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This retrospective study aimed to analyze volumetric changes of the maxillary sinus after modified endoscopic-assisted sinus surgery (MESS) and to assess short-term treatment outcomes. The volumes of the total maxillary sinus, aeration, and sinus pathology were calculated using computed tomography data obtained prior to surgery and six months after surgery. Postoperative radiological improvement was assessed using the Lund-Mackay score. Bone regeneration around the bony window was evaluated during plate removal. A total of 32 patients were evaluated. Compared with before surgery, air and sinus pathology volumes improved significantly (air, increase by 6.0 cm3, p < 0.001; sinus pathology, decrease by 6.4 cm3, p < 0.001). However, there was no statistically significant change in the total maxillary sinus volume after surgery. The preoperative Lund-Mackay score was 2.9, decreasing to 0.4 six months after surgery (p < 0.001). The only predictors of postoperative aeration rate and Lund-Mackay score were preoperative sinus pathology volume (p = 0.049) and Lund-Mackay score (p = 0.015), respectively. The continuity between the bony window and surrounding sinus wall was restored in all patients. The results of this study suggest that MESS can be a successful, effective, and minimally invasive surgical treatment option for treating maxillary sinus diseases.
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Endoscopía , Seno Maxilar , Humanos , Femenino , Masculino , Seno Maxilar/cirugía , Seno Maxilar/diagnóstico por imagen , Persona de Mediana Edad , Endoscopía/métodos , Resultado del Tratamiento , Estudios Retrospectivos , Adulto , Anciano , Enfermedades de los Senos Paranasales/cirugía , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Imagenología TridimensionalRESUMEN
BACKGROUND: Cholesterol granuloma is not a common entity in the paranasal sinuses. It is a foreign body reaction to the cholesterol crystal deposition. Mostly associated with chronic middle ear diseases. CASE PRESENTATION: This article reports a case of cholesterol granuloma in the maxillary sinus. A 23-year-old Asian man presented with cough, nasal obstruction, and postnasal discharge. On endoscopy, there was a mass protruding from the right maxillary ostium. On computed tomograpy imaging, there was a polypoidal mass in the right maxillary sinus. Endoscopic sinus surgery was performed, the cholesterol granuloma was removed from the right maxillary sinus, and the tissue was submitted for histopathological examination, which showed foreign body giant cell reaction to cholesterol crystals. CONCLUSION: Cholesterol granuloma of maxillary sinus is not common and often missed by clinicians. It is necessary to consider the cholesterol granuloma of maxillary sinus in the differential diagnosis sinonasal lesions. Histopathological analysis is required for confirmation and should be removed surgically. This case may help as a reference for clinician to approach these kinds of cases.
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Colesterol , Granuloma de Cuerpo Extraño , Seno Maxilar , Enfermedades de los Senos Paranasales , Tomografía Computarizada por Rayos X , Humanos , Masculino , Seno Maxilar/patología , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/cirugía , Granuloma de Cuerpo Extraño/cirugía , Granuloma de Cuerpo Extraño/diagnóstico , Granuloma de Cuerpo Extraño/patología , Granuloma de Cuerpo Extraño/diagnóstico por imagen , Adulto Joven , Enfermedades de los Senos Paranasales/cirugía , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/patología , Enfermedades de los Senos Paranasales/diagnóstico , Endoscopía , Diagnóstico Diferencial , Obstrucción Nasal/etiología , Obstrucción Nasal/cirugíaRESUMEN
Objective:To compare the efficacy of endoscopic sinus surgery and conservative treatment for orbital apex syndrome caused by sinus lesions. Methods:The clinical data of 56 patients with orbital apex syndrome caused by sinus lesions who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to August 2023 were retrospectively analyzed and divided into a surgical group of 21 cases and a conservative group of 35 cases. The clinical features and prognosis of the two groups were compared. Results:Among the sinus lesions in the surgical group, 61.9% were fungal sinusitis, 28.6% were bacterial sinusitis, and 9.5% were sphenoid sinus tumors. In the conservative group, non-fungal sinusitis accounted for 65.7% and fungal sinusitis accounted for 34.3%. In addition to sinus lesions, patients had underlying diseases. In the surgical group, 71.4% had hypertension and 80.9% had diabetes; in the conservative group, 28.6% had hypertension and 42.9% had diabetes. After a follow-up of 1 month to 5 years, the symptom improvement rate in the surgical group was 85.7%, with 1 case of recurrence. No recurrence was found after reoperation, while the symptom improvement rate in the conservative group was 22.9%, and 6 cases recurred after symptom improvement, and were transferred to rhinology department. No recurrence was seen after surgery. Conclusion:Most of the sinus lesions in this study were fungal sinusitis. In addition, patients with underlying diseases such as diabetes, hypertension, nephrotic syndrome, etc. have reduced nasal immunity, which significantly increases the risk of disease. Since early nasal symptoms are not obvious, multidisciplinary cooperation in diagnosis and treatment is very necessary. Once imaging examination suggests orbital apex syndrome caused by sinus lesions, endoscopic sinus opening should be performed as soon as possible.
