Search Results (427)

Background/Objectives: The aim of this study was to compare two methods for maxillary sinus volume measurement, assessing their accuracy. The analysis compared the maxillary sinus volume in patients with unilateral cleft lip and palate (UCLP) and in a non-cleft group, using a manual method and a three-dimensional (3D) semi-automated segmentation method. Methods: The research was conducted according to the STROBE guidelines. Sixty patients were included in this study: thirty patients with UCLP were in the research group, and the control group consisted of 30 patients with no craniofacial deformities. Cone-beam computed tomography (CBCT) was analyzed. The manual maxillary sinus volume was calculated based on its approximation to two geometric shapes based on mathematical formulas using linear measurements that were performed on all sinus CBCT scans in the maximum diameter in three planes. The semi-automatic segmentation method using ITK-SNAP 3D-imaging software version 4.2.2 was used to automatically calculate the maxillary sinus volume of the sinuses. The manually calculated volume was compared with the automatically calculated one, and statistical analysis was performed. Results: The cleft group presented lower values in both the automatic and manually calculated volumes for both the right (automatic: p = 0.49; manual p = 0.009) and left (automatic: p = 0.46; manual p = 0.11) maxillary sinuses than the non-cleft group. The cleft group presented statistically significant higher discrepancies in values between the manual and semi-automatic method than the control group (RMSV p = 0.0011; LMSV p = 0.033; TMSV p = 0.003). Conclusions: The manual method may not reveal the exact anatomical topography of the maxillary sinuses. In UCLP patients, the maxillary sinus anatomy may be more complex. Therefore, a semi-automated method may be more advisable to preserve the accuracy of the measurements. Full article

The maxillary sinus is frequently implicated in facial pain syndromes arising from infection, neoplasia, dental procedures, and, importantly, migraine, which can mimic “sinus headache” and contribute to misdiagnosis and inappropriate antibiotic use. Despite the clinical burden of chronic maxillary sinus pain, the sensory neuron subtypes that convey nociceptive and mechanosensory signals from the sinus mucosa remain incompletely defined. In this study, trigeminal ganglion (TG) neurons innervating the maxillary sinus (maxillary sinus TG neurons) were retrogradely labeled with the fluorescent dye DiD in mice and characterized using ex vivo patch-clamp electrophysiology and single-cell RT-PCR. Maxillary sinus TG neurons were found to be predominantly small-diameter, C-afferent nociceptors with electrophysiologic features including high thresholds, repetitive firing, and broad action potentials. Notably, maxillary sinus TG neurons formed a distinct molecular and functional subgroup: they expressed Nav1.9, while showing minimal Nav1.8 expression and limited overlap with Nav1.8-positive nociceptor populations. A majority of maxillary sinus TG neurons were mechanically responsive, generating mechanically activated currents with heterogeneous adaptation profiles, and a subset expressed the mechanoreceptor Piezo2. Collectively, these findings identify maxillary sinus TG neurons as a specialized population of Nav1.9-enriched C-afferent nociceptors with mechanosensitive properties, providing a mechanistic framework for pressure-evoked sinus pain. This work advances the neurobiological basis of sinus-related pain and suggests that Nav1.9 and mechanoreceptor pathways may be potential therapeutic targets for conditions in which sinus symptoms overlap with migraine and other craniofacial pain disorders. Full article

Background/Objectives: The aim of this study was to develop a novel Nasal Spine-Guided Classification for assessing the alveolar vertical extension of the maxillary sinus and to evaluate its anatomical relationship with the roots of the posterior teeth using CBCT in a Saudi subpopulation. Methods: Maxillary sinus pneumatization was measured using cone-beam computed tomography for 380 patients. The assessment was performed along a horizontal plane extending between anterior and posterior nasal spine. In addition, pneumatization was evaluated in edentulous areas, and between the roots of multi-rooted teeth. Maxillary sinus membrane thickness was also measured. The results were expressed as mean, median and interquartile range, and considered statistically significant at a p-value < 0.05. Results: The mean maxillary sinus pneumatization on the left side was 8.8 ± 4.32 mm, and 8.58 ± 4.85 mm on the right side, with no statistically significant difference. The median of pneumatization in the edentulous area and between the roots on left side were 5.1 and 3.8 mm respectively, while on the right side, the median pneumatization was 5.03 and 3.04 mm. In addition, the proximity of the maxillary root apices to the sinus floor revealed a zero distance in 80.49% of the roots on the left side and in 79.48% on the right side. Furthermore, the results indicated no statistically significant association between maxillary sinus membrane thickness and pneumatization in the edentulous area. Conclusions: CBCT analysis revealed a predominance of advanced maxillary sinus pneumatization (Class III) and a high frequency of direct contact between posterior maxillary root apices and the sinus floor in the studied population. Additionally, no significant association was identified between maxillary sinus membrane thickness and sinus pneumatization in edentulous areas. Full article

