• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.48 no.5
• /
• pp.292-296
• /
• 2022

Objectives: During Le Fort I osteotomy, the separation of the pterygomaxillary junction (PMJ) is a difficult procedure for most surgeons because it is invisible. In this process, damage to the posterior structures constituting the sinus or those adjacent to it, including the maxillary sinus posterior wall and pterygoid plate, may occur. We would like to investigate the effects of this on the inside of the maxillary sinus after surgery and whether there are complications. Materials and Methods: One-hundred patients who underwent Le Fort I osteotomy from 2013 to 2020 using cone-beam computed tomography images were classified into two groups (clean-cut type and fractured type) according to the PMJ cutting pattern. In addition, the mucosal thickness in the maxillary sinus was divided into preoperative, postoperative three months, one year, and the change over the course of surgery was evaluated retrospectively. Results: Of the total 100 cases, the clean-cut type numbered 28 cases and the fractured type totaled 72 cases. Among the fracture types, part of the sinus wall and the pterygoid plate were broken in 69 cases, and the maxillary sinus posterior wall was detached in three cases. There was no statistically significant difference in sinus mucosal thickening between the clean-cut type and fractured type of the PMJ, three months and one year after surgery between the two groups. However, there was a significant difference in sinus mucosal thickness at postoperative one year in the case where a partial detachment of the maxillary sinus posterior wall occurred compared to not. Conclusion: Even if there is some damage to the structures behind the PMJ, it may not be reasonable to spend some time on the PMJ separation process considering the overall postoperative complications, if there is no significant difference inside the sinus, or increased probability of postoperative complications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.49 no.4
• /
• pp.192-197
• /
• 2023

Objectives: Surgical extraction of maxillary third molars is routine in departments devoted to oral and maxillofacial surgery. Because maxillary third molars are anatomically adjacent to the maxillary sinus, complications such as oroantral fistula and maxillary sinusitis can occur. Here we explore the factors that can cause radiographic postoperative swelling of the maxillary sinus mucosa after surgical extraction. Materials and Methods: This retrospective study reviewed the clinical records and radiographs of patients who underwent maxillary third-molar extraction. Preoperative panoramas, Waters views, and cone-beam computed tomography were performed for all patients. The patients were divided into two groups; those with and those without swelling of the sinus mucosa swelling or air-fluid level in a postoperative Waters view. We analyzed the age and sex of patients, vertical position, angulation, number of roots, and relation to the maxillary sinus between groups. Statistical analysis used logistic regression and P<0.05 was considered statistically significant. Results: A total of 91 patients with 153 maxillary third molars were enrolled in the study. Variables significantly related to swelling of the maxillary sinus mucosa after surgical extraction were the age and the distance between the palatal cementoenamel junction (CEJ) and the maxillary sinus floor (P<0.05). Results of the analysis show that the relationship between the CEJ and sinus floor was likely to affect postoperative swelling of the maxillary sinus mucosa. Conclusion: Maxillary third molars are anatomically adjacent to the maxillary sinus and require careful handling when the maxillary sinus is pneumatized to the CEJ of teeth.