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Endoscopía , Humanos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto , Sinusitis/complicaciones , Enfermedades Orbitales/etiología , Síndrome , Tratamiento Conservador/métodos , Enfermedades de los Senos Paranasales/complicaciones , Enfermedades de los Senos Paranasales/cirugía , PronósticoRESUMEN
We report a challenging and uncommon case involving a 53-year-old Japanese man with cerebrospinal fluid (CSF) leakage caused by a meningocele in the lateral recess of the sphenoid sinus. Our innovative treatment approach involved a combination of transpterygoid and endoscopic modified medial maxillectomy techniques, with special emphasis on the preservation of the sphenopalatine artery. This strategic preservation was pivotal to the successful use of the ipsilateral nasoseptal flap for reconstruction, which played a crucial role in the prevention of postoperative CSF leakage. Otolaryngologists and neurosurgeons collaborated to perform the bath-plugging technique; effective collaboration was instrumental to the success of the procedure. This report highlights significant advancement from conventional frontal craniotomy to a more sophisticated endoscopic technique, shows the importance of meticulous surgical planning and execution, emphasizes careful preservation of critical anatomical structures during complex neurosurgical and otolaryngological procedures, and underscores the evolving landscape of surgical approaches for managing complex medical conditions.
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Pérdida de Líquido Cefalorraquídeo , Endoscopía , Meningocele , Seno Esfenoidal , Humanos , Seno Esfenoidal/cirugía , Seno Esfenoidal/diagnóstico por imagen , Masculino , Meningocele/cirugía , Meningocele/diagnóstico por imagen , Persona de Mediana Edad , Endoscopía/métodos , Pérdida de Líquido Cefalorraquídeo/cirugía , Pérdida de Líquido Cefalorraquídeo/etiología , Rinorrea de Líquido Cefalorraquídeo/cirugía , Rinorrea de Líquido Cefalorraquídeo/etiología , Colgajos Quirúrgicos , Enfermedades de los Senos Paranasales/cirugía , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Mucoceles of the paranasal sinuses are benign, expansile lesions that develop secondary to sinus ostia obstruction. Presenting signs and symptoms vary widely but frequently include frontal headache and swelling, as well as visual changes and globe displacement depending on orbital involvement in the case of frontal sinus mucoceles. Given the potential for orbital or intracranial involvement, urgent imaging with computed tomography (CT) is important for patients with symptoms concerning for a frontal sinus mucocele. Definitive treatment is surgical. In this article, we report a case of a 50-year-old male who presented to a primary care clinic with a painful forehead mass, found to have a frontal sinus mucocele with erosion through the frontal bone that was eventually treated surgically. We also summarize presenting signs and symptoms of frontal mucoceles reported in the literature as these are important for clinicians to be familiar with, considering the potential emergent complications.
