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Left maxillary sinusitis (total opacification) with blockage of the osteo-meatal complex and oroantral fistula due to a traumatic extraction of the 1st maxillary molar
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Aims and objectives
The traditional Caldwell-Luc approach for maxillary diseases has been criticized for its shortcomings such as removal of a large amount of bone, numbness of the teeth, flap dehiscence, and recurrent sinusitis. On account of its minimal invasiveness and physiological approach, functional endoscopic sinus surgery (FESS) has come t...
Citations
... Kende et al. [14] assessed the feasibility and limitations of functional endoscopic sinus surgery in combination with an intraoral open approach for the treatment of Chronic Maxillary Sinusitis of Dental Origin (CMSDO). They concluded that FESS with Caldwell-Luc approach should be considered as a part of the treatment of CMSDO for stable long-term results and minimal complications. ...
IntroductionRhinomaxillary Mucormycosis (RMM) is a condition peculiarly seen as post-COVID-19 opportunistic infections with Maxillary Sinus Disease and Osteomyelitis (MSDO). The open method of debridement and closed method are two types of surgical modalities available. There is no scoring method for this infection in maxilla. This paper aims to study the clinical and CT-based outcome of open versus closed surgery of MSDO in post-COVID-19 RMM and propose a new scoring method to evaluate the disease severity, progression as well as recovery.Material and Methods
Symptomatic cases of RMM (n = 17) with a history of closed surgical treatment were enrolled for this prospective clinical study. These cases were then treated by medicinal and open surgical method. The clinical and CT scan outcomes were compared by proposed new scoring method.The CT-based score for Maxillary Sinus Disease (MSD) and Maxillary Osteomyelitis (MO) from pre-FESS (CT1), Post-FESS (Preoperative, CT2), and Post-operative (CT3) were compared for both right and left sides. One-way ANOVA test and post HOC tests were used for statistical evaluation.Conclusion
The open method of maxillary sinus surgery has given significant improvement in the treatment of RMM already treated by a closed endoscopic approach.
... Endoscopic surgery for OCs in the maxillary sinus has been reported in the literature 2,13 . However, in transnasal endoscopic surgeries, the cyst cannot be removed under direct vision. ...
A large maxillary odontogenic cyst could intrude into the maxillary sinus. The traditional approach following surgery for such a cyst is the Caldwell–Luc procedure. However, the traditional CDL procedure is associated with more complications and damage of the sinus mucosa. The purpose of this study was to assess a new method with easier operation, which not only prevented postoperative infection but also caused less damage to the maxillary sinus mucosa. A large odontogenic cyst in the maxillary sinus of 40 patients was diagnosed through radiographic imaging and postoperative histopathology. Twenty patients were treated with maxillary sinus saline irrigation after surgery, while 20 patients underwent the traditional Caldwell–Luc procedure. The therapeutic efficacy was evaluated by clinical examination and radiographic imaging; the longest follow-up was 36 months. The postoperative reaction was evaluated. There was a statistically significant difference in facial swelling, visual analog scale (VAS) and temperature elevation between the 2 groups. Sinus irrigation following large odontogenic cyst surgery involving the maxillary sinus can serve as an alternative to standard CDL and has the advantages of fewer complications, reduced trauma, restoration of the mucosa and more satisfactory results.
... Meanwhile, infection occurs in the form of chronic maxillary sinusitis (CMS). 2 Traditionally, cyst enucleation and the Caldwell-Luc (CDL) procedure are performed for OCs involving the maxillary sinus. However, complete stripping of the hyperplastic in amed tissue and sinus lining often leads to sclerosis of the sinus walls and osteitis and damages the mucociliary function of the sinus lining. ...
... RCs are the most common OC lesion, accounting for more than 50% of all OCs. 2 RCs appear to result from infection and necrosis in tooth pulp and account for more than 50% of all OCs. [6][7][8][9] Dentigerous cysts are the second most common cysts of the jaw, comprising 14-20% of all jaw cysts. ...