• The Korean Nurse
• /
• v.33 no.4
• /
• pp.62-85
• /
• 1994

The data were analyzed by using an S. P. S. S. computerized program for mean, standard deviation, percentage and paired t-test. The results of this study were as follows: 1. The increase in $PaO_2$ after hyperoxygenation and hyperinflation was highly statistically significant(p=0.041), and the increase in $PaO_2$ immediately after suctioning was not significant (p=0.752). The time of lowest $PaO_2$ was 30 seconds after the endotracheal suction. 2. The occurrance of cardiac arrhythmia after the endotracheal suction included sinus tachycardia, sinus arrhythmia, sinus bradycardia, premature atrial contraction (PAC), and premature ventricular contraction (PVC). The most frequent cardiac arrhythmia was sinus tachycardia (a subjects). Sinus arrhythmia was observed in 5 subjects and continued till 10 minutes after suctioning in two of these. Sinus bradycardia occurred in only 3 subjects and among them, 1 subjects shows sinus arrythmia till 10 minutes after suctioning along. PAC was observed in only one subject and continued till five minutes after suctining along with sinus arrhythmia. PVC was observed in three subjects: it lasted for only 30 seconds after suctioning in two subjects. but continued for 10 minutes after suctioning in the third. 6 subjects manifested two kinds of Cardiac arrhythmia Three of them showed sinus tachycardia with PVC, another 2 showed sinus bradycardia with sinus arrhythmia, and the other subject showed sinus arrhythmia with PAC. 3. The increases in heart rate during the endotracheal suction immediately after and at 30 seconds after suctioning were statistically significant (p=0.005). The increase in heart rate at one minute after suctioning was also significant (p=0.023). The increase in heart rate continued until 10 minutes after the endotracheal suction, but was not statistically significant In this study, endotracheal suctioning with hyperoxygenation and hyperinflation was effective in preventing a decrease in $PaO_2$ after suctioning, but not in preventing cardiac arrhythmias. Nurses should be aware of the complications of endotracheal suctioning and do effective hyperoxygenation and hyperinflation before and after suctioning. Further research is needed to develop a efficient endotracheal suction method which will minimize complications. This study needs to be replicated with different population of patients intubatted or having a tracheostomy, specifically, patients who cardiac or pulmonary desease. The data were analyzed by using an S. P. S. S. computerized program for mean, standard deviation, percentage and paired t-test. The results of this study were as follows: 1. The increase in $PaO_2$ after hyperoxygenation and hyperinflation was highly statistically significant(p=0.041), and the increase in $PaO_2$ immediately after suctioning was not significant (p=0.752). The time of lowest $PaO_2$ was 30 seconds after the endotracheal suction. 2. The occurrance of cardiac arrhythmia after the endotracheal suction included sinus tachycardia, sinus arrhythmia, sinus bradycardia, premature atrial contraction (PAC), and premature ventricular contraction (PVC). The most frequent cardiac arrhythmia was sinus tachycardia (a subjects). Sinus arrhythmia was observed in 5 subjects and continued till 10 minutes after suctioning in two of these. Sinus bradycardia occurred in only 3 subjects and among them, 1 subjects shows sinus arrythmia till 10 minutes after suctioning along. PAC was observed in only one subject and continued till five minutes after suctining along with sinus arrhythmia. PVC was observed in three subjects: it lasted for only 30 seconds after suctioning in two subjects. but continued for 10 minutes after suctioning in the third. 6 subjects manifested two kinds of Cardiac arrhythmia Three of them showed sinus tachycardia with PVC, another 2 showed sinus bradycardia with sinus arrhythmia, and the other subject showed sinus arrhythmia with PAC. 3. The increases in heart rate during the endotracheal suction immediately after and at 30 seconds after suctioning were statistically significant (p=0.005). The increase in heart rate at one minute after suctioning was also significant (p=0.023). The increase in heart rate continued until 10 minutes after the endotracheal suction, but was not statistically significant In this study, endotracheal suctioning with hyperoxygenation and hyperinflation was effective in preventing a decrease in $PaO_2$ after suctioning, but not in preventing cardiac arrhythmias. Nurses should be aware of the complications of endotracheal suctioning and do effective hyperoxygenation and hyperinflation before and after suctioning. Further research is needed to develop a efficient endotracheal suction method which will minimize complications. This study needs to be replicated with different population of patients intubatted or having a tracheostomy, specifically, patients who cardiac or pulmonary desease.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
• /
• v.24 no.1
• /
• pp.115-124
• /
• 1994