Background/Objectives: The sphenoid sinus (SS) exhibits marked morphological variability, influencing the relationship of critical neurovascular skull base structures. This study aimed to characterize sphenoid sinus pneumatization (SSP) patterns and assess their impact on the course of the internal carotid artery (ICA), optic nerve (ON), Vidian nerve (VN), and maxillary nerve (MN) within a Greek adult population. Methods: A retrospective analysis of 253 adult skull base computed tomography (CT) scans was performed. The degree and direction of SSP were classified according to established radiological criteria. Anterior, lateral, and posterior extensions were evaluated. The course of adjacent neurovascular structures was categorized as typical, protruding, or dehiscent. Associations between pneumatization types and neurovascular variants were analyzed. Results: The sellar complete type was the predominant SS pattern (63.2%), followed by sellar incomplete (27.7%) and presellar (8.7%) types; agenesis was rare (0.4%). Posterior (63.6%) and lateral (46.6%) extensions were most common. Lateral and posterior pneumatization significantly correlated with protrusion and/or dehiscence of adjacent neurovascular structures, particularly the ICA, ON, and VN. LW extension was strongly associated with ON protrusion (96%), while PP and full-lateral extensions correlated with VN protrusion (56.1% and 79.9%, respectively). No significant sex- or side-related differences were identified. Conclusions: SSP demonstrates extensive morphological variability that significantly affects the anatomical course and osseous coverage of neighboring neurovascular structures. Comprehensive preoperative CT evaluation of SS anatomy is essential for planning endoscopic transsphenoidal and extended skull base procedures to minimize the risk of neurovascular injury. Full article

Background: Accessory ostia (AOs) can notably alter maxillary sinus ventilation, yet configuration-specific effects remain unclear. This study quantified how AO location and orientation regulate sinus ventilation using in vitro measurements and numerical analyses. Methods: One patient-specific sinonasal geometry (control) was used to reconstruct five models with varying AO numbers, locations, and orientations (AO-F, AO-FC, AO-F30, AO-B, AO-FB). E-vapor was used as a visual tracer for sinus clearance under breath-hold and quiet breathing conditions. Complementary simulations characterized flow dynamics and sinus ventilation rates. Results: Both inhalation and AO presence accelerate e-vapor clearance for all conditions considered. The e-vapor clearance time in AO-FB decreases from 51 s under breath-hold to 29 s under quiet breathing (1 m/s). Configuration-wise, posterior AO ventilates the sinus faster than anterior AO, with dual anterior–posterior ostia (AO-FB) consistently performing the best. Among the three anterior AO, an uptilt AO ventilates the sinus faster than a parallel one, which is in turn faster than an AO located closer to the natural ostium (NO), i.e., AO-F30 > AO-F > AO-FC. CFD predictions provide a mechanistic understanding of the configuration-specific differences observed in vitro. Flow patterns in the ostium–sinus region, as well as the ventilation rate and driving pressure, show high sensitivities to AO location and orientation. At 1 m/s, the predicted AO-NO pressure drop ranges 2–18 mPa, with the lowest in AO-FC and highest in AO-B. Conclusions: The high sensitivity of sinus ventilation to AO configurations underscores the clinical importance of examining NO-adjacent openings in surgical planning and physiological interpretation. Full article

Objectives: This study aimed to develop and validate a hybrid deep learning model combining Convolutional Neural Networks (CNN) and Vision Transformers (ViT) to automatically classify maxillary sinus membrane morphologies on Cone-Beam Computed Tomography (CBCT) images, distinguishing between Normal, Flat, Polypoid, and Obstruction types. Methods: A dataset of 959 CBCT images was collected and categorized into four morphological classes: Normal, Flat, Polypoid and Obstruction. A custom hybrid model was developed, integrating a lightweight residual CNN for local feature extraction, learnable weighted feature fusion with a bidirectional feature pyramid network and a Transformer encoder for global context modeling. The performance of proposed model was compared against six different architectures, including ResNet50, MobileNetV3L and standard ViT models, using accuracy, precision, recall and F1-score metrics. Results: The proposed hybrid model achieved the highest overall accuracy of 98.44%, outperforming six strong CNN and ViT models including ResNet50 (97.92%) and ViT-B16 (86.46%) models. In class-wise analysis, the model demonstrated superior diagnostic capability, particularly for the “Obstruction” class, achieving 100% accuracy. High discrimination was also observed for “Flat” (98.21%) and “Polypoid” (98.04%) morphologies, confirming the model’s sensitivity to shape-based features. Conclusions: The proposed hybrid CNN-ViT model successfully classifies maxillary sinus membrane morphologies with high accuracy, effectively overcoming the limitations of standard ViT models on limited datasets. Detection of membrane morphology is vital for predicting surgical risks like membrane perforation and post-operative sinusitis. This model serves as a reliable clinical decision support tool, enabling clinicians to objectively assess specific risk factors before implant surgery and sinus floor elevation. Full article