... 10 OCs can reach the maxillary sinus easily through areas of weakened bone. 2 The cyst and sinus membrane always adhere tightly because of bone resorption and in ammation. ...
Objective: A large maxillary odontogenic cyst could intrude into the maxillary sinus. The traditional approach following surgery for such a cyst is the Caldwell-Luc procedure However the traditional CDL procedure is associated with more complications and damage of the sinus mucosa. The purpose of this study was to assess a new method with easier operation, which not only prevented postoperative infection but also caused less damage to the maxillary sinus mucosa.
Methods: A large odontogenic cyst in the maxillary sinus of 40 patients was diagnosed through radiographic imaging and postoperative histopathology. Twenty patients were treated with maxillary sinus saline irrigation after cyst resection surgery, while 20 patients underwent the traditional Caldwell-Luc procedure. The therapeutic efficacy was evaluated by clinical examination and radiographic imaging; the longest follow-up was 36 months.
Results: The postoperative recovery of the 20 patients treated with sinus irrigation. Six patients had mild swelling (30%), 12 had moderate swelling (60%), and 2 had severe swelling (10%); 16 had mild pain (80%), 4 had moderate pain (20%), and 0 had severe pain (0%). Among the 20 patients treated by the Caldwell-Luc approach. Immediately postoperatively, 2 patients had mild swelling (10%), 12 had moderate swelling (60%), and 6 had severe swelling (30%); 10 had mild pain (50%); 6 had moderate pain (30%), and 4 had severe pain (20%). On the second day after surgery, a mild temperature elevation (38.0°C-39.0°C) was noted in 8 patients (40%) treated with the Caldwell-Luc procedure and 1 patient (5%) treated with saline irrigation.
Conclusion: Sinus irrigation following large odontogenic cyst surgery involving the maxillary sinus can serve as an alternative to standard CDL and has the advantages of fewer complications, reduced trauma, restoration of the mucosa and more satisfactory results.
... Oral and maxillofacial surgery is mainly performed in maxillofacial fracture repair, soft-tissue repair, and treatment of cleft lip and palate, head and neck tumors, etc. Due to the rich blood circulation and complex anatomical structure of the oral and maxillofacial region, surgery can easily destroy the micro-ecological balance of the oral cavity, and coupled with the widespread use of antimicrobial drugs, it is easy to cause hospital infections and prolong hospitalization time [1][2][3]. Multi-drug resistant organism (MDRO) is one of the main pathogenic bacteria of hospital infections, and MDRO refers to bacteria that are resistant to the clinical application of ≥3 classes of antimicrobial drugs, due to the misuse of antimicrobial drugs and adaptive mutations [4]. Hospital infections have become a major challenge in hospital nursing management due to its rapid spread, complexity, and refractory nature. ...
Objective:
Care models of Healthcare Failure Mode and Effect Analysis (FMEA) were evaluated for the prevention of multi-drug resistant organisms (MDRO) infections in oral and maxillofacial surgery.
Methods:
Two hundred patients who received oral and maxillofacial surgery from January to December 2017 were enrolled as the control group, and another 200 patients who received oral and maxillofacial surgery from January to December 2018 were enrolled as the FMEA group. The incidence of MDRO, the implementation of preventive and control measures, the mastery of preventive and control knowledge, and oral self-care ability were compared between the two groups. Risk Priority Number (RPN) and behavioral changes of health care personnel were observed in FMEA group.
Results:
The FMEA group had a lower incidence of MDRO (2.00%) than the control group (6.00%) and a higher rate of acquisition of prevention and control knowledge (93.00%) than the control group (84.50%) (P < 0.05). Patients in FMEA group were higher than those in the control group in terms of compliance towards isolation signs and precautions, appropriate use of PPE, implementation of disinfection measures, hand hygiene and exercise of self-care agency (ESCA) scale scores (P < 0.05). The total RPN score of the FMEA group before and after management was 1384 and 180, respectively, and the reduction rate of total RPN scores was 86.99%. Scores with regard to knowledge, attitude, and behavior of health care personnel were increased after FMEA treatment (P < 0.05).
