Exostoses of the paranasal sinuses

Which types of bony changes in the maxillary sinus indicate chronic sinusitis?

OBJECTIVES

To determine which types of bone lesion (spicules, lobules, porous bone) in the maxillary sinus indicate sinusitis METHODS: Subadjacent dental disease is a cause of maxillary sinusitis; if a lesion type indicates sinusitis it should be more common above diseased posterior maxillary teeth than a lesion type that is not indicative of sinusitis. The study sample is a British Mediaeval human skeletal collection.

RESULTS

Porous bone lesions (chiefly new bone deposits) in maxillary sinuses are associated with subadjacent dental disease; spicules/lobules of bone in the sinus are not.

CONCLUSIONS

The results support the idea that porous lesions indicate sinusitis but the spicules/lobules may not. Spicules, lobules and porous lesions within the maxillary sinus should be analysed separately in biocultural studies; it would be prudent to regard only the porous lesions as indicative of sinusitis.

SIGNIFICANCE

Maxillary sinusitis is commonly used as a health indicator in palaeopathology, and spicular deposits are generally the most common type of alterations. By assuming that they are indicative of sinusitis we may have been greatly overestimating the prevalence of bony sinusitis in the past.

LIMITATIONS

These conclusions are provisional. Further work on larger, more diverse samples, together with more detailed anatomical studies on lesion location and structure is ongoing.

The prevalence of antral exostoses in the maxillary sinuses, evaluated by cone-beam computed tomography

Background/purpose

Exostoses are outgrowths of normal compact and cancellous bone and may occur in different locations of the jaw. Exostoses are a rare anatomic variation in the maxillary sinuses. The purpose of this study was to investigate retrospectively the prevalence of location, size, shape, and symmetry of exostoses in the maxillary sinus, and to assess the relationship between demographic variables (i.e., age and sex) via cone-beam computed tomography images.

Materials and methods

Cone-beam computed tomography images of 1000 patients [521 (52.1%) females and 479 (47.9%) males], aged 10–85 years (mean age, 44 years), were examined. Two investigators examined the exostoses for location (i.e., inferior wall, medial wall, lateral wall, or posterior wall of the maxillary sinuses), size, shape (i.e., broad-based or mushroom-like), and symmetry (i.e., unilateral or bilateral). The age of the patients was categorized into three groups: 10–30 years, 31–50 years, and 51+ years. The data were statistically analyzed by using chi-square test, Fisher's exact test, and the t test.

Results

In total, 52 exostoses from 48 patients (4.8%) were identified. Exostoses were more common in females (n = 28, 58.3%) than in males (n = 20, 41.7%); however, there was no statistically significant difference between the sexes (P > 0.05). The presence of exostoses was very similar for all age groups with no statistically significant differences (P > 0.05).

Conclusion

Most exostoses were unilateral and on the inferior wall of the maxillary sinus. No statistically significant difference existed between the frequency and location of exostoses for sex or age groups (P > 0.05).

Comprehensive review on endonasal endoscopic sinus surgery

Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.

Idiopathic bilateral antral exostoses: A rare case in maxillary sinus

INTRODUCTION

Exostoses in paranasal sinuses have been reported in the otolaryngology literature, but they have not been described in the dental literature to our knowledge. The aim of this article is to describe an idiopathic and rare case of bilateral exostosis obtained by cone-beam computed tomography.

PRESENTATION OF CASE

The case shows a healthy and asymptomatic patient with a different size and form of exostoses in both maxillary sinuses.

DISCUSSION

It is difficult to clinically diagnose the antral exostosis due the asymptomatic nature of this condition, unless the approach would be through endoscope. Sometimes this condition is related with nasal irrigants, however in this case the patient asserted not having used nasal irrigation ever; thus, it is impossible to relate this kind of treatment as a principal cause.

CONCLUSION

The published data of exostoses in maxillary sinus seem to be limited in the dental literature, and this condition is important to consider in an implant treatment planning. Also, it is important to perform a follow-up of the cases in trying to find the possible causes of exostosis.

Irrigation nose: CT findings of paranasal sinus exostoses

We report the case of a 57-year-old male who presented with recurrent sinus infections and frequent nasal irrigation. He was found at nasal endoscopy to have multiple outgrowths along his ethmoid and maxillary sinuses. Computed tomography (CT) showed multiple bony exostoses along these sinuses. We report the imaging findings of exostoses associated with sinonasal irrigation.

Paranasal sinus exostoses: possible correlation with cold temperature nasal irrigation after endoscopic sinus surgery

Exostoses of the external auditory canal (EEAC) are a commonly encountered clinical exam finding; however, exostoses in other locations are vanishingly rare. The postoperative paranasal sinuses are penetrated with cold water solutions, the reputed etiological agent for EEAC, and development of exostoses in this unexpected location may be observed endoscopically. The surprising appearance of these protuberant lesions within the sinuses could be mistaken for more ominous processes, subjecting the patient to biopsy, surgery, or unnecessary medical therapy. The radiologic appearance of exostoses within the paranasal sinuses is herein reported for the first time, and care is taken to distinguish these bony lesions from the osteoneogenesis of chronic inflammation.

Paranasal sinus exostoses: an unusual complication of topical drug delivery using cold nasal irrigations

OBJECTIVES/HYPOTHESIS

The use of topical drug delivery through nasal irrigations can minimize systemic side effects and deliver higher concentrations of drugs directly to diseased sinus mucosa. Complications related to this popular method of treatment are not well described. We present our experience with paranasal sinus exostosis (PSE), a new diagnostic entity that appears to be a complication of cold nasal irrigations.

STUDY DESIGN

Retrospective chart review.

METHODS

Retrospective chart reviews were performed on patients within the Cleveland Clinic Foundation from 2005 to 2011. Six patients were identified with sinus exostoses. A literature review for "sinonasal exostoses" and "paranasal sinus exostoses" was performed using PubMed.

RESULTS

Six patients with PSE were identified at the Cleveland Clinic Foundation between 2005 and 2011. All patients had undergone sinus surgery, and none had documented evidence of PSE prior to surgery. There was no evidence of worsening PSE once the cold irrigations were stopped. No patients showed any resolution of PSE over time. None of our patients has progressed to have disease burden significant enough to require intervention.

CONCLUSIONS

PSE is a rare condition that mirrors a well-described otologic process; exostoses of the external auditory canal. PSE appears to be a complication of cold nasal irrigations. It does not resolve with the halting of cold irrigations, but does not appear to progress further after intervention. PSE only affects postoperative patients. With the evolving trend to treat postoperative sinus disease topically, the clinician should be aware of the dangers of cold irrigations, and patients should be counseled accordingly.