Association between maxillary sinus floor perforation by dental implants and mucosal thickening: A cone-beam computed tomography study

OBJECTIVE

To investigate the association of perforation of the maxillary sinus floor by dental implants with mucosal thickening and to describe its characteristics in perforated cases.

STUDY DESIGN

One-hundred and twenty-nine maxillary sinuses of 93 patients presenting 202 dental implants in the maxillary posterior region were retrospectively assessed in cone-beam computed tomography scans and classified according to maxillary sinus perforation, bone graft, mucosal thickening, and mucosal appearance. Logistic regression determined the chance of mucosal thickening in perforated maxillary sinuses. The chi-square test compared categorical variables between maxillary sinus perforated or not by implants and maxillary sinus with or without mucosal thickening. The significance level assumed was 5 % (α = 0.05).

RESULTS

There was perforation of 60 maxillary sinuses floor (46.5 %) by 74 dental implants. The chance of mucosal thickening was higher when the implant tip was trespassing on the maxillary sinus floor (p < 0.001). There was a significant association between maxillary sinus mucosal thickening and perforation by a dental implant with the tip trespassing the maxillary sinus floor (p < 0.05).

CONCLUSION

Maxillary sinus mucosal thickening is associated with sinus floor perforation by dental implants and does not depend on the number of implants perforating it.

CLINICAL RELEVANCE

There is an association between dental implants' perforation of the maxillary sinus floor and the thickening of the maxillary sinus. In those cases, the appearance of the mucosa thickening may be irregular, local, or total opacification of the sinus cavity.

Which factors affect the risk of membrane perforation in lateral window maxillary sinus elevation? A prospective cohort study

It was the aim of this prospective cohort study to assess the various anatomical and other patient-related factors that increase membrane perforation risk. Patients underwent cone-beam computed tomography (CBCT) before surgery. The presence of septa, presence of mucous retention cyst, lateral wall thickness, membrane thickness, and residual bone height were predictive factors. Age, gender, and smoking were covariates for the study. The presence or absence of membrane perforation was the study outcome. In total, 140 subjects were studied. The hazard ratio (HR) for the presence of septa with membrane perforation was 8.07 (2.93-22.29) (p < 0.001). The HR for perforation with a single edentulous area relating to two or more teeth was 68.09 (9.52-49.16). The risk of membrane perforation in smokers was 25 times more than in non-smokers - HR 25 (7.58-82.51) (p < 0.001). The HR for membrane perforation in subjects with mucous retention cysts compared with subjects without retention cysts was 27.75 (8.73-88.23) (p < 0.001). Within the limitations of the study it seems that anatomical, habitual, and pathological factors may increase the risk of Schneiderian membrane perforation when a lateral window approach is used for sinus floor augmentation.

In vivo assessment of cerebrospinal fluid efflux to nasal mucosa in humans

Extra-vascular molecular clearance routes from the brain and cerebrospinal fluid (CSF) remain insufficiently characterized in humans. Animal studies consistently suggest that the cribriform plate and nasal lymphatic vessels are crucial for molecular clearance from CSF. In this study, we aimed to examine human in vivo transport of a CSF tracer from CSF to nasal mucosa. We hypothesised a CSF tracer would enrich in nasal mucosa provided that nasal lymphatic drainage has a significant role in CSF molecular clearance. Consecutive magnetic resonance imaging during 48 h after intrathecal administration of a tracer (gadobutrol) was performed in 24 patients. Despite a strong enrichment of CSF tracer in CSF spaces nearby the cribriform plate, there was no significant enrichment of CSF tracer in nasal mucosa, as measured in superior, medial and inferior turbinates, or in the nasal septum. Therefore, this in vivo study questions the importance of CSF drainage to the human nasal mucosa and emphasizes the need of further human studies.

Effects of Intranasal Epinephrine on Cerebrospinal Fluid Epinephrine Pharmacokinetics, Nasal Mucosa, Plasma Epinephrine Pharmacokinetics, and Cardiovascular Changes

PURPOSE

We aimed to assess intranasal (IN) epinephrine effects on cerebrospinal fluid (CSF) absorption, nasal mucosa quality, plasma epinephrine pharmacokinetics (PK), and cardiovascular changes in dogs.

METHODS

CSF epinephrine concentration was measured and nasal mucosa quality was evaluated after IN epinephrine 4 mg and one or two 4 mg doses (21 min apart), respectively. Maximum plasma concentration [C_max], time to C_max [T_max], area under the curve from 0 to 120 min [AUC_0-120], and cardiovascular effects were evaluated after epinephrine IN (4 and 5 mg) and intramuscular (IM; 0.3 mg). Clinical observations were assessed.

RESULTS

After epinephrine IN, there were no changes in CSF epinephrine or nasal mucosa. C_max, T_max, and AUC_1-120 were similar following epinephrine IN and IM. Epinephrine IN versus IM increased plasma epinephrine at 1 min (mean ± SEM, 1.15 ± 0.48 for 4 mg IN and 1.7 ± 0.72 for 5 mg IN versus 0.47 ± 0.11 ng/mL for 0.3 mg IM). Epinephrine IN and IM produced similar heart rate and ECG results. Clinical observations included salivation and vomiting.

CONCLUSIONS

Epinephrine IN did not alter CSF epinephrine or nasal tissue and had similar cardiovascular effects as epinephrine IM. Epinephrine IN rapidly increased plasma epinephrine concentration versus epinephrine IM.

Magnetic resonance features of sinonasal melanotic mucosal melanoma

A 67-year-old man presented to ear, nose and throat department complaining of nasal congestion and recurrent epistaxis for 5 months. Nasal endoscopy revealed a pigmented polyp obstructing the right nasal cavity. MRI with contrast agent showed a right nasal cavity polypoid mass with hyper signal intensity (SI) both in non-enhanced T1-w and diffusion imaging, marked hypo SI in T2-w sequences and avidly contrast enhancement characterised by rapid wash-in without significant wash-out on dynamic perfusion imaging. Histological specimen showed epithelioid and spindle cells with focal intense pigmentations and immunohistochemical features compatible with primary melanotic sinonasal mucosal melanoma (SNM). As melanotic SNM shows MRI pathognomonic high non-enhanced T1-w SI, this case underlines the crucial role of MRI not only in assessing the local tumour extension/recurrence but also in increasing the diagnostic confidence of detecting melanotic SNM. Thus, MRI should be always performed in case of clinical-endoscopic suspicion of SNM.

Real-life effectiveness of MP-AzeFlu in Irish patients with persistent allergic rhinitis, assessed by visual analogue scale and endoscopy

INTRODUCTION

Most allergic rhinitis (AR) patients have moderate-to-severe, persistent disease. Meda Pharma's AzeFlu (MP-AzeFlu) combines intranasal azelastine hydrochloride (AZE) and fluticasone propionate (FP) in a novel formulation in a single device to treat AR. This prospective, noninterventional study sought to assess the effectiveness of MP-AzeFlu (one spray/nostril twice daily; 548 µg AZE/200 µg FP daily dose) in relieving AR symptom severity.

METHODS

A visual analogue scale (VAS) was used prior to MP-AzeFlu treatment on days 0, 1, 3, 7, 14, 21, 28, 35, and 42 by 53 persistent AR (PER) patients seen in routine clinical practice in Ireland. An endoscopy was performed on days 0 and 28, and symptoms of edema, discharge, and redness were scored on a three-point scale (for both nostrils).

