Diagnosis and Treatment of Diseases of the Facial Skeleton, Oral Cavity, and Paranasal Sinuses

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Dentistry".

Deadline for manuscript submissions: 20 May 2024 | Viewed by 9259

Special Issue Editors


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Guest Editor
Maxillo-Facial Surgery Ward, EuroMediCare Hospital, Wrocław, Poland
Interests: sinusitis; head and neck surgery; orthognathic surgery; oral cancer; endoscopic surgery; maxillofacial surgery

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Guest Editor

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Guest Editor
Department of Anaesthesiology and Intensive Care, Sokołowski Hospital, Sokołowskiego 4, 58-309 Wałbrzych, Poland
Interests: mandibular defect reconstruction; bone grafting

Special Issue Information

Dear Colleagues,

Diseases of paranasal sinuses are quite often diagnosed and treated with a multidisciplinary approach. The scope of diseases of the sinuses and adjacent bones, teeth, and close anatomical sites requires good diagnostics with CT, MR, SPECT, and other imaging methods to ensure the best treatment plan possible. Modern dentistry and improved endodontics can easily help in treating odontogenic sinus infections and lesions, while the scope of endoscopic FESS procedures performed by otorhinolaryngologists grants good and accurate treatment of most diseases. Good patency of the osteomeatal complex (OMC) can be assured after FESS/ESS surgery. In some cases, when endoscopic or conservative methods of treatment are not sufficient enough, some standard open surgical approach is needed to remove a cyst, tumor, or another lesion within the sinus walls, antrum, maxillary jaw bones, eye socket, and surrounding craniofacial area. It seems that nowadays, literature mostly focuses on endoscopic approaches to the sinuses, but what about a Caldwell-Luc procedure or other more invasive approaches; should they also be used nowadays? The sinuses should be a special topic of consideration, especially since some diseases tend to grow within the sinuses and they manifest themselves in more advanced stages or are just found accidentally on some routine radiographs and computed tomography imaging. Each pathology can be treated in many possible ways and approaches; however, some interesting cases can underline new possibilities and treatment modalities or present a novel or atypical scope of the disease. Paranasal sinus pathologies are not only related to cysts, tumors, or lesions; the scope of possible teeth-related and odontogenic origins should also be remembered. The ability and knowledge of surgical procedures used to properly close an oroantral communication after teeth or cyst removal from the maxillary bone should be widespread among clinicians to reduce dangerous complications and iatrogenic-related sinusitis. On one hand, we have a communication that requires suturing; however, in some cases, when there is a big bone deficiency, we also require bone grafting and some other regenerative techniques to improve the bone size and volume and enable future dental implant placement. Nowadays, there are a lot of methods and materials that can be used quite easily to ensure not only maxillary bone stability but also to reconstruct the sinuses walls and enable good air patency along the sinuses, without any cases of mucous accumulation or inflammatory process formation within the sinuses.

The aim of this Special Issue should be discussed in articles, reviews, and case reports concerning various diseases, pathologies, clinical relevances, new outcomes and perspectives, and interesting surgical, and pharmacological treatment of not only paranasal sinuses but the entire scope of co-related diseases of adjacent structures. Moreover, special attention should be focused on the scope of diseases, differential diagnosis, good adequate diagnostics, regenerative techniques and reconstruction, and improved approach towards the paranasal sinuses.

Topics to be covered in this Special Issue include:

  • Paranasal sinuses anatomy and physiology;
  • Paranasal sinuses pathologies;
  • Treatment modalities of oroantral fistulas and communications;
  • Odontogenic and non-odontogenic inflammation of paranasal sinuses;
  • Physicochemical properties of bone substitute materials for sinus reconstruction;
  • Surgical endoscopic FESS/ESS paranasal surgery;
  • Chronic rhinosinusitis treatment;
  • Open surgical approach toward the paranasal sinuses;
  • 3D printing in bone regeneration;
  • Cysts, tumors, and lesions of paranasal sinuses;
  • Differential diagnosis of paranasal sinus diseases;
  • Tumor spread towards paranasal sinuses;
  • Craniofacial skeleton-related pathologies with paranasal sinus manifestation;
  • Modern titanium alloys in maxilla, maxillary sinsues or mandible reconstructions;
  • Materials in endodontic surgery;
  • Mechanical and biocompatible properties of CAD/CAM restorative materials;
  • Materials in osteosynthesis and implantology;
  • Stable bone osteosynthesis for major fractures within the paranasal sinuses region;
  • Paranasal sinus's role in ventilation;
  • Improvements in nasal breathing after sinus surgery;
  • Pharmacological agents used in paranasal sinus treatment.

