Syndromic silent sinus syndrome - management and outcomes in patient suffering from skeletal dento-facial deformity 1,2

Silent sinus syndrome (SSS) is a rare entity characterized by ipsilateral chronic hypoventilation and atelectasis of the maxillary sinus, which may lead to facial or ocular asymmetry, hypoglobus, enophtalmos and diplopia. In this report, we present a case of a 21-year-old patient scheduled for an orthognathic procedure due to skeletal malocclusion. Patient complained about problems with nasal breathing. CT scans revealed an atrophic, inflamed, hypoventilated left maxillary sinus with obstruction of the left ostiomeatal complex, septal deviation and hypertrophy of the left interior turbinate. Furthermore atrophic and asymmetrical left zygomaticomaxillary complex with shifting of maxillary bite plane and left malar depression accompanied by slightly displaced inferior border of left lateral orbital wall was noted. Due to clinical symptoms of SSS, patients are often referred to the ears, nose and throat (ENT) department or to the ophthalmologist. Silent sinus syndrome diagnosis begins upon clinical examination and it is confirmed by radiological imaging (usually CT). The most characteristic radiological finding is maxillary sinus volume reduction as a result of inward retraction of the sinus walls. It is important to perform differential diagnosis, taking into consideration other conditions that present with enophtalmos. The main goal of surgical treatment is to normalize the ventilation of maxillary sinus by improving its drainage toward the nasal cavity and, in selected cases, restoration of the orbital floor

Syndromiczny zespół cichej zatoki – postępowanie i wyniki leczenia u pacjenta ze szkieletową wadą zębowo-twarzową 1,2

Zespół cichej zatoki (SSS) jest rzadką jednostką chorobową charakteryzującą się jednostronną hipowentylacją oraz niedodmą zatoki szczękowej, co może skutkować asymetrią oczu i/lub twarzy, zapadnięciem gałki ocznej, enoftalmią i diplopią. W niniejszej pracy przedstawiamy przypadek 21-letniego pacjenta, u którego zostało zaplanowane leczenie ortognatyczne z powodu szkieletowej wady zgryzu. Pacjent uskarżał się na problemy z oddychaniem przez nos. Badanie TK ujawniło atroficzną zapalną lewą zatokę szczękową (z hipowentylacją), niedrożność lewego kompleksu ujściowoprzewodowego, skrzywienie przegrody nosowej i przerost lewej małżowiny nosowej dolnej. Ponadto zauważono atrofię i asymetrię lewego kompleksu jarzmowo-szczękowego z przesunięciem płaszczyzny zgryzowej i zapadnięciem lewego policzka oraz nieznaczne przemieszczenie dolnego ograniczenia bocznej ściany lewego oczodołu. Z powodu objawów klinicznych SSS, pacjenci często kierowani są na oddział laryngologiczny lub do okulisty. Diagnostyka zespołu cichej zatoki rozpoczyna się od badania klinicznego i potwierdzana jest badaniami obrazowymi (zazwyczaj TK). Najbardziej charakterystyczny radiologicznie jest obraz redukcji objętości zatoki szczękowej, będącej rezultatem dośrodkowej retrakcji ścian zatoki. Istotne jest przeprowadzenie diagnostyki różnicującej z innymi schorzeniami związanymi z enoftalmią. Głównym celem leczenia operacyjnego jest normalizacja napowietrzenia zatoki szczękowej poprzez poprawę jej drożności do jamy nosowej, a w niektórych przypadkach także rekonstrukcja dna oczodołu

Risk factors involved in orofacial cleft predisposition – review

Clefts that occur in children are a special topic. Avoiding risk factors, and also an early diagnosis of cleft possibility can result in minimizing or avoiding them. If on the other hand when clefts occur they require a long-term, multistage specialized treatment. Etiology of clefts seems to be related to many factors. Factors such as genetic, environmental, geographic and even race factors are important. Identification of risk factors can lead to prevention and prophylactic behaviors in order to minimize its occurrence. Exposure to environmental factors at home and work that lead to cleft predisposition should not be disregarded. It seems that before planning a family it would be wise to consult with doctors of different specializations, especially in high-risk families with cleft history in order to analyze previous lifestyle. Clefts are very common in hereditary facial malformations and are causing a lot of other irregularities in the head and neck region. In this paper after a brief papers review authors present socio-geographic, environmental and also work place related factors that are influencing pregnant women condition and should be taken under serious consideration