RESULTS

Patients using MP-AzeFlu experienced rapid VAS score reduction from 73.4 mm (standard deviation [SD], 20.3) at Day 0 to 31.5 mm (SD, 25.0) at day 28 (P < 0.0001) to 28.1 mm (SD, 24.1) at day 42 (P < 0.0001), a 45.3-mm reduction. On average, patients achieved a clinically relevant VAS score cutoff of 50 mm before Day 7. Total endoscopy score decreased from 7.5 mm (SD, 3.1) at baseline to 3.5 mm (SD, 2.5) at Day 28. The incidence of severe edema on endoscopy decreased from 53.1% at baseline to 3.8% at Day 28. A similar reduction in the incidence of thick/mucousy discharge (from 28.3% to 4.8%) and severe redness (from 34.9% to 0%) was also observed.

CONCLUSIONS

MP-AzeFlu provided effective, rapid control of PER as assessed by VAS in a real-world clinical setting in Ireland. Symptom improvement was observed at Day 1, sustained for 42 days, and associated with improved mucosal appearance after 28 days. These results confirm the safety of MP-AzeFlu and exceed the efficacy demonstrated in phase 3 clinical studies for controlling AR in PER patients.

Relation between periapical lesions and sinus membrane thickening assessed by Cone Beam Computed Tomography

The aim of this study was to evaluate thickening of the Schneiderian membrane and to determine its association with periapical pathologies, using computerized cone beam tomography. An observational, analytical, cross-sectional retrospective study was conducted. A total 179 maxillary sinuses were evaluated using CBCT. The presence of sinus membrane thickening and its association with unhealthy teeth was analyzed. Results are shown as percentages with 95% confidence intervals (95%CI); Chi square test was used with a significance level of 5%.Sinus membrane thickening was detected in 70 cases (39%; 95%CI=32% to 46%) and no sinus membrane thickening was observed in 109 (61%; 95%CI = 54% to 68%) (p<0.05). The 70 cases showing sinus membrane thickening included 46 of odontogenic origin (66%; 95%CI = 54% to 76%) and 24 (34%; 95%CI = 24% to 46%) of non odontogenic origin (p<0.05). The frequency of odontogenic causes followed a heterogeneous distribution (p<0.05): penetrating caries, failing endodontic therapy, root remnants, deep restorations, implants, periodontal pathology. The main cause was caries (46%; 95%CI=32% to 60%) followed by failing endodontic therapy (26%, 95% CI=16% to 40%). The frequency distribution of involved teeth was uneven (p<0.05), with tooth 16 (33%; 95%CI=21% to 47%) being the most frequently involved, followed by tooth 26 (30%; 95%CI=19% to 45%).The high incidence of sinus pathology of odontogenic origin shows the need for interdisciplinary work involving dentists and ear-nose-throat specialists. Caries, inadequate restorations, periodontal lesions, implants, and the presence of root remnants are the main causes of Schneiderian membrane thickening. The use of CBCT for diagnosis and treatment planning allows detecting maxillary sinus membrane thickening and determining its association with an odontogenic etiology.

Oncocytic Schneiderian papilloma-associated adenocarcinoma and KRAS mutation: A case report

RATIONALE

Oncocytic Schneiderian papillomas (OSP) are an uncommon type of sinonasal papillomas that arise from the Schneiderian epithelium, accounting for only 6% of all sinonasal papillomas. Malignancies arising in OSP are rare and are almost always described as in situ or invasive squamous cell carcinoma, although mucoepidermoid, small cell carcinoma and sinonasal undifferentiated carcinoma have also been reported. To our knowledge, only 18 such instances have been reported in the medical literature.

PATIENT CONCERNS

Here, we report the case of an 81-year-old man presenting with a left sinonasal neoplasm, who had undergone 4 operations. The first postoperative pathology revealed a benign nasal polyp. The following several postoperative pathology revealed a novel, human papillomavirus-negative adenocarcinoma with increasing malignant features with each recurrence arising in an OSP. In addition, the most recent recurrences were associated with metastasis of cervical lymph nodes. And after the operation, the patient refused adjuvant radiotherapy. On 6-month follow-up after the last operation, the patient developed an in situ tumor recurrence 1 month after the fourth operation and refused to undergo surgery again.

DIAGNOSIS

Immunohistochemistry for Ki67, CK7, CK5/6, P53, and P63 showed a progression of malignancy. HPV assay presented the 21 most prevalent HPV types were negative. In addition, KRAS gene exon 2 G12C presented mutation in the OSP-associated adenocarcinoma.

INTERVENTIONS

During the whole course of the patient's disease, we performed four nasal endoscopic operations. And after the last operation, the patient refused adjuvant radiotherapy and KRAS-targeted therapy.

OUTCOMES

We are the first to describe adenocarcinoma arising in an OSP. To our surprise, from the first benign neoplasm to the second OSP-associated adenocarcinoma, it went through a long period of 10 years. However, after the adenocarcinogenesis, the differentiation of tumor became worse with the shorter interval of each recurrence.

LESSONS

Therefore, for elderly patients with unilateral nasal polyps, long-term follow-up is necessary. Once OSP turns into malignant, radical resection should be performed as much as possible to reduce the irritability of tumors.

Measurement and implications of the distance between the sphenopalatine ganglion and nasal mucosa: a neuroimaging study

BACKGROUND

Historical reports describe the sphenopalatine ganglion (SPG) as positioned directly under the nasal mucosa. This is the basis for the topical intranasal administration of local anaesthetic (LA) towards the sphenopalatine foramen (SPF) which is hypothesized to diffuse a distance as short as 1 mm. Nonetheless, the SPG is located in the sphenopalatine fossa, encapsulated in connective tissue, surrounded by fat tissue and separated from the nasal cavity by a bony wall. The sphenopalatine fossa communicates with the nasal cavity through the SPF, which contains neurovascular structures packed with connective tissue and is covered by mucosa in the nasal cavity. Endoscopically the SPF does not appear open. It has hitherto not been demonstrated that LA reaches the SPG using this approach.

METHODS

Our group has previously identified the SPG on 3 T-MRI images merged with CT. This enabled us to measure the distance from the SPG to the nasal mucosa covering the SPF in 20 Caucasian subjects on both sides (n = 40 ganglia). This distance was measured by two physicians. Interobserver variability was evaluated using the intraclass correlation coefficient (ICC).

RESULTS

The mean distance from the SPG to the closest point of the nasal cavity directly over the mucosa covering the SPF was 6.77 mm (SD 1.75; range, 4.00-11.60). The interobserver variability was excellent (ICC 0.978; 95% CI: 0.939-0.990, p < 0.001).

CONCLUSIONS

The distance between the SPG and nasal mucosa over the SPF is longer than previously assumed. These results challenge the assumption that the intranasal topical application of LA close to the SPF can passively diffuse to the SPG.

Detection of an unusual inverted schneiderian papilloma by cone beam computed tomography

An inverted schneiderian papilloma (ISP) is a rare neoplasm that affects the nasal cavity or a paranasal sinus, especially the maxillary sinus. Although histologically benign, the lesion has a high potential for local destruction, has a high recurrence rate, and presents the possibility of malignant transformation into squamous cell carcinoma. To determine the extent of the injury and possible impairment of adjacent maxillofacial structures, accurate imaging, such as cone beam computed tomography (CBCT), is necessary. A 47-year-old man reported a nasal obstruction on the right side of his face, signs of oroantral communication, and facial asymmetry. The CBCT examination revealed an extensive lesion of mixed density and irregular contours involving the entire right maxillary sinus and nasal cavity. The association between the clinical signs and symptoms and the tomographic features of the lesion resulted in a differential diagnosis of an ISP, which was confirmed through histopathologic examination. This case report confirms that CBCT is a valuable method for the detection of pathologic alterations affecting the maxillary sinus, especially ISPs.