Background: Odontogenic sinusitis (ODS) represents a distinct form of maxillary sinus inflammation arising from dental pathology and is most commonly unilateral. Despite its polymicrobial nature and predominance of anaerobic organisms, molecular characterization of the bacterial profile and its relationship to clinical severity remains limited. This study aimed to evaluate associations between targeted quantitative PCR (qPCR) findings from paired maxillary sinus and periapical lesion samples and clinical, endoscopic, and radiological features of disease. Additionally, the influence of oroantral communication on microbial concordance between odontogenic and sinus sites was examined. Methods: Twenty-eight patients with confirmed ODS were included for analytical cross-sectional study and underwent combined otolaryngological and dental assessment. During endoscopic sinus surgery with extraction of the causative tooth, paired specimens were collected from sinus mucosa and periapical lesions under sterile conditions and preserved for molecular analysis. Targeted qPCR assays using 16S rRNA–based primers were performed to detect predefined odontogenic pathogens. Associations between bacterial detection patterns and clinical, endoscopic, and imaging variables were analyzed. Results: Detection of Streptococcus anginosus group organisms was significantly associated with complete maxillary sinus opacification. Fusobacterium nucleatum and Porphyromonas endodontalis demonstrated higher detection rates in patients with more advanced radiological disease, although statistical significance was not reached. Purulent nasal discharge correlated with detection of Fusobacterium nucleatum, Porphyromonas endodontalis, and streptococcal species. Cases with intraoperative oroantral communication exhibited greater concordance between sinus and dental microbial profiles. Conclusions: ODS is characterized by a polymicrobial environment dominated by anaerobic bacteria, with specific organisms associated with markers of disease severity such as purulent secretion and extensive sinus opacification. Targeted molecular profiling may improve recognition of odontogenic origin and support individualized therapeutic strategies, although larger studies integrating clinical outcomes are required to clarify prognostic implications. Full article

Background: Rehabilitation of the severely atrophic maxilla remains a major challenge in implant dentistry, particularly when conventional endosseous implants and regenerative procedures are contraindicated due to extensive bone loss, sinus pathology, or patient-related factors. Advances in digital planning and additive manufacturing have enabled the reintroduction of juxta-osseous subperiosteal implants as a graftless, patient-specific treatment option. This case report aimed to describe the complete digital workflow, surgical placement, and immediate prosthetic rehabilitation of a customized juxta-osseous subperiosteal implant in a patient with severe posterior maxillary atrophy and a history of failed sinus augmentation procedures. Case Presentation: A 75-year-old male patient presenting with left severe posterior maxillary atrophy and previous unsuccessful sinus lift surgeries was rehabilitated using a digitally designed, additively manufactured titanium subperiosteal implant. Cone-beam computed tomography–based planning and CAD–CAM technology were used to design a patient-specific framework, which was rigidly fixed to stable maxillofacial support and immediately loaded with a screw-retained provisional prosthesis. Results: Clinical and radiographic follow-up demonstrated stable implant fixation, soft tissue healing, absence of biological or mechanical complications, and satisfactory functional and aesthetic outcomes. The patient reported high levels of comfort and satisfaction throughout the treatment period. Conclusions: Digitally manufactured juxta-osseous subperiosteal implants may represent a predictable and minimally invasive graftless alternative for selected patients with severe maxillary atrophy, particularly when conventional implant placement or extensive bone augmentation is not feasible. Accurate digital planning, rigid fixation, and appropriate patient selection appear to be key factors for clinical success. Full article