The purpose of this study was to examine the differences in representation of a globular radiopaque mass on the pantomograms and Waters' views and to compare the efficacy of periapical radiograms, pantomograms and Waters' views in detection of defects on the internal walls of the maxillary sinus. This study was performed with dried human skull. For the study of difference of radiopaque mass shadow in the two views, rubber ball with a diameter of 10㎜ was used as the experimental lesion. It was placed successively on the internal wall of the anterior, posterior, medial, lateral walls and floor of the maxillary sinus. To examine the detectability of defects for radiographic techniques, defects were formed in the anterior, posterior, medial, lateral walls, and floor of the maxillary sinus. They were formed with 0.5㎜, 0.75㎜, 1.0㎜, 2.0㎜ and 3.0㎜ sized steel round burs with a slow speed dental handpiece. By subsequently plugging the holes with zinc oxide eugenol paste, radiopaque defects were produced. After that the periapical radiograms, the pantomograms and the Waters' views were taken each and every defect. The obtained results were as follows: 1. Rubber balls placed on each internal wall of the maxillary sinus were correctly depicted on the posterior wall and the floor in case of the pantomogram, and on the anterior wall and the medial wall in case of the Waters' view. 2. On the detectability of defects for each radiographic technique, radiolucent defects were detected in different places for each technique. Periapical radiogram could detect 1.0㎜ defect on the floor of the maxillary sinus, pantomogram could detect 2.0㎜ defect on every internal wall of the maxillary sinus, and Waters' view could detect 3.0㎜ defect on the anterior wall of the maxillary sinus. 3. On the detectability of defects for each radiographic technique, radiopaque defects were detected in different places for each technique. Periapical radiogram could clearly detect 0.5㎜ defect on the floor of the maxillary sinus, pantomogram could detect 0.5㎜ defect on every internal wall of the maxillary sinus, and finally Waters' view could detect 0.5㎜defect on the anterior wall of the maxillary sinus but 0.75㎜ defect on the anterior wall, lateral wall and floor of the maxillary sinus. As the result, the periapical radiogram is the most simple and satisfactory method for investigating in the maxillary sinus. The pantomogram is suitable method for screening of changes in the maxillary sinus. And the Waters' view is available for detect of lesion in the anterior wall of the maxillary sinus. For the purpose of accurate diagnosis and evaluation of lesion in the maxillary sinus, these techniques supplement each other.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.32 no.5
• /
• pp.482-487
• /
• 2006

As the uses of dental implants are prevailing, the need for sinus bone graft is increasing. Deproteinized bovine bone mineral (DBBM) was not mentioned in 1996 Sinus Bone Graft because of the deficit of the available data. Since then, many clinical and laboratory reports support the use of DBBM in the sinus bone graft procedure. In this report, the histological and clinical successes of sinus bone grafting with DBBM is discussed with available literatures. After sinus bone grafts with DBBM, the proportion of new bone formed was similar or superior to natural maxillary posterior alveolar bone after healing period of 6 months to 1 year. It seems that the grafted DBBM is not be either resorbed nor replaced with bone, but this may not disturb the osseointegration of dental implants installed into it. The clinical survival rates of dental implants installed on the sinus grafted with DBBM was similar to those installed on the ungrafted posterior maxillary alveolar ridge or grafted with autogenous bone. So, it can be concluded that DBBM can be used successfully in the sinus bone graft.

• Archives of Craniofacial Surgery
• /
• v.17 no.3
• /
• pp.103-110
• /
• 2016

Fractures of frontal sinus account for 5%-12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.

• Imaging Science in Dentistry
• /
• v.40 no.2
• /
• pp.59-62
• /
• 2010

Purpose : To investigate and compare the prevalence, size, and location of maxillary sinus septa on panoramic and cone beam computed tomography (CBCT) images. Materials and Methods : Two hundred patients who had taken both panoramic and CBCT images were included. The location of maxillary sinus septa on the panoramic radiographs were recorded and confirmed on the CBCT images. Also the size of septa was measured on the reformatted CBCT images. Results : The prevalence of the patients who had maxillary sinus septa was 51.0% and they showed 179 septa totally. Among them 51.0% of the patients had one septum, 32.4% two septa, 13.7% three, and 2.9% four. The measured heights of the septa were $4.37{\pm}2.87\;mm$, $3.51{\pm}2.47\;mm$, and $3.04{\pm}2.37\;mm$ in the medial, middle, and lateral areas, respectively. It was revealed that 1.0% was located at canine region, 18.0% at first premolar, 25.0% at second premolar, 22.7% at first molar, 19.8% at second molar, and 14.0% at third molar region. Among 213 septa depicted by the panoramic radiographs, only 69.0% were confirmed at the CBCT images. Conclusion : Since various heights and courses of the septa can develop in all parts of the maxillary sinus, adequate assessment of the inner aspect of the maxillary sinus is essential to avoid complications during sinus augmentation procedures. CBCT scanning is the preferred radiographic method for detecting the presence of sinus septa.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.49 no.5
• /
• pp.297-303
• /
• 2023