Incidence of and Factors Associated with Sinus Membrane Perforation During Maxillary Sinus Augmentation Using the Reamer Drilling Approach: A Double-Center Case Series

Maxillary sinus membrane perforation has been reported as the most common intraoperative complication during sinus augmentation, potentially leading to postoperative infection and consequent loss of graft or even implant failure. Numerous anatomical factors have been demonstrated to affect membrane tearing. However, careful use of proper instrumentation, such as a reamer, seems to play an important role in minimizing the incidence of these complications. Hence, the aim of the present study was to (1) investigate the reliability of reamer drilling for lateral window preparation; (2) examine the incidence of membrane perforation; and (3) study the factors that might influence membrane perforation. Results from this study showed the safety and effectiveness of using a reamer to perform lateral window approach sinus augmentation. The sinus membrane perforation rate was found to be 12.5%. A slightly higher perforation rate was noted in thinner maxillary lateral walls (< 1.25 mm). The authors concluded that reamer drilling is a safe and effective alternate technique for opening the lateral window wall when the lateral wall thickness is ≥ 1.25mm.

Impact of Sex, Age, and Season on Sinus Membrane Thickness

PURPOSE

Sinus membrane thickness has been associated with the incidence of membrane perforation during the sinus elevation procedure. Understanding the sinus membrane thickness is essential for prevention of this specific surgical complication. Therefore, the aim of this retrospective study was to investigate the impact of sex, age, and season on the membrane thickness.

MATERIALS AND METHODS

The charts of 144 healthy patients were included in the study. Cone beam computed tomography (CBCT) images from these patients were analyzed to determine the sinus membrane thickness in the coronal and sagittal views. Sex, age, and season were correlated with the membrane thickness.

RESULTS

The mean thickness of the sinus membrane was 1.81 ± 1.66 mm (range: 0.47 to 9.49 mm). In 22.12% of the CBCT images, the sinus membrane was not visible. Membrane thickness of less than 2 mm was found in 70.8% of the cases. Age was found to be strongly correlated (P < .05) with sinus membrane thickness but not sex or season.

CONCLUSION

Based on CBCT assessment, age was found to be a factor influencing sinus membrane thickness but not sex or season.

Correlation of quantitative MR imaging findings with symptoms in patients with incidentally detected inflammatory sinonasal disease

PURPOSE

To assess the relationships between mucosal thickness, T1-weighted, T2-weighted signals and restricted diffusion on magnetic resonance imaging (MRI) with the degree of symptoms in patients with incidentally detected inflammatory sinonasal disease.

MATERIALS AND METHODS

Conventional and diffusion-weighted MRI of 100 patients with incidental sinonasal mucosal thickening were prospectively evaluated. There were 53 men and 47 women, with a mean age of 44.6 years±15.17 (SD) (range: 18-81 years). Correlations between quantitative values (T1-signal, T2-signal and apparent diffusion coefficient [ADC]) and three different quality of life questionnaires (chronic sinusitis survey, sinonasal outcomes test-22 and nasal obstruction and septoplasty effectiveness scale [NOSE]) were searched using the Spearman correlation test.

RESULTS

The mean SNOT-22 score was 35.81±20.36 (SD) (range: 0-83), CSS score was 4.64±3.42 (SD) (range: 0-14), and NOSE score was 5.91±4.84 (range: 0-18). All patients (100%) had maxillary sinus involvement. Ethmoidal sinus involvement was present in 57% of patients, frontal sinus involvement in 33% and sphenoidal sinus involvement in 27%. Morphologically, 40 patients (40%) had septal deviation, 41 (41%) had maxillary sinus retention cyst and 78 (78%) had hypertrophy of the conchae. No correlations were found between morphological abnormalities, quantitative values and patient scores in none of the questionnaires.

CONCLUSION

Incidental morphological abnormalities or restricted diffusion of the paranasal sinuses on MRI do not correlate with the degree of symptoms in patients with incidentally detected inflammatory sinonasal disease.

Estimates of nasal airflow at the nasal cycle mid-point improve the correlation between objective and subjective measures of nasal patency

INTRODUCTION

The nasal cycle represents a significant challenge when comparing pre- and post-surgery objective measures of nasal airflow.

METHODS

Computational fluid dynamics (CFD) simulations of nasal airflow were conducted in 12 nasal airway obstruction patients showing significant nasal cycling between pre- and post-surgery computed tomography scans. To correct for the nasal cycle, mid-cycle models were created virtually. Subjective scores of nasal patency were obtained via the Nasal Obstruction Symptom Evaluation (NOSE) and unilateral visual analog scale (VAS).

RESULTS

The correlation between objective and subjective measures of nasal patency increased after correcting for the nasal cycle. In contrast to biophysical variables in individual patients, cohort averages were not significantly affected by the nasal cycle correction.

CONCLUSIONS

The ability to correct for the confounding effect of the nasal cycle is a key element that future virtual surgery planning software for nasal airway obstruction will need to account for when using anatomic models based on single instantaneous imaging.

Migraine: A look down the nose

BACKGROUND

Studies have suggested that contact between opposing mucosal surfaces in the nasal wall and cavity can be a target of the surgical treatment of migraines. Unfortunately, not enough is known about the role of nasal pathology in the pathogenesis of this condition. The co-existence of further rhinological disorders can be an impediment to defining the cause and effect of anatomical variants. The authors compared the MRI scans of migraine- and non-migraine patients (MPs and NMPs, respectively) to determine the prevalence of such mucosal contact points in order to extrapolate whether there is a significant association with migraines.

METHODS

Coronal and axial MRI brain scans of 522 patients (412 migraineurs and 110 non-migraineurs) were analysed for the prevalence of anatomical variations of the nasal cavity, e.g. concha bullosa, septal deviations, mucosal swelling and contact points.

RESULTS

The results showed no significant difference between MPs and NMPs patients for any of the parameters examined. Moreover, 87% MPs and 79% NMPs had at least one contact point. The most frequent contact point was between the middle turbinate and the septum, observed in 54% of MPs and 45% of NMPs.

CONCLUSIONS

Contact points with the nasal mucosa are highly prevalent in both MPs and NMPs. Although a contact point does not cause a migraine in the absence of the disease, the concomitant presence of migraine and contact points can trigger an attack, and therefore, it is necessary to differentiate or exclude a rhinological disorder in these patients.

[Significance of differential diagnosis for sinonasal mass by CT value]

OBJECTIVE

To explore whether CT value is useful in identifying different disease in tumors of rhinosinus parenchyma.
 Methods: The data of preoperation noncontrast CT in 277 patients were retrospectively reviewed. The final diagnosis and classification were based on the result of surgical histopathological examination. The CT value range for different classification was calculated and was compared. All patients were re-diagnosed according to CT value range combined with pathological results by the same doctor team. The diagnosis rates according to CT value range were compared.
 Results: The CT value was (25.3±3.5) Hu in nasal polyp, (7.9±3.5) Hu in serous cyst, (42.2±4.7) Hu in mucocele, (40.7±5.3) Hu in papilloma, (112.3±10.9) Hu in fungus ball, (41.7±4.8) Hu in hemangioma, (51.2±9.9) Hu in malignant melanoma, and (47.1±9.9) Hu in squamous carcinoma. The CT value in nasal polyp is significantly higher than that in serous cyst, which was significantly lower than that in mucocele, papilloma, fungus ball, hemangioma, malignant melanoma and squamous carcinoma (all P<0.05); the CT value in serous cyst was significantly lower than that in other classification diseases (all P<0.05); the CT value in fungus ball was significantly higher than that in other classification diseases (all P<0.05); there was no significant difference in CT value among mucocele, papilloma, hemangioma, malignant melanoma, squamous carcinoma (all P﹥0.05). The diagnosis rate was elevated (from 71.1% to 92.4%) according to CT value range, with significant difference (χ2=42.150, P<0.01).
 Conclusion: CT value in nasal polyp, serous cyst, fungus ball is different from other diseases, and the 3 diseases can be distinguished only by CT value range; the CT value in mucocele, papilloma, hemangioma, malignant melanoma and squamous carcinoma is similar, and their differential diagnosis should combine with imaging data and other clinical characters. The diagnosis rates can be improved when the CT value range is taken into account.