Previous cases of trigeminal neuralgia (TN) caused by fungal sinusitis have been reported, but mainly in immunocompromised patients. We present a case of fungal sinusitis masquerading as trigeminal neuralgia in an immunocompetent patient and discuss the potential implications of these two diseases. The patient is a 59-year-old male who presented with a four-year duration of left facial pain. He had been diagnosed and treated for trigeminal neuralgia by a pain specialist but was subsequently referred to ENT after a MRI of the brain showed left maxillary sinusitis. Nasoendoscopy findings and a CT scan of the paranasal sinuses were concordant with left maxillary sinusitis. The patient underwent left functional endoscopic sinus surgery and recovered uneventfully. Our study shows that even in immunocompetent patients who present with non-resolving or worsening facial pain resembling the original diagnosis of TN, clinicians should remain vigilant for the possibility of alternative underlying pathologies including fungal sinusitis. Full article

Maxillary sinus augmentation is a key procedure for rehabilitating the atrophic posterior maxilla and enabling predictable implant-supported restorations. Although autogenous bone remains the biological gold standard due to its osteogenic potential, its clinical use has declined because of donor-site morbidity, limited availability, and increased surgical burden. Deproteinized bovine bone mineral (DBBM) is currently the most widely used substitute, providing excellent biocompatibility and long-term volumetric stability. However, its inert nature, limited bioactivity, and slow resorption have driven the development of next-generation graft materials. Recent biomaterial innovations aim to enhance vascularization, accelerate osteogenesis, modulate immune responses, and achieve controlled resorption while maintaining favorable handling properties. These include ion-releasing bioactive ceramics, growth factor-enhanced allografts, polysaccharide–hydroxyapatite composites, smart hydrogels, and synthetic scaffolds with tunable degradation profiles. Given the complexity of bone regeneration, effective clinical translation requires an integrated framework combining in vitro assays, animal models, and human clinical studies. This review synthesizes evidence published since 2018 on emerging biomaterials for sinus floor elevation, critically evaluating their potential to overcome the limitations of DBBM and highlighting the importance of a coordinated preclinical-to-clinical research continuum. Full article

Background: Regenerative endodontic treatment (RET) has emerged as a biologically based alternative to traditional apexification for managing immature permanent teeth with pulp necrosis. By promoting tissue ingrowth and continued root development, RET aims not only to eliminate infection but also to reinforce structurally compromised roots. Although its clinical use has expanded, evidence regarding the long-term predictability and durability of RET remains limited, as most published studies provide only short- or mid-term follow-up. Case presentation: This report describes two pediatric cases involving regenerative procedures performed on three immature permanent maxillary incisors, each followed for more than six years. The first case involved a 7-year-old girl who developed pulp necrosis in a maxillary lateral incisor after acute dental trauma. Management followed a regenerative protocol using triple antibiotic paste (ciprofloxacin, metronidazole, and minocycline) as intracanal medication and mineral trioxide aggregate as the coronal barrier. The second case concerned an 8-year-old girl presenting with chronic infection and sinus tracts affecting both maxillary central incisors. These teeth were treated using a regenerative approach with calcium hydroxide as the intracanal medicament and Biodentine as the sealing material. Clinical, radiographic, and cone beam computed tomography evaluations demonstrated complete symptom resolution and periapical healing but incomplete progressive apical closure. All treated teeth developed a calcified apical barrier, and outcomes remained stable throughout the extended follow-up period. Conclusions: While inherently limited by the nature of case reports, these findings support RET as a reliable and durable therapeutic option for necrotic immature permanent teeth, including cases in which conventional apexification has not been successful. Full article

Iatrogenic maxillary sinusitis accounts for a significant proportion of unilateral sinus infections. This report describes a 36-year-old HIV-positive patient with Serratia marcescens chronic left maxillary sinusitis and ethmoiditis caused by migration of a dental implant into the maxillary sinus. The implant was successfully removed endoscopically via functional endoscopic sinus surgery. Histopathological examination revealed polypoid mucosa with chronic inflammation, while microbiological culture grew Serratia marcescens, an uncommon and opportunistic pathogen. Targeted antibiotic therapy with trimethoprim/sulfamethoxazole was administered for 20 days. Six-month follow-up revealed complete remission without recurrence of sinusitis. Full article

