Search

The maxillary sinus is the paranasal sinus that impacts most on the work of the dentist as they will often be required to make a diagnosis in relation to orofacial pain that may be sinogenic in origin. Maxillary sinus disease is often coincidentally observed on radiographs, and dentists often have to make a diagnosis and plan treatment based on the interpretation of the image. This paper aims to guide the dental professional through some of the disease processes involving the paranasal sinuses and in particular the maxillary sinus. The outcome is to encourage comprehensive history taking and examination of the patient to facilitate an accurate diagnosis that will enable successful treatment.

The author describes 7 clinical cases of epilepsy with the presence of sinusitis and one case with chronic otitis. Sphenoiditis was noted in all cases. In tree cases, epileptic seizures disappeared after the sanation of sinuses and after the radical surgery intervention in one patient as well. To exclude respiratory origin of epilepsy, CT and MRT of paranasal sinuses in all cases of epilepsy are recommended.

Background: Although multiple clinical trials have demonstrated that balloon dilation of sinus ostia in patients diagnosed with chronic rhinosinusitis (CRS) results in sustained symptomatic improvement, less data are available to measure the effects of sinusitis on worker productivity. The objective of our research was to analyze work and activity impairment before and after transantral, endoscopically-guided balloon dilation of the maxillary sinus ostia and ethmoid infundibulum., Methods: Subjects diagnosed with CRS and computed tomography (CT) evidence of disease in the maxillary sinuses alone, or maxillary and anterior ethmoid sinuses, completed the Work Productivity and Activity Impairment (WPAI) questionnaire and the Work Limitation Questionnaire (WLQ) before treatment and at 3, 6, and 12 months postprocedure., Results: A total of 56 subjects were enrolled and 53 completed the 1-year follow-up. The lost productivity composite score computed from the WLQ improved by 73% (9.0 to 2.4; p < 0.0001) at 1-year follow-up whereas lost productivity at work as measured by the WPAI improved by approximately 76% (38.3 to 9.2; p < 0.0001) 12 months after treatment., Conclusion: These results indicate that sinus-related health problems impose a substantial burden on work productivity and physical/mental activity levels. Treatment of CRS by dilating the maxillary sinus ostium and ethmoid infundibulum can significantly improve quality of life (QOL) and work productivity., (Copyright © 2011 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.)

Purpose: The aim of this study was to investigate how clinical features such as sex, age, etiologic factors, and presenting symptoms of odontogenic sinusitis are differentiated from other types of sinusitis. Also, this study was designed to find methods for reducing the incidence of odontogenic sinusitis., Materials and Methods: A retrospective chart analysis was completed on twenty-seven patients with odontogenic sinusitis. They were all treated at Kangbuk Samsung Hospital between February 2006 and August 2008. The study protocol and informed consent forms were approved by the institutional review boards for human beings at Kangbuk Samsung Hospital., Results: Ten patients (37.0%) had dental implant related complications and 8 (29.6%) had dental extraction related complications. Unilateral purulent nasal discharge was the most common symptom (66.7%). The therapeutic modality included transnasal endoscopic sinus surgery in 19 (70.4%) patients, and a Caldwell-Luc operation in two (7.4%) patients., Conclusion: In our study, there was no significant difference in the incidence between genders. The average age of the patients was 42.9 years. The incidence was highest in the fourth decade. There were no significant differences between the symptoms of odontogenic sinusitis and that of other types of sinusitis. However, almost all of the patients with odontogenic sinusitis had unilateral symptoms. Iatrogenic causes, which include dental implants and dental extractions, were the most common etiologic factors related to the development of odontogenic sinusitis. Therefore, a preoperative consultation between a rhinologist and a dentist prior to the dental procedure should be able to reduce the incidence of odontogenic sinusitis.

Purpose: The purpose of this study was to evaluate the prognosis and treatment of infection of the maxillary sinus associated with dental implants., Methods: Oral and radiographic general clinical features of 2 patients who developed maxillary sinusitis after implant placement., Results: The symptoms of maxillary sinusitis were improved by curettage through the lateral wall of the maxillary sinus, antibiotics, and sinus irrigation after 2 weeks of the operation., Conclusion: It was concluded that acute maxillary sinusitis should be treated with a direct approach to the maxillary sinus via lateral wall opening, regular irrigation in hospital, and antibiotics.

A prospective, multicenter research study is under way to demonstrate long-term improvement in chronic rhinosinusitis symptoms after transantral balloon dilation of the ethmoid infundibulum. Trial results from an interim analysis of symptomatic status using the Sino-Nasal Outcome Test 20 survey demonstrate significant and sustained improvement through post-procedure 1-year follow-up. Additionally, these data provide evidence that the symptomatic improvements following balloon expansion within the ostiomeatal unit to treat medically refractory inflammation of the maxillary sinuses, either alone or with concomitant anterior ethmoid disease, are similar.