Evaluation of nasal fluid flow in fetuses by Doppler ultrasound

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Density of Middle Turbinate Subepithelial Mucous Glands in Patients with Chronic Rhinosinusitis

OBJECTIVE: Histologic changes have not been systematically assessed in chronic rhinosinusitis. Quantitative histochemical studies evaluated the extent of sinus disease and gland density in the middle turbinates.

STUDY DESIGN AND SETTING: Sinus computed tomography scans of 34 patients with chronic rhinosinusitis were retrospectively graded 0 to IV according to the May classification. Middle turbinates from patients with chronic rhinosinusitis (n = 46) and normal patients (n = 7) were harvested during endoscopic sinus surgery. The areas of Alcian blue-stained glands were assessed in paraffin sections using a computer-assisted microscopy video system.

RESULTS: Alcian blue-stained glands occupied 7.94% of normal mucosa. The staining in all grade III rhinosinusitis subjects was increased to 12.94% ( P < 0.01). In contrast, grade IV pansinusitis was associated with nasal polyposis (6 of 6) with decreased gland area (3.04%, P < 0.01). When polyp patients were excluded from grade III rhinosinusitis, the Alcian blue-staining area was 17.68% ( P < 0.01).

CONCLUSIONS: Distinct polypoid and glandular histopathologic patterns are present in chronic rhinosinusitis.

Relationship between preoperative cone beam computed tomography and intraoperative findings in sinus augmentation

PURPOSE

To investigate whether the presence of bony septum, thickness of sinus membrane (schneiderian membrane), and residual alveolar bone height affects membrane perforation and the duration of sinus augmentation.

MATERIALS AND METHODS

Preoperative cone beam computed tomography (CBCT) images obtained from patients undergoing lateral sinus augmentation were evaluated for the presence of bony septum, thickness of sinus membrane, and residual alveolar bone height. During the operation, membrane perforation and duration of surgery were noted. The Student t test was used to compare descriptive statistics (mean, standard error) and quantitative variables between groups. The Fisher exact χ(2) test was used to compare the qualitative data, and Pearson correlation test was used to evaluate the correlation between data. P < .05 was considered significant.

RESULTS

Data from 57 patients were evaluated. Membrane perforation occurred in 14 patients included in the study and in 8 patients with sinus septum. A significant relationship was found between the presence of septum and membrane perforation during sinus augmentation (P = .014). However, the relationship among other CBCT and intraoperative findings was not significant.

CONCLUSION

Presence of septum in the maxillary sinus increases the risk of membrane perforation, but does not extend the duration of the sinus augmentation.

Measurement of ciliary beat frequency using Doppler optical coherence tomography

BACKGROUND

Measuring ciliary beat frequency (CBF) is a technical challenge and difficult to perform in vivo. Doppler optical coherence tomography (D-OCT) is a mesoscopic noncontact imaging modality that provides high-resolution tomographic images and detects micromotion simultaneously in living tissues. In this work we used D-OCT to measure CBF in ex vivo tissue as the first step toward translating this technology to clinical use.

METHODS

Fresh ex vivo samples of rabbit tracheal mucosa were imaged using both D-OCT and phase-contrast microscopy (n = 5). The D-OCT system was designed and built to specification in our lab (1310-nm swept source vertical-cavity surface-emitting laser [VCSEL], 6-μm axial resolution). The samples were placed in culture and incubated at 37°C. A fast Fourier transform was performed on the D-OCT signal recorded on the surface of the samples to gauge CBF. High-speed digital video of the epithelium recorded via phase-contrast microscopy was analyzed to confirm the CBF measurements.

RESULTS

The D-OCT system detected Doppler signal at the epithelial layer of ex vivo rabbit tracheal samples suggestive of ciliary motion. CBF was measured at 9.36 ± 1.22 Hz using D-OCT and 9.08 ± 0.48 Hz using phase-contrast microscopy. No significant differences were found between the 2 methods (p > 0.05).

CONCLUSION

D-OCT allows for the quantitative measurement of CBF without the need to resolve individual cilia. Furthermore, D-OCT technology can be incorporated into endoscopic platforms that allow clinicians to readily measure CBF in the office and provide a direct measurement of mucosal health.

Changes in Sinus Membrane Thickness After Lateral Sinus Floor Elevation: A Radiographic Study

PURPOSE

To radiographically monitor sinus membrane swelling after lateral sinus floor elevation surgery at short and long healing periods.

MATERIALS AND METHODS

For 26 patients seeking posterior maxillary implant-supported reconstruction, 32 lateral sinus floor elevations were performed using Piezosurgery. Sinus membranes were grafted using synthetic calcium phosphate bone substitutes, and graft volume was measured in cubic centimeters for each case. Cone beam computed tomography (CBCT) examination was conducted preoperatively in all patients and for each grafted sinus at 1 day (n = 8), 2 days (n = 9), 3 days (n = 8), or 7 days (n = 7) after surgery. Control CBCT was then performed for all patients at 3, 6, and 12 months after surgery. Sinus membrane thickness was measured on cross-sectional CBCT images at nine standardized points per sinus, before lateral sinus floor elevation and at all postoperative examinations.

RESULTS

Mean sinus membrane thickness was 0.73 mm before surgery, and 5 mm, 4.1 mm, 5.9 mm, and 7 mm, respectively, at 1, 2, 3, and 7 days after surgery. First week combined postoperative CBCT measurements of membrane thickness was 5.4 mm, then 1.3, 0.68, and 0.39 mm at 3, 6, and 12 months, respectively, after surgery. Membrane thickness significantly increased the first week after surgery and gradually decreased significantly at 3, 6, and 12 months in all groups (P < .001). First-week postoperative measurements showed a significant increase in membrane thickness at 3 days compared with the 1- and 2-day results (P < .001) and at 7 days compared with all other time points (P < .001). Membrane thickness at 2 days did not change significantly compared with 1-day measurements. Larger graft volume was positively correlated with an increase in membrane thickness after surgery at all time points (n = 32; r = 0.527; P < .001).

CONCLUSION

After lateral sinus floor elevation surgery, transient swelling of sinus membrane is observed. It reaches a peak value 7 days after surgery and completely resolves over months. This swelling is correlated to the extent of sinus floor elevation.

An Analysis of Frequency, Morphology, and Locations of Maxillary Sinus Septa Using Cone Beam Computed Tomography

PURPOSE

To evaluate the frequency, morphology, and locations of maxillary sinus septa using cone beam computed tomographic (CBCT) imaging of the entire maxillary sinus and to analyze factors influencing the presence or absence of septa.

MATERIALS AND METHODS

CBCT images of the maxilla taken during a 1-year study period (October 1, 2012, to September 30, 2013) were evaluated for the presence and type of septa as well as the health or pathology of the maxillary sinus. Differences in age, gender, type of dentition, septa location, and sinus pathology with regard to the incidence of sinus septa were analyzed statistically.

RESULTS

The study included 294 maxillary sinuses in 212 patients (126 women and 86 men) with a mean age of 53.8 years. Sinus septa were present in 141 patients (66.5%) and in 166 of 294 sinuses (56.5%). The most common orientation of the septa was coronal (61.8%), 7.6% were oriented axially, and 3.6% were aligned sagittally. Most septa were located on the floor of the maxillary sinus (58.6%), commonly (60.7%) in the region of the first and second molars. The maxillary sinuses were diagnosed in 36.4% of cases as healthy and without thickening of the sinus membrane. Sex was a significant variable in the health of the maxillary sinus; 57.7% of the sinuses in women and 72.3% in men were diagnosed as pathologic.

