Bone production by human maxillary sinus mucosa cells

The Schneider membrane is the mucosa that covers the inner part of the maxillary sinus cavities. The free surface is a ciliated pseudostratified epithelium, while the deeper portion is a highly vascularized connective tissue. The stromal fraction, bordering the bony wall of the sinus, after tooth loss can exhibit increased osteoclastic activity resulting in resorption of the bone in the posterior maxilla. Goal of our study was to isolate and characterize mesenchymal progenitors in the Schneider's membrane connective net and to evaluate their self ability to differentiate toward osteoblastic lineage, in absence of osteoinductive factors and osteoconductive biomaterials of support. This should indicate that maxillary sinus membrane represents an useful an approachable source of MSCs for bone tissue engineering and cell therapy and owns the intrinsic capacity to restore maxillary bone after tooth loss without the needing of biomaterials.     

Comparison of CGRP distributions in the maxillary sinus and trigeminal ganglion between elderly dentulous and edentulous humans

Thickening of the Schneiderian membrane (SM, mucosa of the maxillary sinus) appears in the paranasal sinus. Information on SM thickening is available for patients receiving sinus lift treatments, which is a risk factor for SM excretory dysfunction. However, more information is needed on the structure of the SM and the relationship between the maxilla sinus and palatine with the alveolar bone and the SM for dental implant treatment in the human maxilla. One hundred twenty-six sides of the maxilla from 71 cadavers were subjected to cone-beam computed tomography analysis and macroscopic and immunohistochemical observations in this study. A thickened SM was mainly observed in the middle region of the basal layer of the maxillary sinus (MS). Strong calcitonin gene-related peptide (CGRP)-positive reactions were observed in the alveolar bone, oral mucosa, mucosa of the MS, and trigeminal ganglion (TG) cells in dentulous samples compared with edentulous samples. TG cells play important roles in delivering CGRP through axons to the mucosal gland and in regulating the maxilla-related thickening of the SM. These data could help determine CGRP functions in the mucosal gland and bone formation between dentulous and edentulous samples and indicate that CGRP may pass from the TG to the MS glands.Key words: Mucosa, maxillary sinus, cone-beam computed tomography, immunohistochemistry, calcitonin gene-related peptide, trigeminal ganglion     

The maxillary sinus of Paradolichopithecus sushkini (late Pliocene, southern Tajikistan) and its phyletic implications

Paradolichopithecus sushkini is a large fossil cercopithecine from the late Pliocene discovered at Kuruk-Say, southern Tajikistan. Despite its rather long face and large size, many authorities regard Paradolichopithecus not as a baboon, but as a large macaque, mainly based on the cranial morphology of European specimens. Among Old World monkeys, macaques are the only species that possess a maxillary sinus. Thus, we evaluated the presence/absence and morphology of this feature in P. sushkini using computed tomography (CT) scans of two Kuruk-Say cranial specimens in order to assess this species' taxonomic affinities. One of the specimens shows a thin bony wall separating a small area from the nasal cavity. Posterior to this structure is a pair of bony ridges: one protrudes from the alveolar process and the other descends from the superior portion of the nasal wall. A similar configuration was detected in the other specimen. These features strongly suggest the presence of a maxillary sinus in this species. This interpretation is supported by the fact that the superior portion of the alveolar process is excavated in the adult specimen. Thus, both specimens exhibit a maxillary sinus expanding laterally to share the external thin wall of the muzzle, and such a configuration may depend on the reduction of the maxillary bone, i.e., the presence of a maxillary fossa. The Kuruk-Say specimens probably retained a small maxillary sinus, despite the reduced size of the maxillary body. Thus, based on this evidence, P. sushkini probably belongs to the macaque lineage rather than that of baboons, although structural influences of the maxillary fossa leading to formation of the maxillary sinus have yet to be evaluated in extant macaques and baboons.     

