BACKGROUND: Cholesterol granuloma is not a common entity in the paranasal sinuses. It is a foreign body reaction to the cholesterol crystal deposition. Mostly associated with chronic middle ear diseases.
METHODS: This article reports a case of cholesterol granuloma in the maxillary sinus. A 23-year-old Asian man presented with cough, nasal obstruction, and postnasal discharge. On endoscopy, there was a mass protruding from the right maxillary ostium. On computed tomograpy imaging, there was a polypoidal mass in the right maxillary sinus. Endoscopic sinus surgery was performed, the cholesterol granuloma was removed from the right maxillary sinus, and the tissue was submitted for histopathological examination, which showed foreign body giant cell reaction to cholesterol crystals.
CONCLUSIONS: Cholesterol granuloma of maxillary sinus is not common and often missed by clinicians. It is necessary to consider the cholesterol granuloma of maxillary sinus in the differential diagnosis sinonasal lesions. Histopathological analysis is required for confirmation and should be removed surgically. This case may help as a reference for clinician to approach these kinds of cases.

Periodontitis is a highly prevalent oral microbial biofilm-driven chronic inflammatory disease. If unmanaged, periodontitis leads to progressive destruction of the ligamentous attachments of teeth to the alveolar bone and resorption of the alveolar bone. It eventually leads to tooth hypermobility and loss. Periodontitis commonly causes overlying maxillary sinus inflammation (mucositis), reflected on radiographic imaging as maxillary sinus mucosal thickening. While uncommon, advanced periodontitis (stage III/IV) or chronic perio-endo lesions can lead to purulent odontogenic sinusitis (ODS). This article describes periodontitis pathophysiology, diagnostic features, and its potential to cause ODS. Clinical practice guideline conform therapy is very successful in managing periodontitis and enabling long-term tooth retention. Localized tooth extration is reserved to end-stage disease.

BACKGROUND: Underlying disorders of the maxillary sinus (MS), including a history of sinus surgeries, chronic sinusitis, or congenital anomalies can potentially impact sinus function and structure, necessitating careful evaluation and management. Moreover, intact sinuses are crucial in gender determination in forensic anthropology. The present study was undertaken to check the accuracy and reliability of MS in gender determination using morphometric parameters.
METHODS: This retrospective study was carried out on 74 lateral cephalograms (37 males and 37 females) aged between 18 to 50 years from the North Indian population. The MS area was measured using a NewTom CBCT machine (NewTom, Imola, Italy) with slicer software. The anatomical landmarks for the sinus were identified, and the area was calculated in square millimeters (mm2).
RESULTS: In terms of surface area, females had a mean of 13,210.40 mm2 with a standard error of 713.46. Males, however, exhibited a higher mean surface area of 18,713.82 mm2, but with a significantly larger standard error of 3,371.70. The difference in MS area between males and females was statistically significant (p<0.01). In the receiver operating characteristic (ROC) curve, the area under the curve (AUC) was 0.77, suggesting good discriminative ability.
CONCLUSIONS: The MS area on lateral cephalograms shows significant sexual dimorphism. Overall, the findings suggest that the MS surface area can be a useful anatomical feature for distinguishing between male and female North Indian subjects, given the statistically significant difference and the good discriminative performance indicated by the ROC curve analysis.