Objectives: We describe the clinical presentation and management of a patient with a remote history of orbital trauma who presented with spontaneous right enophthalmos and radiographic findings consistent with silent sinus syndrome over 30 years after her initial orbital injury., Methods: The patient chart and imaging results were reviewed. A literature review of silent sinus syndrome and traumatic enophthalmos was performed., Results: Our patient had both clinical and radiographic findings consistent with silent sinus syndrome. Only 2 other cases of silent sinus syndrome after orbital trauma have been reported in the literature. The underlying anatomic pathology common to all cases is obstruction of the ostiomeatal complex with subsequent maxillary sinus hypoventilation and sinus collapse. Our patient underwent single stage repair with endoscopic maxillary antrostomy and had resolution of the mucosal disease at 6-month follow-up., Conclusions: Posttraumatic cases of silent sinus syndrome are much less common than spontaneous cases but share similar pathophysiology and can be effectively treated using endoscopic techniques.

Background: The appropriate surgical approach to the severely diseased maxillary sinus is still debatable. Some advocate creating a wide maxillary antrostomy to allow for increased ventilation and improved delivery of postoperative medication. Others, however, recommend more aggressive surgery with complete clearance of all diseased tissue. The aim of this study was to evaluate the outcome of canine fossa puncture and canine fossa trephine (CFT) for the severely diseased maxillary sinus., Methods: A retrospective chart review was performed on 97 patients who underwent a CFT as a part of endoscopic sinus surgery or modified Lothrop procedure. Outcomes were measured in terms of the maxillary sinus endoscopy grade at last follow-up and need for revision surgery. Two groups were formed: those who experienced recurrence of disease and those who were disease free at last follow-up. A comparison was made between the two groups and differences were noted., Results: A CFT was performed in 97 patients with nasal polyposis (NP) who had an average number of 2.38 previous sinus surgeries. At an average follow-up of 27.8 months, 80 of the patients were disease free. In 17 patients disease recurred, and 11 of those required revision surgery with a CFT. Those patients who had recurrence of disease tended to be more allergic, have higher Lund-Mackay score, and had an increased number of prior sinus surgeries. In addition, allergic fungal sinusitis was associated with a poorer prognosis after CFT., Conclusion: CFT allows for complete clearance of all gross disease in the maxillary sinus. CFT decreases the chance of disease recurrence in patients with severe NP.

We report an unusual case of a displaced maxillary molar and associated dentigerous cyst within the maxillary sinus in an adolescent presenting as recurrent sinusitis. Although a rare cause of sinusitis in children, dentigerous cysts should be included in the differential diagnosis for causes of persistent or recurrent sinusitis in this age group. This report provides further evidence for obtaining imaging studies when managing pediatric sinusitis that does not respond to standard antibiotic therapy. We discuss management options for these lesions including the differential diagnoses and need for follow-up.

From October 2006 through September 2007, balloon sinusotomies were attempted on 89 sinuses in 45 patients with chronic sinus disease. Ninety-eight percent of sinuses were successfully dilated, 3.4% required revision surgery, and one complication (unlikely related to use of the balloon) occurred. Forty-four percent had previous conventional endoscopic sinus surgery (ESS), 87% were hybrid cases (combination of balloon and conventional ESS instruments used), 33% had nasal polyposis, and 1.98 sinuses per patient were dilated. Preoperative Lund-Mackay radiographic sinus-staging scores averaged 12.62. Sinus balloon dilators (SBDs) were used on the frontal sinuses 81% of the time, sphenoids 13%, and maxillary sinuses 6%. SBDs were found to be efficacious and safe. The devices were useful in identifying and dilating the frontal recess, especially in cases with altered anatomy or limited visibility. When compared to conventional ESS instrumentation, however, SBDs were found to offer little advantage in opening the maxillary or sphenoid sinuses. In frontal sinus hybrid cases, using the author's proposed surgical algorithm reduces operative time, costs and, in some cases, the need for balloon dilatation. SBDs have limited indications in a select group of patients.

