Search Results (188)

Tooth-bearing structures are commonly involved in the spread of various odontogenic lesions. Radicular and dentigerous cysts are among the most common odontogenic cysts, exhibiting significant variations in size and morphology within the jawbones. On the other hand, the influence of dental caries, periodontal diseases, and periapical lesions extends beyond tooth-bearing bone and also affects adjacent anatomical structures, especially the maxillary sinuses. In addition to untreated odontogenic lesions, treatment-related complications in the posterior maxilla may also disturb the sinus environment, particularly when oroantral communication is not recognized or adequately managed. The etiology of sinusitis is multifactorial; however, tooth-related infections are the primary cause of odontogenic sinusitis (ODS). Routine upper posterior tooth extraction may also become clinically significant when pre-existing sinus mucosal changes, close sinus floor proximity, or persistent oroantral communication are overlooked. When ODS is undiagnosed or overlooked on a classic computed tomography or a cone beam computed tomography (CBCT) scan, it is frequently inadequately managed by otolaryngological interventions alone; this leaves the underlying dental pathology unaddressed. Consequently, the utilization of CT/CBCT and close collaboration between dentists, oral surgeons, and otolaryngologists are essential for the successful management of these conditions. In advanced cases of ODS, isolated intranasal otolaryngological procedures are often insufficient. Comprehensive management relies on the elimination of all sources of odontogenic infection through endodontic therapy, dental extractions, and localized bone curettage. While the traditional Caldwell–Luc approach (CLA) is not commonly used nowadays, it remains an important surgical option in select cases, especially when infection spreads beyond tooth-bearing structures or soft tissue abscesses are present. This paper presents the radiological and clinical findings of two ODS cases with different etiologies and demonstrates how these findings influenced surgical planning. The aim is not to introduce the Caldwell–Luc approach as a novel technique but to illustrate its selective role when the direct treatment of the odontogenic source and oroantral defect is required. Full article

Background: Surgical removal of jaw cysts may result in bone defects that compromise local structural integrity and delay spontaneous regeneration. Photobiomodulation (PBM) has been proposed as a minimally invasive intraoperative adjunct capable of modulating osteogenic activity; however, translational evidence derived from freshly harvested human jawbone tissue remains limited. Objective: This study evaluated the effects of an intraoperative 980 nm PBM protocol on early osteogenic activity, osteoblast-like cell abundance, morphometric outcomes, and cell viability in primary human jawbone explants obtained during cystectomy. Materials and Methods: A comparative translational ex vivo study was conducted using cortical bone explants harvested from 40 patients undergoing surgical treatment of medium- to large-sized maxillary or mandibular cystic lesions. For each patient, one explant was exposed immediately after harvesting to pulsed 980 nm laser irradiation (20 J total energy; 40 J/cm² fluence), whereas the paired explant served as an untreated control. Explants were cultured using a primary outgrowth technique and subjected to osteogenic induction for 14 days. Osteogenic activity was evaluated by immunofluorescence staining for alkaline phosphatase (ALPL) and osteocalcin (OCN), followed by confocal microscopy and quantitative morphometric analysis. Cell viability was assessed using a live/dead fluorescence assay. Results: Viable cultures were successfully established from 34 patients (85% experimental yield). PBM-treated explants exhibited significantly greater osteoblast-like cell counts than paired controls (median: 2820 vs. 1525 cells; p < 0.001), together with greater cumulative osteoblastic area (median: 537,028 vs. 325,166 relative units; p < 0.001) and higher osteoblastic area occupancy (median: 19.00% vs. 11.75%; p < 0.001). Immunofluorescence analysis demonstrated qualitatively stronger ALPL and OCN expression in PBM-treated cultures. Cell viability did not differ significantly between paired PBM-treated and control cultures (Wilcoxon signed-rank test, p = 0.18). Conclusions: In this comparative ex vivo model, intraoperative 980 nm PBM significantly enhanced early osteogenic activity and increased osteoblast-like cellular abundance in human jawbone explants while maintaining cellular viability. These findings provide translational support for further investigation of PBM as a biostimulatory adjunct to enhance bone regeneration following cyst surgery. Full article