CONCLUSION

Septa are common anatomical structures and are most often found in the first or second molar region on the floor of the maxillary sinus. To prevent possible complications during sinus floor elevation procedures, a thorough three-dimensional radiographic examination of the sinus prior to surgery is recommended.

Endonasal mucosal contact points in chronic migraine

Some anatomo-functional alterations of the nose may be considered as possible causes of headache: deviations of the nasal septum, abnormal turbinates, especially middle or superior, with consequent areas of mucosal contact with the septum. This study was performed on 100 subjects, 27 chronic migraine (CM) sufferers and 73 subjects who never suffered from migraine as control group. In the CM group, a direct endoscopic assessment was carried out in order to search for mucosal points of contact. Following the endoscopy, the patients underwent a computerized tomography (CT) in order to confirm the mucosal contact and for a better evaluation of its localization. The control group (C group) consisted of subjects who underwent a CT of the skull for various reasons. In CM group, a mucosal contact was highlighted in 14 patients (51.8 %); it was unilateral in 50 % of cases. In C group, the contact was present in 27 cases (36.9 %); in 81.5 % of them (n = 22), it was unilateral. A single site of contact was present in 6 (22 %) patients in CM group and 20 (27.3 %) patients in C group; more sites, in 8 (29.6 %) CM group patients and in 7 (9.5 %) patients of the C group. The connection between subjects and the number of single or multiple contacts in the two groups was statistically significant (p = 0.049). Furthermore, the frequency of the septum-middle turbinate was significantly (p = 0.0013) more frequent in CM sufferers (13/14) compared with control subjects (11/27). This study suggests, although with extremely early data, the need to select carefully patients for a possible surgical approach, using various parameters: in particular, the site of the mucosal contact, favoring the cases with multiple areas of contact, mainly between septum-middle turbinate and septum-superior turbinate.

Evaluation and treatment of failed nasolacrimal duct probing in Down syndrome

PURPOSE

To elucidate the mechanisms underlying failed nasolacrimal duct (NLD) probing in children with Down syndrome (DS) utilizing computed tomography (CT) scans and histopathology of nasal mucosa.

METHODS

The medical records of children with DS and NLD obstruction confirmed by dye disappearance testing who failed NLD surgery were retrospectively reviewed. Dimensions of the bony NLD and presence of postductal mucosal obstruction were obtained from CT scans. Histopathology of the nasal mucosa was performed in a subset of patients. Subsequent treatment was topical or intranasal corticosteroids or submucosal corticosteroids alone or combined with surgical reduction of the inferior turbinate.

RESULTS

A total of 9 subjects (age range, 8-10 years) and 43 age-matched controls were included. Both groups demonstrated a logarithmic increase in NLD and maxilla dimensions with increasing age; however, the transverse diameter of the NLD was consistently 1-2 mm smaller in children with DS ≤5 years age (n = 4) than in age-matched controls. The transverse diameter in DS children overlapped that of controls after 5 years age. Histopathology revealed abnormal lymphoplasmacytic inflammation of the mucosa in 4 of 5 biopsies of DS patients, consistent with chronic infection, allergic disease, or immune dysregulation. The postductal obstruction was successfully treated with topical or intranasal corticosteroids or by surgical reduction of the inferior turbinate submucosa with corticosteroid injection.

CONCLUSIONS

Before 5 years of age, NLD obstruction in children with DS was associated with reduced dimensions of the NLD and hypertrophic nasal mucosa. In DS children older than 5 years of age, the dimensions of the NLD are normal and postductal obstruction due to hypertrophic nasal mucosa should be considered.

Is the Schneiderian membrane thickness affected by periodontal disease? A cone beam computed tomography-based extended case series

OBJECTIVE

The aim was to assess the thickness of Schneiderian membranes (SM) in patients with advanced periodontal disease.

METHODS

17 dentate patients (DG) scheduled for periodontal surgery on maxillary molars were consecutively recruited and cone beam computed tomographies performed for preoperative diagnosis. Twenty-one patients (EG) requiring cone beam computed tomography-based planning of implant placement in the edentulous posterior maxilla served as controls.

RESULTS

Schneiderian membrane thickness measured from cone beam computed tomography was significantly greater in the dentate group compared to the edentulous group, both in the first (p = 0.028) and second (p < 0.001) molar position. In the dentate group, clinical signs of periodontal destruction (increased probing pocket depth or furcation involvement) were not associated with Schneiderian membrane thickness. Additional findings, such as periapical lesions (p = 0.008), and the distance between root tips and maxillary sinus revealed a significant association (p = 0.036) with Schneiderian membrane thickness.

CONCLUSION

In molar regions with periodontal destruction, Schneiderian membrane thickening occurred, particularly in combination with small bone layers above the root tips or periapical lesions.

Radiographic assessment of findings in the maxillary sinus using cone-beam computed tomography

OBJECTIVES. To assess the presence of anatomic variations and pathology of the maxillary sinus using cone beam computed tomography (CBCT) of the maxilla where pre- implant surgery is planned. MATERIAL AND METHODS. This retrospective study evaluates a sample CBCT scans of 34 dental patients (68 sinuses). CBCT is used to assess maxillary sinus mucosa and outflow and prevalence of septa. The mucosal thickening was measured and the sinus outflow was classified as open or obstructed. RESULTS. Mucosal thickening was found in 48.5%, septa in 20.6% and total opacity in 2.9% of the sinuses. Maxillary sinus outflow was blocked in 26.5% of the scans. Strong association between radiological signs of maxillary sinus ostium blockage and thickened mucosa was observed. CONCLUSIONS. Anatomic variations and lesions of the maxillary sinus were common findings in CBCT examinations of the maxilla required for dental preprosthetic planning. Routine CBCT scans, including maxillary sinus ostium are recommended for risk assessment prior to surgery.

[Study for the histopathologic change of ethmoid bone in patients with chronic rhinosinusitis and its correlation factors]

OBJECTIVE

To investigate the histopathologic changes of ethmoid bone and its correlation with clinical types of chronic rhinosinusitis (CRS).

METHOD

All ethmoid bones and mucosa from 180 patients with CRS after endoscopic sinus surgery were collected for histopathologic detection with HE staining. The number and the rate of cases were counted according to different histopathologic types. To analyze the correlation between ethmoid bones and clinical types of CRS, mucosal pathologic change, the CT-scanning types of sinusitis, the course of disease as well as operational history.

RESULT

The ethmoid bone of all patients had varying degrees of histopathologic changes. There were 5 cases (2.78%) in stage I, 38 cases (21.11%) in stage II, 71 cases (39.44%) in stage III, and 66 cases (36.67%) in stage NIV. The histopathologic changes of ethmoid bone varied in different clinical types. In type I, there were 5 cases (8.33%) in stage I, 33 cases (55.00%) in stage II, 15 cases (25.00%) in stage III, and 7 cases (11.67%) in stage NV. In type I, there were 5 cases (8.33%) in stage II, 37 cases (61.67%) in stage mI, and 18 cases (30.00%) in stage NV. In type III, there were 19 cases (31.67%) in stage III, and 41 cases (68.33%) in stage NV. All histopathologic changes of ethmoid bone were statistically correlated (P < 0.01) with clinical types of CRS, pathologic mucosal change, the CT-scanning types of sinusitis, the course of disease as well as operational history.

CONCLUSION

Almost all patients with CRS manifest different-degrees of histopathologic changes, which are correlated with the clinical types of CRS, pathologic mucosal change, the CT-scanning types, the course of disease as well as operational history.

