Background During surgical planning for the excision of odontogenic cysts and tumors, surgeons should consider choosing the appropriate endoscopic approach to reach all parts of the maxillary sinus and cyst walls during its enucleation. Using the endoscopic trans-nasal approaches results in less than one-third of the maxillary sinus being reached regardless of antrostomy or angled instruments used. Also, the expansion process and involvement of maxillary sinuses in odontogenic cysts and tumors are variable, adding more difficulties during excision. This study aimed to assess the expansion process of large benign odontogenic cysts and tumors involving nasoantral regions and adaptability to different endoscopic approaches for enucleation. Six patients were included in this case series study. Preoperative panoramic views plain film radiography, and computed tomography scans were obtained. Lesion characteristics, relation to teeth origin, the nose, and maxillary sinus wall displacement, location of lesions about typical vertical and horizontal nasomaxillary constructions, and associated inflammation of the paranasal sinuses were evaluated. Three surgical approaches were tailored, allowing viewing and endoscopic enucleation. Results Four periapical (radicular) cysts, one ameloblastoma, and one calcifying epithelial odontogenic tumor, ranging in size from 3 to 5 cm, were enucleated endoscopically in patients aged 15–40 years. Intra-sinus expansion of the cyst and lesion level above the nasal floor allowed endoscopic enucleation using wide middle meatal antrostomy in 1 (17%). Lesions localized to the anterior wall and the nasal process of the maxilla permitted endonasal minimal rhinotomy approach in 1 (17%). Central lesions, cyst extension below the level of the nasal floor, and lateral wall expansion with or without anterior maxillary wall scalloping had adequate exposure using a minimal sublabial approach in four patients (67%). Together with its role in complete enucleation, endoscopy allowed associated rhinosinusitis surgical treatment in five patients (83%). Conclusion Tailoring surgical approaches to the expansion process allowed endoscopic enucleation of large odontogenic cysts/tumors without wall remnants. The integrity of the Schneiderian membrane was preserved, protecting the critical surrounding structures.
Background Platelet-rich fibrin (PRF) which is considered a second-generation platelet-rich plasma having a high content of growth factors could be implied as a sealant and adjuvant to grafting materials during tympanoplasty operation. This work aimed to evaluate the role of autologous platelet-rich fibrin as an adjuvant in type 1 tympanoplasty (myringoplasty) for the closure of central tympanic membrane perforations. A prospective comparative study was conducted including one-hundred patients with chronic suppurative otitis media with dry central TM perforations. The patients were classified into two equal groups: group A (case group) was subjected to myringoplasty operation with the use of autologous PRF added to the temporalis fascia graft, and group B (control group) was subjected to myringoplasty operation using graft only without PRF. Both groups were assessed for successful closure of perforation defined as an intact eardrum, success in terms of hearing defined as closure of air-bone gap down to 10 dB or lesser, and hearing gain at 6 months postoperatively. Results At 6 months postoperatively, the success rate (graft taking) in group A (90%) was significantly higher than in group B (70%). Success in terms of air-bone gap closure (< 10 dB) revealed that in group A, success was achieved in 39 patients (78%), which was significantly higher than in group B 27 patients (54 %). Air-bone gap at 6 months postoperatively was more in the graft taken cases in the case group than in the control group with a significant difference. There was a nonsignificant correlation between graft uptake and either hemoglobin or platelet concentrations in both groups. In addition, there was a nonsignificant correlation between graft uptake and the size of the perforation in both groups. Conclusion Platelet-rich fibrin is a cheap, cost-effective, and completely autologous platelet concentrate with enriched growth factors. It improves the overall success rate of myringoplasty with no noticeable side effects.
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