Background and Objectives: Unicameral bone cyst (UBC) is a benign cystic lesion originating from the metaphysis, often extending toward the diaphysis as the individual grows. It is more common in boys aged 5–15 years, typically affecting long bones like the humerus and femur. UBC is usually asymptomatic and found incidentally on imaging, with pathological fractures being a common complication. Treatment options include conservative observation, percutaneous injection, and surgery. This study aims to compare the diagnostic, treatment, and follow-up processes of UBC cases across multiple centers in our country. Materials and Methods: This study reviewed 180 UBC cases in patients aged 0–20 from seven clinical centers in our country. Patient demographics, symptoms, diagnostic methods, treatment approaches, and follow-up data were collected. Radiological and histopathological diagnostic accuracy, treatment methods (conservative, percutaneous injection, surgical), and recovery were analyzed using Musculoskeletal Tumor Society (MSTS) scores and Capanna criteria. Results: Among 180 patients, 50% had pain. Most diagnoses were made through radiographic imaging, with 96.1% diagnostic accuracy. The humerus (44.7%) and femur (30.7%) were the most commonly affected bones. Pathological fractures were found in 35% of cases. Treatment included conservative (19%), percutaneous injection (31.8%), and surgery (49.2%). The average follow-up period was 81 months, with early complications being skin issues and late complications primarily limb shortening. Conclusions: The study highlights the effectiveness of different treatment approaches for UBC, showing that surgical treatment offers the best clinical outcomes, while percutaneous injection is a less invasive option. Treatment should be tailored to individual patient needs. Full article

Background: Osteochondral lesions of the talus (OLT) remain a challenging condition due to the limited regenerative potential of articular cartilage. Conventional bone marrow stimulation (BMS) techniques often result in fibrocartilage formation with inferior biomechanical properties. This study aimed to evaluate the safety and preliminary clinical efficacy of an arthroscopically assisted, single-stage injection of a heparin-conjugated fibrin hydrogel (HCFH) for OLT treatment. Methods: Twelve patients with symptomatic OLT underwent arthroscopic debridement, microfracturing, and HCFH injection containing autologous mesenchymal stromal cells (MSCs) and growth factors. Safety was assessed through systematic monitoring of adverse events (graded according to Common Terminology Criteria for Adverse Events criteria), wound healing, and serial laboratory inflammatory markers (leukocytes, erythrocyte sedimentation rate, C-reactive protein) during early and late follow-up. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) and American Orthopedic Foot and Ankle Society score (AOFAS) preoperatively and at 6 and 12 months. Morphological assessment was performed using magnetic resonance imaging (MRI) with the modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system, evaluated independently by two blinded musculoskeletal radiologists. Results: No serious adverse events (Grade III–IV) were observed during the 12-month follow-up. All adverse events were mild (Grade I) and self-limited. A transient postoperative elevation in inflammatory markers was observed, returning to clinically acceptable levels by day 14. Significant improvements were noted in pain (VAS decreased from 6.0 to 2.0) and ankle function (AOFAS increased from 70.0 to 90.6) (p < 0.001). MRI demonstrated progressive morphological improvement, with the MOCART score increasing from 34.16 ± 17.1 at 6 months to 75 ± 5.43 at 12 months (p < 0.001). This increase corresponded with imaging features consistent with tissue maturation over time. The favorable MOCART outcomes observed in this study may be explained by the regenerative properties of heparin-conjugated fibrin hydrogels; however, larger randomized controlled trials with longer follow-up are needed to confirm the durability of the regenerated tissue. Interobserver agreement was substantial to almost perfect for MOCART scoring (κ = 0.68–0.84), with perfect agreement observed for surface assessment, bony defect/overgrowth, and cysts. Conclusions: Within the limitations of this study, single-stage HCFH injection demonstrated an acceptable safety profile and favorable preliminary clinical and radiological outcomes at 12 months. These findings suggest potential regenerative capability; however, controlled studies with larger cohorts and longer follow-up are required to determine comparative efficacy and long-term durability. Full article

