Volumetric study of the maxillary sinus in patients with sinus pathology

OBJECTIVES: The aim of this study is 1) to obtain the area and volumes of the maxillary sinuses in patients affected by clinically unilateral sinus pathology by comparing the results to the contralateral sinus and 2) to determine the importance of the volumetric measures when diagnosing the percentage of sinus obliteration. MATERIALS AND METHODS: A single-centre observational retrospective clinical study was conducted in 214 patients with clinically unilateral sinus pathologies. Linear (mm), area (mm2) and volume (mm3) measurements were taken from Cone Beam Computed Tomography (CBCT) images of the affected sinus as well as from the contralateral ones. Histopathological study was performed using haematoxylin/eosin and PAS or Groccot stains. The lesions were classified into non-specific sinusitis, polyps, inverted papilloma, fungal sinusitis, cysts, mucocele and other lesions. Chi-squared test, ANOVA for independent samples and Pearson test were used for the statistical analysis. RESULTS: A total of 100 sinuses were measured in 50 patients (28 men and 22 women, with an age of 43.6 years (SD = 18.3), 50 pathological and 50 healthy contralateral sinuses. The three-dimensional occupation volume of the affected sinuses was 97.1 mm3 (62.5%) vs. 40.6 mm3 (22.8%) in the healthy ones (p<0.0001). The medial-lateral width of the sinus in the frontal plane was significantly higher in the cysts group (32.4 mm, CI: 23-41.8 mm). CONCLUSION: In medical terms, the global percentage of occupation determined using the classic manual determination method does not differ from the three-dimensional percentage calculated using specific complex software

Sensitivity of panoramic radiographs in diagnosing maxillary sinusitis: a scoping review

Objectives: The purpose of this study was to determine the sensitivity of using this panoramic radiograph in diagnosing maxillary sinusitis. Review: Scoping Review with article searches was carried out through NCBI's PubMed database, Science Direct, and EbscoHost from January 2020 to March 2021, with the inclusion criteria being articles published in 2010-2020.&nbsp;&nbsp; Conclusion: Panoramic radiographs were found to be less sensitive for diagnosing maxillary sinusitis, but due to the low availability and accessibility of CBCT and CT, and related to their expensive cost and high radiation, panoramic radiographs are considered to be quite optimal

Paranasal Sinuses Anatomy and Conditions

This book discusses selected topics on the anatomy of paranasal sinuses and related conditions, providing insight into advancements in the field. The first section covers morphological aspects of the maxillary sinus, infectious causes of acute and chronic sinusitis, posterior ethmoidal artery, and paranasal sinuses anatomy and anatomical variations. The second section covers sinonasal-associated midfacial expansion and maxillary sinus in dental implantology. Chapters present new clinical and research developments as well as future perspectives on ever-expanding upper airway and jaw problems

Sinusitis de origen odontogénico, diagnostico diferencial: Revisión de literatura

Objetivo: Analizar la importancia de realizar un buen diagnóstico de la sinusitis de origen odontogénico, mediante la búsqueda en diferentes bases digitales. Metodología: Se realizó bibliográfica en las bases de datos Pubmed y Scopus de estudios publicados entre 2017-2022 haciendo uso de las palabras claves, además se utilizó el operador Booleano AND para la unión entre estos descriptores y se realizaron las preguntas de indagación basado en la abreviatura PICO. Resultados: Se obtuvieron 1270 estudios entre las dos bases digitales de estos 50 fueron los seleccionados después de aplicar criterios de exclusión e inclusión. Conclusión: La sinusitis odontogénica debe presentar un diagnóstico multidisciplinario Odontólogo-Otorrinolaringólogo. Los focos odontogénicos más frecuentes son patologías periapicales, cirugías previas, molares que están en cercanía al piso del seno maxilar. Se debe tomar en cuenta síntomas y estudios radiográficos como la CBCT.Objective: To analyze the importance of making a good diagnosis of sinusitis of odontogenic origin, by means of a search in different digital databases. Methodology: A bibliographic search was performed in the Pubmed and Scopus databases of studies published between 2017-2022 using keywords, in addition, the Boolean operator AND was used for the union between these descriptors and the inquiry questions were asked based on the abbreviation PICO. Results: 1270 studies were obtained between the two digital databases, of which 50 were selected after applying exclusion and inclusion criteria. Conclusion: Odontogenic sinusitis should be diagnosed by a multidisciplinary Odontologist-Otorhinolaryngologist. The most frequent odontogenic foci are periapical pathologies, previous surgeries, molars that are close to the floor of the maxillary sinus. Symptoms and radiographic studies such as CBCT should be taken into account.0000-0002-6395-770

