosinusal morphological correlations and also added itself within the limits of the Mullan's triangle. It appears so that such postero-infero-lateral extended pneumatization of an Onodi cell alters the surgical landmarks and also can blur clinical pictures, by adding maxillary and pterygopalatine signs and symptoms.
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Seno Cavernoso/anatomía & histología , Nervio Maxilar/anatomía & histología , Seno Esfenoidal/anatomía & histología , Seno Cavernoso/diagnóstico por imagen , Humanos , Masculino , Nervio Maxilar/diagnóstico por imagen , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Seno Esfenoidal/diagnóstico por imagenRESUMEN
A completely horizontally impacted upper third molar was revealed after routine dissection of a 62-year-old human cadaver of a Caucasian male. The molar was penetrating into the maxillary sinus and there was antral dehiscence of its bony alveolus. The bony alveolus was immediately in front of the greater palatine canal contents, and the bottom of the alveolus was dehiscent towards the greater palatine foramen. Within the greater palatine canal and foramen the greater palatine artery was duplicated and the nerve was found. Such antral relations of an impacted upper third molar predispose to oroantral communications if extraction is performed, while the close neurovascular relations represent a risk factor for postextractional haemorrhage and neurosensory disturbances and must be borne in mind when deciding on or performing the extraction.