Naczyniak limfatyczny torbielowaty u dorosłej, starszej osoby - opis przypadku

Introduction: Cystic hygromas are very uncommon malformations in adults. In most of the cases, they present as a painless, fluctuant swelling, usually located in the neck region. They tend to grow extensively if not removed. Cystic hygromas can range from 1 mm to several centimeters in size and are filled with clear- to straw-colored fluid. Surgical treatment remains the gold-standard treatment for these tumors. In some cases they can be misdiagnosed with branchial cysts, swollen lymph nodes or other pathologies. When this malformation is present in the prevertebral fascia its surgical treatment is challenging, and some authors advise its conservative treatment, which is in a great risk of its reoccurence. Because of potential malignant transformation in some percentage of branchial cyst cases, a similar situation was suspected. Case report: The present report describes a case of cystic hygroma of the left side of the neck in a 92-year-old female adult and its clinical, radiological and operative features.Wstęp: Naczyniak limfatyczny torbielowaty jest bardzo rzadko spotykaną u osób dorosłych zmianą patologiczną. W większości przypadków objawia się on jako bezbolesne, chełboczące wygórowanie tkanek miękkich, umiejscowione w obrębie szyi. Gdy guz nie zostanie usunięty, może dochodzić do jego znacznego wzrostu. Średnica, wielkość naczyniaków limfatycznych torbielowatych wynosi od 1 mm do kilku centymetrów, zaś ich wnętrze wypełnione jest płynem w kolorze od przezroczystego do słomkowego. Leczenie chirurgiczne pozostaje „złotym standardem” postępowania w przypadku tych guzów. Niekiedy mogą one zostać błędnie zdiagnozowane jako: torbiel boczna szyi, obrzęk węzłów chłonnych lub inne zmiany patologiczne. W sytuacji, gdy guz pokryty jest powięzią przedkręgową, jego leczenie operacyjne, chirurgiczne jest skomplikowane i wiążę się z podwyższonym ryzykiem uszkodzenia istotnych, sąsiednich struktur anatomicznych (naczynia, nerwy). W takich sytuacjach niektórzy autorzy zalecają zastosowanie alternatywnych, niechirurgicznych metod leczenia. Ze względu na potencjalną transformację złośliwą w pewnym procencie torbieli bocznych szyi, w opisywanym przypadku brano pod uwagę możliwość wystąpienia podobnej sytuacji. Opis przypadku: W niniejszej publikacji opisano przypadek naczyniaka limfatycznego torbielowatego, zlokalizowanego w obrębie tkanek miękkich szyi po stronie lewej u 92-letniej kobiety, z uwzględnieniem jego cech klinicznych, obrazu radiologicznego i zastosowanego leczenia operacyjnego

What Features on Routine Panoramic Radiographs Could Help Orthodontists to Estimate the Occurrence of Condylar Hyperplasia from Other Mandibular Asymmetries—Retrospective Analysis Study

Hemimandibular hyperplasia (HH) and elongation (HE) are the most common pathologies present in the mandible. Presented condylar hyperplasias have their own radiological and clinical features. In most cases, patients suffer from various forms of malocclusion. From a total of 150 asymmetrical jaw radiographs evaluated, 46 were evaluated and included in this study. A retrospective study on the data of 46 selected patients treated, diagnosed, and consulted from various forms of mandibular and skeletal asymmetry based on routine diagnostic panoramic radiographs evaluated typical and atypical radiological and anatomical symptoms of condylar hyperplasia. The presented evaluation focused on mandibular, maxillary, and other bones, in order to distinguish condylar hyperplasia from other forms of mandibular asymmetry. The degree of maxillary downward growth followed by the occurrence of an open bite on the affected side estimate the degree/presence or cessation of growth in the affected condyle. Mandibular asymmetry with incisor teeth inclination remains the most typical characteristic of condylar hyperplasia. Increased height of mandibular ramus differentiates between condylar hyperplasia and elongation, which also influences the position of the inferior alveolar nerve. Mentioned symptoms, described as the acronym “Go Moira!”, are useful in a quick and simple “glimpse of an eye” differential diagnostic approach. It is possible to quickly and accurately establish the first diagnosis simply by a careful evaluation of patients’ panoramic radiographs

What Features on Routine Panoramic Radiographs Could Help Orthodontists to Estimate the Occurrence of Condylar Hyperplasia from Other Mandibular Asymmetries—Retrospective Analysis Study

Hemimandibular hyperplasia (HH) and elongation (HE) are the most common pathologies present in the mandible. Presented condylar hyperplasias have their own radiological and clinical features. In most cases, patients suffer from various forms of malocclusion. From a total of 150 asymmetrical jaw radiographs evaluated, 46 were evaluated and included in this study. A retrospective study on the data of 46 selected patients treated, diagnosed, and consulted from various forms of mandibular and skeletal asymmetry based on routine diagnostic panoramic radiographs evaluated typical and atypical radiological and anatomical symptoms of condylar hyperplasia. The presented evaluation focused on mandibular, maxillary, and other bones, in order to distinguish condylar hyperplasia from other forms of mandibular asymmetry. The degree of maxillary downward growth followed by the occurrence of an open bite on the affected side estimate the degree/presence or cessation of growth in the affected condyle. Mandibular asymmetry with incisor teeth inclination remains the most typical characteristic of condylar hyperplasia. Increased height of mandibular ramus differentiates between condylar hyperplasia and elongation, which also influences the position of the inferior alveolar nerve. Mentioned symptoms, described as the acronym “Go Moira!”, are useful in a quick and simple “glimpse of an eye” differential diagnostic approach. It is possible to quickly and accurately establish the first diagnosis simply by a careful evaluation of patients’ panoramic radiographs

