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Li Y, Xie Q, Li C, Yang Q, Zhang Z, Yang C, Xu G. Long-term investigation of minimally invasive alcohol-based therapy as the treatment of odontogenic keratocyst:A retrospective cohort study. J Craniomaxillofac Surg 2024; 52:324-333. [PMID: 38368215 DOI: 10.1016/j.jcms.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/05/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024] Open
Abstract
The aim of this study was to evaluate the clinical efficacy of alcohol-based therapy for patients with large odontogenic keratocysts (OKCs). The study was implemented as a retrospective, single-center study. Patients treated with ethanol-based therapy for odontogenic keratocyst were retrospectively evaluated for baseline and postoperative data. The pre- and postoperative clinical situation and the extent of radiographic shrinkage were compared. The event is defined as the achievement of >50% reduction in cyst volume. The cyst reduction rate calculated on panoramic radiographs ranged from 7.4% to 99.9% (mean [standard deviation] 55.3% [27.9%]) and was statistically significant (P < 0.05). Specifically, it has been found that, radiographically, 47.6% of patients achieved >50% reduction in cyst volume within 12 months. The continuous cortical bone was rebuilt, and the cyst cavity was filled with regenerated trabecular bone. The 22 included patients presented with nonclinical problems, had no need for further intervention, and exhibited persistent impaction of the teeth. The results of this study demonstrated that ethanol-based therapy triggered marked radiographic reductions of large OKC, indicating that using this technique is efficient.
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Affiliation(s)
- Yan Li
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Qianyang Xie
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Chenlin Li
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China; Shanghai Xuhui District Dental Center, Oral and Maxillofacial Surgery, 200011, PR China
| | - Qingran Yang
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Zhiyuan Zhang
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China.
| | - Chi Yang
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China.
| | - Guangzhou Xu
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China.
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Alamri M, Violante T, Schellati N, Hinchy NV, Aguirre A. Maxillary radiolucency in a 39-year-old man. J Am Dent Assoc 2023; 154:1112-1118. [PMID: 36526453 DOI: 10.1016/j.adaj.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 12/15/2022]
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Xu D, Han M, Cao R, Liu D, Zhang Q, Sun C. A Clinical Observation Study for Transnasal Endoscopic Marsupialization in the Treatment of Maxillary Cyst. J Craniofac Surg 2023; 34:2430-2432. [PMID: 37643077 DOI: 10.1097/scs.0000000000009707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 08/31/2023] Open
Abstract
The aim of this study was to investigate the feasibility and evaluate the clinical effects of transnasal marsupialization of maxillary cyst under nasal endoscope. Twenty patients with maxillary bone cysts were treated with endoscopic marsupialization. According to the location of the maxillary bone cyst, the opening window was selected in the nasal base or the inferior or middle nasal meatus. The cyst wall of the window was removed, and the fluid was drained out. The diameter of the opening window was more than 1 cm, so that the cyst and the maxillary sinus can be fused into a cavity. This ensured nasal drainage through the cyst cavity and nasal cavity or maxillary sinus. The patients were followed up for 6 to 18 months. No serious complications occurred. The cyst wall epithelialized 2 or 3 months after the operation, and the cyst cavity drained well with no recurrence. Intranasal marsupialization under a nasal endoscope is a feasible alternative for the treatment of maxillary cysts. It makes the procedure simple, safe, less traumatic, has definite clinical effects, and low recurrence rate. Especially suitable for maxillary cysts protruding into the nasal floor or maxillary sinus.
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Affiliation(s)
- Dapeng Xu
- Department of Oral and Maxillofacial Surgery
| | | | | | - Dianwei Liu
- Department of Oral and Maxillofacial Surgery
| | - Qingquan Zhang
- Department of Combined Oral and Nasal surgery, Yantai Stomatological Hospital Affiliated to Binzhou Medical College, Yantai, Shandong, P.R. China
| | - Chao Sun
- Department of Oral and Maxillofacial Surgery
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El-Anwar MW, Elnashar I, Hussein A, Nofal AA. Trans-antral Endoscopic Assisted Excision of Dentigerous and Radicular Maxillary Cyst; our Experience. J Maxillofac Oral Surg 2023; 22:470-475. [PMID: 37122784 PMCID: PMC10130242 DOI: 10.1007/s12663-022-01772-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 07/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background maxillary cysts of dental origin are not common diagnosis. There is still debate about their perfect treatment method. There are many approaches to manage the odontogenic maxillary cysts; either intraoral, sublabial, or transnasal endoscopic approach. In this study, we present our technique of trans-antral endoscopic assisted excision of maxillary cysts of dental origin with assessing feasibility, results, and complications. Results Thirty-two patients were reported; 14 dentigerous cysts (43.75%) and 18 dental (radicular) cysts (56.25%). Complete cyst removal could be achieved in all cases without jeopardizing the maxillary sinus drainage through its natural ostium to the nasal cavity. Postoperative pain and facial swelling were mild in all cases and resolved within few days. No tooth loss, Sino nasal symptoms, infection or recurrence was reported throughout follow-up period ranging from 2 to 6 years. Conclusion Trans-antral endoscopic assisted approach for excision of odontogenic maxillary cyst is a reliable, safe, and effective procedure without recurrence, or permanent negative sequels over the long-term follow-up. Supplementary Information The online version contains supplementary material available at 10.1007/s12663-022-01772-9.
