Schneiderian Membrane Regeneration After Lateral Bony Window Repositioning in Modified Endoscopic-Assisted Maxillary Sinus Surgery: Transmission Electron Microscopy Evaluation

Abstract

: Mandibular reconstruction is one of the most complex procedures concerning the patient’s postoperative facial shape and occlusion condition. In this study, the authors integrated mixed reality, three-dimensional (3D) printing, and robotic-assisted navigation technology to complete the mandibular reconstruction in a novel and more accurate way. Mixed reality can visualize the significant anatomical structures of the operative area, but only be used in simulated operation by now. Three-dimensional printing surgical guide plate makes it easy to separate tissue, while imprecision often occurs due to the potential of displacement and deformation. In recent years, most robotic-assisted navigation surgery technology can only achieve precise position by 2D view on the screen but not realistic 3D navigation. in this study, the integrated 3 technologies were used in mandibular reconstruction. Preoperative imaging examination was performed, and the data were imported into the digital workstation before operation. First, the original data was edited and optimized to reconstruct the digital model and formulate the surgical plan. Then MR was used to output the visualized project and matched the 3D reconstruction model in reality. The 3D plate was printed for surgical guidance. Last, robotic-assisted navigation was used to guide and position the vascularized fibula autograft and the immediate dental implantation. In conclusion, the authors integrated the 3 technologies and constructed a new digital surgical procedure to improve surgical accuracy and simplify the procedure comparing with traditional surgery.

Appropriate Implant Rehabilitation in Patients With Iatrogenic Oroantral Fistula and Odontogenic Maxillary Sinusitis

“…The main advantage of MESS is that the physiological functions of paranasal sinus are maintained while avoiding the formation of postoperative maxillary cysts or sinus scar tissues 7. A previous study by Han et al9 demonstrated the successful outcomes of MESS through histopathologic and ultrastructural findings indicating the regeneration of SM and complete bone healing with clinical restoration of maxillary sinus functions that were achieved optimally 6 months after the treatment 9. Periodic radiographs and clinical follow-ups are important to ensure that the maxillary sinus is normalized before proceeding with implant treatment.…”

“…Rare but several cases of esophageal and pharyngeal perforation due to migration and extrusion of screw have been reported. 2,3,9 On the patient's first visit to hospital due to dysphagia, there was no plate migration on radiologic findings with lateral neck x-ray at extension or flexion view. There was no abnormal hypopharynx posterior wall mucosal finding either.Retropharyngeal granulation is also one of rare complications in ACS surgery.…”

Transantral Approach With an Optical Navigation System for Cystic Lesions at the Pterygoid Process

“…The per-oral TAA implemented in this study minimized the amount of bone removed using an optical navigation system, minimized complications, and maximized bone healing and regeneration of the Schneiderian membrane by repositioning the bony window. 8 In addition, this approach allows a wide field of view and operation of instruments, enabling faster surgery and more efficient operation for surgeons.…”

“…5 There is no consensus regarding mandibular bone surgical margins that should be planned to ensure a safe oncologic outcome. In 1988, McGregor and MacDonald 6 recommended planning a clinical resection of 0.5 to 1.0 cm of unaffected bone around the tumor and, more recently, 3 separate groups-Namin et al, 7 Wysluch et al, 8 and Weitz et al 9 -report resection of at least 1.0 cm of uninvolved bone, as measured from either macroscopic tumor or suspected bone involvement. In the preoperative assessment, a computerized tomography (CT) scan, a positron emission tomography CT and eventually an magnetic resonance imaging are performed.…”

Sinusitis Following Reduction Malarplasty

“…Regeneration of the Schneiderian membrane and restoration of the physiologic function of the maxillary sinus are essential for the successful treatment of odontogenic maxillary sinusitis. 7 In 66 patients, Han performed modified endoscopic sinus surgery with repositioning of the lateral bony window for the treatment of odontogenic maxillary sinusitis. Histologically, in the inflamed maxillary sinus membrane, squamous metaplasia was observed with infiltration of inflammatory cells including neutrophils, eosinophils, and plasma cells.…”