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Frente , Seno Frontal , Mucocele , Tomografía Computarizada por Rayos X , Humanos , Masculino , Mucocele/diagnóstico por imagen , Mucocele/complicaciones , Mucocele/diagnóstico , Mucocele/cirugía , Persona de Mediana Edad , Seno Frontal/diagnóstico por imagen , Seno Frontal/patología , Enfermedad Crónica , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/complicaciones , Enfermedades de los Senos Paranasales/cirugía , Sinusitis Frontal/complicaciones , Sinusitis Frontal/diagnóstico por imagenRESUMEN
Headache and rhinosinusitis are 2 of the most common conditions seen in clinical practice. Consider sinusitis in those with new-onset headache, along with nasal congestion, maxillary tooth discomfort, anosmia, cough, or fever. Most chronic and recurring headaches, especially if migraine features are present, are not due to sinus disease, with the possible exception of rhinogenic headache due to nasal contact points. Nasal endoscopy and neuroimaging with computed tomography or MRI can confirm diagnosis and guide treatment with antibiotics, adjuvant therapies and surgery.
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Cefalea , Enfermedades de los Senos Paranasales , Humanos , Cefalea/etiología , Cefalea/diagnóstico , Enfermedades de los Senos Paranasales/complicaciones , Enfermedades de los Senos Paranasales/diagnóstico , Enfermedades Nasales/complicaciones , Enfermedades Nasales/etiología , Enfermedades Nasales/diagnóstico , Sinusitis/complicaciones , Sinusitis/diagnósticoRESUMEN
OBJECTIVES: To assess the performance of deep learning (DL) in the detection, classification, and segmentation of maxillary sinus diseases. METHODS: An electronic search was conducted by two reviewers on databases including PubMed, Scopus, Cochrane, and IEEE. All English papers published no later than February 7, 2024, were evaluated. Studies related to DL for diagnosing maxillary sinus diseases were also searched in journals manually. RESULTS: Fourteen of 1167 studies were eligible according to the inclusion criteria. All studies trained DL models based on radiographic images. Six studies applied to detection tasks, one focused on classification, two segmented lesions, and five studies made a combination of two types of DL models. The accuracy of the DL algorithms ranged from 75.7% to 99.7%, and the area under curves (AUC) varied between 0.7 and 0.997. CONCLUSION: DL can accurately deal with the tasks of diagnosing maxillary sinus diseases. Students, residents, and dentists could be assisted by DL algorithms to diagnose and make rational decisions on implant treatment related to maxillary sinuses.
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Aprendizaje Profundo , Seno Maxilar , Enfermedades de los Senos Paranasales , Humanos , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Seno Maxilar/diagnóstico por imagen , AlgoritmosRESUMEN
This case report discusses a diagnosis of rhino-orbital-cerebral mucormycosis in a man aged 61 years who presented with vision loss, ophthalmoplegia, and ptosis.
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Infecciones Fúngicas del Ojo , Mucormicosis , Enfermedades Orbitales , Humanos , Mucormicosis/diagnóstico , Mucormicosis/microbiología , Mucormicosis/tratamiento farmacológico , Enfermedades Orbitales/microbiología , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/tratamiento farmacológico , Infecciones Fúngicas del Ojo/microbiología , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Masculino , Antifúngicos/uso terapéutico , Imagen por Resonancia Magnética , Enfermedades de los Senos Paranasales/microbiología , Enfermedades de los Senos Paranasales/diagnóstico , Enfermedades de los Senos Paranasales/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Enfermedades Nasales/microbiología , Enfermedades Nasales/diagnóstico , Enfermedades Nasales/tratamiento farmacológico , Femenino , Persona de Mediana Edad , Anfotericina B/uso terapéuticoRESUMEN
The aim of this study is to examine the frequency of maxillary sinus pathologies and their relationship with each other using cone beam computed tomography (CBCT) and to make a new grade according to the number of affected walls. 1000 maxillary sinuses of 500 patients with CBCT images were included in the study. Anatomical variations and pathological formations of the maxillary sinuses were examined. Images were evaluated for the presence of flat, polypoidal, partial and generalized mucosal thickening, partial and total opacification, polyps and mucous retention cysts. Maxillary sinus pathologies were graded according to the number of walls affected. In the examined CBCT images, no pathology was found in 54.2% of the maxillary sinuses, while pathology was observed in 45.8%. The most common sinus pathologies were mucous retention cyst (12.3%) and polypoidal thickening (12.2%). While pneumatization, ostium obstruction, and the presence of sinus-related roots were associated with sinus pathology, no relationship was found with nasal septum deviation and the presence of septa. Before dental implant and sinus surgery applications, the presence of sinus pathologies and their relationship with anatomical variations can be evaluated with CBCT, a three-dimensional technique, and complications such as sinus membrane perforation, infection, failure to break the bone window due to the presence of antral septa, graft loss and oroantral fistula formation can be reduced.
