A Retrospective Study on Silent Sinus Syndrome in Cone Beam-Computed Tomography Images—Author Classification Proposal

Round 1

Reviewer 1 Report

The CT images in Manuscript are very nice. However, in order to improve the quality of the paper, many parts need to be revised (major revision).

1.Since the number of cases finally included in the paper is small, it seems preferable to write a case series rather than a retrospective study.

2.Statistical processing is meaningless because the case number is small, and it is desirable to record only the frequency (%).

3.In Table 5 and Table 6, only the frequency needs to be recorded. The p-value is meaningless.

4. SSS and CMA are types of MSH. Since MSH is caused by various causes, it is difficult to identify etiology, and it is thought that it can be classified by estimated factors. For the classification of MSH, the method of "Bolger et al." is widely used and cited. Bolger's article was not cited in this manuscript, but the authors read, describe, and add the references to the paper below.

"Bolger et al. Maxillary sinus hypoplasia: Classification and description of associated uncinate process hypoplasia. Otolaryngol Head Neck Surg. 1990; 103: 759-765"

5. One of the causes of MSH is "Inferior Meatus Pneumatization". Read, describe, and insert the papers below into the references.

---"Park et al. Long-term outcomes of the implants accidentally protruding into nasal cavity extended to posterior maxilla due to inferior meatus pneumatization. Clin. Implant Dent. Relat. Res. 2020; 22: 105-111."

6.In the manuscript, there were 7 classifications of SSS, which are too cumbersome to apply to diagnosis. To be more concise, classify them into three categories.

Author Response

Dear reviewer thank You very much.

Response to Reviewer 1 Comments

 

Point 1.  The CT images in Manuscript are very nice. However, in order to improve the quality of the paper, many parts need to be revised (major revision).

Response 1: Please provide your response for Point 1. (in red) thank you –

 

Point 2.  Since the number of cases finally included in the paper is small, it seems preferable to write a case series rather than a retrospective study.

Response 2: Please provide your response for Point 2. (in red) thank you – Authors dont agree on case series, since SSS/CMA pathologies are rare findings, mostly undiagnosed and quite often diagnosed not correctly. Thanks to Authors proposal based on the following patient database, the world literature can influence greately on atuhors paper. Second issue concern the toatal amount of patients diagnosed with CBCT radiographs, and such a findings as SSS/CMA are still rare. Case series is not usitable for this kind of study

 

Point 3. Statistical processing is meaningless because the case number is small, and it is desirable to record only the frequency (%).

Response 3: Please provide your response for Point 3. (in red) thank you – statistical evaluation had been made according to the methods section described in the paper and, mayby the numbers are small, they do add up. Second thing is, because of small number of cases, special statystical approach was used, as presented in the paper. Similar issues were present in the past, but they had been improved accoridng to internationally used examples

 

Point 4.In Table 5 and Table 6, only the frequency needs to be recorded. The p-value is meaningless.

Response 4: Please provide your response for Point 4. (in red) thank you – same as in point 3 – the method for statystical analysis was specialy used to investigate small number of patient cases, and improved to evaluate presented small amount of cases

 

Point 5. SSS and CMA are types of MSH. Since MSH is caused by various causes, it is difficult to identify etiology, and it is thought that it can be classified by estimated factors. For the classification of MSH, the method of "Bolger et al." is widely used and cited. Bolger's article was not cited in this manuscript, but the authors read, describe, and add the references to the paper below.

"Bolger et al. Maxillary sinus hypoplasia: Classification and description of associated uncinate process hypoplasia. Otolaryngol Head Neck Surg. 1990; 103: 759-765"

Response 5: Please provide your response for Point 5. (in red) thank you – The article of Bolger et al. Focuses on MSH cases mostly. Nowadays the SSS amd CMA pathologies are not related with MSH, thats why AUTHORS WANTED TO PRESENT their own point of view, based on CBCT database and patients treated by Authors. Bolger also evaluated sinus CT, not CBCT and co-related not-sinus realted factors.  Citing this paper will not add to the current article.

 

 

 

 

Point 6. One of the causes of MSH is "Inferior Meatus Pneumatization". Read, describe, and insert the papers below into the references.

---"Park et al. Long-term outcomes of the implants accidentally protruding into nasal cavity extended to posterior maxilla due to inferior meatus pneumatization. Clin. Implant Dent. Relat. Res. 2020; 22: 105-111."

Response 6: Please provide your response for Point 6. (in red) thank you – on behalf of myself and all co-Authors I dont see the meaning and clue of citing this articles. Its pointless and doesnt add to the article itself.

 

Point 7. In the manuscript, there were 7 classifications of SSS, which are too cumbersome to apply to diagnosis. To be more concise, classify them into three categories.