Laser Doppler flowmetry (LDF) was used to study microcirculation in mucous membranes of the nasal cavity and maxillary sinuses of 60 patients with chronic purulent maxillary sinusitis . The treatment included local infrared therapy (IR therapy) and lavage of the maxillary sinuses with a colloid solution containing silver ions. Post-treatment analysis of LDF data showed impaired microcirculation and shunt indices, increased coefficients of variation and microcirculation efficiency at the affected side. These findings confirm high effectiveness and safety of IR therapy and lavage of the maxillary sinuses with a colloid solution containing silver ions for the treatment of patients with chronic purulent maxillary sinusitis. It is concluded that LDF can be used as an additional, objective and highly informative, non-invasive method for the diagnosis of chronic purulent maxillary sinusitis and evaluation of the outcome of its treatment. Persistent disturbance of microcirculation in the nasal cavity and maxillary sinuses of the patients with chronic purulent maxillary sinusitis observed in the present study may be a cause of chronic inflammatory process in the maxillary sinuses.

Maxillary sinusitis are common infections. A dental origin is found in about 10% of the cases. The roots of the posterior maxillary teeth are adjacent to the sinus floor. Extensions of dental infections are therefore possible to the sinus. An odontogenic source should be considered in patients with a history of dental pain or recent oral surgery and those with extended unilateral sinusitis or unilateral sinusitis resistant to conventional treatment. Maxillary sinusitis of dental origin are polymicrobial infections. Conventional radiographs and CT-scans are required for the diagnosis and proper management. Dental treatments to remove the underlying cause combined with oral antibiotics to treat the infection are required. Endoscopic or open surgery may be necessary to complete the treatment and restore adequate sinusal function.

Introduction: The problem of maxillofacial and neck tissue inflammatory diseases constantly draws attention of otolaryngologists and maxillofacial surgeons in assosiation with steady frequency of pathology. Despite a modern antibiotic therapy, there still exist cases in which an initial delay in diagnosis and treatment may result in a life-threatening situation., Material and Methods: We have analyzed a clinical picture of 219 patients aged from 5 up to 91 years. The patients have been distributed according to the spread of purulent process and the laboratory research data into the following groups., Results and Discussion: In inoculations from a wound during the primary surgical treatment in 67.6% of patients 1 microorganism has been revealed, in 7.9%--2 microorganisms, in 5%--3 and more microorganisms, in 19.4% of patients microorganisms have not been revealed. The most frequent cultures extracted from wound contents, were staphylococci and streptococci (61.2%). The presence of mixed (aerobic and anaerobic) microflora in the inflammation center has been marked recently. We have analyzed 64 MRI and X-CT at suspicion on diffusion of purulent process in deep neck cellular space. In 52 patients the process was localized within the limits of neck spaces and in 12 patients--the pyoinflammatory process extended on mediastinum though the clinical suspicion on mediastinitis was only in 10 patients., Conclusions: The treatment of maxillofacial and neck pyoinflammatory diseases and their complications remains a complex and difficult problem. Alongside with clinical methods of diagnosis of maxillofacial and neck pyoinflammatory diseases it is necessary to use accessory methods such as X-CT and MRI which clinical-diagnostic efficiency is very high. An antimicrobial therapy plays a significant role in the treatment of maxillofacial phlegmons. Antimicrobial regiments have been recommended and should cover the polymicrobial etiology.

Objective: The aim of this study was to further evaluate the safety and effectiveness of balloon catheter devices to dilate obstructed sinus ostia/perform sinusotomy., Methods: Through a prospective, multicenter evaluation, safety was assessed by rate of adverse events, patency was determined by endoscopic examination, and sinus symptoms were determined by the Sino-Nasal Outcome Test (SNOT 20)., Results: At the conclusion of the 24-week analysis, endoscopy determined that the sinusotomy was patent in 80.5% (247 of 307) sinuses and nonpatent in 1.6% (5 of 307), and could not determine ostial patency status in 17.9% (55 of 307). Of the ostia visualized on endoscopy, 98% were patent (247 of 252), while 2% (5 of 252) were considered nonpatent. SNOT 20 scores showed consistent symptomatic improvement over baseline. Revision treatment was required in 3 sinuses (3 of 307 sinuses, 0.98%) in 3 patients (3 of 109 patients, 2.75%)., Conclusion: Balloon catheter technology appears safe and effective in relieving ostial obstruction. Patients were pleased and indicated that they experienced symptomatic improvement.