Cone beam CT: non-dental applications

Initially Cone Beam CT was almost exclusively used to perform dental radiology. However, the first generation CBCT systems were later increasingly used to study sinuses, facial and nose fractures, temporomandibular joints etc. 3D-cephalometric head and neck studies became possible once CBCT systems were available that allowed scanning of the complete head. For this purpose a double rotation technique with stitching of the resulting two data sets was needed. CBCT systems on which the rotation could be stopped were needed to perform dynamic swallow or pharyngography studies. The advent of more powerful high-end CBCT systems led the way to temporal bone and skull base imaging. Finally, high-end “supine” CBCT systems using a “gantry” made small joint musculoskeletal imaging possible. These non-dental CBCT studies gradually replaced conventional X-rays and CT/MDCT studies because they allowed imaging with higher resolution, lower radiation dose and less metal artifacts. In this paper the most important non-dental CBCT indications will be discussed

Survey of recommended referral patterns for incidental maxillary sinus and airway findings on CBCT analysis in an orthodontic population.

University of Minnesota M.S. thesis. July 2017. Major: Dentistry. Advisor: Brent Larson. 1 computer file (PDF); v, 118 pages.Introduction: Cone beam computed tomography (CBCT) is an increasingly more common form of radiography, and dental professionals are obligated to manage all incidental findings identified on scans. Clarification of standards for management of CBCT findings would help the practitioner, especially for findings of the airway and sinuses. Aims: The primary aim was to evaluate recommendations of otolaryngologists to dentists for follow up of sinus and airway findings identified on CBCT analysis. The secondary aim was to report on prevalence of maxillary sinus and airway findings on CBCT analysis in an orthodontic population. Methods: A survey with CBCT images of 22 sinus and airway findings was submitted to otolaryngologists (n = 269) for review, and de-identified CBCT reports of orthodontic patients were reviewed to evaluate the prevalence of sinus and airway findings. Frequencies were calculated for responses and findings. Results: Thirty-six otolaryngologists participated in the survey. The most commonly recommended actions were to 1) immediately refer the patient to an otolaryngologist, and 2) ask additional questions regarding sinonasal symptoms before referring. In the orthodontic population studied, a total of 53.8% patients had maxillary sinus or airway findings listed on CBCT scan reports. The most commonly reported finding was mucosal thickening. Conclusions: Incidental maxillary sinus and airway findings are commonly found on CBCT scans. When such findings are identified on CBCT analysis, otolaryngologists generally recommend evaluating the patient for symptoms, and referring the patient to an otolaryngologist for follow up. For findings that are variants of normal, the recommendation is to not refer the patient for follow up unless they are positive for sinonasal symptoms. For findings that demonstrate inflammatory conditions, the recommendation is to refer the patient for follow up, especially if they have sinonasal symptoms. For findings with changes in the bony wall of the sinuses, the recommendation is to immediately refer the patient to the otolaryngologist for follow up. Consultation with an oral and maxillofacial radiologist or otolaryngologist is recommended to best manage incidental sinus and airway findings present on CBCT scans

