Volume 04 Issue 10-2024
56
International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
04
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10
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AGES
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56-63
OCLC
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ABSTRACT
In recent decades, inflammatory diseases of the nose and paranasal sinuses have firmly taken first place in the overall
structure of morbidity of ENT organs, both in the analysis of visits to the clinic and in the group of patients undergoing
treatment in inpatient settings. Cysts of the paranasal sinuses are one of the most common diseases in clinical practice.
KEYWORDS
Maxillary sinus cyst, paranasal sinuses, mucous membrane.
Research Article
TREATMENT OF MAXILLARY SINUS CYSTS: LITERATURE REVIEW
Submission Date:
October 02, 2024,
Accepted Date:
October 07, 2024,
Published Date:
October 12, 2024
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume04Issue10-10
Mirzayev S.P.
Tashkent Medical Academy, Uzbekistan
Jabborov N.N.
Tashkent Medical Academy, Uzbekistan
Akhmedov S.E.
Tashkent Medical Academy, Uzbekistan
Botirov A.J.
Tashkent Medical Academy, Uzbekistan
Abdullaev U.P.
Tashkent Medical Academy, Uzbekistan
Akhundjanov N.A.
Tashkent Medical Academy, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
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INTRODUCTION
The author's review focuses on the following topics:
periapical inflammatory processes, inflammatory
changes in the mucous membrane of the maxillary
sinus, sinusitis, cysts, causes of odontogenic sinusitis,
differential diagnosis of periapical inflammatory
processes, endodontic treatment or apical surgery [2].
1. Periapical inflammatory processes. Inflammatory
changes in the mucous membrane of the maxillary
sinus.
According to foreign studies (presented in the Journal
of Endodontics, Oral & Maxillofacial Surgery, Clinical
Oral Investigations):
-
“I
nflammation in the periapical tissues can
affect the sinus mucosa both in the presence and
absence of perforation of the cortical plate of its
floor.”
-
“Infectious
agents
and
inflammatory
mediators can spread through the medullary spaces,
blood and lymph
atic vessels into the maxillary sinus.”
–
“Inflammatory changes in the mucous membrane of
the maxillary sinuses occur in 70-80% of cases of
periapical inflammatory processes of molars and
premolars of the upper jaw.”
-
“The most common of these changes a
re
inflammatory thickening of the sinus mucosa (77-83%)
and sinusitis (35%).”
Inflammatory processes in the pulp and periodontium
of the chewing teeth can affect the integrity of the
bottom of the maxillary sinus and the condition of the
mucous membrane, causing inflammatory changes in it
[3-6]. The spread of periapical inflammation into the
maxillary sinus was first described by Bauer in 1943. He
conducted a study of cadavers using microscopy of
sections of dentoalveolar segments with the adjacent
part of the sinus [1]. The study showed that
inflammation in the periapical tissues can affect the
sinus mucosa both in the presence and absence of
perforation of the cortical plate of its floor. Infectious
agents and inflammatory mediators can spread
through the bone marrow spaces, blood and lymphatic
vessels into the maxillary sinus [7].
Studies by Ariji et al report a high prevalence (70-88%)
of inflammatory changes in the maxillary sinus
associated with apical periodontitis of the chewing
teeth of the upper jaw [8-14]. According to Lofthag-
Hansen et al., the most common of these changes are
inflammatory thickening of the sinus mucosa (77-83%)
and sinusitis (35%).
Longhini and co-authors' data are interesting.
According to their observations, patients who
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underwent up to three maxillofacial surgeries
maintained sinusitis for three to 15 years until the
elimination of odontogenic causes. Moreover, all these
years, patients were under the observation of dentists,
but no connection between apical infection and
sinusitis was found [15].
According to Spanish colleagues published in 2010,
among the most common odontogenic causes of
sinusitis are:
- peri-apical inflammatory processes of the lateral teeth
of the upper jaw - 46% (21% of teeth after endodontic
treatment);
- removal of infected tissue or filling material during
endodontic treatment - 8%. Thus, about 50% of
odontogenic sinusitis are associated with teeth that
require or have previously undergone endodontic
treatment. Speaking of group dental involvement, it
should be noted that the most frequent inflammatory
processes in the jejunum are caused by the first molar
(about 40%), the second molar (27%), the second
premolar (6%), and the first premolar (2.5%). In this
case, the first molar is most often caused by the
celestial root, the second molar by the anterior
maxillary root, and the first premolar by both roots [1].
2. What do the literature data suggest about the role of
endodontics in the complex treatment of maxillary
sinus diseases?
Two studies published more than 40 years ago
indicated that 30% and 70% of patients experienced
complete endodontic hypertrophy within one year of
endodontic treatment. Meanwhile, tooth removal
caused complete restoration of the mucous membrane
within 11 months in 80% of cases. There are also
descriptions of individual clinical cases of restoring the
healthy state of the mucous membrane after
endodontic treatment [15-18]. All of these studies had
an observation period of one year or more.