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Tomografía Computarizada de Haz Cónico , Seno Maxilar , Humanos , Tomografía Computarizada de Haz Cónico/métodos , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/patología , Femenino , Masculino , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Anciano , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/patología , Anciano de 80 o más Años , Adolescente , Adulto JovenRESUMEN
BACKGROUND Odontogenic keratocyst (OKC) is a common odontogenic cyst, and it occurs more frequently in the mandible, with the posterior region of the dental arch, the angle, or the ramus being the most commonly affected sites. Odontogenic keratocyst occurring within the maxillary sinus is extremely rare, accounting for only about 1% of cases. CASE REPORT A 20-year-old female patient without any clinical symptoms underwent an oral examination, during which a dense dental shadow was identified within the maxillary sinus, surrounded by a low-density shadow. Physical examination revealed absence of the left maxillary third molar, with intact mucosa. The patient reported no history of tooth extraction. X-ray and cone-beam computed tomography revealed a high-density image within the left maxillary sinus, resembling a tooth and surrounded by a soft-tissue shadow, which exhibited a greater density in comparison to conventional odontogenic cysts. The initial diagnosis was odontogenic keratocyst in the maxillary sinus with an ectopic maxillary third molar. Surgical enucleation of the cyst and extraction of the impacted tooth were carried out utilizing the Caldwell-Luc approach. Histopathological analysis confirmed the presence of OKC. No significant recurrence was noted during the 6 months of follow-up. CONCLUSIONS Odontogenic keratocysts in the maxillary sinus with ectopic third molar are rare and may not have any symptoms in the early stage. Surgery can be performed using the Caroler-Luke approach to achieve ideal treatment results. In view of the high recurrence rate of OKC, close follow-up should be conducted after surgery.
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Seno Maxilar , Tercer Molar , Quistes Odontogénicos , Humanos , Quistes Odontogénicos/cirugía , Quistes Odontogénicos/diagnóstico por imagen , Femenino , Tercer Molar/cirugía , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/patología , Adulto Joven , Tomografía Computarizada de Haz Cónico , Enfermedades de los Senos Paranasales/cirugía , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Extracción DentalRESUMEN
OBJECTIVES: We aimed to investigate the relationship between the presence of the accessory maxillary ostium (AMO) with mucosal thickening (MT) and maxillary sinus cysts (MSCs). STUDY DESIGN: This single-center retrospective study included patients who underwent paranasal sinus computed tomography (CT) between November 2022 and February 2023. We excluded patients with natural maxillary ostium (NMO) occlusion. Two radiologists evaluated the presence of AMOs, MT, and MSCs in CT images and measured their dimensions using a three-dimensional volumetric analysis program. RESULTS: We included 125 patients (mean age: 36.47 ± 16.0 years; male/female: 67/58). In total, 65 patients (52%) had single or multiple AMOs. No significant relationship was found between the presence of an AMO and the presence of MT on either side (P ≥ .306). There was a statistically significant difference between the presence of an AMO and MSC on the right side (P = .002), but not on the left side (P = .477). The diameter of the AMO and the distance from the AMO to the maxillary sinus floor were not correlated with mucosal thickness or MSC volume, but the distance from the AMO to the sinus floor had a small positive correlation with total maxillary sinus volume. CONCLUSIONS: The presence of an AMO and its increased diameter may not contribute to ipsilateral maxillary sinusitis in patients whose unilateral or bilateral NMOs are not occluded.