Response 7: Please provide your response for Point 6. (in red) thank you – as the paper stands for, this is Authors own proposal based on clinical and radiological data. Secondly further studies are ongoing to investigate this matter. Perhaps in the future the classification will be changed. Please not that there is not only 7 classification of SSS, but it is focused on other sinus-related pathologies like CMA and MSH also. Its impossible to change anything, since it Will not match Authors findings.

Because Authors are not presenting their findings accoridng to some specific guidelines, but are presenting their own point of view and proposal for classification, Its not possible to change the paper. Everyone can suggest their own method of classification, and it should be considered as a valuable addition to current literature, and not like and unnecessary evil.

Thank you

 

Author Response File: Author Response.docx

Reviewer 2 Report

The authors have proposed an interesting study evaluating the effect of maxillary sinusitis and silent sinus infection.

The study purpose to classify SSS/CMA is interesting but it is difficult to see the clinical impact of the differentiation between the classifications. Furthermore, the classification is difficult to understand without an organized table showing the differences between classification of CMA and SSS.

 

In all, the study is very interesting and important but the manuscript needs to be revised to ensure that the work can be used in a clinically meaningful way.

The language is now quite up to scientific level of publication. Suggestions for corrections:

L36: I would suggest that the authors remove “try” from the sentence, as the authors propose a classification.

L45: “Doesn’t” should be written, “does not”.  

L41: “Own patients database” this sentence is not appropriate as it does not make sence. The database is composed of patients treated at the dep. of OMF surgery and as such is not the property of the authors. This should be clarrified.

 

Author Response

Response to Reviewer 2 Comments

 

Comments and Suggestions for Authors

The authors have proposed an interesting study evaluating the effect of maxillary sinusitis and silent sinus infection.

Thank you dear reviewer for kind words

 

 

Point 1.  The study purpose to classify SSS/CMA is interesting but it is difficult to see the clinical impact of the differentiation between the classifications. Furthermore, the classification is difficult to understand without an organized table showing the differences between classification of CMA and SSS.

Response 1: Please provide your response for Point 1. (in red) thank you – the table 1 + table 3 ilustrates SSS pathology, and fully describes the problem, while in the following text a single explanation on SSS/CMA differences is present – namely SSS is sympless in CRS – chronic rhinosinusitis – see line: 97-112. I hope some slight changes will help to understand most issues raised. Thank you

„….SSS is a spontaneous painless progressive unilateral collapse of the maxillary sinus and orbital floor with complete or partial opacification of the collapsed sinus with the absence of trauma, tumors, chronic rhinosinusitis (CRS), and surgery-related factors. SSS typical characteristics in some cases might vary because of possible CRS presence, as well as lack of full MS opacification or OMC blockage, along with other modifications of clinical and radiological symptoms reported widely [4-12]. Some Authors distinguish the SSS and chronic maxillary atelectasis (CMA). The MS walls atelectasis  quite often results in painless enophthalmos, hypoglobus, and mid-facial asymmetry, however, sometimes atypical SSS manifestations might be also present [17-19]. Severe cases might include diplopia without extraocular eye movement disruption. From the Authors’ perspective, the clinically present CRS might be helpful to distinguish some visualized in CT/CBCT (computed tomography/cone beam computed tomography) radiological pathologies. For years SSS was the topic of some studies and investigations, mostly because of the influence on eye socket displacement, facial and maxillary asymmetry, and maxillary sinus volume loss with the coexistence of its decreased ventilation through the osteomeatal complex (OMC)[12-15].

 

 

 

 

 

 

 

Point 2.   In all, the study is very interesting and important but the manuscript needs to be revised to ensure that the work can be used in a clinically meaningful way.

Response 2: Please provide your response for Point 1. (in red) thank you – the necessary revision and advices had been improved

 

 

Point 3. Comments on the Quality of English Language

The language is now quite up to scientific level of publication. Suggestions for corrections:

L36: I would suggest that the authors remove “try” from the sentence, as the authors propose a classification.

L45: “Doesn’t” should be written, “does not”. 

L41: “Own patients database” this sentence is not appropriate as it does not make sence. The database is composed of patients treated at the dep. of OMF surgery and as such is not the property of the authors. This should be clarrified. à database collected by Authors

Response 3: Please provide your response for Point 3. (in red) thank you – changes made in text

 

Dear rewiever, thank you very much for help. Your kind and wise insights are very valuable, and perhaps could increase this article chances for publishing, since its a very intersting because of classification proposal based on gathered data.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The revision of the manuscript was well done.

Reviewer 2 Report

The authors have performed an acceptable revision of the manuscript. I believe that the manuscript can be excepted in the current form.

Acceptable.