Kasvovammojen kuvantaminen monileiketietokonetomografialla

Facial fractures are a common problem worldwide. They are often caused by falls, falls from heights, motor vehicle accidents, and violence. In Studies I-IV, we retrieved all 2413 emergency room physicians’ multidetector computed tomography (MDCT) requests for facial injury during a 62-month time period. These were categorized by etiology: 155 cases of fall-from-height accidents, 500 cases of falling accidents, 727 cases due to violence, and 374 cases following a motor vehicle accident. The fractures were divided into groups: nasal bone, orbital, naso-orbito-ethmoid, zygomatic complex, zygomatic arch, Le Fort I, II, and III, frontal bone, maxillary, mandibular, and skull base fractures. These were further classified into different subtypes. Paranasal sinus effusions were noted as well. Further, the age, gender, and a more precise injury mechanism were registered. When taking into account the patients with a fracture, males predominated in all our studies (I-IV). In falls, the difference between genders was the smallest and most distinctive in falls from heights. In falls from heights, nasal bone and zygomatic arch fractures were seldom solitary fractures, but were indicators of a more severe fracture. There was a slight increase in the number and severity of fractures with increasing height. However, there was considerable overlap in heights, and thus, falling height cannot be the only predictor of injury probability. In falls, the most common fracture was the zygomatic complex fracture, whereas in violence-related fractures nasal and orbital fractures predominated. In motor vehicle accidents, Le Fort, frontal bone, and zygomatic arch fractures were always accompanied by other fractures. We also found that a clear sinus sign is a valuable aid in detecting facial fractures, but it might be less reliable than previously thought. Le Fort fractures were often asymmetric or unilateral. Postoperative maxillofacial imaging has earlier been somewhat challenging due to the artifacts caused by metal. In Study V, we compared different devices and protocols by scanning a phantom with a 64-slice computed tomography, cone-beam computed tomography, and a high-definition multislice computed tomography with dual-energy scan and iterative reconstruction methods. For postoperative maxillofacial imaging, cone-beam computed tomography was not optimal. Multidetector computed tomography with adaptive statistical iterative reconstruction offers fast image volume reconstruction with good image quality.Kasvomurtumat ovat maailmanlaajuisesti yleisiä vammoja. Ne syntyvät usein kaatumisen, putoamisen, moottoriajoneuvo-onnettomuuden tai väkivallan seurauksena. Osatöitä I-IV varten kävimme läpi 62 kuukauden ajalta Töölön sairaalassa suoritettujen kasvojen monileiketietokonetomografiakuvausten lähetetekstit, ja tapaukset lajiteltiin vammamekanismin perusteella. Kuvauksista 155 tehtiin putoamisten, 500 kaatumisten, 727 väkivallan ja 374 moottoriajoneuvo-onnettomuuksien herättämän kasvomurtumaepäilyn vuoksi. Digitaaliseen kuva-arkistoon tallennetut kuvat tulkittiin murtumien havaitsemiseksi. Murtumat jaoteltiin ryhmiin sijainnin perusteella ja luokittelua jatkettiin vielä murtumien eri alatyyppeihin. Nenän sivuonteloiden effuusiot kirjattiin. Lisäksi potilaiden ikä, sukupuoli sekä vammautumisen tarkempi mekanismi huomioitiin. Kaikissa tutkimissamme ryhmissä murtumapotilaista enemmistö oli miehiä, ero naisiin oli pienin kaatumis- ja suurin putoamistapaturmissa. Putoamisten yhteydessä todettiin, että nenämurtumat ja zygomakaaren murtumat olivat harvoin yksittäisiä löydöksiä, vaan ne viittasivat usein vakavampaan murtumaan. Putoamiskorkeus ei myöskään yksinään määrittänyt vammojen todennäköisyyttä. Kaatumisten yhteydessä yleisin murtumatyyppi oli zygomakompleksin murtumat, kun taas väkivallan seurauksena yleisimmät vammat olivat nenän ja orbitan murtumat. Moottoriajoneuvo-onnettomuuksissa Le Fort -murtumat, frontaaliluun murtumat ja zygomakaaren murtumat eivät koskaan esiintyneet yksittäisinä murtumina. Tutkimuksissa havaitsimme, että Le Fort -murtumat olivat usein epäsymmetrisiä tai toispuolisia. Lisäksi totesimme, että vaikka nenän sivuonteloiden effuusioiden huomioiminen on hyvä apu murtumien havaitsemisessa, se saattaa kuitenkin olla aiemmin ajateltua epäluotettavampi apukeino. Kasvomurtumien leikkauksen jälkeinen kuvantaminen on ollut aiemmin melko haastavaa metallin aiheuttaman artefaktan vuoksi. Osatyössä V vertasimme eri tietokonetomografialaitteita ja protokollia kuvaamalla fantomia. Kartiokeilatietokonetomografia ei ollut optimaalinen kasvomurtumien postoperatiiviseen kuvantamiseen. Sen sijaan monileiketietokonetomografia ASiR:lla (adaptive statistical iterative reconstruction) tuottaa nopeasti hyvälaatuista kuvaa ja soveltuu hyvin kasvovammojen postoperatiiviseen kuvantamiseen

