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Maxillofacial and Dental Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Although these fractures are best diagnosed clinically by finding focal bony tenderness, request facial X-rays including occipitomental views (OM 10° and OM 30°). Look carefully for the fractures, comparing with the normal side, orLook for secondary evidence of injury, e.g. opacity of the maxillary antrum from bleeding into the maxillary sinus or overlying soft-tissue swelling.Request a computed tomography (CT) scan for more complex injuries to the zygomaticomaxillary (malar) complex, or for an associated ‘blow-out’ fracture of the orbital floor.
Disorders of the Orbit
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Nithin D. Adappa, James N. Palmer
Imploding maxillary sinus or silent sinus syndrome is believed to originate from obstruction of the osteomeatal complex of the paranasal sinuses leading to hypoventilation of the maxillary sinus. This enclosed cavity in certain settings is thought to undergo air resorption, thus creating a suction effect of subatmospheric pressure within the maxillary antrum.34-36 The development of a pressure vacuum within the sinus, in turn, results in the accumulation of mucous into the antrum, subclinical inflammation and eventual collapse of the maxillary sinus through attenuation of the maxillary bony side walls. The hallmark of the disease is lack of traditional chronic sinusitis symptoms. Instead patients present with enopthalmos, occasionally with double vision as well.
Answers
Published in John D Firth, Professor Ian Gilmore, MRCP Part 2 Self-Assessment, 2018
John D Firth, Professor Ian Gilmore
E The CT scan shows soft tissue masses occupying the left nasal cavity, left ethmoid sinus, left maxillary antrum, and both orbits. The staining of neutrophils shows granular fluorescence of the cytoplasm typical of c-ANCA that in this clinical context virtually clinches the diagnosis of Wegener’s granulomatosis, which would be confirmed by a specific test for antibodies directed against proteinase-3 (PR3-ANCA).
Silent sinus syndrome: combined sinus surgery and orbital reconstruction – report of 15 cases
Published in Acta Oto-Laryngologica, 2019
Pedro Clarós, Aleksandra Zofia Sobolewska, Antonio Cardesa, Marta Lopez-Fortuny, Andres Claros
Another hypothesis called ‘mechanical’ suggests that movements of masticatory muscles can cause aspiration of sinus walls. Baujat et al. reported a case of conservative treatment of orbital fracture which ended with fat herniation into pterygopalatine fossa and collapse of the maxillary sinus. In case of maxillary antrum occlusion, the air is able to pass between pterygopalatine fossa and maxillary sinus, so constriction and relaxation of masticatory muscles may cause aspiration and subsidence of the sinus walls [3]. Admittedly, closure of the natural ostium of the maxillary sinus is a common finding among the patients with chronic sinus disease. However, the prevalence of SSS is very rare. So, another vital factor must contribute to the development of this syndrome besides just closure of maxillary ostium. In fact, one of the suggested reasons for bone erosion is increased activity of osteoclasts and absence of osteoblasts induced by inflammation in the unventilated sinus [12]. As well, diminution of the bone might be the result of osteomalacic changes caused by hyperaemia and negative pressure. Characteristic histopathological findings usually consist of thickening of basal membrane and lymphoplasmacytic infiltration of the sinus mucosa associated with chronic inflammation. Also, the importance of eosinophilic infiltration has been described in the literature [9]. In our cases, signs of compression atrophy of sinus mucosa and muco-eosinophilic secretion were present. So, the role of eosinophils in the pathogenesis of this condition might be relevant.
Rapid remodeling of the maxillary sinus in silent sinus syndrome
Published in Orbit, 2019
Jacqueline M. Jacobs, Eva L. Chou, Nathan T. Tagg
It is thought that the onset of symptoms can be acute because it is a manifestation of the spontaneous collapse of the maxillary antrum.8 However, previous literature has described the process of SSS as slowly progressive,9 insidious, and gradual with continued changes due to low grade inflammation.3 No exact time frame has been proposed for the course of the disease, but it is largely thought to be chronic. One case report showed normal premorbid sinus anatomy 3 years prior to diagnosis of SSS.10 Our patient had dramatic, image-documented remodeling of the maxillary sinus over the course of just 5.5 months, demonstrating that changes can occur on a much shorter time scale than previously reported.
Successful endoscopic endonasal surgery for very huge trigeminal schwannomas in nasopharynx
Published in British Journal of Neurosurgery, 2021
Duc-Anh Nguyen, The-Hao Nguyen, Hoang-Long Vo
The Brainlab Kick® neuronavigation was used. The posterior two-third of the right middle turbinate and both inferior turbinates were removed to approach the maxillary sinus. The maxillary ostium was identified and opening of the medial wall of the maxilla began through the ostium and progressed upward, downward, and posteriorly. The posterior ethmoid sinus was opened and widely exposed by angled forceps and rongeur to widely expose the maxillary antrum. After resecting the nasal septal bone, a nasal septal pediculated mucosal flap was easily removed laterally to extend the surgical field. Additionally, the sphenoidal sinus was also resected with a high-speed drill under endoscopic visualisation.