Fibrous dysplasia is one of the most common skeletal lesions. The wide spectrum of clinical manifestations ranges from asymptomatic conditions (typical of monostotic forms) to severe skeletal diseases with deformity and fractures for polyostotic fibrous dysplasia. The classical radiological features include: an osteolytic geographic pattern, ground-glass bone matrix, cortical thinning/cortical scalloping, bone deformities and enlargement, concavity of margins (evaluated with MRI), and cystic areas (MRI). All the bones can be affected, and the proximal femur is the most common one (about 30% of cases). Nonetheless, the disease can also affect cranio-facial bones, leading to compression of neural structures, as well as deformation and enlargement of facial bones, leading to the so-called “leontiasis ossea” or “facies leonine”. The polyostotic forms of fibrous dysplasia can be associated with multiple soft-tissue myomas (Mazabraud syndrome) or several endocrine diseases (McCune–Albright syndrome). In every diagnostic step of the disease, as well as in different fibrous dysplasia forms, imaging plays a key role. Indeed, radiology is fundamental to assess the suspicion of fibrous dysplasia in classical monostotic forms, representing the sole diagnostic tool needed in many cases. Imaging is also fundamental to staging and following up on more severe polyostotic forms, as well as for detecting complications. In this comprehensive updated review article, we examine every aspect of the disease, with a main focus on imaging presentation. The indications for biopsy are discussed as well. Most importantly, the article details the potential risk of malignant transformation (osteosarcoma, fibrosarcoma, chondrosarcoma, and other rarer sarcomas, all accounting for <1% of cases) underlying the radiological patterns of these conditions. The occurrence of aneurysmal bone cyst-like changes on fibrous dysplasia is also analyzed in the article. This review article aims to be a comprehensive guide for radiologists and clinicians involved in the care of patients affected by various forms of fibrous dysplasia, and a starting point for future research. Many classical and atypical cases are collected as an iconographic comprehensive representation. Full article

Background and Clinical Significance: Mandibular cystic lesions are heterogeneous in biologic behavior, radiologic appearance, and surgical management. Treatment selection is influenced by lesion extent, cortical bone condition, structural stability, and proximity to adjacent teeth and vital anatomical structures. In large mandibular lesions, case-specific decision-making may range from staged decompression or marsupialization to single-stage enucleation, peripheral ostectomy, graft-assisted reconstruction, and preventive mandibular plating (PMP). Case Presentation: In the first case, a 60-year-old female presented with bilateral mandibular lesions: a dentigerous cyst on the right side, treated with marsupialization followed by enucleation, and a contralateral glandular odontogenic cyst (GOC) managed with primary enucleation alone. The second case involved a large, unilateral odontogenic keratocyst (OKC) managed with a radical approach, including enucleation followed by peripheral ostectomy and PMP. Histopathologic evaluation was performed in both cases to confirm diagnosis and support definitive treatment planning. Radiologic follow-up at 1 year demonstrated bone regeneration in all treated sites. Conclusions: This case report presents two different clinical cases involving three mandibular cystic lesions managed according to case-specific surgical indications and evaluated with standardized postoperative panoramic and CBCT imaging; limited supportive assessment of trabecular bone remodeling was also performed to further characterize radiologic healing patterns. The authors aimed to descriptively document postoperative bone condition, radiologic healing, and patient safety in these cases, and to highlight the most important surgical and radiological findings that may influence case-specific clinical decision-making. Full article

Background and Clinical Significance: Aneurysmal bone cyst (ABC) is a benign but locally aggressive osteolytic lesion that typically arises in the metaphysis of long bones in children and adolescents. Extension across an open proximal humeral physis into the epiphysis is uncommon and creates a diagnostic challenge because unicameral bone cyst and telangiectatic osteosarcoma may show overlapping radiological features. Case Presentation: A 12-year-old girl presented with pain and restricted motion of the left shoulder after a bicycle-related fall. Radiographs demonstrated a large expansile lytic lesion of the proximal humerus with cortical thinning and pathologic fracture. CT showed cortical ballooning, septation-like internal architecture, and extension across the open proximal humeral physis into the epiphysis. MRI demonstrated a multiloculated cystic lesion with thin internal septa and thin peripheral/septal enhancement, without nodular solid enhancement or a bulky extraosseous soft-tissue component. Curettage, bone cement filling, and elastic intramedullary nailing were performed. Histopathology, immunohistochemistry, and USP6 FISH analysis supported the final integrated diagnosis of ABC, although USP6 rearrangement was not detected. At 40 months, the patient was pain-free, had essentially normal shoulder motion, had returned to normal school and daily activities, and required no further surgery; radiographs showed stable remodeling without aggressive re-expansion. Conclusions: A focused literature review supports that frank transphyseal ABC is rare, particularly in the proximal humerus. The diagnostic contribution of this case lies in the integration of radiography, CT, MRI, histopathology, ancillary testing, and long-term clinical and radiographic follow-up. In a skeletally immature patient with a proximal humeral cystic lesion, transphyseal extension should prompt careful multimodality assessment. Imaging can substantially narrow the differential diagnosis, but integrated radiologic–pathologic confirmation remains essential when malignant mimics are possible. Full article