Background: We aimed to determine paranasal sinus volumes using 3D volumetric measurements and to evaluate the effect of anatomical variations on these volumes, ensuring balanced age and sex distribution during childhood. Methods: Thirteen age groups (0–16 years), each including 10 males and 10 females, were formed. After excluding sinus pathologies, a total of 260 subjects were randomly selected from CT head examinations. Right and left frontal, maxillary, and sphenoid sinus volumes were calculated using 3D Slicer software (version 5.6.2) following manual segmentation of axial CT slices. Also, the presence of right and left Agger Nasi cells, Haller cells, Onodi cells, and concha bullosa were recorded. Results: No significant difference was found between males and females in sinus volumes (p > 0.05). Mean right and left maxillary sinus volumes were 6.23 cm³ and 6.27 cm³ (p = 0.551); frontal sinuses were 0.79 cm³ and 0.86 cm³ (p = 0.170); and sphenoid sinuses were 1.64 cm³ and 1.85 cm³ (p = 0.041). Sphenoid sinus pneumatization appeared in 30% of the 0–6-month group and in over 75% of older groups. Frontal pneumatization began at age 2–3 and exceeded 50% after age 4. Agger Nasi, Haller, Onodi cells, and concha bullosa were detected in 58.8%, 31.2%, 10%, and 22.3% of cases, respectively. Anatomical variations showed no significant effect on sinus volumes (p > 0.05). Conclusions: We developed a paranasal sinus volume chart applicable to routine practice, showing that anatomical variations had no significant impact on the development. This is the first study to investigate the impact of anatomical variations on sinus development and volume, along with the age at which variations emerge, with a balanced distribution of age and sex. Full article

Objectives: This study aimed to comprehensively evaluate and compare the therapeutic effects of Right Angle Maxillary Protraction Appliance (RAMPA) therapy on nasal airway volume in pediatric patients, specifically differentiated by their baseline radiological paranasal sinus status. The objective was to quantify airway volume changes (absolute and percentage) in clear and opacified sinus groups, investigate the influence of age, sex, and treatment duration on these changes, and elucidate potential differences in the underlying mechanisms of airway expansion between groups. Study Design: A retrospective comparative cohort study design was employed. This study includes a “clear sinus group” of 26 patients (mean age: 6.6 years) with radiologically clear sinuses at baseline and an “opacified sinus group” of 20 patients (mean age: 6.8 years) diagnosed with rhinosinusitis and exhibiting significant sinus opacification on baseline CBCT scans. Upper airway volumetric measurements were performed using CBCT scans acquired pre- (T1) and post-treatment (T2), with data analyzed using Invivo 5 software. Results: RAMPA therapy significantly increased upper airway volume in both cohorts. The clear sinus group showed an approximate 18% mean increase (4886.9 mm³ absolute), while the opacified sinus group demonstrated a remarkably greater 61% mean increase (11,192.8 mm³ absolute). This difference was statistically significant. In the clear sinus group, airway volume gain positively correlated with treatment duration (p = 0.0303). Conversely, no significant correlation was found in the opacified sinus group (p = 0.288), suggesting rapid obstruction relief as a dominant mechanism. Sex did not significantly influence outcomes, and age was not a strong independent predictor of volume change magnitude. Conclusions: RAMPA therapy effectively increases upper airway volume in pediatric patients, with a substantially greater effect in those with baseline sinus opacification due to rapid obstruction resolution complementing skeletal changes. The mechanism of action differs by sinus status, with clear sinus patients showing gradual, duration-dependent skeletal adaptation and opacified sinus patients exhibiting immediate, duration-independent gains primarily from sinus clearance. These findings provide crucial insights for tailored clinical decision-making. Full article

Background: Primary intraosseous carcinoma (PIOC) is a rare and aggressive odontogenic malignancy that originates within the jaw bones without initial mucosal involvement. Its atypical and nonspecific symptoms frequently lead to diagnostic delays, especially in maxillary presentations. Methods: A 74-year-old male presented with persistent trigeminal-like neuralgic pain along the ophthalmic branch, initially misdiagnosed as secondary trigeminal neuralgia. MRI revealed a 45 × 46 × 34 mm mass occupying the right maxillary sinus with orbital wall destruction and dural invasion. Following histopathological confirmation of malignancy, a multidisciplinary team performed total maxillectomy with orbital exenteration and dural resection, followed by reconstruction using a temporoparietal flap. Adjuvant radiotherapy was administered. Results: Histopathology revealed invasive odontogenic carcinoma with atypical squamous features, dentinoid deposition, and perineural invasion. Postoperative recovery was uneventful, with complete pain resolution. MRI and PET surveillance over 2.5 years demonstrated no local recurrence. Conclusions: Maxillary PIOC may present exclusively with neuropathic pain, mimicking trigeminal neuralgia and leading to delayed diagnosis. In cases of unexplained facial pain with sinus or skull base involvement, odontogenic malignancies should be considered in the differential diagnosis. Early imaging and multidisciplinary management are key to achieving timely diagnosis, effective treatment, and improved quality of life. Full article