Conclusion:
The nursing model of FMEA for oral and maxillofacial surgery can prevent MDRO infections, reduce RPN, improve the implementation of preventive and control measures as well as oral self-care ability and the acquisition of knowledge.
... Concluiu-se então que a combinação de ambas as técnicas resulta em resultados satisfatórios, sem diferenças estatísticas em relação à incidência de complicações para os grupos estudados. Dessa forma, pontua-se a importância da abordagem multidisciplinar da sinusite maxilar crônica com a atuação conjunta do Otorrinolaringologista e do Cirurgião Bucomaxilofacial (KENDE et al., 2019). ...
Apesar de consagrada na literatura, a antrostomiaendoscópica nem sempre consegue fornecer acesso absoluto à mucosa do seio maxilar, fato que suscita debates a respeito da sua extensão. A antrostomia mediante acesso de Caldwell-luc é realizada há mais de 120 anos, com anestesia geral ou local, e busca garantir maior visibilidade da área explorada. Sendo assim, o presente caso versa sobre paciente do sexo feminino, 40 anos, que comparece ao ambulatório de cirurgia e traumatologia bucomaxilofacial do Hospital do Oeste -Barreiras (BA) para avaliação. Referesinusite crônica há aproximadamente um ano, após tratamento endodôntico, com constante obstrução nasal em lado direito e sem melhora com uso de medicamentos. O tratamento proposto foi a antrostomia maxilar com acesso de Caldwell-luc, com anestesia geral, seguido da instalação de dreno rígido para irrigação direta em seio maxilar, através de abertura na parede lateral da cavidade nasal do lado acometido. A antrostomia mediante acesso cirúrgico de Caldwell-luc é um procedimento clássico na literatura, tendo permanecido como técnica cirúrgica hegemônica para tratamento de sinusites até o surgimento da cirurgia endoscópica funcional, que possibilitou uma técnica menos invasiva. No entanto, os avanços da cirurgia endoscópica esbarram na limitação da área acessada neste tipo de procedimento. Apesar das possíveis complicações relacionadas à técnica, a cirurgia de Caldwell-luc permanece como um método viável para tratamento de morbidades do seio maxilar.
... Compared to other surgical techniques such as intraoral and traditional Caldwell-Luc's (CL) approach, the total FESS to retrieve a foreign body is accompanied by minimal invasiveness and surgical trauma with shorter time to recovery for the patient and consequently lower complication rates [19]. Therefore, we highly recommend a total endoscopic surgical approach whenever possible, or a combined endoscopic and intraoral approach for the most complicated cases [20]. The traditional Caldwell-Luc technique for maxillary sinusitis presents several disadvantages, such as such as large bone removal, numbness of the teeth and flap dehiscence; for all these reasons it should limited to intractable cases and preferably a modified technique should be considered [21]. ...
Introduction
Differential diagnosis of unilateral sinus disease (USD) is important in clinical practice as it can be broad, and for which timely and effective treatment is important. With this report we would like to present a case of a patient with a foreign body retained in the left maxillary sinus for eight years.
Presentation of case
A 50-year-old gardener referred to have been injured on the job in 2010. Even though he was wearing his safety helmet with face shield and earmuffs, he had the sensation to have been hit by an object coming from the soil, while he was using his grass trimmer. However, the patient was asymptomatic with no complications. After eight years, the man started experiencing left nasal obstruction associated with purulent discharge and ipsilateral headache. A fetid odor coming from inside the nose and described as “the carcass of a dog” led him to seek medical attention. The patient underwent a functional endoscopic sinus surgery (FESS) with septoplasty and a foreign body, consisting of a metal nail, was retrieved.