Computed tomography (CT) is used to support the diagnosis of equine temporomandibular joint (TMJ) disease; however, its diagnostic accuracy remains unclear. This study aimed to evaluate the relationship between CT findings and histopathological manifestations of osteoarthritis (OA) in equine TMJs. A total of 82 TMJs were CT-imaged, sampled, grouped into age-related and OA-related groups, and analyzed for frequency distributions, correlations, and CT-based TMJ OA diagnosis. CT findings were observed in 79% of joints, including ‘CT anatomical variations’ considering to reflect age-related remodeling. Only 50% of joints showed co-occurrence of CT findings and histopathological manifestations of OA, confirming that not all CT findings are indicative of disease. Including all CT findings in the CT-based diagnosis of TMJ OA yielded a specificity of 0.41 (95% CI: 0.26–0.58), suggesting a high rate of false-positive diagnoses. Excluding all ‘CT anatomical variations’ resulted in a sensitivity of 0.56 (95% CI: 0.40–0.72), indicating a substantial number of false-negative diagnoses. However, inclusion of specific ‘CT anatomical variation’—subchondral bone cysts—into the studied CT-based diagnosis increased sensitivity to 0.79 (95% CI: 0.62 to 0.89) while maintaining high specificity of 0.92 (95% CI: 0.80–0.98). Including this subset of CT findings in the diagnosis of equine TMJ OA may improve the accuracy of disease detection; however, the clinical relevance of the present cadaver investigation needs to be confirmed in in vivo studies. Full article

Objectives: To analyze the prevalence of bone changes in the temporomandibular joint (TMJ) and describe their distribution regarding age and sex using Cone Beam Computed Tomography (CBCT). Methods: This retrospective study analyzed CBCT images of 483 individuals (326 females, 157 males) retrieved from a computer database and assessed using the iCAT Workstation. Right and left condyles were evaluated for the presence of flattening, osteophytes, sclerosis, erosion, and subchondral cysts. Pearson’s chi-square test was used to identify potential associations between these alterations and demographic variables (p < 0.05). Results: At least one TMJ alteration was observed in 91.5% of the participants. Flattening was the most frequent finding (76.4%), followed by osteophytes (53%), sclerosis (32.3%), erosion (20.1%), and subchondral cysts (2.7%). No statistically significant association was found between gender and the presence of alterations (p > 0.05), with a high prevalence in both females (91.1%) and males (92.4%). However, specific degenerative changes showed a significant upward trend with age: osteophytes increased from 43.9% in patients under 20 to 68.9% in those over 60, while erosion doubled from 12.2% to 24.4% in the same groups (p < 0.05). Alterations were slightly more frequent on the left side (81.6%) than on the right side (76.6%). Conclusions: Degenerative TMJ changes are highly prevalent in the studied population, with flattening appearing as a widespread finding across all groups. While some specific alterations, such as osteophytes and erosion, show an increased prevalence in older age groups, these associations reflect a descriptive trend of bone remodeling over time rather than a direct causal relationship. Full article

Anterior cruciate ligament reconstruction relies on interference screw fixation, yet insufficient graft osseointegration remains a critical clinical challenge. This study aimed to develop and characterize a 3D-printed polymeric–hydroxyapatite composite interference screw with an osteoinductive surface to enhance localized osteogenic responses. Screws were designed, modeled, and fabricated using fused deposition modeling 3D printing with a polycaprolactone-poly(lactic-co-glycolic acid)-hydroxyapatite composite. Physico-chemical characterization was performed using scanning electron microscopy. Biocompatibility was assessed through mesenchymal stem cell metabolic activity assays and morphological analysis. Osteogenic gene expression was quantified by RT-qPCR following culture in osteogenic differentiation medium. In vivo osseointegration was evaluated histologically at five and nine weeks following implantation in the proximal tibial epiphysis of a rat model. 3D printing successfully produced screws with consistent geometry and surface characteristics. The composite material supported robust mesenchymal stem cell proliferation without cytotoxicity or morphological abnormalities. Histological examination revealed progressive bone formation with no adverse tissue reactions, including the absence of cyst formation, osteolysis, or excessive fibrosis. RT-qPCR revealed upregulation of osteogenic markers in those enhanced screws. These results indicate that the 3D-printed polymeric–hydroxyapatite composite screws are biocompatible and capable of stimulating localized osteogenic activity, supporting their potential as a biological foundation for future evaluation in anterior cruciate ligament reconstruction applications. Full article