Sinusitis is a very common acute or chronic illness that affects a significant percentage of individuals. Recently, therapeutic ultrasound was reported as a treatment for chronic sinusitis. The purpose of this study was twofold: 1) to evaluate the effectiveness of low-intensity pulsed ultrasound (US) in chronic sinusitis using a pretest-posttest research design and 2) to determine the level of association between the independent variables of initial presence of symptoms, age, gender, and duration of disease and the dependent variable of improvement of symptoms. Patients with chronic sinusitis were treated with low-intensity pulsed US, 3 days per week for 15 sessions. Fifty-seven patients (18 females and 39 males; mean age, 35 years) were included in the study. The results of the McNemar test showed a significant change in proportions of post nasal drip and nasal obstruction, two common leading symptoms of patients with chronic sinusitis (p < 0.001). Most of the major and minor symptoms showed significant changes after US therapy (p < 0.05). The total improvement of symptoms was 81.3%. The greatest improvement in symptoms was observed in nasal discharge (100%), followed by facial pain (95.4%) and postnasal drip (82.7%), three major factors in sinusitis. There was a significant, low association between the initial presence of symptoms and the improvement of symptoms after US therapy (chi(2) = 30.352; df = 12; p = 0.002; phi value = 0.356). A significant, low association was also noted between the age and the improvement of symptoms after intervention (chi(2) = 17.548; df = 6; p = 0.007; phi value = 0.270). It may be concluded that low-intensity pulsed US has a significant effect on chronic sinusitis and improves patient symptoms in our study group.

Objectives: This study was undertaken to evaluate the aerobic and anaerobic microbiology of acute maxillary sinusitis of odontogenic origin presenting with periodontal infection in children., Methods: Aspirates of 18 acutely infected maxillary sinuses that were associated with odontogenic infection in children who presented with periorbital cellulitis were processed for aerobic and anaerobic bacteria., Results: A total of 54 isolates were recovered (3.0 per specimen): 13 aerobic and facultative (0.7 per specimen) and 41 anaerobic (2.3 per specimen). The number of isolates per specimen varied from 1 to 4. Aerobic and facultative organisms alone were recovered in 2 specimens (11%), anaerobes only in 7 (39%), and mixed aerobic and anaerobic bacteria in 9 (50%). The predominant aerobic and facultative organisms were alpha-hemolytic streptococci (4), microaerophilic streptococci (3), and Streptococcus pyogenes and Staphylococcus aureus (2 each). The predominant anaerobic bacteria were anaerobic gram-negative bacilli (17), Peptostreptococcus spp (11), Fusobacterium spp (8), and Propionibacterium acnes (2). Twelve beta-lactamase-producing bacteria were recovered from 9 specimens (50%)., Conclusions: This study demonstrates the unique aerobic and anaerobic microbiological features of acute maxillary sinusitis of odontogenic origin presenting with periorbital cellulitis in children.

Mucormycosis is a rare acute fatal fungal infection. It is typically observed in diabetic or immunocompromised patients but not in systemically healthy individuals. Here, we describe an unusual mucormycosis case in an immunocompetent patient who had clinical signs of a maxillary sinusitis and associated osteomyelitis at the first examination. He was treated by surgery and removal of the necrotic bone and amphotericin B medication. At 1-year follow-up he shows complete recovery.

Odontogenic sinusitis is a well-recognized condition and accounts for approximately 10% to 12% of cases of maxillary sinusitis. An odontogenic source should be considered in individuals with symptoms of maxillary sinusitis with a history of odontogenic infection, dentoalveolar surgery, periodontal surgery, or in those resistant to conventional sinusitis therapy. Diagnosis usually requires a thorough dental and clinical evaluation including appropriate radiographs. The most common causes of odontogenic sinusitis include dental abscesses and periodontal disease that had perforated the Schneidarian membrane, irritation and secondary infection caused by intra-antral foreign bodies, and sinus perforations during tooth extraction. An odontogenic infection is a polymicrobial aerobic-anaerobic infection, with anaerobes outnumbering the aerobes. The most common isolates include anaerobic streptococci and gram-negative bacilli, and Enterobacteriaceae. Surgical and dental treatment of the odontogenic pathological conditions combined with medical therapy is indicated. When present, an odontogenic foreign body should be surgical removed. Surgical management of oroantral communication is indicated to reduce the likelihood of causing chronic sinus disease. The management of odontogenic sinusitis includes a 3- to 4-week course of antimicrobials effective against the oral flora pathogens.

Study Objectives: In maxillary nosocomial sinusitis (MNS) related to severe sepsis, nitric oxide (NO) concentration in the maxillary sinuses is drastically reduced secondarily to a downregulation of type-2 NO synthase. NO plays a major role in nonspecific immune defense of sinuses. We therefore aimed to study maxillary NO concentration during the treatment of MNS with drainage, daily lavage, and removal of any nasally introduced tube., Patients and Methods: Nine patients were studied during the first 4 days of treatment of MNS. We measured the concentration of NO gas in the maxillary sinus and in the nasal cavity, and the NO metabolite levels (nitrites/nitrates [NOx]) in the sinus lavages., Measurements and Results: Maxillary NO concentration (median [25 to 75 percentile]) increased from 70 parts per billion (ppb) [40 to 100 ppb] to 2,050 ppb (1,700 to 3,000 ppb) after 4 days of treatment of MNS (p < 0.0001). In the meantime, nasal NO increased from a median of 100 ppb (98 to 148 ppb) to 180 ppb (180 to 188 ppb) [p < 0.001]. At any time, there was a correlation between maxillary NO (logarithmic value) and nasal NO (r2 = 0.57, p < 0.0001). NOx levels remained stable in the lavages., Conclusions: We conclude that the treatment of the sinusitis with drainage, daily lavage, and removal of the gastric tube lead to a spectacular increase of maxillary and nasal NO concentrations.

