Unique canal communicating between both maxillary sinuses through the palatine recess with hypertrophy of sinuses

The result of an inappropriate growth of the jaws is in many cases related to abnormalities in the rest of the facial skeleton. We present a 21-year-old patient with a possibly unique anomaly of the maxillary sinus in skeletal class III dentofacial deformity. This anatomical variant has not to our knowledge been previously reported and all clinicians should be aware of it. It presented not only as hypertrophy of the sinuses but also as a communication between the two maxillary sinuses, and might be associated with a severe III class deformity with an extremely narrow maxilla. We describe this as a narrowed maxillary canal with no septum or membrane.     

Cyanoacrylate adhesive for closing sinus membrane perforations during sinus lifts

INTRODUCTION: Sinus lift procedures depend greatly on fragile structures and anatomical variations. The procedure may cause sinus membrane perforations, which can lead to graft infection and early failure. AIM: To assess the efficacy of cyanoacrylate adhesive in the management of large perforations of the maxillary sinus membrane during sinus lifts. MATERIAL AND METHODS: Six rabbits were used in the study. Sinus membrane perforations (about 1.5 cm in length) were repaired with cyanoacrylate adhesive on one side of the maxillary sinus. On the contralateral side, an identical laceration was not repaired. Histological evaluation was performed 2 weeks after the operation. RESULTS: Wounds repaired with cyanoacrylate adhesive showed newly formed continuous epithelium across the previous perforation site and there was sinusitis on the contralateral side. CONCLUSION: These results support the clinical use of cyanoacrylate adhesive for repairing sinus membrane perforations.     

新型剥离器与伞形剥离器行羊上颌窦黏膜剥离对比实验

目的通过羊经牙槽突上颌窦底提升法,对比0.012型号、0.014型号镍钛双级上颌窦黏膜剥离器以及伞形剥离器剥离窦底黏膜的效果。方法选择年龄1.5~2岁山羊24只,配伍组设计随机分成0.012型号组（A组）、0.014型号组（B组）、伞形剥离器组（C组）,每组8只。建立动物模型,在上颌窦内提升冲顶后,3组分别向窦底的近中和远中剥离上颌窦黏膜至本器械的最大剥离限度或窦底黏膜穿孔时,测量剥离长度。结果A组平均剥离长度为12.41 mm±4.35 mm,2例出现上颌窦黏膜穿孔。B组平均剥离长度为23.38 mm±4.84 mm,1例出现上颌窦黏膜穿孔。C组平均剥离窦底黏膜长度是2.61 mm±0.30 mm。经方差分析计算得3组剥离上颌窦黏膜总体均值不全相同（P<0.01）。各组再行SNK法比较后得出,A、B、C组剥离窦底黏膜长度的均数差异均有统计学意义（P<0.05）。结论镍钛双级上颌窦黏膜剥离器在行上颌窦黏膜剥离能获得较大的黏膜剥离范围。0.014型号弹性及刃适中、安全,能够大面积剥离窦底黏膜。     

Anatomical aspects of sinus floor elevations

Inadequate bone height in the lateral part of the maxilla forms a contra-indication for implant surgery. This condition can be treated with an internal augmentation of the maxillary sinus floor. This sinus floor elevation, formerly called sinus lifting, consists of a surgical procedure in which a top hinge door in the lateral maxillary sinus wall is prepared and internally rotated to a horizontal position. The new elevated sinus floor, together with the inner maxillary mucosa, will create a space that can be filled with graft material. Sinus lift procedures depend greatly on fragile structures and anatomical variations. The variety of anatomical modalities in shape of the inner aspect of the maxillary sinus defines the surgical approach. Conditions such as sinus floor convolutions, sinus septum, transient mucosa swelling and narrow sinus may form a (usually relative) contra-indication for sinus floor elevation. Absolute contra-indications are maxillary sinus diseases (tumors) and destructive former sinus surgery (like the Caldwell-Luc operation). The lateral sinus wall is usually a thin bone plate, which is easily penetrated with rotating or sharp instruments. The fragile Schneiderian membrane plays an important role for the containment of the bonegraft. The surgical procedure of preparing the trap door and luxating it, together with the preparation of the sinus mucosa, may cause a mucosa tear. Usually, when these perforations are not too large, they will fold together when turning the trap door inward and upward, or they can be glued with a fibrin sealant, or they can be covered with a resorbable membrane. If the perforation is too large, a cortico-spongious block graft can be considered. However, in most cases the sinus floor elevation will be deleted. Perforations may also occur due to irregularities in the sinus floor or even due to immediate contact of sinus mucosa with oral mucosa. Obstruction of the antro-nasal foramen is, due to its high location, not a likely complication, nor is the occurrence of severe haemorrhages since the trap door is in the periphery of the supplying vessels. Apart from these two aspects, a number of anatomical considerations are described in connection with sinus floor elevation.     