Discussion
This case highlights a two key learning points. The first one concerns occupational safety measures; full-face shield helmets are the best option and should be employed in order to avoid the penetration of any possibly dangerous materials. Secondly, grass trimmers with more sophisticated designs are required in order to prevent injuries like this.
Conclusions
Besides being peculiar because of the onset of clinical symptoms, this case report highlights the importance of full-face shield helmets and certified machinery.
... Compared to other surgical techniques such as intraoral and traditional Caldwell-Luc's (CL) approach, the total FESS to retrieve a foreign body is accompanied by minimal invasiveness and surgical trauma with shorter time to recovery for the patient and consequently lower complication rates [19]. Therefore, we highly recommend a total endoscopic surgical approach whenever possible, or a combined endoscopic and intraoral approach for the most complicated cases [20]. The traditional Caldwell-Luc technique for maxillary sinusitis presents several disadvantages, such as such as large bone removal, numbness of the teeth and flap dehiscence; for all these reasons it should limited to intractable cases and preferably a modified technique should be considered [21]. ...
... Porém, mesmo assim, indica-se a remoção do dente no intuito de evitar complicações posteriores, como processos inflamatórios responsáveis por sinusites maxilares odontogênicas. No caso em questão, o paciente já estava em um quadro de sinusite maxilar devido à introdução do elemento dentário (28) para dentro do seio maxilar 20 dias após uma tentativa de extração (8,(10)(11)(12). ...
... Os elementos dentários podem se movimentar dentro da cavidade sinusal e que as tomadas radiográficas preferencialmente devem ser realizadas em momentos antes da cirurgia. No caso em questão, foi optada por realizar uma tomografia computadorizada, por permitia uma visão tridimensional da região a ser abordada (2,7,8,11,12). ...
Aim:
To describe the histological events that occur after maxillary sinus floor elevation when the elevated and undetached sinus mucosa are in close proximity or in contact with each other.
Materials and methods:
From 76 rabbits, 152 elevated maxillary sinuses were analyzed histologically. Sites without adhesions were classified as "No proximity," whereas the adhesion stages were divided into "Proximity," "Fusion," and "Synechia stages." The width of the pseudostratified columnar epithelium and the distance between the two layers of the elevated and undetached sinus mucosae were measured at various standardized positions.
Results:
Thirty-one sites presenting with adhesions were found. Twelve sites were in the proximity stage," presenting cilia of the two epithelial layers that were shortened and interlinked within the mucous context. Hyperactivity of the goblet cells was also observed. In the other cases, the hyperplastic epithelium showed attempts to reach the contralateral mucosa. The 15 "fusion stage" sites presented regions with epithelial cells of the two mucosal layers that penetrated each other. Four sites presented "synechiae stages," represented by bridges of connective tissue connecting the two lamina propria.
Conclusions:
Close proximity or tight contact between the elevated and undetached mucosa adhering to the bone walls might occur after maxillary sinus floor elevation. This induced hyperplasia of the epithelial cells and adhesion of the two layers until synechiae formation.
A 28-year-old male patient was referred from an otorhinolaryngologist for managing unilateral chronic maxillary sinusitis (MS). The patient had undergone two functional endoscopic sinus surgeries (FESS), although the MS was not resolved. Based on his dental history, endodontic treatment had been done on the symptomatic area. A leak of endodontic sealer and peri-apical lesion on tooth #14 was found on cone-beam computed tomographic examination. Extraction of tooth #14 and the modified Caldwell-Luc operation were performed to remove the endodontic sealer material and relevant inflammatory tissue. The sinus membrane lining was maintained as much as possible during the surgery. Implant placement was performed on the tooth extraction site. All clinical symptoms disappeared after the surgery. Radiographic and endoscopic examination revealed successful osseointegration of the implant and complete resolution of the MS. FESS alone may not be sufficient to treat MS derived from dental origin. For unilateral MS, dental history should be carefully checked.