Objectives: To assess the impact of canine fossa puncture (CFP) with clearance of the maxillary sinus during endoscopic sinus surgery on the subjective and objective outcomes as defined by quality of life questionnaires, endoscopic findings, endoscopic aspirate for culture and sensitivity, and magnetic resonance imaging (MRI) evaluation., Study Design: Retrospective, cross-sectional study., Methods: Twenty-five patients who had undergone canine fossa were compared to 12 patients who had undergone routine endoscopic middle meatal clearance of the maxillary sinus. At an average postoperative time point of 19.9 months, all patients were administered the chronic sinusitis survey (CSS) and a visual analogue scale (VAS). At this visit, patients underwent nasendoscopy, sampling of the ostial region for bacterial and fungal cultures, and MRI of the sinuses., Results: There were 42 sides for analysis from 25 patients on the study arm; the control arm comprised 12 patients with completely opacified maxillary sinuses and 17 sides for analysis. The CSS symptom subscore was better in the CFP group (Mann-Whitney test, P = .02). The overall VAS score was less in the CFP group (Mann-Whitney test, P = .01), indicating better symptom control. No opacification was evident in 61.9% of patients in the CFP group compared with 11.8% in the control arm (chi, P < .001)., Conclusion: CFP is a useful technique to address the severely diseased maxillary sinus and is associated with significantly better symptom control compared with the transnasal middle meatal antrostomy clearance of the maxillary sinus.

We present a case of Langerhans cell histiocytosis (LCH) diagnosed in the mastoid bone. The tumor recurred in the ureter and maxillary sinus mucosa two years later. The diagnosis of LCH was based on morphology and immunohistochemistry. Involvement of the ureter and the maxillary sinus in LCH is extremely rare. To the best of our knowledge, this is the first case of LCH affecting the mastoid bone in a 16-year-old boy and recurring later in the ureter and maxillary sinus mucosa.

To improve treatment of outpatients with maxillary inflammation (MI) it is recommended, in case of failure of previous standard conservative therapy, to drain the maxillary sinus for a long time. Catheter should be inserted into the maxillary sinus for maximum time but not longer than for 10-12 days. When inflammation is not corrected by the first course of therapy, the drainage is removed and the patients receive conditioning, mucolytic and immunostimulating therapy in combination with physiotherapy for 8-10 days with a following another course of drainage. In persistent maxillary sinusitis, it is possible to use long-term lavage of the maxillary sinus via catheter attached to the dispenser. Such an approach is effective in the majority of patients.

Introduction: Chronic sinusitis is recognized as having a strong inflammatory component, and failures of endoscopic sinus surgery (ESS) are frequently attributed to persistent inflammation. A test that would allow rhinologists to evaluate the inflammatory state of a patient's sinuses would be helpful to evaluate cases refractory to therapy, determine appropriate medical therapy, and monitor the response to therapy., Objectives: The goal of this preliminary research is to assess the optimal method of collection and the reproducibility and specificity of sinus lavages., Method: Twelve patients who had undergone ESS were recruited. They were divided into two groups according to the persistence of their symptoms and the recurrence of acute sinusitis after ESS. The subjects were seen twice. Three successive lavages were collected from each maxillary sinus and were analyzed by cell count., Results: Intrasession cell counts were most reproducible (Spearman rank correlation .7 for eosinophils and .6 for neutrophils) for the second lavage. Intersession cell counts were highly reproducible for eosinophils (r = .7) for the second lavage. The two-tailed t-test did not reveal any statistically significant differences between the good and the poor outcome groups., Conclusion: Assessment of eosinophil cell counts on sinus lavage is a feasible and reproducible method to evaluate the inflammatory state of a patient's sinuses in patients who have undergone ESS.

Although sinusitis is a common condition its pathogenesis is not clearly understood and there is lack of consensus concerning its treatment and prevention. Sinusitis is regarded as being primarily rhinogenous in origin, and oral/dental infections are considered to be predisposing factors. A review of the literature suggests that many cases of recurrent acute sinusitis are due to secondary rhinogenous bacterial colonization of antral mucosa that have been weakened and degenerated by chronic dental infection/inflammation. Unless the underlying dental condition, which may be asymptomatic or mildly symptomatic, is diagnosed and treated, the value of antibiotic treatment in such cases is questionable. In order to halt disease progression and avoid excessive antibiotic treatment, early intervention (both preventive and therapeutic) is necessary. Further research is required to establish the sequence of events by which infection of odontogenic origin initiates degenerative changes in the antral mucosa, culminating eventually in sinusitis.