Dr. Kamil Nelke
Dr. Maciej Dobrzyński
Dr. Marceli Łukaszewski
Guest Editors

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Keywords

  • paranasal sinuses
  • facial skeleton
  • oral cavity
  • eye socket
  • bone regeneration
  • mucous membrane

Published Papers (5 papers)

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12 pages, 2082 KiB  
Article
Prelacrimal Recess Approach in Unilateral Maxillary Sinus Lesions: What Is the Impact and Efficacy?
by Mohamed Abdulla, Osama Refaat, Mohamed Alahmer, Ayman Yehia, Hesham Abdelsalam, Khaled Abdelaal and Mohamed Shams Eldin
Medicina 2024, 60(2), 222; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina60020222 - 27 Jan 2024
Viewed by 795
Abstract
Background and Objectives: Chronic sinusitis is a commonly encountered diagnosis for otorhinolaryngologists. The profound negative effect of rhinosinusitis on patients’ quality of life is frequently overlooked, and surgical lines of treatment are numerous. The aim of the study was to assess the [...] Read more.
Background and Objectives: Chronic sinusitis is a commonly encountered diagnosis for otorhinolaryngologists. The profound negative effect of rhinosinusitis on patients’ quality of life is frequently overlooked, and surgical lines of treatment are numerous. The aim of the study was to assess the comparative efficacy of endoscopic middle meatal antrostomy with the endoscopic prelacrimal recess approach, combined with middle meatal antrostomy in the treatment of unilateral chronic maxillary sinus lesion. Materials and Methods: Thirty patients with unilateral chronic maxillary sinus lesions enrolled in the study at Alahsa hospital. Patients were divided into two groups: 15 treated through a middle meatal antrostomy and 15 treated via a combined middle meatal antrostomy and prelacrimal recess approach. Demographic and clinical information of the patients, including the medical history, CT scan findings, diagnosis, recurrence, and complications, were gathered and analyzed. Pre- and postoperative clinical findings were graded utilizing the Lund–Kennedy Endoscopic Scoring System. Results: The enrolled patients varied in age from 18 to 56, with 60% being male and 40% being female. Antrochoanal polyp, maxillary sinus mucocele, and unilateral allergic fungal sinusitis were among the pathological diagnoses. The follow-up period averaged 14.3 months. Following surgery, two patients in Group II encountered nasal discomfort, which included synechia and epiphora. The success rate for preserving a patient’s disease-free condition was 86.7%. A statistically significant difference in disease-free incidence was observed among the patients in group II. In group I, recurrence was identified in 26.7% of the patients. The postoperative symptoms diminished considerably, and the VAS score was reduced substantially. In Group II patients, however, there was no significant difference in scarring. Clinically significant differences were observed in the mean total Lund–Kennedy Endoscopic scores when compared to their preoperative values. Conclusions: Achieving endoscopic access to the sinus’s anterior, lateral, inferior, and inferomedial regions is facilitated by operating via the prelacrimal recess, which is the most advantageous approach. This approach facilitates rapid mucosal healing by maintaining the integrity of the nasolacrimal duct and mucosal covering. The specific pathology, surgical objectives, surgeon expertise, and equipment accessibility influence the choice of endoscopic surgical technique. Full article
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16 pages, 16177 KiB  
Article
Esthetic Surgery of the Chin in Cis- and Transgender Patients—Application of T-Genioplasty vs. Single-Piece Segment Lateralization
by Rafał Pokrowiecki, Barbora Šufliarsky and Maciej Jagielak
Medicina 2024, 60(1), 139; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina60010139 - 11 Jan 2024
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Abstract
Background and Objectives: Correction of lower face asymmetry still remains challenging in maxillofacial surgery. This report describes techniques for the lateral transposition of the symphyseal segment to restore lower face symmetry while maintaining gender-related features in cis- and transgender patients. Materials and Methods: [...] Read more.