Correlation of cone beam computed tomography (CBCT) findings in the maxillary sinus with dental diagnoses: a retrospective cross-sectional study

This study was conducted to assess the coincidence of mucosal hyperplasia in the maxillary sinus and related clinical diagnoses of posterior maxillary teeth found in cone beam computed tomography (CBCT) scans. A total of 204 patients who underwent CBCT examinations between 2006 and 2008 were evaluated retrospectively. Clinical and CBCT findings were correlated using patient records. Absolute frequencies, odds ratios (OR), and 95% confidence intervals (95% CI) were calculated for statistical evaluations. There was a pronounced association between periodontitis and radiological signs of sinusitis. Basal mucosal wall thickening was more likely in patients with decayed and non-vital teeth compared to patients with sound teeth (OR = 5.2; 95% CI = 1.2-23.1). Basal mucosal wall thickening was also more likely than total mucosal thickening (OR = 10.4; 95% CI = 2.6-42.2). Patients with decayed and endodontically treated teeth were more likely to exhibit involvement of the basal wall (OR = 9.2; 95% CI = 3.3-25.2) than were patients with healthy teeth. CBCT examinations revealed a correlation between basal mucosal thickening in the maxillary sinus and decayed posterior maxillary teeth or periodontitis. Chronic symptoms involving the sinuses are one of the most common reasons for patients to consult physicians. One reason for chronic orofacial pain is the prevalence of undiagnosed sinus conditions.

Radiographic findings in the maxillary sinus: comparison of panoramic radiography with computed tomography

PURPOSE

To assess the prevalence of radiographic signs of maxillary sinus pathology in patients undergoing dental implant treatment and to compare the efficacy of panoramic radiography, computed tomography (CT), and three-dimensional (3D) CT with Implametric software in the diagnosis of sinus pathology.

MATERIALS AND METHODS

Thirty patients were selected at random from those being treatment-planned to receive implant-supported restorations in the maxilla and who had a panoramic radiograph, a conventional CT scan in acetate, and a 3D CT scan in digital format. The radiographic maxillary sinus findings were categorized as: (1) no sign of pathology, (2) mucosal thickening, (3) mucous cyst, or (4) occupation of the entire sinus.

RESULTS

Seventeen women and 13 men were included, with a mean age of 50.9 years. There was a 38.3% prevalence of radiographic abnormalities (23.3% mucosal thickenings, 10% mucous cysts, and 5% occupation of the entire sinus). Of the 23 sinuses that displayed radiographic signs of pathology, only 1 (4.3%) was correctly diagnosed by the panoramic radiograph.

CONCLUSIONS

The most common radiographic maxillary sinus finding was mucosal thickening, followed by mucous cysts and occupation of the whole sinus. Conventional CT can be considered a reliable method for the diagnosis of maxillary sinus pathology.

[Comparison of the nasal sinus development of children with or without sinusitis in Yunnan province]

OBJECTIVE

To investigate the nasal sinus development and discuss the relation between sinusitis and nasal development.

METHOD

One thousand seven hundred and five healthy children and 1424 children with sinusitis were selected randomly. All children underwent naso sinus computer tomography. Sagittal, coronal and transverse diameters of all sinuses were measured and statistically analyzed.

RESULT

The measured sinus diameters of children with sinusitis were longer than that of healthy children (P < 0.01). Pearson analyses revealed a low correlation of age and the history of sinusitis (P < 0.01), and no correlation of gender and the history of sinusitis. There was moderate to high consistency between clinical diagnosis and nasal CT results about sinusitis (P < 0.01).

CONCLUSION

These results demonstrated that the differences of sinus development exist between the healthy children and children with sinusitis, and the sinus development in children with sinusitis were better than that of healthy children.

Sinonasal clear cell adenocarcinoma: a case report

BACKGROUND

Nonsalivary adenocarcinomas are the most interesting tumors found in the sinonasal area. They are rare tumors arising from surface epithelium. The clear cell type of this tumor is even more rare. We present cytologic findings of clear cell sinonasal adenocarcinoma and related pitfalls.

CASE

A 52-year-old woman presented with a left-cheek facial mass of 3-4 years' duration, with progressive enlargement, nasal discharge and discoloration of the lateral side of her left eye. Computed tomography was performed, revealing an expansile mass involving the nasal cavity, left maxillary sinus, ethmoid sinus with extension to sphenoid sinus, left side of oral cavity and left orbit. Fine needle aspiration performed through the upper buccogingival canine fossa showed clusters of epithelial cells with clear cytoplasm, round nuclei, inconspicuous nucleoli and slight pleomorphism. Some normal ciliated columnar epithelial cells are identified in the vicinity of neoplastic cells. The mass was reported to be a clear cell neoplasm, and excision of the whole mass was performed.

CONCLUSION

Cytologic findings of this rare tumor overlap with those of salivary gland-type tumors with clear cell change and should be added to the list of head and neck tumors with clear cell change.

Preoperative evaluation of chronic rhinosinusitis patients by conventional radiographies, computed tomography and nasal endoscopy

OBJECTIVES

The aim of this study was to compare the efficacy of conventional radiography (CR), computed tomography (CT) and nasal endoscopy for the preoperative evaluation of chronic rhinosinusitis in patients with persistent complaints despite appropriate medical therapy.

PATIENTS AND METHODS

Forty-three patients (26 males, 17 females; mean age 43 years; range 15 to 73 years) were prospectively evaluated. All patients underwent detailed physical examination, CR and coronal high resolution CT of paranasal sinuses. Thirty of them were evaluated with detailed nasal rigid and/or flexible endoscopy as well. The anatomic variations and mucosal changes in paranasal sinuses were noted. The specificity and sensitivity of CR was calculated using CT findings as a reference point. Surgery was performed on two of the other three patients because of obstructive symptoms of middle turbinate. Paradoxal middle turbinate surgery was performed on one patient due to a headache of rhinogenic origin.

RESULTS

In our study 40 (93%) of all patients showed mucosal abnormalities on CT. Computed tomography scanning of the patients revealed anatomic variations in 74.4% of the cases. Mucosal pathology was most frequently observed in the anterior ethmoid region (middle meatus). While we found mucosal anomalies in 47.4% of all sinuses using CR, 42.2% of these cases were confirmed with CT. Also, 19.5% of all sinuses evaluated as normal with CR presented pathologic findings on CT. An overall correlation of 75.3% was observed between CR and CT, while diagnostic nasal endoscopy and CT findings were correlated at a rate of 87%.

CONCLUSION

(i) While no ipsilateral maxillary or frontal sinus disease was detected when no abnormality in the anterior ethmoid region and infundibulum was observed endoscopically in the presence of mucosal abnormalities similar abnormalities were seen at the same side for maxillary or frontal sinuses. (ii) Anatomic variations of nasal and paranasal sinuses may be considered as etiologic and predisposing factors of chronic rhinosinusitis. (iii) Conventional radiography should not be used as a single diagnostic tool in preoperative evaluation; however, due to its high sensitivity, CR technique may be used alone in the diagnosis and follow-up of maxillary sinus disease. (iv) Nasal endoscopy may reduce unnecessary diagnostic CT scanning procedures.

Relationship between the superior attachment type of uncinate process and presence of agger nasi cell: a computer-assisted anatomic study

OBJECTIVE

The uncinate process (UP) is an important anatomic landmark in frontal recess surgery. Its superior attachment shows great anatomic variability. The agger nasi (AN) cell is another important structure that affects frontal recess anatomy and there is a close neighborhood between them. The aim of this study was to investigate the relationship between superior attachment type of UP and the presence of AN cell.

STUDY DESIGN

A retrospective anatomical study.

METHOD

Computed tomography scans were evaluated of 486 sides of 243 patients who had had paranasal sinus. In 125 (26%) sides, the superior attachment of the UP could not be identified. In the remaining 361 (74%) sides, the prevalence of superior attachment of UP types and the presence of AN cell in each side were recorded. The results were evaluated with chi2 test.