Objectives: To study the views of patients and physicians on the management of suspected acute maxillary sinusitis and on suggested changes in practice., Design: Cross-sectional survey and focus group interviews of both patients and physicians., Setting: Primary care in Finland., Results: A total of 175 patients and 245 physicians replied to the survey (response rates 88% and 70%, respectively). Eight focus groups were conducted, four with patients (n = 22) and four with physicians (n = 20). Patients had less trust than physicians in the natural healing process of acute maxillary sinusitis: only 33% as opposed to 95% of physicians agreed that acute maxillary sinusitis might heal without medication. The patients emphasised the importance of careful diagnosis. Physicians experienced the diagnostic uncertainty and the demands from authorities to use fewer antibiotics as problematic., Conclusions: Most patients with suspected acute maxillary sinusitis primarily want the physician to aim at making a specific diagnosis. Physicians feel they are forced to prescribe too many antibiotics for sinusitis because of patient's expectations and lack of good diagnostic means for acute maxillary sinusitis. Better diagnostic tools, both national and local guidelines, and patient information might help to change practice towards the use of fewer antibiotics.

A case of non-invasive aspergillosis affecting the maxillary sinus is presented. Reference is made to its possible aetiology (spores introduced to the antrum at the time of a root canal overfilling with a zinc oxide paste). A review is presented and the management of the case is described.

The bacterial flora taken by sinus puncture from 115 patients with uni and bilateral acute exacerbation of chronic maxillary sinusitis was analyzed. Germ-free culture was obtained in 49 cases (40%) and in 69 cases (60%) bacteria were isolated from all sinus aspirates. Microbiological evaluation shows, that in majority of cases (90%) of acute exacerbation of chronic sinusitis there were pathogenic bacteria namely aerobic and anaerobic. The most frequent pathogens isolated from the aspirates were; Staphylococcus aureus, Haemophilus influenzae, Escherichia coli, Streptococcus pneumoniae, Staphylococcus hominis, Propionibacterium acnes i Candida albicans. The culture analysis proves that one or more pathogens can be the etiological factor. In the majority of cases (64%) the sinusitis is caused by monoculture.

We present a case of sinusitis and orbital cellulitis in a 9-year-old girl caused by the Gram-positive bacillus Arcanobacterium haemolyticum. In addition to antimicrobial chemotherapy, two surgical procedures were required to drain the ethmoid and maxillary sinus cavities and a subperiosteal abscess.

Because of the anatomical proximity, infection of posterior upper teeth can spread into the maxillary sinus. When confronted with a large persistent periapical lesion on a posterior maxillary root-treated tooth, the practitioner should question the quality of the previous endodontic treatment, evaluate the impact of the potential causes of failure and consider, in the majority of cases, the conservative non-surgical retreatment instead of extraction or periapical surgery of the dental element. This paper reports two cases of healing of extensive periapical bone destruction and of the co-existing sinus pathology of odontogenic origin after non-surgical endodontic retreatment of previously root-treated upper molars. Misconceptions concerning the role of epithelium in the periapical lesion are discussed. Also, emphasis is put on the need of precise radiological diagnosis, pre-operatively as well as post-operatively to ascertain healing and to avoid unnecessary delay in the appropriate management of these patients.

Halotherapy was applied for non-puncture treatment of 45 patients with acute purulent maxillary sinusitis. The response was evaluated by changes in clinico-immunological, cytological, x-ray and bacteriological parameters. Halotherapy was found effective in the treatment of acute purulent maxillary sinusitis without puncture.

Clinical laboratory characteristics of acute odontogenic maxillary sinusitis are presented. All the patients (n = 132) were examined in accordance with a special diagnostic protocol. Two variants of acute inflammatory process were distinguished: serous and destructive. Conservative and surgical methods of treatment are suggested, depending on the disease pattern and complications. The treatment efficiency is compared to the results of traditional treatment.

The author presents the results of application of intrasinus low-frequency ultrasound in the treatment of 61 patients with chronic purulent maxillary sinusitis. Compared to the control group of 10 patients given conventional treatment, ultrasound-treated patients responded better. Thus, intrasinus low-frequency ultrasound used in patients with chronic purulent maxillary sinusitis makes the treatment cheaper and faster. Simple and convenient in management, the above ultrasonic equipment can be applied both in hospitals and outpatient setting.