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Imagenología Tridimensional , Seno Maxilar , Enfermedades de los Senos Paranasales , Tomografía Computarizada por Rayos X , Humanos , Femenino , Masculino , Estudios Retrospectivos , Adulto , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/patología , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/patología , Quistes/diagnóstico por imagen , Quistes/patología , Persona de Mediana Edad , Mucosa Nasal/diagnóstico por imagen , Mucosa Nasal/patologíaRESUMEN
Despite the widespread adoption of nasal endoscopy (NE) in the evaluation of sinonasal disease, its diagnostic potential may still be underutilized. Developments in endoscopic technology have led to significant improvements in video quality and maneuverability. However, there is concern that NE continues to be used primarily for the identification of gross pathology, with relative neglect of more subtle findings such as surface features of inflammation and mucus. With fewer technical limitations to perceive these abnormalities, there is potential to greatly improve the diagnostic value of NE. The reader is herein asked to consider several important visual nuances encountered during NE, with the hope that this engenders an appreciation of the versatility of NE as a diagnostic tool.
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Endoscopía , Humanos , Endoscopía/métodos , Senos Paranasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/diagnóstico , Nariz/patología , Enfermedades Nasales/diagnósticoRESUMEN
BACKGROUND: This study aimed to determine if there is a relationship between the presence of maxillary sinus pathology, nasal septum deviation and various lengths of the osteomeatal complex. METHODS: A total of 223 CBCT images were included in the study. The lengths of the osteomeatal complex (maxillary sinus ostium width, infundibulum length, maxillary sinus ostium height) were analyzed. The presence of maxillary sinus pathology, nasal septum deviation, age, sex, right-left, septum deviation level, and the relationship between pathology level and all variables were evaluated. RESULTS: The average maxillary sinus ostium width, ostium height and infundibulum length were 3.06 ± 0.70 mm, 30.10 ± 5.43 mm and 8.82 ± 1.86 mm, respectively. Ostium width was significantly higher in the healthy group than in the groups evaluated in the presence of deviation and pathology. A significant difference was found in infundibulum length only between the healthy condition and the condition evaluated in the presence of deviation. No significant difference was observed between the groups in terms of ostium height. In all groups, ostium height and infundibulum length were significantly higher in men than in women. The age group with the highest average ostium height was found in the 35-44 age group (p < 0.001). CONCLUSION: Identifying normal and abnormal conditions in the osteomeatal complex area is important for diagnosing the cause of a patient's complaint, guiding the surgical procedures to be performed, and preventing possible complications that may arise during surgical procedures.
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Tomografía Computarizada de Haz Cónico , Seno Maxilar , Tabique Nasal , Humanos , Tomografía Computarizada de Haz Cónico/métodos , Masculino , Femenino , Tabique Nasal/diagnóstico por imagen , Tabique Nasal/patología , Tabique Nasal/anomalías , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/patología , Adulto , Persona de Mediana Edad , Adolescente , Anciano , Adulto Joven , Factores Sexuales , Factores de Edad , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/patologíaRESUMEN
Maxillary sinus retention cysts (MRCs) are typically asymptomatic and require no treatment. An early 30s man presented with a decade-long history of severe left-sided chronic facial pain (CFP). Multiple prior treatments resulted in an edentulous patient with persistent pain. Imaging revealed a dome-shaped radiopaque change in the left maxillary sinus. History and clinical examination suggested persistent idiopathic facial pain, and doubts about the outcome of a surgical intervention were explained to the patient. Surgical removal of the MRC via lateral antrotomy led to complete symptom resolution of CFP. This case substantiates the importance of considering MRCs as a possible cause of CFP. It also emphasises the need for a systematic multidisciplinary approach in cases of unexplained CFP.