Background and Objectives: Correction of lower face asymmetry still remains challenging in maxillofacial surgery. This report describes techniques for the lateral transposition of the symphyseal segment to restore lower face symmetry while maintaining gender-related features in cis- and transgender patients. Materials and Methods: A retrospective review of medical records of 31 patients who attended for esthetic corrective surgery after orthodontic camouflage or orthognathic treatment, or during facial feminization of the lower face between June 2021 and June 2023 was performed. Result: All patients underwent lateralization genioplasty (with or without advancement or setback), either with or without narrowing T-osteotomy supplemented with necessary procedures in order to obtain proper facial balance and desired esthetical effects, such as bichectomy, liposuction, and face and neck lift. The mean asymmetry of the chin was 5.15 mm and was surgically corrected either by single segment lateralization or T-shape narrowing genioplasty depending on the gender and esthetical requirements. No complications were reported. Conclusions: Lateral shift genioplasty serves as a powerful tool in primary and secondary corrective surgery for lower face asymmetry that maintains gender-specific facial features. It may serve either as an additive to orthodontic camouflage or a way to correct previous orthognathic surgery pitfalls. The surgeon performing esthetic genioplasty associated with gender-specific expectations must be trained in facelift and facial liposculpting techniques in order to provide the best results and properly choose the right procedures for the right patients. Full article
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14 pages, 11823 KiB  
Article
Feminization Surgery of the Upper Face as the Crucial Factor in Gender Confirmation—Pearls and Pitfalls
by Rafał Pokrowiecki, Barbora Šufliarsky and Maciej Jagielak
Medicina 2024, 60(1), 120; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina60010120 - 09 Jan 2024
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Abstract
Background: Upper-face feminization is a frequently executed procedure in sexual reassignment surgery, owing to its ability to influence gender identity through adjustments to the hairline, forehead, and peri-orbital area. The procedure includes reducing the hairline, lifting the brows, shaving the orbital region, [...] Read more.
Background: Upper-face feminization is a frequently executed procedure in sexual reassignment surgery, owing to its ability to influence gender identity through adjustments to the hairline, forehead, and peri-orbital area. The procedure includes reducing the hairline, lifting the brows, shaving the orbital region, and applying specific techniques to reduce the frontal bone. This research aims to assess the outcomes, results, and potential complications associated with this surgery among transgender patients. Material and Method: Retrospective review of medical records of 20 patients who attended for facial feminization surgery of the upper face between June 2022 and June 2023, analyzing the previously performed procedures, complications and revision surgery outcomes, and first-time procedures. A literature review was performed for similar studies. Results: 20 patients were included in the study. Among the cohort treated elsewhere (n = 11), the primary complaint was insufficient browbone reduction and anterior frontal sinus table setback. They underwent poorly performed Type 1 reduction when full forehead reconstruction (Type 3/4) was indicated (n = 3), or no reduction was performed during hairline advancement (n = 4). Type 3 forehead reduction with orbital shaving and hairline advancement with simultaneous temporal browlift was most commonly performed in both revision and first-time surgical upper face feminization (n = 15) (75%). Type 1 osteoplasty was performed in four patients (10%), one Type 3 revision surgery was performed after insufficient Type 3 reduction, and one case of shock-induced alopecia was reported, treated with PRP/peptides and a FUE hair graft. Conclusions: The author’s preferred technique, ‘whole-in-one’ upper face feminization by modified bi-coronal incision with frontal trichophytic hyper-beveled incision, provides sufficient insight into the frontal bone and orbital region, the desired forehead osteoplasty and the most efficient insight into the temporal area, enabling safe dissection between fasciae, ligamentous adhesion removal, and periosteal attachment, providing full soft and hard tissue feminization. Nevertheless, feminization procedures should be meticulously planned, and all concerning issues should be addressed during the first surgery in order to prevent revisions, complications, and patient dissatisfaction. Full article
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12 pages, 2091 KiB  
Article
Physical Conditions Prevailing in the Nasal and Maxillary Sinus Cavities Based on Numerical Simulation
by Monika Morawska-Kochman, Ziemowit Miłosz Malecha, Krzysztof Zub, Jakub Kielar, Krzysztof Dudek, Kamil Nelke and Tomasz Zatonski