RESULTS

The AN cell was found in 290 (80.3%) of 361 sides. The prevalence of AN cell according to superior attachment of UP types were 79.6% for type 1/2, 90.1% for type 3, 71.4% for type 4, 86.5% for type 5, and 83.3% for type 6. The presence of AN cell according to superior attachment types of UP was not statistically significant (chi2= 3.54, P = 0.315).

CONCLUSIONS

The AN cell was found to be present in 80.3% of the cases. However, the relationship between the presence of the AN cell and the superior attachment types of UP was not statistically significant.

Effect of snuff on nasal mucosa

PURPOSE

The inhalation of nasal snuff (powdered tobacco) is a common addiction in the Indian subcontinent. In the western world, there is a resurgence of interest in nasal snuff because it does have the morbidity associated with smoked tobacco. Very few studies have reported the long-term effects of snuff on nasal mucosa. The objective of the present study was to investigate the effect of long-term use of snuff on the nasal mucosa.

MATERIALS AND METHODS

We conducted a retrospective study on 29 snuff users. We investigated the reasons for initiation of this particular form of addiction along with the clinical signs and symptoms of long-term snuff usage. At the time of the study, all patients complained of one or more nasal symptoms. Nasal obstruction and nasal discharge taken together were reported by 62.5% of patients. Gross mucosal edema of the septum and turbinates was the main finding on nasal examination. The absolute eosinophil count and total serum immunoglobulin E were elevated in 62.5% and 66.7% of patients, respectively. On skin prick test, 41% of patients reacted positively to snuff and 25% to tobacco. Histopathologic examination of the turbinates (16 patients) showed squamous metaplasia, capillary proliferation, capillary and venous dilatation, inflammatory cell reaction, subepithelial edema, and fibrosis.

CONCLUSIONS

Much has been written about the advantages of nasal snuff over products that deliver tobacco smoke. Our study shows that snuff users, after long-term abuse, develop a form of chronic rhinitis, as a consequence of which they develop blocked and stuffy noses. We conclude that nasal snuff is not a suitable substitute for smoked tobacco because it does not avoid ill health.

Evaluation of the clearance characteristics of various microspheres in the human nose by gamma-scintigraphy

The nasal cavity possesses many advantages as a site for drug delivery, such as; ease of administration, applicability for long-term treatments and a large surface area for absorption. One important limiting factor for nasal drug delivery is the limited time available for absorption within the nasal cavity due to mucociliary clearance. Several drug delivery systems including different kinds of microspheres have been tried for encapsulation of drugs and increasing the residence time in nasal cavity. In this study the clearance rate of three kinds of microspheres (Alginate, PLGA, and Sephadex) was determined by gamma-scintigraphy with lactose powder being used as negative control. (99m)Tc labeled microspheres were prepared using technetium pertechnetate in the presence of a potent reducing agent, stannus chloride. The labeling procedure was set in a manner that each 3-5 mg of microspheres contained 2 MBq of radioactivity. Labeling efficiency was calculated by paper chromatography using acetone as a mobile phase. Each delivery system containing 2 MBq of activity was administered into right nostril of four healthy volunteers and 1 min static views were repeated each half an hour until 4 h. Clearance rates were compared using two regions of interest (ROIs); the initial site of deposition of particles, and all of the nasopharynx region. The clearance rate of each one of microspheres was calculated after applying the physical decay corrections. The mean labeling efficiencies for Alginate, PLGA, and Sephadex microspheres were calculated as 60%, 59%, and 74%, respectively. The cleared percent of formulations from nasopharynx region after 4 h was determined as follows: PLGA microspheres 48.5 +/- 8.2%; Alginate microspheres 45.0 +/- 0.8%; Sephadex microspheres 63.1 +/- 3.4%; lactose powder 74.5 +/- 4.9%. Alginate and PLGA microspheres showed the lowest clearance rate compared to lactose powder (P < 0.0001 and P < 0.001, respectively), followed by Sephadex microspheres (P < 0.01). The clearance profiles of formulations from deposition ROI and nasopharynx ROI were identical. This study shows that Alginate and PLGA microspheres have the highest mucoadhesion properties and are suitable nasal delivery systems. Futhermore, this study proves that limiting step for the nasal clearance of nasally administered particulate systems is their dislocation from the initial site of deposition, and their following interactions with mucus layer in the rest of the nasal passage does not significantly affect the clearance time.

Evaluation of paranasal sinus mucosa in coal worker's pneumoconiosis: a computed tomographic study

OBJECTIVE

To evaluate by computed tomographic scanning the paranasal mucosal changes of coal workers with and without pneumoconiosis.

METHODS

Examination of images and scores from paranasal computed tomographic scans. The study participants were 26 coal workers with pneumoconiosis, 29 coal workers without pneumoconiosis, and 20 controls. All were men. The extent and patterns of inflammatory paranasal sinus disease were evaluated on computed tomographic scans by 2 radiologists using the terminology and definitions of Newman and associates.

RESULTS

Interobserver agreement for the presence of abnormalities was from good to excellent (kappa, 0.63-0.89). The mucosal scores of individuals and groups were higher for coal workers than for control subjects. Both scores were significantly higher in the pneumoconiosis group than in the 2 other groups.

CONCLUSIONS

This study shows that paranasal sinuses were affected more severely in coal workers than in control subjects. In coal workers with pneumoconiosis, the affection was most severe. The relationship between coal dust exposure and paranasal mucosal changes needs further study.

Ten-year experience using a plastic, disposable curette for the diagnosis of primary ciliary dyskinesia

BACKGROUND

Primary ciliary dyskinesia (PCD) results in impaired mucociliary clearance. Patients with this disorder develop chronic sinopulmonary disease with recurrent sinusitis, otitis media, nasal polyposis, pneumonia, and, ultimately, bronchiectasis. Other associated findings of dysfunctional ciliary activity include situs inversus, dextrocardia, and infertility.

OBJECTIVE

To describe our 10-year experience using a small, plastic, disposable curette to perform a screening procedure for cilia function and to collect samples for electron microscopy.

METHODS

In the past 10 years, we screened infants and children with severe chronic sinusitis and other chronic recurrent upper respiratory tract problems for PCD by using a plastic, disposable curette to collect tissue samples from the nasal mucosa. Samples were placed in sterile saline and examined under light microscopy for the presence of cilia. Failure to note ciliary movement prompted another examination 1 month later. If no functional cilia were noted at the follow-up examination, a specimen was obtained and sent for electron microscopy.

RESULTS

We identified 7 patients with PCD; 2 had situs inversus totalis. Average age at diagnosis was 3 years. The most common symptom at presentation was frequent upper respiratory tract infections with severe otitis media (7 patients) and sinusitis (5 patients). Recurrent pneumonia was present in 6 patients. Dynein arm deficiency was the most common electron microscopic diagnosis.

CONCLUSIONS

Evaluating children for PCD by using a plastic, disposable curette is a relatively simple procedure that could be used by allergists in practice. Primary ciliary dyskinesia occurs frequently enough that physicians should consider it as part of the differential diagnosis in evaluating children with recurrent, severe sinopulmonary infections.

Radiological study of the intumescentia septi nasi anterior

Intumescentia septi nasi anterior (ISNA) is a common anatomical variation that is not routinely noticed by surgeons or radiologists. ISNA is a mucosal bulging located on each side of the anterior part of the septum. The aim of this study was to investigate the prevalence of ISNA in different ages and sexes. In this study, computerized tomography (CT) scans of the paranasal sinus were obtained from 595 patients who had symptoms of chronic sinusitis. Among 595 subjects, ISNA was found in 332 (55.79 per cent) of subjects. It was found more frequently in males than females in every age group. Although ISNA is a common anatomical variation, it is generally overlooked. This is the first report on ISNA in different age groups and sexes.