A resorbable barrier membrane is commonly used for the repair of perforated sinus membranes during sinus lifting surgeries. However, repairing largescale perforations poses challenges for clinicians as the protection and isolation of graft material remain uncertain. With this technique, we aimed to prevent graft material loss and subsequent sinus-related complications using intra-sinus rigid fixation of the resorbable barrier membrane in cases with a large perforation of the sinus membrane.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.30 no.5
• /
• pp.457-464
• /
• 2008

Purpose: The aim of this study was to evaluate the clinical results of implants which were installed with maxillary sinus elevation by using lateral window technique. Materials and methods: We performed the maxillary sinus elevation by lateral window technique to 87 patients who visited Dept. of Oral & Maxillofacial Surgery, Chonnam National University Hospital from January, 2003 to January, 2007. When the residual bone height was from 3 mm to 7 mm, the sinus elevation and simultaneous implant installation was mostly performed. When the residual bone height was less than 3 mm, the sinus elevation was performed and the delayed implant installation was done after 5 or 6 months. No artificial membranes were used for coverage of the lateral bony window site and freeze dried fibrin sealant was applied to the grafted bone. The mean follow-up period was 28.5 months (ranged from 10 months to 48 months) Results: 1. Unilateral sinus elevations were performed in 51 patients and bilateral sinus elevations were performed in 36 patients. And the total number of sinus elevation procedure was 123 cases. 2. The sinus elevation and simultaneous implant installation was performed in 89 sinuses and 249 implants were installed. The sinus elevation and delayed implant installation was performed in 44 sinuses and 141 implants were installed. The total number of implants were 390 in 133 sinuses. The average healing period after sinus elevations was 6.1 months in delayed implant installation. 3. Only autogenous bone, autogenous bone mixing with allografts or autogenous bone mixing with xenografts were used as graft materials. 4. The average period from first surgery to second surgery was about 7.2 months. 5. Some patients complications, such as perforation of sinus membrane, swelling, infection and exposure of cover screw. Two implants were removed in the infected sinus. 6. The survival rate of implants with maxillary sinus elevation by lateral window technique was 99.5% and the success rate of implants was 95.1%. Conclusions: These results indicated that the implants which were installed with maxillary sinus elevation by lateral window technique showed high survival and success rates.

• Imaging Science in Dentistry
• /
• v.47 no.4
• /
• pp.261-267
• /
• 2017

Purpose: Analyzing different patterns of maxillary sinus septa in cone-beam computed tomography (CBCT) images and predicting maxillary sinus membrane perforations. Materials and Methods: In this cross-sectional study, CBCT images of 222 patients ranging from 20 to 81 years old were evaluated. One hundred fifty-two patients (93 females and 59 males) who had maxillary sinus septa in axial views were included in this study. Cross-sectional images were used to determine classifications of sinus septa and the risk of membrane perforation using a method modified from Al-Faraje et al. Variables of sex, age, and dental status were considered. Chi-squared and Kruskal-Wallis tests were used for data analysis(P<.05). Results: In this study, 265 maxillary sinus septal patterns were found. The mean age of the patients was $44.1{\pm}14.7$ years old. The Class I and VII-div II patterns had the greatest and least prevalence, respectively. Furthermore, there was a significant relationship between the location of septa and the frequency of membrane perforation risk (P<.05). In this study, the relationship of different patterns of septa with dental status did not differ significantly (P>0.05). Conclusion: A higher prevalence of moderate risk of membrane perforation in the molar region relative to the premolar region was observed. Furthermore, maxillary sinus septa occur most frequently in the molar region, demonstrating the importance of paying attention to this region during sinus lift surgery. This study did not show any relationship between tooth loss and the presence of septa.