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Dolor Facial , Seno Maxilar , Enfermedades de los Senos Paranasales , Humanos , Masculino , Dolor Facial/etiología , Dolor Facial/cirugía , Seno Maxilar/cirugía , Seno Maxilar/diagnóstico por imagen , Adulto , Enfermedades de los Senos Paranasales/cirugía , Enfermedades de los Senos Paranasales/complicaciones , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Mucocele/cirugía , Mucocele/complicaciones , Mucocele/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Quistes/cirugía , Quistes/complicaciones , Quistes/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Rhinogenic headache (RH), arising from nasal and sinus pathologies, present a diagnostic challenge due to their diverse etiologies. This study investigates a unique case where RH coincides with infraorbital nerve dehiscence, delving into the intricate relationship between sinonasal anatomy and neurovascular complications. The infraorbital nerve contacted a cyst in the maxillary sinus. Centripetal endoscopic sinus surgery was performed to open the maxillary sinus and remove the cyst. After 3 months of follow-up, the patient had a notable improvement in symptoms with a reduced headache. This case highlights the significance of considering uncommon anatomic variations, such as infraorbital nerve dehiscence, within the context of RH. Diligent history-taking and appropriate use of radiologic investigations are pivotal for guiding clinicians toward an accurate diagnosis and determining the most appropriate course of treatment.
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Endoscopía , Seno Maxilar , Humanos , Seno Maxilar/cirugía , Seno Maxilar/diagnóstico por imagen , Cefalea/etiología , Tomografía Computarizada por Rayos X , Femenino , Masculino , Enfermedades de los Senos Paranasales/cirugía , Enfermedades de los Senos Paranasales/complicaciones , Nervio MaxilarRESUMEN
OBJECTIVE: This study aimed to examine the characteristics of nasal and imaging findings of sinonasal lesions in granulomatosis with polyangiitis (GPA) patients and how these lesions change over time in both the active and remission phases of the disease. METHODS: We retrospectively reviewed GPA patients with sinonasal lesions who were followed up at our department between January 2005 and December 2020. The following data were collected: age, sex, symptoms at initial presentation, anti-neutrophil cytoplasmic antibody (ANCA) type, and histopathological, nasal (initial and follow-up), and imaging (initial and follow-up) findings. RESULTS: This study included 17 patients with GPA aged 30 to 79 years. Computed tomography (CT) of the sinuses showed mucosal thickening in 16 patients, bone thickening in 12, bone destruction in 4, and an orbital invasion mass in 3 at the time of diagnosis. After initiating treatment, mucosal thickening of the sinuses improved in 3 of 16 patients and remained unchanged in 13. Bone thickening at the time of diagnosis remained unchanged in 10 of 12 patients and worsened in 2; 1 patient displayed newly developed bone thickening. Destructive nasal findings on CT were positive for proteinase 3-ANCA. CONCLUSIONS: Our study revealed that mucosal thickening, bone thickening, bone destruction, and orbital invasion mass were major CT findings in patients with GPA. Intranasal findings such as granulations, crusting, and necrosis were seen in the active phase; moreover, saddle nose, loss of turbinate, and nasal septal perforation were subsequently seen in the course of the disease. Sinonasal findings of GPA vary depending on the disease stage and period.
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Anticuerpos Anticitoplasma de Neutrófilos , Granulomatosis con Poliangitis , Mucosa Nasal , Tomografía Computarizada por Rayos X , Humanos , Persona de Mediana Edad , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/diagnóstico por imagen , Granulomatosis con Poliangitis/patología , Masculino , Femenino , Estudios Retrospectivos , Anciano , Adulto , Anticuerpos Anticitoplasma de Neutrófilos/inmunología , Mucosa Nasal/patología , Mucosa Nasal/diagnóstico por imagen , Senos Paranasales/diagnóstico por imagen , Senos Paranasales/patología , Mieloblastina/inmunología , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/etiología , Enfermedades de los Senos Paranasales/patologíaRESUMEN
KEY POINTS: Silent sinus syndrome (SSS) and chronic maxillary atelectasis (CMA) represent an overlapping clinical entity, both likely lying on the spectrum of one disease process. There is widespread inconsistency of diagnosis in the literature of reported cases of SSS and CMA. We propose a novel, comprehensive staging system to simplify diagnosis and inform management.