One of the latest research on this topic was conducted
by Nurbakhsh and co-authors. During this study, 30
upper jaw teeth (four first premolars, six second
premolars, 15 first molars, and five second molars) and
maxillary sinus were examined. In 24 out of 30 sinuses,
inflammatory changes were detected (80%). A
decrease in the thickness of the hypertrophied mucous
membrane to the norm (less than 3 mm) within three
months after endodontic treatment was observed in
30% of cases and amounted to 41% to 89% of the initial
values. In 30% of cases, a less pronounced decrease in
mucosal thickness occurred (9% to 14%). In other cases,
no significant decrease in mucosal thickness was
observed. This may be due to the short observation
period [19].
According to various authors, the prevalence of cysts
ranges from 15% to 45%. Knowing that the success of
conservative treatment of apical periodontitis is about
80%, it is reasonable to assume that in some cases,
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cysts can be treated conservatively. However,
according to Ramachandran Nair P. N., Pajarola G.,
Schroeder, true epithelial cysts persist after
conservative treatment [20-24].
Therefore, differential diagnosis of cysts from granules
is of great importance for choosing between surgical
and conservative treatment options.
For the first time, the use of CT for differential
diagnosis of radicular cysts and granules was described
by Trope et al. In his research, he examined eight teeth
with near-peak inflammatory lesions [25-29]. Seven out
of eight foci had fuzzy contours and uniform density,
similar to the density of soft tissues. One focus in the
center had homogeneous lighting of low density in the
center. Histologically, this site turned out to be a cyst,
while the other seven were granules.
In one of the recent works, Aggarwal and co-authors
used CT to differentiate the diagnosis of true
granulomatous cysts. They were able to determine
density values in Hounsfield units for these formations.
The study examines 12 clinical cases [30]. In each case,
a computer scan was performed and further surgical
treatment with a histological examination was
performed.
Two lesions were identified as granules, the remaining
10 as cysts. However, HU values greater than 40 are
characteristic of granules, and from -20 to 20 are
characteristic of cysts.
Therefore, CLT can be an adequate minimally invasive
method
for
differential
diagnosis
of
apical
periodontitis.
Recently, thanks to the development of modern
diagnostic equipment and augmentation systems,
surgical methods for treating near-peak inflammatory
lesions are becoming increasingly widespread [31-35].
The teeth of the chewing group that do not require
endodontic treatment are candidates for such
treatment and should be removed only if it is
impossible to do so. The difficulties of surgical
treatment of such teeth are related to their location in
the distal parts of the oral cavity, which determines the
difficulties in obtaining adequate access and close
proximity to the maxillary sinus [29].
Apicalctomies of the upper jaw molars and premolars
are accompanied by complications characteristic of
apicalctomies
of
any
localization.
Specific
complications include perforation of the maxillary
sinus and introduction of foreign bodies/materials into
the sinus.
Ericson et al. obtained a perforation of the bottom or
wall of the maxillary sinus in 18% of cases during apical
rectomy of 159 molars and premolars of the maxillary
sinus. According to these authors, the introduction of
foreign bodies into the lumen can cause thickening of
the Schneider membrane and sinusitis.
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Friedman et al. received a perforation in 11.8% of cases
during apiclectomy of 94 upper molars.
Persson reports perforation in 44% of cases. Despite
this, the treatment outcome is 78%. They did not
establish a correlation between the successful
outcome of treatment and the perforation of the
Schneider membrane.
Ioannides et al. underwent 47 operations on the upper
jaw in 14.8% of cases. According to these authors, the
presence of perforation does not affect the formation
of peri-apical bone and the success of treatment [22].
Rud et al. performed 200 apiclectomies of the first
molars of the upper jaw, averaging 50% of the cases
were perforated. Despite this frequency of
perforations, sinusitis was registered in only two cases
[20].
Freedman Horowitz, in a study of 440 patients who
underwent apical removal of 472 upper jaw teeth,
reports membrane perforation in 10.4% of cases (23 in
the second molars and two in the first premolars).
However, no cases of sinusitis or mucosal hypertrophy
were observed.
Penarrrocha et al. in a study of 50 clinical cases received
a perforation in three cases, a radiographic picture of
bone tissue restoration in 46 cases, and no bone tissue
restoration in four cases. The authors did not find a
connection between the perforation of the maxillary
sinus and the success of treatment.
CONCLUSIONS
1.Endodontic treatment of periapical inflammatory
lesions leads to an improvement in the condition of the
maxillary mucosa in an average of 60% of cases.
2. Considering the prevalence of root cysts from 15% to
45%, it can be assumed that in these cases, the
treatment is done with granules and granulating
lesions.
3.For differential diagnosis of periapical inflammatory
processes, it is advisable to use low-FOV CLCT.
4.To evaluate treatment outcomes, a long observation
period (up to one year) is necessary.
5.In cases of ineffective endodontic treatment, apical
surgery is the method of choice.
6. At the same time, the appearance of a perforation of
the maxillary sinus does not affect the success of
treatment.
7. In case of ineffective apical surgery, tooth removal is
recommended.
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