Naturally draining ostium of an agger nasi cell: a case report

We describe the case of a 61-year-old woman who underwent functional endoscopic sinus surgery for chronic hyperplastic rhinosinusitis. During surgery, we were able to visualize the natural ostium of her left agger nasi cell. To our knowledge, such a finding has not been previously documented in the literature.

Reduced nitric oxide in sinus epithelium of patients with radiologic maxillary sinusitis and sepsis

Radiologic maxillary sinusitis is an important risk factor for development of bronchopneumonia in mechanically ventilated patients. Nitric oxide produced within the paranasal sinuses is considered to provide an antibacterial environment and to modulate mucociliary clearance function. We hypothesized that a reduced formation of nitric oxide might contribute to the compromised local host defense in radiologic maxillary sinusitis and measured nitric oxide levels directly within maxillary sinuses of septic patients with radiologic maxillary sinusitis (n = 11), whose sinuses were fenestrated to eliminate a possible septic focus. Data were compared with those of patients without airway inflammation (n = 11, control subjects). Despite local inflammation and infection, we found considerably lower maxillary nitric oxide levels than in control subjects (31 +/- 10 versus 2554 +/- 385 parts per billion, mean +/- standard error of the mean, p < 0.001). Consistently, immunohistochemical and in situ hybridization investigations revealed strongly reduced expression of inducible nitric oxide synthase. By applying ultrastructural immunolocalization, we identified cilia and microvilli of the maxillary sinus epithelium as the major nitric oxide production site in control subjects. Our findings provide evidence of markedly reduced nitric oxide production in maxillary sinuses of patients with radiologic maxillary sinusitis and sepsis, implicating impaired local host defense and an increased risk for secondary infections.

Morpho-functional evaluation of osteomeatal complex in chronic sinusitis by coronal CT

The objective was to determine whether or not there exists a clinical-radiological correlation in chronic sinusitis of anterior paranasal sinus and to quantitatively evaluate the importance of osteomeatal complex structures and anatomic variants in chronic sinusitis etiopathology. We analyzed 208 nasal fossae with high-resolution and low-irradiation coronal computed tomography. The following inclusion criteria we established: one case control and one control group. We considered any chronic thickness of sinusal mucosal as a radiological indicator of chronic sinusitis. We evaluated the mucosal thickness of internal, external, superior and inferior maxillary walls, the addition of four maxillary walls and the maximal mucosal thickness in frontal sinus and anterior ethmoidal cells. We also obtained 15 parameters of osteomeatal complex structures and anatomical variants in each nasal fossa, and we correlated them statistically with chronic sinusitis radiological indicators. Uncinate process length is the only anatomic element from which we have been able to obtain a statistically significant cut point between case and control groups, but only with a sensitivity of 51.6%, specificity of 71.2%, positive predictive value of 74.2%, and negative predictive value of 47.9%. No association of radiological parameters exists that can explain chronic sinusitis.

[Primary malignant melanoma of the nasal mucosa with orbital involvement. Case report]

Melanoma of nasal mucosa is a rare tumor, and only 0.5% of the malignant melanomas arises in the nasal cavities. This article reports a case of an achromatous melanoma localized in the nasal fossae, with orbital involvement and paresis of the extraocular muscles, which was studied by means of contrast-medium CT scan and histological and immunohistochemical evaluation. Of particular interest is the voluminous extension of the tumor mass upon initial diagnosis.

[Drug allergy among patients suffering from nasal polyps]

The study was performed in order to evaluate quantity and morphology of nasal polyps in patients with diagnosed drug allergy to aspirin, antibiotics, polocain, procain and other drugs. The study included 60 patients (27 females, 33 males aged between 18-69 years). Nasal polyp morphology was examined under electron microscope and light microscope. Morphological evaluation of epithelial and subepithelial structures was done under light microscope, taking not of inflammatory infiltration type, basal membrane, as well as degree of intestinal edema. Evaluation of epithelial cell type, their relative proportion, as well as area percentage covered by cilium, microvilli and squamous epithelium was done under electron microscope. Polyps in patients with idiosyncrasy to polish aspirin and sodium metamizole (12 patients) featured increased eosinophilic infiltration, thickened basal membrane, with elevated eosinophil percentage differential count. The epithelial percentage area was covered by squamous cells without villi. Polyps associated with idiosyncrasy to polish aspirin differed morphology compared to polyps originality from patients allergic to other medications. On the other hand polyps from patients allergic to other drugs, such as: penicillin, procainamide were morphologically (electron light microscope, light microscope) similar to those polyps caused by inflammatory factors.

Nasal mucociliary transport: new evidence for a key role of ciliary beat frequency

OBJECTIVES/HYPOTHESIS

Mucociliary transport is an important defense mechanism of the respiratory tract. Nonetheless, the factors determining mucociliary transport are only partially understood. Ciliary beat frequency is assumed to be one of the main parameters, although the experimental evidence remains inconclusive.

STUDY DESIGN

Comparing influences on mucociliary transport to influences on ciliary beat frequency.

METHODS

The present study measures the effects on mucociliary transport of two ciliary beat frequency-inhibiting compounds (0.1% xylometazoline and 0.9% NaCl) and a ciliary beat frequency enhancer (0.1% salbutamol). The measurements were performed by a technetium-99m nebulizing scintigraphic method. The experiments were carried out in 15 healthy young volunteers.

RESULTS

The 0.1% xylometazoline appeared to slow ciliary transport, although the decrease was not significant (P = .44). The 0.9% NaCl did reduce mucociliary transport significantly (P = .033). The 0.1% salbutamol resulted in a highly significant increase of mucociliary transport (P = .009). Xylometazoline brings about drastic changes in the nasal cavity, both anatomically and physiologically. Any comparison of mucociliary transport before and after using this vasoconstrictive agent must take this effect into account.

CONCLUSIONS

The present study demonstrates a significant similarity in the effects of NaCl and salbutamol on ciliary beat frequency in vitro and on mucociliary transport in vivo. The evidence from our experiments suggests that ciliary beat frequency is a determining factor in the mucociliary transport rate in the nose.

Eosinophilic rhinitis accompanies the development of lower airway inflammation and hyper-reactivity in sensitized mice exposed to aerosolized allergen

BACKGROUND

Allergic rhinitis is a risk factor for the development of asthma. About 80% of asthmatic patients also have rhinitis. However, the pattern of induction of allergic rhinitis and asthma remains unclear.

OBJECTIVE

The purpose of this study was to investigate the development of upper airway inflammation in mice during the development of an asthma-like disease and after an acute allergen provocation.

METHODS

BALB-c mice were sensitized intraperitoneally (i.p) to ovalbumin (OA, days 1-13) and were challenged with aerosols of either OA or saline on 8 consecutive days (days 33-40). In a second experiment, chronic exposure for 8 days was followed by 10 days of rest and then an acute nebulized allergen provocation was performed (day 50). Inflammatory parameters were investigated at different time-points.

RESULTS

Upper and lower eosinophilic airway inflammation were simultaneously induced in the course of repeated inhalations of nebulized OA, as shown by analyses of nasal and broncho-alveolar lavage fluids and histological sections of the nose and bronchi. Mice that developed bronchial hyper-responsiveness also had increased thickness of the nasal mucosa on magnetic resonance image (MRI) scans. When chronic exposure was followed by acute allergen provocation, the latter caused a systemic increase in IL-5 levels, with a concomitant rise in blood and airway eosinophils, primarily in the nose.

CONCLUSIONS

Simultaneous induction of eosinophilic inflammation in the nose and lungs was found in a mouse model of respiratory allergy. These findings support the viewpoint that upper and lower airway disease represent a continuum of inflammation involving one common airway and provide evidence for the concept of global airway inflammation after inhalation of allergen.