Data from: The presence of bacterial microcolonies on the maxillary sinus ciliary epithelium in healthy young individuals

Objective: The aim of this cross-sectional in vitro study was to evaluate the mucosal surfaces of healthy maxillary sinuses, explore different forms of bacterial microorganism colonies present on the mucous membrane, and determine a mucosal surface area they occupy. Methods: Samples of the maxillary sinus mucosa were collected from 30 healthy patients (M=11; F=19). The material was obtained during the Le Fort I osteotomy performed during corrective jaw surgery. The morphological and morphometric analysis of sinus mucosa and bacterial film that was grown on it was performed using scanning electron microscopy (SEM) as well as imaging software. Results: Scanning electron microscopy analysis showed the presence of different bacterium and bacteria-like structures in all the analyzed samples. In most cases, the bacterial film was mostly composed of diplococci-like and streptococci-like structures on the mucosa of the paranasal sinus. In any case, the mucous layer did not cover the whole lining of the evaluated sample. Each colony consists of more than 20 single bacterial cells, which has grown in aggregates. Conclusions: Under the conditions of normal homeostasis of the body, the maxillary sinuses present diverse bacterial colonization. The bacteria are dispersed or concentrated in single microcolonies of the biofilm on the border of the mucous covering the ciliary epithelium. There is no uniform layer of the biofilm covering the mucosa of the maxillary sinuses. Because the biofilm is detected on healthy individuals sinus mucosa, the clinical question if it may become pathogenic is unclear and require an explanation

The presence of bacterial microcolonies on the maxillary sinus ciliary epithelium in healthy young individuals.

OBJECTIVE:The aim of this cross-sectional in vitro study was to evaluate the mucosal surfaces of healthy maxillary sinuses, explore different forms of bacterial microorganism colonies present on the mucous membrane, and determine a mucosal surface area they occupy. METHODS:Samples of the maxillary sinus mucosa were collected from 30 healthy patients (M = 11; F = 19). The material was obtained during the Le Fort I osteotomy performed during corrective jaw surgery. The morphological and morphometric analysis of sinus mucosa and bacterial film that was grown on it was performed using scanning electron microscopy (SEM) as well as imaging software. RESULTS:Scanning electron microscopy analysis showed the presence of different bacterium and bacteria-like structures in all the analyzed samples. In most cases, the bacterial film was mostly composed of diplococci-like and streptococci-like structures on the mucosa of the paranasal sinus. In any case, the mucous layer did not cover the whole lining of the evaluated sample. Each colony consists of more than 20 single bacterial cells, which has grown in aggregates. CONCLUSIONS:Under the conditions of normal homeostasis of the body, the maxillary sinuses present diverse bacterial colonization. The bacteria are dispersed or concentrated in single microcolonies of the biofilm on the border of the mucous covering the ciliary epithelium. There is no uniform layer of the biofilm covering the mucosa of the maxillary sinuses. Because the biofilm is detected on healthy individuals sinus mucosa, the clinical question if it may become pathogenic is unclear and require an explanation

Usage of Guided Bone Regeneration in the Case of Lateral Periodontal Cyst in the Maxilla with Buccal Cortical Expansion

A lateral periodontal cyst (LPC) is a rare finding. Patients diagnosed with LPC younger than 40 years of age are not that common. Mostly asymptomatic LPCs can be discovered on routine radiographs as an oval radiolucency between two mandibular premolar teeth roots and can vary in shape and size. Most cases are treated with enucleation, bone curettage, or a combination of both, greatly depending on the surgeon’s preference. Because most LPCs are quite small, lesions do not require any regenerative procedures. In the presented case, because of cortical expansion of the lesion and loss of vital bone bridge surrounding two adjacent maxillary teeth, a guided bone regenerative procedure (GBR) with xenograft bone substitute was used. Despite that small lesions can heal on their own, nowadays the approach of full-mouth therapy (FMT), including direct soft or hard tissue reconstruction in the oral cavity, seems to be a wise treatment. The presented paper presents and describes an unusual LPC case with cortical bone expansion in a very rare maxillary canine–premolar region

Physical Conditions Prevailing in the Nasal and Maxillary Sinus Cavities Based on Numerical Simulation

Background and Objectives: This paper presents a unique study that links the physical conditions in the nasal passage with conditions that favour the development of bacterial strains and the colonization of the mucous membranes of the nose and paranasal sinuses. The physical parameters considered were air flow, pressure, humidity, and temperature. Materials and Methods: Numerical models of the human nose and maxillary sinus were retrospectively reconstructed from CT images of generally healthy young subjects. The state-of-the-art numerical methods and tools were then used to determine the temperature, humidity, airflow velocity, and pressure at specific anatomical locations. Results: The results were compared with optimal conditions for bacterial growth in the nose and sinuses. Conclusions: Temperature, humidity, air velocity, and pressure were shown to play critical roles in the selection and distribution of microorganisms. Furthermore, certain combinations of physical parameters can favour mucosal colonisation by various strains of bacteria