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Affiliation(s)
- Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ismail Elnashar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Atef Hussein
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Abdelfattah Nofal
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Ragab AA, Abo El Naga HAR. Endoscopic-assisted approaches for enucleation of invaded sinonasal region by benign odontogenic cysts: a case series study. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00327-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
During surgical planning for the excision of odontogenic cysts and tumors, surgeons should consider choosing the appropriate endoscopic approach to reach all parts of the maxillary sinus and cyst walls during its enucleation. Using the endoscopic trans-nasal approaches results in less than one-third of the maxillary sinus being reached regardless of antrostomy or angled instruments used. Also, the expansion process and involvement of maxillary sinuses in odontogenic cysts and tumors are variable, adding more difficulties during excision. This study aimed to assess the expansion process of large benign odontogenic cysts and tumors involving nasoantral regions and adaptability to different endoscopic approaches for enucleation. Six patients were included in this case series study. Preoperative panoramic views plain film radiography, and computed tomography scans were obtained. Lesion characteristics, relation to teeth origin, the nose, and maxillary sinus wall displacement, location of lesions about typical vertical and horizontal nasomaxillary constructions, and associated inflammation of the paranasal sinuses were evaluated. Three surgical approaches were tailored, allowing viewing and endoscopic enucleation.
Results
Four periapical (radicular) cysts, one ameloblastoma, and one calcifying epithelial odontogenic tumor, ranging in size from 3 to 5 cm, were enucleated endoscopically in patients aged 15–40 years. Intra-sinus expansion of the cyst and lesion level above the nasal floor allowed endoscopic enucleation using wide middle meatal antrostomy in 1 (17%). Lesions localized to the anterior wall and the nasal process of the maxilla permitted endonasal minimal rhinotomy approach in 1 (17%). Central lesions, cyst extension below the level of the nasal floor, and lateral wall expansion with or without anterior maxillary wall scalloping had adequate exposure using a minimal sublabial approach in four patients (67%). Together with its role in complete enucleation, endoscopy allowed associated rhinosinusitis surgical treatment in five patients (83%).
Conclusion
Tailoring surgical approaches to the expansion process allowed endoscopic enucleation of large odontogenic cysts/tumors without wall remnants. The integrity of the Schneiderian membrane was preserved, protecting the critical surrounding structures.
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Raponi I, Giovannetti F, Buracchi M, Priore P, Battisti A, Scagnet M, Genitori L, Valentini V. Management of orbital and brain complications of sinusitis: A practical algorithm. J Craniomaxillofac Surg 2021; 49:1124-1129. [PMID: 34607756 DOI: 10.1016/j.jcms.2021.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/24/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022] Open
Abstract
The aim of this work was to present a practical management algorithm for orbital and brain complications of sinusitis. According to the inclusion criteria, a sample of 68 patients was collected between 2008 and 2018 (39 males and 29 females). Among them, 44 were adults, with a mean age of 50.46 years, and 24 were pediatric patients, with a mean age of 10.33 years. Oral or intravenous antibiotic therapy was administered to all patients. Pharmacological resolution was observed in 14 cases. Early surgical treatment within 48 hours was necessary in 10 cases. Surgery consisted of abscess drainage, associated or not with functional endoscopic sinus surgery. Delayed surgery within 15-30 days was performed in 44 patients. The core procedure was functional endoscopic sinus surgery. Subsidiary procedures were abscess drainage, tooth extraction or cranial base repair. The combination of two or more of these procedures was case selected. Median follow-up was of 46.36 months. Sinusitis complications necessitate rapid diagnosis and prompt treatment. Antibiotic therapy alone is enough for mistreated rhinosinusitis with no anatomical predisposing factor. Surgery is mandatory for altered nasal and paranasal sinus anatomy or odontogenic infections.
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Affiliation(s)
- Ingrid Raponi
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Lazio, Italy.
| | - Filippo Giovannetti
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Lazio, Italy; Department of Neurosurgery, Meyer Children's Hospital, Florence, Toscana, Italy
| | - Matteo Buracchi
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Lazio, Italy
| | - Paolo Priore
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Lazio, Italy.
| | - Andrea Battisti
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Lazio, Italy
| | - Mirko Scagnet
- Department of Neurosurgery, Meyer Children's Hospital, Florence, Toscana, Italy
| | - Lorenzo Genitori
- Department of Neurosurgery, Meyer Children's Hospital, Florence, Toscana, Italy
| | - Valentino Valentini
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Lazio, Italy
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Abstract
PURPOSE OF REVIEW The endoscopic medial maxillectomy (EMM) has remained a relevant procedure for certain sinus diseases and at the same time reemerged as a salvage technique or even as a primary procedure for other diseases. Several mucosal-sparing techniques have also been described and the outcome of the surgeries is available for review. RECENT FINDINGS Modifications of the EMM technique in the last two decades, aimed at mucosal preservation of the inferior turbinate, nasolacrimal duct, and medial maxillary wall have been successful in addressing a multitude of diseases. There are also evidences to support adjunct procedures/methods to improve access, healing, and to address associated dysfunction such as impaired mucociliary clearance. Tailored approaches have shown favourable outcomes with a low rate of adverse effects. SUMMARY The EMM is appropriate for selected indications, in particular lesions causing medial wall destruction or extensive tumour involving the anterior wall or the prelacrimal recess. As for other maxillary sinus diseases including those identified to a limited site, a modified EMM is a reasonable consideration. The choice is appropriate provided instrument access, visualization, the ability for complete resection, postoperative care, and the requirement for surveillance is not compromised. A tailored approach with or without adjunct procedures is recommended.
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