Omami, GMS

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Title Palatine recess of maxillary sinus masquerading as radiolucentlesion: case reportAuthor(s) Omami, GMSCitation The Libyan Dentail Journal, 2013, v. 3, article no. 14815171Issued Date 2013URL http://hdl.handle.net/10722/207218Rights Creative Commons: Attribution 3.0 Hong Kong LicenseCopyright © 2013. LDJ. This is an open access article distributed under the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.	   Citation: Libyan Dent J 2013, 3: 14815171 -http://dx.doi.org/10.5542/LDJ.v3i0. 14815171  (Page numberis not for citation purpose).    1	  	  PALATINE RECESS OF MAXILLARY SINUS MASQUERADING AS RADIO-LUCENT LESION: CASE REPORT Galal Omami, Lecturer, Department of Oral Medicine and Radiology, Benghazi University College of Dentistry, Benghazi, Libya     ARTICLE INFORMATION  Article History Received: 20 August, 2013 Accepted in revised form: 25 Septe-  mber, 2013 Published: 28 October, 2013  Corresponding author Galal Omami E-mail: jellodent@yahoo.com  Keywords palatine recess, maxillary sinus, pneumatiza-tion, cone beam CT   لﻝﺎﻘﻣﻟاﺍ تﺕﺎﻣوﻭﻠﻌﻣ  :لﻝﺎﻘﻤﻟاﺍ ﺦﯾﻳرﺭﺎﺗ   ABSTRACT    In this report we breifly present a case of a 13-year-old boy referred to the department of orthodontics for evaluation of malocclusion. A maxillary occlusal radiograph showed a well-defined multilocular-appearing radiolucent lesion in the right hard palate. Subsequent cone beam CT examination revealed pneumatization of the right maxillary sinus into the palatine process of maxilla. This anatomic variation has been sparsely reported in literature and dental practitioners should be aware of such a condition as it could be easily mistaken for pathology.            رﺭﻌﻟاﺍ صﺹﺧﻠﻣﻟاﺍﻲﺑﻗلﻝﺑ ﻲﻓ ﺔﻌﺟاﺍرﺭﻣﻟاﺍ دﺩﻌﺑ:25  ،٬رﺭﯾﻳﺑﻣﺗﺳ2013    مﻡﻠﺗﺳأﺃﻲﻓ:20  ،٬سﺱطﻁﺳﻏأﺃ2013  ﻲﻓ رﺭﺷﻧ: ،٬2013   اﺍ:لﻝوﻭﺆﺴﻤﻟاﺍ ﻒﻟاﺍﺆﻤﻟ  ﻲﻣﺎﻤﻌﻟاﺍ كﻙوﻭﺮﺒﻤﻟاﺍ لﻝﻼﺟ jellodent@yahoo.com  ﻲﻧوﻭﺮﺘﻜﻟﻻاﺍ ﺪﯾﻳﺮﺒﻟاﺍ:   :ﺔﯿﻴﺣﺎﺘﻔﻤﻟاﺍ تﺕﺎﻤﻠﻜﻟاﺍ ﺐﯿﻴﺠﻟاﺍ ﻚﻔﻟاﺍ،٬ ﻒﻘﺳ ﻢﻔﻟاﺍ ﻲﻤﻈﻌﻟاﺍ،٬ دﺩﺪﻤﺗ بﺏﻮﯿﻴﺠﻟاﺍ ﺔﯿﻴﻔﻧﻷاﺍ  ﺔﻌﺷﻷاﺍ ﺔﯿﻴﺼﯿﻴﺨﺸﺘﻟاﺍ تﺕاﺍذﺫ ﺔﻣﺰﺤﻟاﺍ ﺔﯿﻴطﻁوﻭﺮﺨﻤﻟاﺍ                    لﻝﻛﺷ ﻲﻓ رﺭﮭﻬظﻅﯾﻳ مﻡﻔﻟاﺍ فﻑﻘﺳ ﻲﻓ ﻲﻛﻔﻟاﺍ بﺏﯾﻳﺟﻟاﺍ دﺩدﺩﻣﺗآﺁﺔﻟﺎﺣ ضﺽرﺭﻋ :ﺔﯾﻳﺿرﺭﻣ ﺔﻓ  ﻲﻣﺎﻤﻌﻟاﺍ كﻙوﻭﺮﺒﻤﻟاﺍ لﻝﻼﺟ،٬ ﺮﺿﺎﺤﻣ،٬  ﺐطﻁ ﺔﯿﻴﻠﻛ ،٬ﺔﻌﺷﻷاﺍوﻭ ﺺﯿﻴﺨﺸﺘﻟاﺍوﻭ ﻢﻔﻟاﺍ ﺐطﻁ ﻢﺴﻗ،٬يﻱزﺯﺎﻐﻨﺑ ﺔﻌﻣﺎﺟ ،٬نﻥﺎﻨﺳﻷاﺍ  يﻱزﺯﺎﻐﻨﺑ-  ﺎﯿﻴﺒﯿﻴﻟ   ﻲﻓ اﺍﺬھﮪﮬﻫ ﺮﯾﻳﺮﻘﺘﻟاﺍ ضﺽﺮﻌﻧ ﺔﺳاﺍرﺭدﺩ ﺔﻟﺎﺣ ﻰﺘﻔﻟ ﻎﻠﺒﯾﻳ ﻦﻣ ﺮﻤﻌﻟاﺍ 13 ﺎﻣﺎﻋ ضﺽﺮﻋ ﻰﻠﻋ ﻢﺴﻗ ﻢﯾﻳﻮﻘﺘﻟاﺍ جﺝﻼﻌﻟ ءﻮﺳ قﻕﺎﺒطﻁﻹاﺍ .ﻢﺗ ءاﺍﺮﺟإﺇ ﺺﻓ ﺔﻌﺷﻷﺎﺑ ﺔﯾﻳﺪﯿﻴﻠﻘﺘﻟاﺍ ﻚﻔﻠﻟ يﻱﻮﻠﻌﻟاﺍ ﻲﺘﻟاﺍوﻭ تﺕﺮﮭﻬظﻅأﺃ دﺩﻮﺟوﻭ ﺎﻣ ﮫﻪﺒﺸﯾﻳ ﺔﻓﻻاﺍ ﺔﯿﻴﺿﺮﻤﻟاﺍ ﻲﻓ ﺔﮭﻬﺠﻟاﺍ ﻰﻨﻤﯿﻴﻟاﺍ ﻦﻣ ءﺰﺠﻟاﺍ ﻲﻤﻈﻌﻟاﺍ ﻒﻘﺴﻟ ﻢﻔﻟاﺍ ﮫﻪﯿﻴﻠﻋوﻭ ﺎﻨﻤﻗ ءاﺍﺮﺟﺈﺑ ﺺﺤﻓ ﺔﻌﺷﻷﺎﺑ ﺔﯿﻴﻌﻄﻘﻤﻟاﺍ تﺕاﺍذﺫ ﺔﻣﺰﺨﻟاﺍ ﺔﯿﻴطﻁوﻭﺮﺨﻤﻟاﺍ ﻲﺘﻟاﺍوﻭ ﺎھﮪﮬﻫرﺭوﻭﺪﺑ تﺕﺪﻛأﺃ نﻥأﺃ ﺎﻣ ﺮﮭﻬظﻅ وﻭ ﮫﻪﻧﺄﻛ ﺔﻓاﺍ ﺔﯿﻴﺿﺮﻣ ﺎﻣ ﻲھﮪﮬﻫ ﻻإﺇ دﺩﺪﻤﺗ ﺐﯿﻴﺠﻠﻟ ﻲﻜﻔﻟاﺍ ﻦﻤﯾﻳﻷاﺍ ﻲﻓ ﻒﻘﺳ ﻢﻔﻟاﺍ .