Background and Objectives: Subcortical bone cysts at the tibial attachment of the medial meniscus posterior root (MMPR) may reflect chronic degenerative changes; however, their clinical significance in medial meniscus posterior root tear (MMPRT) remains unclear. This study assessed whether bone cysts are associated with symptom duration and whether their presence influences healing status or medial meniscus extrusion (MME) after transtibial pullout repair (TPR). Materials and Methods: Seventy-four consecutive patients who underwent arthroscopic TPR for MMPRT between January 2022 and December 2024 were retrospectively reviewed. After applying exclusion criteria, 50 patients were included and divided into cyst-positive (n = 20) and cyst-negative (n = 30) groups based on preoperative MRI findings. Clinical outcomes, MME, and second-look arthroscopic healing status at 6 months postoperatively were compared between groups. Multivariable linear regression analysis was performed to identify independent predictors of postoperative MME. Results: The cyst-positive group had significantly longer symptom duration than the cyst-negative group (13.8 ± 3.0 vs. 8.8 ± 2.8 weeks, p < 0.001) and demonstrated higher grades of MMPR degeneration (p < 0.05). Complete healing was observed in 60.0% of patients in each group, and no failed healing cases were noted. Postoperative MME at 6 months was comparable between groups (3.8 ± 0.8 vs. 3.8 ± 1.0 mm). Multivariable regression analysis identified baseline MME as the strongest independent predictor of postoperative MME (β = 0.67, p < 0.001), whereas bone cyst presence was not independently associated with postoperative extrusion. Conclusions: Subcortical bone cysts at the MMPR attachment are associated with longer symptom duration and more advanced root degeneration. However, their presence was not significantly associated with healing status or postoperative MME after MMPRT repair. These findings suggest that bone cyst formation may be associated with chronic degenerative changes at the root attachment, but should not discourage surgeons from performing root repair. Full article

Introduction: Odontogenic sinusitis (ODS) is an underrecognized cause of maxillary sinus inflammation and is frequently associated with dental, periodontal, endodontic, and iatrogenic factors. Accurate identification of the odontogenic source is essential for appropriate treatment planning. Cone-beam computed tomography (CBCT) allows detailed evaluation of the maxillary sinus, adjacent teeth, alveolar bone, and periodontal structures, and may improve the radiologic differentiation of ODS. Materials and Methods: This retrospective observational study analyzed radiologic data from patients evaluated and treated by the authors for suspected odontogenic sinusitis between 2019 and 2026. The final study group included 85 patients with CBCT-based evidence of odontogenic pathology affecting the maxillary sinus. CBCT scans were reviewed to identify tooth-related and treatment-related etiologic factors associated with ODS. Based on the radiologic findings, the authors developed a CBCT-based classification of odontogenic etiologies and proposed an imaging-guided management algorithm. Results: CBCT identified a broad spectrum of odontogenic factors associated with maxillary sinus disease. The most relevant radiologic patterns included endodontic and periapical pathology, periodontal or combined endo-periodontal disease, post-extraction inflammatory changes, odontogenic cysts, oro-antral communication or fistula, retained roots or teeth, displaced endodontic materials, and grafting or implant-related complications. These findings were organized into 16 radiologic categories reflecting the principal etiologic pathways of ODS. The proposed classification facilitated correlation between radiologic presentation and the recommended dental, surgical, and otolaryngologic treatment approach. Conclusions: CBCT is a valuable imaging modality for identifying odontogenic causes of maxillary sinus inflammation and provides more precise diagnostic information than conventional radiography alone. A structured CBCT-based evaluation may improve etiologic diagnosis, support multidisciplinary decision-making, and help guide individualized management of patients with ODS. Full article