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Seno Maxilar , Humanos , Enfermedad Crónica , Seno Maxilar/patología , Síndrome , Enfermedades de los Senos Paranasales/patología , Enfermedades de los Senos Paranasales/diagnóstico , Masculino , Femenino , Persona de Mediana EdadRESUMEN
OBJECTIVE: Computer aided diagnostics (CAD) systems can automate the differentiation of maxillary sinus (MS) with and without opacification, simplifying the typically laborious process and aiding in clinical insight discovery within large cohorts. METHODS: This study uses Hamburg City Health Study (HCHS) a large, prospective, long-term, population-based cohort study of participants between 45 and 74 years of age. We develop a CAD system using an ensemble of 3D Convolutional Neural Network (CNN) to analyze cranial MRIs, distinguishing MS with opacifications (polyps, cysts, mucosal thickening) from MS without opacifications. The system is used to find correlations of participants with and without MS opacifications with clinical data (smoking, alcohol, BMI, asthma, bronchitis, sex, age, leukocyte count, C-reactive protein, allergies). RESULTS: The evaluation metrics of CAD system (Area Under Receiver Operator Characteristic: 0.95, sensitivity: 0.85, specificity: 0.90) demonstrated the effectiveness of our approach. MS with opacification group exhibited higher alcohol consumption, higher BMI, higher incidence of intrinsic asthma and extrinsic asthma. Male sex had higher prevalence of MS opacifications. Participants with MS opacifications had higher incidence of hay fever and house dust allergy but lower incidence of bee/wasp venom allergy. CONCLUSION: The study demonstrates a 3D CNN's ability to distinguish MS with and without opacifications, improving automated diagnosis and aiding in correlating clinical data in population studies. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:3927-3934, 2024.
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Diagnóstico por Computador , Imagen por Resonancia Magnética , Seno Maxilar , Humanos , Masculino , Persona de Mediana Edad , Femenino , Anciano , Estudios Prospectivos , Seno Maxilar/diagnóstico por imagen , Diagnóstico por Computador/métodos , Imagen por Resonancia Magnética/métodos , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/epidemiología , Enfermedades de los Senos Paranasales/diagnóstico , Redes Neurales de la Computación , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: Maxillary sinusitis can be a sequela of medication-related osteonecrosis of the jaw (MRONJ). This study aims to characterize the microbiome of maxillary MRONJ with concurrent maxillary sinusitis and radiographic maxillary sinus opacification to determine if there is a relationship between the microbiome of MRONJ and sinus disease. STUDY DESIGN: This retrospective case series was conducted using electronic health records from the University of Pennsylvania and affiliated hospitals. The target population was surgically managed maxillary MRONJ patients. The primary predictor variables were tissue culture results. The primary outcomes were maxillary sinusitis or maxillary sinus opacification. Statistical analysis was performed using chi-squared tests at the 95% confidence interval. RESULTS: Thirty-nine subjects were selected: 25 had sinus opacification and 11 had sinusitis. Resident bacteria were present in 90% of subjects, nonresident bacteria in 74%, and opportunistic organisms in 15%. There were significantly more subjects with chronic sinusitis microbes (79%) than without. There were significantly more gram-positive anaerobes, specifically Propionibacterium, as well as the gram-negative facultative anaerobe, Capnocytophaga, in subjects with concurrent sinusitis. CONCLUSIONS: Maxillary MRONJ with concurrent maxillary sinusitis may be associated with gram-positive anaerobic species, Propionibacterium, and Capnocytophaga colonization. Maxillary MRONJ patients may benefit from sinus evaluation and concurrent surgical intervention.
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Sinusitis Maxilar , Enfermedades de los Senos Paranasales , Sinusitis , Humanos , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/microbiología , Seno Maxilar/diagnóstico por imagen , Estudios Retrospectivos , Sinusitis/microbiologíaRESUMEN
Treatment of patients with severe chronic and recurrent forms of sinusitis, complicated by pathological stretching of the paranasal sinuses, is not a trivial task. This is especially true for those clinical cases where a pathological increase in the size of the sinus leads to widespread destruction of its walls and may be accompanied by serious complications from adjacent structures. The paper presents an analytical review of publications on the topic of pathological stretching of the paranasal sinuses. Potential factors influencing the development of this pathology, mechanisms of pathogenesis and classification options are described in detail. Modern approaches are considered in the surgical treatment of this pathology, which can be carried out in one or two stages, depending on the presence of secondary aesthetic defects.