ﻰﻠﻋ ءﻮﺿ هﻩﺬھﮪﮬﻫ ﺔﻟﺎﺤﻟاﺍ ﻲﺻﻮﻧ  ةﺓرﺭوﻭﺮﻀﺑ ﻢﻠﻗﺄﺗ ﻲﯿﻴﺻﺎﺼﺘﺧإﺇ ﺐطﻁ ﻷاﺍنﻥﺎﻨﺳ ﻊﻣ تﺕﺎﻓﻼﺘﺧﻹاﺍ ﺔﯿﻴﺤﯾﻳﺮﺸﺘﻟاﺍ ﺔﯿﻴﻌﯿﻴﺒﻄﻟاﺍ ﺐﯿﻴﺠﻠﻟ ﻲﻜﻔﻟاﺍ ﻲﺘﻟاﺍوﻭ ﻦﻜﻤﯾﻳ ﺎﮭﻬﻀﻌﺑ نﻥأﺃ ﺮﮭﻬﻈﺗ ﻲﻓ ﺔﻌﺷﻷاﺍ ﺔﯿﻴﺼﯿﻴﺨﺸﺘﻟاﺍ  ﻲﻓ ﻞﻜﺷ ﮫﻪﺒﺸﯾﻳ ﺔﻓﻻاﺍ ﺔﯿﻴﺿﺮﻤﻟاﺍ ﻲﻓ ﻚﻔﻟاﺍ يﻱﻮﻠﻌﻟاﺍ .                Galal Omami Citation: Libyan Dent J 2013, 3: 14815171 -http://dx.doi.org/10.5542/LDJ.v3i0. 14815171  (Page numberis not for citation purpose).    2	  	  CASE REPORT  13-year-old boy was presented by his parents to the department of orthodontics for evaluation of malocclusion of maxil-lary anterior teeth. Patient’s past medical history was negative. Initial baseline radiographic ex-amination consisted of panoramic and maxillary occlusal views. The later has incidentally shown a a   well-demarcated multilocular-appearing radio-lucent lesion of the right half of the hard palate, with corticated margin undulating between the roots of right maxillary anterior and premolar teeth (Figure 1). The lesion has seemingly caused resorption, and possibly displacement, of the root of right central incisor. However, in-traoral clinical examination was unremarkable for intraoral swelling or abnormal teeth mobility. A provisional diagnostic impression of a benign tumor/cyst-like condition has been suggested, so our differential diagnosis list was narrowed out to keratocystic odontogenic tumor and simple bone cyst. A suggesion of needle aspiration has been delayed in favor of further 3D imaging assessment. Cone beam        CT scan was acquired and  it surprisingly showed partitioning of the maxillary sinus cavity into the right part of the hard palate forming palatine recess of maxillary sinus (aerated hard palate) (Figure 2). Final diagnosis was recognised and patient’s parents were reassured.  DISCUSSION The hard (bony) palate constitutes the roof of the oral cavity and the floor of the nasal cavity. It is anatomically formed of the palatine process of maxilla (anterior 2/3) and horizontal plate of palatine bone (posterior 1/3). Paranasal sinuses are named after the bones they are housed in, and it has been reported that a paranasal sinus can extend to pneumatize the entire bone. There-fore, the palatine process of maxilla can be pneumatized by maxillary sinus and this variant is known as palatine recess of maxillary sinus. Earwaker recognizes the palatine recess when it extends to a distance more than the half of the width of the corresponding nasal floor at the level of the inferior meatus.1 To best of our knowledge, palatine recess of maxillary sinus has only been sparsely reviewed in English liter-ature. Earwaker has demonstrated the frequency of palatine recess in 11.5% of his patient series.1 The sinonasal cavity is normally captured (partly or wholly) in most radiographic techniques per- taining to maxillary teeth.  