Ancestral loss of the maxillary sinus in Old World monkeys and independent acquisition in Macaca

Cercopithecoid monkeys are unique among primates in that all species (except macaques) lack a maxillary sinus, an unusual condition among eutherian mammals. Although this uncommon distribution of cranial pneumatization was noted previously, the phylogenetic ramifications have not been investigated fully. Recently, character state optimization analysis of computed tomography (CT) data from extant Old World monkeys suggested that the loss of the sinus may have occurred at the origin of the group, unlike previous hypotheses positing only a reduction in size of the structure. To critically evaluate the "early loss" hypothesis, a recently recovered complete cranium of Victoriapithecus macinnesi from Maboko Island, Kenya, was examined by CT to determine the extent of its cranial pneumatization. This taxon is crucial for evaluating character state evolution in Old World monkeys, due to its phylogenetic position, preceding the cercopithecine/colobine split. CT analysis reveals only cancellous bone lateral of the nasal cavity, indicating that Victoriapithecus does not possess a maxillary sinus. Phylogenetic evaluation of the fossil with extant catarrhine taxa strongly supports the early loss of the sinus in cercopithecoids. The results suggest that the maxillary sinus found in the genus Macaca is not homologous with that of other eutherians, which may provide insights into the origin and function (if any) of the paranasal pneumatizations.     

Maxillary sinus atelectasis in a wild born gibbon (Hylobates moloch)

In a mixed sex sample of ten adult gibbon (Hylobates moloch) skulls, one cranium of a male with maxillary sinus atelectasis of the left side was identified. While external inspection revealed a slight drop of the left orbital floor, serial coronal computer tomography (CT) scans show characteristic changes of the left maxillary sinus and its surrounding structures. In addition to the sunken orbital floor, radiological features of the specimen include an inward bowing of the medial sinus wall, sinus opacification, and a reduction in maxillary sinus size to a slit-like cavity, which suggest a diagnosis of silent sinus syndrome. This report is the first, to our knowledge, of maxillary sinus atelectasis in a non-human primate. This finding is valuable for the understanding of the pathogenesis and etiology of maxillary sinus atelectasis. At the same time, however, paleoanthropologists and primatologists may refer to this information when dealing with the interpretation of maxillary sinus pneumatization of partially broken archaeological and fossil skulls.     

An allometric study of the frontal sinus in Gorilla, Pan and Pongo

There is considerable speculation about the role and significance of the paranasal sinuses in the Hominoidea, and this study aims to present new data about an old problem from cephalograms of dried crania. Measurements of frontal sinus volumes were determined for Gorilla gorilla gorilla; G. gorilla beringei and Pan troglodytes. By adopting an allometric approach it was determined that the frontal sinus volume of Gorilla is relatively smaller than that of Pan, and that the frontal sinus of G. g. gorilla is relatively smaller than that of G. g. beringei. Frontal sinus volume scales in a positive allometric fashion relative to skull length. Since the slope is steeper for Pan, frontal sinus volume is increasing at a faster rate than in Gorilla. Sexual dimorphism in frontal sinus volume is present. Thirty crania of Pongo were investigated for evidence of pneumatization of the frontal bone. In no case was secondary invasion of the frontal bone by the maxillary antrum observed. In Gorilla, the nasal cavity volume scales isometrically with skull length. The scaling relationships discussed do not support any 'functional' role of the frontal sinus associated with nasal function but suggest a 'structural' role associated with craniofacial architecture.     

Variation in maxillary sinus anatomy among platyrrhine monkeys

Variations in the maxillary sinus anatomy of extant and fossil catarrhine primates have been extensively examined using computed tomography (CT), and have potential utility for phylogenetic analyses. This approach has also been used to demonstrate its anatomical variation in eight of the 16 extant genera of platyrrhines and the absence of the sinus in Saimiri and Cacajao. We used this approach to evaluate the three-dimensional anatomy of the maxillary sinus in all extant platyrrhine genera, and here argue the phylogenic implications of this variation. This study confirms, for the most part, previous CT studies and augments them with the six genera not studied previously: Ateles, Lagothrix, Callithrix, Cebuella, Pithecia and Chiropotes. The entire maxilla is pneumatized by the sinus in the atelines, Cebus, and Callicebus, whereas the sinus pneumatizes only the medial part of the maxilla in the callitrichines and Aotus. Pithecia has a unique conformation in which the maxillary sinus and the expanded inferior meatus pneumatize the posteromedial and anterolateral parts of the entire maxilla, respectively. Chiropotes has no sinus, and the inferior meatus possibly expands into the area between the middle meatus and medial surface of the maxilla to disturb sinus formation, as in the case of its close relative Cacajao. Finally, we argue that the sinus that pneumatizes the entire maxilla is a primitive feature in extant platyrrhines and was probably shared by the last common ancestor of the anthropoids.     