OBJECTIVE: The aim of this study was to propose a comprehensive maxillary sinus (MS) contour classification system based on the evaluation of anatomical characteristics from cone beam computed tomography (CBCT) examination and investigate the relationship between sinus contours and sinus floor elevation (SFE).
METHODS: A total of 283 CBCT scans from patients who had single tooth loss in the posterior maxilla and underwent SFE were analyzed. The MS was classified at each tooth position. For buccal-palatal evaluation, the classification from Type A to E was narrow-taper, taper, ovoid, square, and irregular, respectively. For mesial-distal evaluation, the classification from Type 1 to 4 was flat, slope, concave, and septa, respectively. The major anatomical parameters evaluated were (1) residual bone height (RBH), (2) sinus width (SW), (3) maxillary sinus angle (MSA), (4) buccal dip angle (BDA), (5) palatonasal recess (PNR), and (6) sinus depth.
RESULTS: Eleven groups of MS contour were classified after detailed calculation. Differences in the RBH, MSA, BDA, and SW among different groups were statistically significant. The narrow-taper and slope MS (A2) group had the highest RBH (8.66 ± 0.77 mm), largest BDA (79.9° ± 3.18°), smallest MSA (19.8° ± 2.01°), and narrowest SW (6.30 ± 1.23 mm). The lowest RBH was in the square and concave sinus (D3) group (5.11 ± 2.70 mm). The ovoid and concave sinus (C3) group had the smallest BDA (50.64 ± 8.73 mm) and largest MSA (74.11° ± 11.52°). The square and flat MS (D1) group had the widest SW (19.13 ± 3.69 mm). A strongly significant positive correlation was observed between the SW and MSA (r = 0.67) and a strongly negative correlation between the SW and BDA (r = - 0.65). The prevalence of PNR (mean angle: 104.06° ± 16.83°, mean height: 14.72 ± 11.78 mm) was 38% and frequently observed in the ovoid and slope MS (C2) group.
CONCLUSIONS: Despite certain characteristics at different tooth sites, the same tooth position was categorized differently using different classification systems, indicating large anatomical variations in the MS. The classification system proposed herein allows for classification based on general characteristics at a single tooth site, aiming to help surgeons in improving presurgical evaluation.

The maxillary sinus floor is formed by the alveolar process of the maxilla. Frequently, the roots of maxillary molars and premolars may protrude into the sinus cavity, with only a thin membrane separating them. Endodontic infections are characterized by mixed biofilms of anaerobic and proteolytic bacteria that can infect the root canal space and accessory anatomy of those teeth producing apical periodontitis. Due to the close relationship with the maxillary sinus, the persistence of apical periodontitis could potentially lead to odontogenic sinusitis. Understanding maxillary sinus anatomy and its relationship with the posterior maxillary dentition is crucial for diagnosing this entity.

BACKGROUND: The anatomical proximity between the root apex of the maxillary posterior teeth and the maxillary sinus can lead to complications, including odontogenic maxillary sinusitis. While several studies have investigated similar variables in different populations, there is limited research on the Indonesian population. This study aimed to describe the anatomical position of the maxillary posterior teeth in relation to the floor of the maxillary sinus using CT scans.
METHODS: A total of 122 patients (432 maxillary premolars and 1,282 maxillary molars) underwent CT scans to evaluate 1,711 roots. The vertical relationship between the root apex of the maxillary posterior teeth and the maxillary sinus was classified into three types: IS (inside sinus), CO (sinus contact), and OS (outside sinus).
RESULTS: The IS type was predominantly found in the palatal roots of the first molars, accounting for 20% of the total roots in this type. The CO type was most frequently observed in the mesiobuccal roots of the second molars, representing 18% of the total roots in this type. The OS type was most commonly found in the first premolar, comprising 20% of the total roots in this type.
CONCLUSIONS: The palatal roots of the first molars exhibited the highest frequency of proximity to the maxillary sinus. CT scans can effectively assess the relationship between the root apex of the posterior teeth and the maxillary sinus.
CONCLUSIONS: Clinicians should consider this information comprehensively when planning treatments for maxillary molars.

Chronic maxillary sinusitis accompanied by severe thickening of the sinus mucosa, blockage of the ostium, and patient-reported symptoms requires preoperative assessment and treatment by an otolaryngologist before maxillary sinus floor augmentation (MSFA). Prescription of antibiotics and nasal saline irrigation are the first choice of treatment; however, endoscopic sinus surgery is considered when the treatment\'s effect is limited and drug resistance is observed. Nevertheless, MSFA performed in the presence of sinus pathologies have been reported to have favorable results when the lesions are managed properly. This report presents cases of two patients who required MSFA but were diagnosed with chronic maxillary sinusitis (case 1 with nasal sinusitis and case 2 with dental sinusitis). After 2 weeks of antibiotic therapy, endoscopic surgery was recommended due to minimal changes in the size of the sinus lesion; however, the patients refused because of improved self-reported symptoms. Therefore, intraoral surgical drainage was planned as an alternative treatment. A large bony window was prepared at the lateral wall of the maxillary sinus, and a long intentional incision was made to improve access for the suction tip in various directions and depths into the sinus cavity. Thorough suction of the purulent exudate and saline irrigation were performed through this access. The size of the perforated area was reduced along with the elevation of the Schneiderian membrane from the sinus floor, and simultaneous bone grafting with implant placement was performed. Prosthesis was delivered after 6-8 months. At 1-year follow-up after loading, favorable outcomes of implant survival and maintenance of augmented bone height were observed, with no recurrence of postoperative sinusitis. Within the limitations of the present case report, thorough sinus drainage and saline irrigation during maxillary sinus floor augmentation resolved sinus infection in patients with chronic maxillary sinusitis with short-term clinical outcomes.