Immunodepressed subjects appear to present as a common adverse event the infections complication of paranasal sinuses which can lead to an unfavourable clinical evolution spreading the infection to encephalic and endo-orbital tissues. The patients described by the authors present a common clinical history of neoplastic disorders concerning the haemopoietic tissue with an indication for bone marrow transplantation. These patients also demonstrated clinical-radiological evidence of rhino-sinusal impairment with specific maxillary sinus involvement. The clinical condition obliged us to reach a final diagnosis of the origin of rhino-sinusal involvement which clearly appeared by performing imaging diagnostic examinations in order to rapidly establish the correct therapy. The resolution of the rhino-sinus complication allows these patients to follow on the treatment for their own initial pathology. In fact, in order to resume the treatment against haemoblastic disorders, an essential step is to approach the paranasal sinus affection. Endoscopy, in the cases reported, permitted us to obtain a correct diagnosis and to develop a correct antimicrobic therapy, achieving the drainage of the maxillary sinus as well. Endoscopy achieved the same results as radical surgery of the maxillary sinus by the Caldwell-Luc approach, proving less aggressive and reducing operative timing, postoperative recovery timing and intra and post operative haemorrhagic complications. Moreover, endoscopy characteristics present a specific validity in patients with severe general conditions, which are described in the examined group, reducing time for diagnosis and therapy resulting specific to solve the rhino-sinus complication and also particularly important in order to interfere less with the delicate medical therapy for the primary pathology by the sample examined.

tgAAVCF, an adeno-associated cystic fibrosis transmembrane conductance regulator (CFTR) viral vector/gene construct, was administered to 23 patients in a Phase II, double-blind, randomized, placebo-controlled clinical trial. For each patient, a dose of 100,000 replication units of tgAAVCF was administered to one maxillary sinus, while the contralateral maxillary sinus received a placebo treatment, thereby establishing an inpatient control. Neither the primary efficacy endpoint, defined as the rate of relapse of clinically defined, endoscopically diagnosed recurrent sinusitis, nor several secondary endpoints (sinus transepithelial potential difference [TEPD], histopathology, sinus fluid interleukin [IL]-8 measurements) achieved statistical significance when comparing treated to control sinuses within patients. One secondary endpoint, measurements of the anti-inflammatory cytokine IL-10 in sinus fluid, was significantly (p < 0.03) increased in the tgAAVCF-treated sinus relative to the placebo-treated sinus at day 90 after vector instillation. The tgAAVCF administration was well tolerated, without adverse respiratory events, and there was no evidence of enhanced inflammation in sinus histopathology or alterations in serum-neutralizing antibody titer to adeno-associated virus (AAV) capsid protein after vector administration. In summary, this Phase II trial confirms the safety of tgAAVCF but provides little support of its efficacy in the within-patient controlled sinus study. Various potentially confounding factors are discussed.

Fifteen patients with odontogenic maxillary sinusitis examined using computed tomography (CT) and single photon emission computed tomography bone scintigraphy (bone SPECT) were reviewed. The changes in bone activity associated with causative maxillary alveolitis, evaluated by bone SPECT, before and after conservative therapy were correlated with the pathologic changes in the maxillary sinus mucosa and ostium demonstrated on CT images following conservative therapy. This combination of imaging methods is valuable for predicting the prognosis and selecting appropriate treatments for the disease.

As a new nonsurgical treatment for odontogenic maxillary sinusitis (OMS), irrigation of the maxillary sinus through the root canal of the causal tooth was carried out to the patient with OMS that had proved refractory to conservative treatments (i.e., root-canal treatment of the causal tooth and antibiotic therapy). Clinical signs, symptoms, and radiographs before and after the new treatment revealed evidence of good healing. The clinical signs and symptoms, such as oppressive pain in the cheek and retrorhinorrhoea, entirely disappeared immediately after the irrigation (which was done only once) without pain, and the obstructed ostiomeatal unit was aerated on the follow-up CT images. There was no side effect associated with saline irrigation, nor any recurrence of symptoms since the irrigation. We therefore propose the irrigation through the root canal of the causal tooth as a new treatment for periapical disease-induced maxillary sinusitis, a technique that should ensure proper ventilation and drainage by relieving obstruction of the ostiomeatal unit.