Isometric scaling of maxillary sinus volume in hominoids

Previous hypotheses of maxillary sinus size evolution have proposed one or more changes in the volume of the structure across hominoid phylogeny. These hypotheses have been used subsequently to support the phylogenetic placement of fossil taxa relative to the living Hominoidea. The null hypothesis, that no change in sinus volume independent of size has occurred in ape evolution, is evaluated here by scaling analysis. Mixed sex samples of adult dry crania for the extant ape genera were examined by computer tomography imaging and the volume of the maxillary sinus was obtained. Sinus volume was then regressed, using both least squares and reduced major axis models, against cranial size variables.The results clearly demonstrate that the null hypothesis of no change in relative sinus volume cannot be rejected; thus, there is no support for hypotheses that maxillary sinus volume, independent of cranial size, has changed in the course of hominoid evolution. This result, in turn, has implications for the phylogenetic placement of fossil taxa and highlights the need for the careful delineation of character states in studies of hominoid systematics.     

A longitudinal study of the growth pattern of the maxillary sinus in the pig-tailed macaque (Macaca nemestrina)

The ontogeny of sexual dimorphism in maxillary sinus size in a nonhuman primate was studied longitudinally for a period of 8 years in 25 female and 25 male Macaca nemestrina via lateral cephalograms. The maxillary sinus was traced and its area digitized. The growth of female maxillary sinuses was described with a Gompertz model; the best fit to the male data was obtained by the logistic model. Growth curves and confidence intervals revealed that the sinuses grew in a similar fashion for 3-4 years in both sexes. After this, female sinuses achieved a plateau in their development while male sinuses continued to grow. Confidence intervals suggested that size dimorphism appeared at the age of 6.3 years. Lowess regression indicated growth spurts in both sexes. Females experienced an earlier and smaller spurt than males. Sexual dimorphism in maxillary sinus size seems to represent a combination of differences in velocity and length of growth. This study indicates that growth of the maxillary sinus follows closely the growth in body size. Nevertheless, due to the variation in sinus size in Macaca, it is questionable if body size is the main determinant of maxillary sinus size. It is suggested that Macaca, with its wide geographic range and different environments, is an especially appropriate genus to use to test hypotheses about the evolution of skull pneumatization in primates.     

Clinal variation of maxillary sinus volume in Japanese macaques (Macaca fuscata)

Macaques (genus Macaca) are unique among cercopithecids in that they possess a maxillary sinus, and among anthropoids in that they demonstrate a relatively weak relationship between the size of this sinus and the cranium. To test the hypothesis that extrinsic factors may contribute to maxillary sinus size variation, a sample of 46 Japanese macaque (M. fuscata) crania from known localities were subjected to computed tomography (CT) imaging, and sinus volume and nasal cavity area were analyzed relative to latitude and temperature variables. The results suggest that the environmental factors are significant determinants of nasal cavity size in Japanese macaques, but that the relationships between the environment and maxillary sinus volume (MSV) are probably a passive consequence of changes in the size of the nasal cavity. The sinus shrinks as the nasal cavity expands, due to an increased need to condition inspired air in colder climates. This in turn suggests that the sinus itself does not contribute significantly to upper respiratory function.     

Comparison of the response to histamine challenge of the nose and the maxillary sinus: effect of loratadine.

