A Clinical Observation Study for Transnasal Endoscopic Marsupialization in the Treatment of Maxillary Cyst

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.

Real-Life Experience in the Management of Sinonasal Complications of Dental Disease or Treatments

Diagnosis and management of sinonasal complications of dental diseases or treatment (SCDDT) may be challenging. We aimed to report our real-life experience in patients treated with endoscopic endonasal approach describing data about symptoms, etiology, extension of the disease and success rate. We evaluated retrospectively data about 262 patients diagnosed as SCDDT and managed from August 2015 to May 2022. In 44.65% cases, maxillary sinus complications were determined by a dental disorder; the remaining 55.34% of cases were iatrogenic. Patients were managed according to our multidisciplinary protocol including ENT, dental, and radiological evaluation. Treatments were planned with a personalized approach, based on the patient’s clinical characteristics; all patients were treated with an endonasal endoscopic mini-invasive conservative approach. Combined dental treatment was performed simultaneously in 152/262 (58%) of patients; in the remaining cases, it was postponed after surgery. The overall treatment success rate (symptom resolution and endoscopically observed maxillary sinus healing) was 96.5%. At 15 days after surgery, we observed a significant improvement in the quality of life. The mean post-operative Sinonasal outcome test-22 (SNOT-22) score was significantly lower compared to baseline (6 versus 43.4; p < 0.05). Our study showed that endoscopic sinus surgery can be a successful procedure for treatment of SCDDT, leading to fast resolution of sinonasal symptoms and improving the quality of life. Furthermore, the technique allows removal of migrated dental material or dental implants even in challenging cases.

A Rare Presentation of Dentigerous Cyst

Dentigerous cysts are benign, slow-growing odontogenic cysts that are considered to be developmental in origin. They are twice as common in men than in women, and most often occur in people between the ages of 20 and 40 years. They are rarely found in young children. They almost exclusively occur in permanent dentition and over 70% of total number of cases are located in the mandible. Dentigerous cysts most commonly involve the mandibular third molar and are infrequent in maxillary canines. They can grow to a considerable size causing painless expansion of the jaw leading to its deformity.

We report a rare and challenging case of ectopically erupted massive dentigerous cyst of maxillary canine in the anterolateral wall of left maxilla leading to facial deformity and shed a light on its surgical management by the endonasal endoscopic approach in a female pediatric patient.

Odontogenic Maxillary Sinusitis: The Interface and Collaboration between Rhinologists and Dentists

Odontogenic maxillary sinusitis (OMS) is an inflammatory condition affecting the paranasal sinuses and is commonly encountered by both Otorhinolaryngologists and Dentists. However, there is an ongoing debate regarding the best sequence of management. Clinicians are faced with the dilemma of first addressing either the affected tooth or the affected sinus. This paper provides a review of the current literature on the aetiology, presentation, and management of OMS, as well as our experience in managing this condition. Overall, the causative pathology of the patient’s OMS, their symptoms, and the risk of surgery should drive decision making with regards to sequence of management.

Endonasal endoscopic management of different cases of dentigerous cysts and ectopic teeth

Dentigerous cyst is a type of developmental odontogenic cysts that arises from the crown impacted, embedded or unerupted teeth that standardly managed by Caldwell-luc procedure, which is found to be associated with morbidities and complications. Endonasal endoscopic removal is a minimally invasive approach aiming to prevent morbidities and complications. The aim of this article is to study the advantages of the endonasal endoscopic approach in managing different cases of dentigerous cyst and ectopic teeth. In this article, we reported three different cases (two pediatric and one adult), one presenting with unilateral dentigerous cyst with traumatic ectopic teeth in the maxillary sinus, and one presenting with bilateral dentigerous cysts and ectopic teeth in the maxillary sinuses, the third case of unilateral ectopic intranasal canine tooth. All managed by endonasal endoscopic approach, with no complications and complete recovery. The endonasal endoscopic approach is a minimally invasive surgical approach. With the use of different angled endoscopes and instruments, this approach is preserving physiological function while minimizing morbidity and preventing complications.

Endoscopic Management of Maxillary Sinus Diseases of Dentoalveolar Origin

Endoscopic surgery on the maxillary sinus has experienced significant advances in technique and approaches since the maxillary antrostomy was introduced in the 1980s. Disease processes that previously required open surgical approaches to the maxillary sinus can now be treated endoscopically while preserving form and function of the sinus and without injuring the maxillary sinus mucosa or disrupting normal mucociliary clearance. Understanding the techniques described in this article will allow surgeons to appropriately plan treatment strategies for patients with a variety of maxillary sinus diseases from dentoalveolar origin.

Surgical management of odontogenic cysts involving the maxillary sinus- a retrospective study

OBJECTIVE

To describe our strategy for the management of odontogenic cysts involving the maxillary sinus, and to define the role of transnasal endoscopic sinus surgery in the treatment algorithm.

METHODS

A retrospective study was conducted. Included were all consecutive patients with odontogenic cysts involving the maxillary sinus who were treated in a single medical center between 2011 and 2019. Their medical records were reviewed for demographic data, preoperative presentation, surgical approach, final pathology, and postoperative course. Odontogenic cysts were classified as small or large according to maxillary sinus extension within or beyond the alveolar recess, respectively.

RESULTS

A total of 30 patients with odontogenic cysts involving the maxillary sinus were treated by a team of maxillofacial and endoscopic sinus surgeons during the study period. There were 11 cases of dentigerous cysts, 11 radicular cysts, seven odontogenic keratocysts (OKCs), and one glandular cyst. Sixteen cases were managed by transnasal endoscopic sinus surgery alone and 14 were managed by a combined intraoral and endoscopic sinus surgery approach. A total of 22 patients had large cysts and total resection was achieved in 20 of them. There was one case of OKC recurrence during an average follow-up of 31 months. No major complications were recorded.

CONCLUSIONS

The endoscopic approach can serve as an alternative to the transalveolar or lateral window approach. The endoscopic approach is associated with low morbidity and low recurrence rates.