Introduction: The causes of spontaneous enophthalmos, without trauma, surgical factors, or systemic illness, which can be found are rare. A particular entity called silent sinus syndrome in the Anglo-Saxon literature, which concerns the long-term effect of hypoventilation of the maxillary sinus responsible for an attraction of the sinus walls, resulting in sagging of the orbital floor, itself responsible for the enophthalmos., Case Report: We report the case about a 29-year-old woman, presenting a left-side spontaneous enophthalmos, with sinus-type pains for 2 months. The clinical examination revealed a horizontal diplopia when looking leftwards. Computed tomography showed a maxillary homolateral sinusitis with characteristic attraction of the sinus walls. The draining of the sinus collection by inferior endoscopic enlargement of the maxillary ostium led to pain resolution. The enophthalmos and diplopia were stabilized., Conclusion: After eradicating the orbital causes of enophthalmos, the sinus causes were sought more precisely, the pauci-symptomatic causes such as the silent sinus syndrome. The recognition of this syndrome stopped the progression of enophthalmos by making the maxillary sinus permeable again. A surgical reconstruction of the orbital floor can be proposed in order to correct the motility of the eyes and esthetic considerations.

18 patients with chronic recurrent inflammation and traumatic defects of the paranasal sinuses have undergone obliteration of the sinuses with biocompositional materials (hydroxyapatite and colapol) and plastic reconstruction of the bone defects with metal ceramics. Control of the repair processes with emission computed tomography registered accumulation of radiopharmaceuticals (RP) in the obliteration zone a week after the operation. Four-six weeks later RP homogeneously filled the obliteration zone. Six-twelve months after the obliteration, metabolism in the implant is close to that in the intact tissue. It is concluded that emission computed tomography can follow up metabolic changes in the implant and assess efficiency of the operation.

Mucormycosis of the nose and paranasal sinuses is a rare invasive fungal infection, which often has a very fulminant course and characteristic clinical findings. The patients are usually immunocompromised, with diabetic ketoacidosis being the commonest underlying disorder. In some immunocompetent patients, the disease is associated with local predisposing factors, such as chronic sinusitis. Although the prognosis has improved in recent decades, the disease can still be fatal. The underlying disease is an important determinant of prognosis and correction of the metabolic disorder, if present, is essential. Herein we report two cases: one of our patients was immunocompetent but had earlier suffered from polypous rhinosinusitis whereas the other had mild adult-type diabetes. Both patients were successfully treated with surgical debridement and amphotericin B.

Oro-maxillary sinus perforation occurs occasionally at the extraction of a maxillary tooth, and it may be a cause of maxillary sinusitis or antro-oral fistula. Our purpose was to investigate the most frequent site of perforation, and to understand the clinical course of patients after perforation. We examined 2,038 maxillary teeth extracted from 1,337 patients (473 males and 864 females) at the First Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University, from January 1991 to December 1993. Perforation occurred in 77 of all 2,038 teeth (3.8%). Of these, 38 teeth were from males (38/733; 5.2%), and 39 were from females (39/1,305; 3.0%). The perforation rate was significantly higher in males. Perforation occurred most often with extraction of an upper first molar, and in the third decade of life. The perforation rate gradually decreased with higher age. We classified 38 cases into 3 categories according to panorama X-P: 1) The tip of the root crossed over the bottom line of the maxillary sinus (29 cases), 2) Not crossed over distinctly (4 cases), 3) Just lie on, or whether the tip of the root crossed over the bottom line of the maxillary sinus was not distinct (5 cases). As to treatment, 30 perforations (39.0%) closed spontaneously in the course of observation, irrigation with physiological saline was used in 43 cases (55.8%), radical sinusotomy accompanied by closure of the perforation was performed in 4 cases, and only flap closure was used in 7 cases. There were no cases of relapse.

Background: Acute and invasive fungal sinusitis represent rare diseases which can lead to life threatening complications. Immunosuppressed patients are affected primarily. The expansion of transplantation medicine and the progress in therapy of malignant diseases of the lymphatic system are associated with an increase of opportunistic systemic mycoses. Therefore the otorhinolaryngologist is confronted increasingly with these problems and questions for surgery, especially if the symptom of a periorbital inflammation occurs as a sign for a beginning orbital complication and radiological signs of involvement of the paranasal sinuses exist., Patients: We report exemplary about two immunosuppressed patients with an invasive and fulminant fungal aspergillosis of the paranasal sinuses. In spite of systemic antifungal therapy and surgical intervention, intracranial and systemic complications caused a lethal course., Conclusions: In immunosuppressed patients with clinical and radiological signs for a sinusitis and a periorbital inflammation an invasive fungal sinusitis should be considered. Pathogenic aspergillus species are the most common identified in fungal sinusitis. The disease with often lethal outcome requires a careful and fast diagnostic and therapy as well as interdisciplinary co-operation. If and when limited or extensive surgery should be performed remains, because of the rarity and the lacking experience with this disease, still a controversially discussed issue and depends on several factors: the kind of disease, the immunity, the subtype of invasive fungal sinusitis and the degree of tissue invasion.