122例外侧壁开窗式上颌窦底提升术相关并发症的研究

目的 研究并讨论外侧壁开窗式上颌窦底提升术相关的并发症以及建议的治疗方法。方法 122例上后牙缺失并且骨量不足的患者于2010年8月1日至2013年7月15日接受了外侧壁开窗式上颌窦底提升手术,均已完成上部修复。测量记录术前剩余牙槽骨高度。记录所有术中或术后并发症,比如过量出血、上颌窦底黏膜穿孔、感染、创口裂开、急性上颌窦炎、移植骨吸收,以及统计种植体存留率。结果 术中8例发生窦底黏膜穿孔,术后3例当晚少量鼻出血,术后1～2周3例伤口裂开,术后2周1例急性上颌窦炎伴化脓性感染;术后6个月内,有6例患者的移植骨出现部分吸收,6颗种植体发生松动或自行脱落。结论 外侧壁开窗式上颌窦底提升术相关的并发症有黏膜穿孔、感染、创口裂开、移植骨吸收以及种植体松动、脱落,可通过术前周密检查、术中控制手术操作、修补穿孔黏膜、术后适当加大抗生素剂量、缝合裂开创口并配合使用漱口水及系统性抗生素治疗等方法预防及治疗相关并发症。     

Repair of a perforated sinus membrane with an autogenous periosteal graft: a study in 24 patients

We describe a technique for repairing a perforation of the sinus membrane with a periosteal graft. Of 117 patients who had augmentation of the sinus floor, the sinus membrane perforated in 24, and these were repaired with autogenous periosteal grafts. Patients were followed up daily for the first 10 days and monthly for the next six months, and clinical and radiographic variables were recorded. Patients had to be free of complications such as wound dehiscence, sinus infections, exposure of the graft, local inflammation, or pain. The radiographs showed correct osseointegration of all implants. Periosteal grafts are an effective alternative for repair of a perforation of the sinus membrane.     

How to avoid intraoperative and postoperative complications in maxillary sinus elevation

Maxillary sinus floor elevation, via the lateral approach, is one of the most predictable bone augmentation procedures performed in implant dentistry. but both intra‑ and postoperative complications can occur, and some of them are severe. Our aim is as follows:

1. To review the pertinent literature on the topic, especially assessing the risk factors related to complications.
2. To give clinical recommendations to minimize intra‑ and postoperative complications with the ultimate scope of improving the standard of clinical care and patient safety.

     

上颌窦内壁分隔的研究进展

上颌窦内壁分隔是上颌窦内壁的皮质骨突起,把窦腔分成2个或多个窦腔.该分隔可能源于牙齿的生长发育阶段,称为原发性分隔;也可能是牙齿缺失后上颌窦气化导致上颌窦内壁形态的改变所致,称为继发性分隔.不同学者运用了不同的观察方法进行测量,发现大约9.5％到50％的上颌窦窦腔内壁存在分隔,该分隔可以存在于上颌窦内壁的任何位置.上颌窦内壁分隔对种植上颌窦底提升术有重要意义,与上颌窦炎症的手术方式选择也紧密相关,还是上颌窦炎症临床误诊的重要原因,所以医师应充分考虑到这一解剖结构的影响,对其深入地了解有助于在临床工作中更好地解决上颌窦的相关问题.     