To study the response of the maxillary sinus to histamine provocation, we performed a double-blind, randomized, crossover trial during which nonallergic subjects without symptoms of rhinitis (n = 25) received either 10 mg loratadine or placebo once daily for a week and then underwent nasal challenge with histamine (3, 10, and 30 mg/ml) followed, 24 h later, by a maxillary sinus challenge while still receiving the medication. Nasal challenge with histamine led to significant increases in vascular permeability, reflex nasal secretions, sneezing, and other nasal symptoms. Sinus challenge resulted in significant increases in vascular permeability within the sinus cavity (P < 0.01) and some nasal symptoms but no significant change in reflex nasal secretions. The response of the sinus mucosa to histamine was lower in magnitude than that of the nose. Treatment with loratadine resulted in a significant inhibition of the histamine-induced changes in both nasal and sinus cavities. Our data suggest the lack of a sinonasal reflex response to histamine provocation of the maxillary sinus of nonallergic individuals.     

Maxillary calcifying epithelial odontogenic tumor with sinus and buccal vestibule extension: a case report and immunohistochemical study

Background

Calcifying epithelial odontogenic tumor (CEOT) is a rare benign neoplasia, locally aggressive, that tends to invade bone and adjacent soft tissues. This case report describes the thirteenth known case of CEOT with maxillary sinus extension and the second one that also involves the buccal vestibule mucosa with peculiar histopathological and immunohistochemical data.

Case presentation

Here we report the case of a 45-year-old female with a CEOT diagnosed and treated at the Oral & Maxillofacial Surgery Department, County Clinical Emergency Hospital of Craiova, Romania. The clinical and imaging investigation revealed an intraosseous tumor developed from the left posterior maxilla with maxillary sinus and buccal vestibule mucosa extension. Histopathology found an epithelium-rich CEOT variant, but with scattered S100 positive clear cells, focal small rounded cementum-like deposits and areas with some degree of nuclear pleomorphism. The immunohistochemical investigations emphasised its local aggressiveness behavior with involvement of multiple molecular mechanisms that underlie tumor invasiveness. A subtotal maxillectomy was performed followed by defect reconstruction.

Conclusions

We discuss the relevant clinicopathological features of an aggressive rare case of CEOT with maxillary sinus extension and buccal vestibule mucosa involvement. The immunohistochemical study suggests its utility in attempting to assess the degree of local tumor aggressiveness and thus in adopting the most efficient therapeutic attitude.

     

Coexistence of aspergillosis and squamous-cell carcinoma in the maxillary sinus proven by preoperative cytology

The case of a 56-year-old female with coexisting aspergillosis and squamous-cell carcinoma in the maxillary sinus is reported. The diagnosis was established by cytologic study of washings of the sinus before and after admission and was confirmed by exploratory antrotomy. To our knowledge, this is the first case in which the coexistence of fungus and neoplasm in the paranasal sinus was established by preoperative cytologic diagnosis.     

Mesenchymal stem cells in maxillary sinus augmentation: A systematic review with meta-analysis

AIM: To investigate the effectiveness of mesenchymal stem cells (MSCs) in maxillary sinus augmentation (MSA), with various scaffold materials.METHODS: MEDLINE, EMBASE and SCOPUS were searched using keywords such as sinus graft, MSA, maxillary sinus lift, sinus floor elevation, MSC and cell-based, in different combinations. The searches included full text articles written in English, published over a 10-year period (2004-2014). Inclusion criteria were clinical/radiographic and histologic/ histomorphometric studies in humans and animals, on the use of MSCs in MSA. Meta-analysis was performed only for experimental studies (randomized controlled trials and controlled trials) involving MSA, with an outcome measurement of histologic evaluation with histomorphometric analysis reported. Mean and standard deviation values of newly formed bone from each study were used, and weighted mean values were assessed to account for the difference in the number of subjects among the different studies. To compare the results between the test and the control groups, the differences of regenerated bone in mean and 95% confidence intervals were calculated.RESULTS: Thirty-nine studies (18 animal studies and 21 human studies) published over a 10-year period (between 2004 and 2014) were considered to be eligible for inclusion in the present literature review. These studies demonstrated considerable variation with respect to study type, study design, follow-up, and results. Meta-analysis was performed on 9 studies (7 animal studies and 2 human studies). The weighted mean difference estimate from a random-effect model was 9.5% (95%CI: 3.6%-15.4%), suggesting a positive effect of stem cells on bone regeneration. Heterogeneity was measured by the I² index. The formal test confirmed the presence of substantial heterogeneity (I² = 83%, P < 0.0001). In attempt to explain the substantial heterogeneity observed, we considered a meta-regression model with publication year, support type (animal vs humans) and follow-up length (8 or 12 wk) as covariates. After adding publication year, support type and follow-up length to the meta-regression model, heterogeneity was no longer significant (I² = 33%, P = 0.25).CONCLUSION: Several studies have demonstrated the potential for cell-based approaches in MSA; further clinical trials are needed to confirm these results.     