Medicina 2023, 59(6), 1094; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59061094 - 05 Jun 2023
Viewed by 1315
Abstract
Background and Objectives: This paper presents a unique study that links the physical conditions in the nasal passage with conditions that favour the development of bacterial strains and the colonization of the mucous membranes of the nose and paranasal sinuses. The physical [...] Read more.
Background and Objectives: This paper presents a unique study that links the physical conditions in the nasal passage with conditions that favour the development of bacterial strains and the colonization of the mucous membranes of the nose and paranasal sinuses. The physical parameters considered were air flow, pressure, humidity, and temperature. Materials and Methods: Numerical models of the human nose and maxillary sinus were retrospectively reconstructed from CT images of generally healthy young subjects. The state-of-the-art numerical methods and tools were then used to determine the temperature, humidity, airflow velocity, and pressure at specific anatomical locations. Results: The results were compared with optimal conditions for bacterial growth in the nose and sinuses. Conclusions: Temperature, humidity, air velocity, and pressure were shown to play critical roles in the selection and distribution of microorganisms. Furthermore, certain combinations of physical parameters can favour mucosal colonisation by various strains of bacteria. Full article
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12 pages, 3968 KiB  
Case Report
The Temporary Mental Nerve Paresthesia as an Outcome of Dentigerous Cyst Removal during Preparation for Dental Implant Placement: A Case Report
by Kamil Nelke, Maciej Janeczek, Edyta Pasicka, Krzysztof Żak, Marceli Łukaszewski, Radosław Jadach and Maciej Dobrzyński
Medicina 2023, 59(4), 711; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59040711 - 05 Apr 2023
Cited by 1 | Viewed by 4094
Abstract
The usage of xenograft material is widely used in almost all oral cavity bone defects for regenerative and reconstructive purposes. The presented xenograft usage in the following care report enabled good bone defect healing and enabled the preservation of affected premolars. It is [...] Read more.
The usage of xenograft material is widely used in almost all oral cavity bone defects for regenerative and reconstructive purposes. The presented xenograft usage in the following care report enabled good bone defect healing and enabled the preservation of affected premolars. It is quite common to use any possible variations of bone materials to ensure bone defect improved healing. In some cases, the scope of surgeries requires the removal of each cyst within close proximity to various nerves and vessels. The inferior alveolar, infraorbital, lingual, and mental nerves are those most commonly adjacent to most operating sites in jaw bones. The usage of some additional materials such as collagen sponges, bone substitutes, resorbable membranes, or other additional materials are useful in each bone defect reconstruction but should be handled with care, as described in the following case. Before planning their usage, it is important to perform each surgery with close cone beam computed tomography imaging, which is very helpful to establish the scope of each lesion and the proximity of vital structures. There are a lot of factors that might influence any possible nerve damage, especially the different nerve anatomical variations. Even factors including the subperiosteal preparation and compression of adjacent tissues might influence later nerve function. When the lesion is expanding through the buccal cortical plate and when soft tissue fluctuation is present, some special care is needed. Similar to the presented case, a limitation in crushing, blowing, or any irritation of nerve fibers improves later postoperative outcomes. When the wound and surrounding tissues are handled with care, a limited possibility of any damage or paresthesia can occur. When the nerve itself is damaged or cut, loss of function can be permanent. Immediately after or even prophylactic prescription 1–2 days before the surgery of Vitamin B with NSAIDs (Non-steroidal anti-inflammatory drugs) (or other additional supplementary medicaments can improve nerve function in time. Possible nerve damage can be divided into many etiological factors. A quite different situation arises when the nerve is pulled in by the cyst growth into the cyst wall. The presented case report describes the outcomes of a cyst removal from the mandibular basis and treatment modalities. Full article
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