Complications that occur after maxillary sinus floor augmentation (MSA) can be divided into early and late complications. Early complication is a side effect that occurs during the MSA procedure or during the initial healing period. Usually, late complication refers to a side effect that occurs after 3 weeks of MSA. However, in the longer term, there are cases that occur during the follow-up period after the prosthesis is delivered, and most of them present with peri-implantitis. In the present two cases, sinus graft complications occurred 1-2 years after prosthesis delivery but were independent of peri-implantitis and had atypical features showing asymptomatic results. Although the route of the infection source is unclear, the lesions were presumed to be caused by slow and delayed inflammation of oral bacteria infiltrating the bone graft area of the maxillary sinus. Within the limitations of present case reports, bone defects were successfully managed with a guided bone regeneration (GBR) procedure that included thorough defect degranulation, surface decontamination of exposed implant, and regrafting. Periodic monitoring of radiographic images is required for the detection of unusual sinus graft complications in sinus-augmented sites.

Maxillary angiosarcoma, an aggressive tumor derived from vascular endothelial cells, is very rare. Recently, antivascular endothelial growth factor (VEGF) therapies have attracted considerable attention. We describe the clinical course of a patient with maxillary angiosarcoma and discuss the expression of VEGF signaling molecules assessed via immunohistological analysis. An 81-year-old man presented with an aggressive tumor in the left maxillary sinus. Biopsy revealed atypical nuclear cell proliferation, and the tumor was suspected to be a sarcoma. The maxillary malignancy was treated using a multidisciplinary approach with a combination of surgery, radiotherapy, and regional chemotherapy. Examination of the specimen obtained in the first surgery revealed maxillary angiosarcoma, found to be positive for CD31, while negative for CD34, D2-40, and factor Ⅷ. Although no pathological residual tumor was observed after the planned wide surgery, cervical lymph node and distant metastases occurred. The patient died 24 months after the first surgery. Staining revealed VEGF receptor (VEGFR) 1, VEGFR2, phosphorylated Ak strain transforming, mitogen-activated protein kinase, and signal transducer and activator of transcription 3 positivity. Although our findings do not indicate that anti-VEGF therapy is beneficial for treating maxillary angiosarcomas, we found that VEGFR signaling pathways were activated in maxillary angiosarcomas similar to angiosarcomas originating at other sites. Herein, we report a case of maxillary angiosarcoma, focused on VEGFR and signaling pathway activation. To our knowledge, this is the first report to describe VEGFR system immunostaining findings in maxillary angiosarcoma.

UNASSIGNED: We aimed to evaluate the morphology of maxilla and sinus dimensions in subjects with unilaterally and bilaterally impacted canine using cone beam computed tomography (CBCT) records.
UNASSIGNED: CBCT records taken during 2020-2022 of 120 patients were obtained to investigate the relationship between impacted canine and maxillary morphology as well as sinus dimensions. The CBCT images were then divided into three groups: control, unilaterally canine impaction and bilaterally canine impaction. Then morphology-related variables (arch circumference, arch length, inter molar width, inter first premolar width, palatal depth, anterior posterior dimension of the right and left sinuses, and mediolateral dimension of the right and left sinuses) were analyzed and compared between groups. All measurements were done by Ondeman 3D dental software. Statistical analysis was carried out by SPSS software version 21 using one-way ANOVA.
UNASSIGNED: There were meaningful differences in patients with canine impaction compared with control group in arch circumference (P value= 0.004) and arch length (P value= 0.001), inter molar width (P value= 0.001), inter first premolar width (P value= 0.001), mediolateral dimension of the right (P value=0.001) and left (P value= 0.001) sinuses of maxilla. Furthermore, Palatal depth and anterior posterior dimension of the right and left sinuses did not show statistically significant difference between groups.
UNASSIGNED: Canine impaction can considerably affect the morphology of maxillary and sinuses dimensions. Nevertheless, future studies are needed to determine the exact structural and molecular effects of the canine impaction on maxillary sinuses and neighboring tissues.