The Utilisation of Craniomaxillofacial Radiology in Preventative Medicine

This thesis discusses the importance of the maximal utilisation of dental, maxillofacial and antenatal craniofacial imaging in preventative healthcare. Many craniomaxillofacial imaging techniques can provide added diagnostic information which assist in the diagnosis of conditions other than those that the study was performed to investigate. The first publication describes use of panoramic dental radiographs in the assessment of stroke risk in the individual patient. The second publication discusses the uses and limitations of panoramic dental radiographs in the evaluation of maxillary sinus disease. The final three articles establish the normal fetal cephalic index, and its value in the antenatal detection of sagittal craniosynostosis. The results of these studies will assist dental and medical professionals in the appropriate investigation and management of patients with carotid artery calcification detected incidentally on orthopantomograms, and the selection of the most suitable imaging studies to evaluate the maxillary sinuses. The antenatal diagnosis of sagittal craniosynostosis can provide valuable information to the expectant mother and her obstetrician with regards to delivery options and choices where there is an increased risk of obstructed labour that could injure mother, child or both. The full utilisation of these imaging studies will provide an increased clinical benefit to the patient and referrer, and can benefit the population as a whole by assisting with preserving the health of the community and managing spiralling healthcare costs. Craniomaxillofacial Radiology Declaration Declaration I, Sarah Christine Constantine, certify that this work contains no material which has been accepted for the award of any other degree or diploma in my name, in any university or other tertiary institution and, to the best of my knowledge and belief, contains no material previously published or written by another person, except where due reference has been made in the text. In addition, I certify that no part of this work will, in the future, be used in a submission in my name, for any other degree or diploma in any university or other tertiary institution without the prior approval of the University of Adelaide and where applicable, any partner institution responsible for the joint-award of this degree. I acknowledge that copyright of published works contained within this thesis resides with the copyright holder(s) of those works. I also give permission for the digital version of my thesis to be made available on the web, via the University’s digital research repository, the Library Search and also through web search engines, unless permission has been granted by the University to restrict access for a period of time. I acknowledge the support I have received for my research through the provision of an Australian Government Research Training Program Scholarship.Thesis (Ph.D.) -- University of Adelaide, Adelaide Dental School, 201

Dental implications of inherited connective tissue disorders in South Africa

The prevalence of Osteogenesis imperfecta type III (OI III) as a category of the inherited connective tissue disorders in South Africa is of paramount importance. Although worldwide, autosomal recessive(AR) OI is rare, it had emerged that the frequency of OI III is relatively high in the indigenous Black African population of South Africa. A review of the literature revealed a paucity of information regarding the dental and craniofacial manifestations of the disorder in this ethnic group. For these reasons, the central theme of this thesis is the identification, documentation and analysis of these features in individuals with OI III in the Black African population of SA. Osteogenesis imperfecta type III (OMIM 259420) is a severe autosomal recessive disorder in which frequent fractures and progressive limb and spinal deformity result in profound physical disability. The condition is heterogeneous and dentin genesis imperfecta (DI) is an important syndromic component of some types of OI III. Other maxillofacial and dental manifestations also have significant implications in terms of management