Risk factors and clinical outcomes of sinus membrane perforation during lateral window sinus lifting: analysis of 120 patients

The aim of this study was to identify the risk factors associated with sinus membrane perforation and the effect of sinus membrane perforation and other risk factors on graft success and postoperative sinusitis. Sinus membrane perforation, graft failure, and postoperative sinusitis were tested for an association with age, sex, operator experience, side of the operation, residual bone height, presence of septa, presence of a mucous retention cyst, and smoking (χ² test). Logistic regression analysis was used to model the odds ratio (OR) with corresponding risk factors. One hundred and twenty patients were included in this study. A total of 22 (18.3%) perforations occurred. A residual bone height of 3–6 mm (OR 6.808, P = 0.002) and presence of septa (OR 4.023, P = 0.025) were identified as significant risk factors. Twenty-eight (23.3%) sinus grafts were classified as failed. Membrane perforation (OR 16.819, P < 0.005) and residual bone height of 3–6 mm (OR 5.363, P = 0.01) were identified as significant risk factors for graft failure. None of the risk factors investigated in this study was significantly associated with postoperative sinusitis. These results suggest that the presence of septa and a residual bone height of 3–6 mm are associated with an increased risk of sinus membrane perforation, and that sinus membrane perforation has a negative effect on graft success.     

Effect of anatomical parameters of maxillary sinus on the outcomes of transcrestal sinus lift

目的 评价上颌窦解剖因素（上颌窦宽度、上颌窦角度、剩余骨高度）对经牙槽嵴顶上颌窦底提升术骨移植材料稳定性的影响。方法 纳入42例行经牙槽嵴顶上颌窦底提升术并同期种植的患者,共计60个上颌窦底提升位点,骨移植材料采用自体骨与小牛骨混合物。术前、术后当天及术后6个月采用锥形束CT（CBCT）进行指标参数的测量,采用Pearson相关分析评价上颌窦宽度、上颌窦角度、剩余骨高度3种解剖因素与术后6个月种植体根端骨吸收量之间的相关性。结果 窦底剩余骨高度为（4.46±1.55）mm,上颌窦宽度为（13.86±2.71） mm,上颌窦角度为78.09°±10.27°。相关分析结果显示,上颌窦宽度与根端骨吸收量之间存在显著的正相关关系（P<0.01）,上颌窦角度与根端骨吸收量之间存在显著的正相关关系（P<0.01）。剩余骨高度与根端骨吸收量之间无相关关系（P>0.05）。结论 上颌窦宽度、上颌窦角度与根端骨吸收量之间存在正相关关系。     

Evaluation of the posterior superior alveolar artery location and diameter with a newly defined stable plane

The aim of this study was to analyse the vertical location of the posterior superior alveolar artery (PSAA) using a reliable new reference plane regardless of tooth and alveolar bone, and to measure the diameter in each posterior tooth region, which is of relevance to lateral sinus floor elevation surgery. A total of 270 sinuses in 139 patients were examined in this study. The A-plane was defined by A-point and the bilateral jugal points on reconstructed three-dimensional images. The distance from the PSAA to the defined plane was measured in four regions: first premolar (P1), second premolar (P2), first molar (M1), and second molar (M2). The average distance of the PSAA above the plane in the P1, P2, M1, and M2 regions was determined to be 10.24 mm, 7.35 mm, 5.47 mm, and 7.23 mm, respectively. The PSAA was found to run above the plane in 97.4% of sinuses, below the plane in 1.1%, and on the plane in 1.5%. In conclusion, the new plane is useful for intraoperative location of the PSAA. According to the study findings, the area below the reference plane can be considered safe for lateral approach sinus surgery in terms of preserving the integrity of the PSAA.     

右上颌窦囊肿误诊为根尖周脓肿1例

上颌窦囊肿为上颌窦常见疾病,虽然生长缓慢,但发展到一定程度后也会出现临床症状。现报道右上颌窦囊肿被误诊为根尖周脓肿1例,并分析其X线片表现和诊断要点。     

Wire loop sinus membrane elevator: a novel instrument for lateral window sinus lift

This technical note introduces a novel instrument to facilitate lateral window sinus membrane elevation. The fabrication and use of the instrument are reported. The features of this instrument include easy control, good tactile sensation, flexibility in adjusting the instrument, and simple to replicate. Since its introduction, it has been the preferred instrument of our implant surgical trainees. Most importantly, it has proved to be an invaluable teaching tool, as it has helped not only to boost trainee confidence in the procedure, but also in their use of other sinus elevation instruments.