Fig.1. Maxillary occlusal view shows a well-demarcated                     radiolucency with scalloped corticated margins (arrows).     Fig.2. Coronal cone beam CT image shows extension of right maxillary sinus into palatine process of maxilla (palatine recess of maxillary sinus) (arrows).  A Galal Omami Citation: Libyan Dent J 2013, 3: 14815171 -http://dx.doi.org/10.5542/LDJ.v3i0. 14815171  (Page numberis not for citation purpose).    3	  	  On the other hand, the anatomy of the sinonasal complex is highly variable that some anatomists portray it as the fingerprint because it is unique to every individual. Many of the anatomic vari-ants of sinonasal cavity have pertinent clinical implications in terms of predisposing to sinus disease, complicating sinus surgery, or simulat-ing pathology.2, 3 This necessitates dental practi-tioners to be familiarized with the anatomical variations of the sinonasal cavity. In this case, the palatine recess of maxillary sinus was en-countered on conventional radiograph and mis-diagnosed for lesion. We recommend the con-sideration of palatine recess of maxillary sinus in the differential diagnosis of a well-defined ra-diolucent lesion of the palate particularly when it is asymptomatic. In this case, the deferral of needle biopsy until cone beam CT had been per-formed was fortunate. Therefore, minimally in-vasive investigative techniques (e.g., needle as-piration, incisional biopsy) for suspicious radio-lucent areas of maxilla should only be performed when a pathologic process is confirmed clinical-ly and/or radiographically. This report supplies a model observation for the utmost usefulness of cone beam CT scan in evaluation of dento-maxillofacial complex at substantially lesser radiation dose. 4  In conclusion, dental practitioners should be alerted of sinonasal variants frequently popping up on routine radiographs and mimicking pa-thology.                         REFERENCES 1) John Earwaker. Anatomic variants in sinona-sal CT. Radiographics1993; 13:381-415. 2) Mecit K, Murat K, Fatih A, Omer O, Adnan O, Adem K. Remarkable anatomic variation in paranasal sinus region and their clinical im-portance. European Journal of Radiology 2004; 50:296-302. 3) Carter LC, Pfaffenbach A, Donley M. Hyper-aeration of the sphenoid sinus: cause for con-cern? Oral Surg Oral Med Oral Pathol Oral Ra-diol Endod 1999; 88: 506–10. 4) Miracle AC, Mukherji SK. Cone beam CT of the head and neck, part 2: Clinical applications. AJNR 2009; 30:1285–92. 	  

Palatine recess of maxillary sinus masquerading as radiolucent lesion: case report

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Palatine recess of maxillary sinus masquerading as radiolucent lesion: case report

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