The hiatus semiluminaris, the infundibulum and the ostium of the sinus maxillaris, the anterior attached zone of the concha nasalis and its distance to the landmarks of the outer and inner nose

The authors described the Infundibulum and Ostium of the maxillary sinus, its width and location and course in the Hiatus semilunaris. There were counted and measured also the accessory Ostia, the Processus uncinatus and Bulla ethmoidalis and distances to landmarks between the outer nose and the Limen nasi to these structures.     

黑水国遗址汉代人群的上颌窦炎症

上颌窦是位于鼻腔周围最大的骨质腔,由于其所处位置及结构的特殊性,相比额窦、筛窦、蝶窦,上颌窦更容易受到感染产生炎症反应,因此上颌窦炎是现代社会最常见的炎症性疾病之一。通过对黑水国遗址汉代人群上颌窦的观察,发现该墓地中有40.5%的个体上颌窦内出现骨形态的改变,以穗状骨片为主。女性上颌窦炎出现率远高于男性,但无统计学上的显著差异,男性上颌窦炎左侧出现率高于右侧,女性右侧高于左侧。按照不同的年龄段划分,从未成年期到中年期上颌窦炎的出现率随着年龄的增长而增长,但是通过二元逻辑回归检验,发现上颌窦炎与年龄之间并无统计学上的显著意义。在患有上颌窦炎的个体中,有66.7%的个体都出现了牙周病,一半以上的个体出现了龋齿。这似乎预示着上颌窦炎与牙齿疾病之间有着一定的联系。张掖黑水国遗址汉代人群上颌窦炎的高出现率可能是多因素导致的结果,包括寒冷干燥的气候环境、空气污染、牙齿疾病以及病原微生物等。     

Epidermal cyst originating from the preauricular sinus

Epidermal cysts are the benign tumors which are found in various regions. We experienced a rare case in which the preauricular sinus was the origin of the epidermal cyst.     

A case report of cysticercosis caused by Cysticercus longicollis, a larval form of Taenia crassiceps in a woodchuck (Marmota monax)

Cysticercosis was found in one of 18 woodchucks imported from the United States and maintained in our laboratory for study of hepatitis and hepatocellular carcinoma. The lesions found in subcutaneous area, lungs and maxillary sinus were multiple cysts containing numerous cysticerci identified as Cysticercus longicollis, a larval form of Taenia crassiceps.     

Frontal sinus fractures: guidelines to management

The appropriate management of frontal sinus fractures is controversial. Experience with 78 frontal sinus fractures over a 9-year period was reviewed, and the fractures were classified into anterior wall, anterobasilar, and frontal skull fracture extensions. The presence of a concomitant CSF leak or an air-fluid level in the sinus was a diagnostic clue of posterior wall involvement. Ablation or obliteration of the fractured frontal sinus is not necessary. Primary reconstruction of the sinus and nasofrontal duct drainage constitute the preferred treatment. "Cranialization" of a severely damaged sinus is performed by excision of the posterior wall plugging of the nasofrontal duct and reconstruction of the anterior wall. Reconstruction of the anterior wall with primary bone grafting may be necessary in selected patients.