Background: Aneurysmal bone cysts (ABCs) of the proximal humerus in children are rare, locally aggressive lesions associated with substantial recurrence rates and risk of structural instability. Conventional treatment by curettage and bone grafting is often limited by recurrence, while selective arterial embolization (SAE) alone may not provide sufficient structural support. This study evaluates a single-stage treatment strategy combining embolization and structural reconstruction to address both the vascular and mechanical components of the disease. Methods: A retrospective analysis was performed on 12 pediatric patients (median age 9 years) with proximal humerus ABCs treated between 2020 and 2024. All patients underwent a standardized single-stage protocol consisting of preoperative SAE, intralesional resection with high-speed burr, and reconstruction using an allogeneic fibula graft combined with cancellous bone augmentation. Radiological consolidation, recurrence, and functional outcomes were assessed. Associations between prior surgery, cyst size, and recurrence were analyzed. Results: Primary consolidation was achieved in 75% of patients, with an overall healing rate of 91.7% after secondary interventions. Recurrence occurred in 16.7% of cases and was significantly associated with prior surgical treatment (p = 0.045). No significant correlation was found between cyst size and recurrence (p = 0.151). At final follow-up (median 8.5 months), all patients demonstrated complete healing according to the modified Neer classification following completion of treatment. Functional outcomes were favorable, with 91.7% of patients regaining full range of motion and no neurovascular complications observed. Conclusions: The presented single-stage approach combining SAE, intralesional resection, and structural allograft reconstruction addresses both the vascular supply and mechanical instability of proximal humerus ABCs. This strategy demonstrated high healing rates and favorable functional outcomes, with acceptable recurrence rates in this cohort while avoiding donor site morbidity. It represents a practical and effective treatment concept for this rare pediatric condition. Full article

Background/Objectives: The radiological and clinical outcomes of elastic stable intramedullary nailing (ESIN) for pediatric humeral solitary bone cysts (SBCs) were assessed, with particular attention to healing, recurrence, complications, and functional recovery. Methods: This retrospective institutional study included 25 children with humeral solitary bone cysts treated with elastic stable intramedullary nailing between January 2019 and December 2025. Patients treated exclusively with ESIN and with a minimum follow-up of 12 months were included. Radiographic healing was assessed using the Capanna classification. Clinical outcomes included pain, range of motion, complications, refracture, and recurrence. Results: The cohort consisted of 16 boys (64%) and 9 girls (36%), with a median age of 11 years. Pathological fractures were present in 56% of cases. A total of 29 surgical procedures were performed, including growth-related implant exchanges in selected patients. Cyst dimensions decreased progressively during follow-up (p < 0.001). At final evaluation, 64% of lesions demonstrated complete healing (Capanna I), 28% incomplete healing (Capanna II), and 8% recurrence (Capanna III); no cases of non-response were observed. No recurrent fractures or postoperative complications occurred. Pain resolved within one month in all patients, and a full range of motion was restored. Conclusions: Elastic stable intramedullary nailing appears to provide reliable stabilization and promotes cyst healing in pediatric humeral SBCs, with low recurrence rates and excellent functional outcomes. Full article

Radicular cysts (RCs) represent the most frequent inflammatory cystic lesions of the jaw, typically arising from non-vital teeth. While standard management via enucleation is well-documented, complex cases involving the anterior maxilla present significant surgical challenges due to their proximity to the nasal cavity floor (NCF) and the maxillary sinus floor (MSF). This report provides a comprehensive revision of a clinical case series involving seven patients (ages 17–50) treated with multimodal surgical and regenerative protocols. The patients were stratified into five distinct anatomical risk groups (A–E) based on the integrity of the bony boundaries and the presence of oronasal communications. The treatment strategies combined meticulous cyst enucleation with advanced regenerative techniques, including platelet-rich fibrin (PRF), allogeneic and xenograft bone substitutes, and local flaps such as the buccal fat pad (BFP). The results across all seven cases demonstrated favorable clinical and radiographic outcomes, with no instances of oronasal fistula formation or recurrence during follow-up periods ranging from 12 months to three years. This report emphasizes the necessity of structured anatomical stratification and multimodal planning to ensure scientific precision and surgical predictability in the management of complex maxillary lesions. The differences between approaches towards the nasal cavity and maxillary sinus have to be highlighted. Further studies with larger cohorts are warranted to evaluate the long-term outcomes of different treatment modalities. Full article