The Journal of Craniofacial Surgery • Volume 26, Number 1, January 2015

3. Flanagan D. Apical (retrograde) peri-implantitis: a case report of an active lesion. J Oral Implantol 2002;28:92–96 4. Silva GC, Oliveira DR, Vieira TC, et al. Unusual presentation of active implant periapical lesions: a report of two cases. J Oral Sci 2010;52:491–494 5. Scarano A, Di Domizio P, Petrone G, et al. Implant periapical lesion: a clinical and histologic case report. J Oral Implantol 2000;26:109–113 6. Quaranta A, Andreana S, Pompa G, et al. Active implant peri-apical lesion: a case report treated via guided bone regeneration with a 5-year clinical and radiographic follow-up. J Oral Implantol 2014;40:313–319 7. Romanos GE, Froum S, Costa-Martins S, et al. Implant periapical lesions: etiology and treatment options. J Oral Implantol 2011;37:53–63 8. Tözüm TF, Sençimen M, Ortakoğlu K, et al. Diagnosis and treatment of a large periapical implant lesion associated with adjacent natural tooth: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e132–e138 9. Peñarrocha-Diago M, Maestre-Ferrín L, Cervera-Ballester J, et al. Implant periapical lesion: diagnosis and treatment. Med Oral Patol Oral Cir Bucal 2012;17:e1023–e1027 10. Toniollo MB, Macedo AP, Rodrigues RC, et al. Three-dimensional finite element analysis of stress distribution on different bony ridges with different lengths of morse taper implants and prosthesis dimensions. J Craniofac Surg 2012;23:1888–1892 11. Quirynen M, Vogels R, Alsaadi G, et al. Predisposing conditions for retrograde peri-implantitis, and treatment suggestions. Clin Oral Implants Res 2005;16:599–608 12. Zhou Y, Cheng Z, Wu M, et al. Trepanation and curettage treatment for acute implant periapical lesions. Int J Oral Maxillofac Surg 2012;41:171–175 13. Sussman HI. Periapical implant pathology. J Oral Implantol 1998;24:133–138 14. Nedir R, Bischof M, Pujol O, et al. Starch-induced implant periapical lesion: a case report. Int J Oral Maxillofac Implants 2007; 22:1001–1006 15. Bousdras V, Aghabeigi B, Hopper C, et al. Management of apical bone loss around a mandibular implant: a case report. Int J Oral Maxillofac Implants 2006;21:439–444 16. Penarrocha-Diago M, Maestre-Ferrín L, Penarrocha-Oltra D, et al. Inflammatory implant periapical lesion prior to osseointegration: a case series study. Int J Oral Maxillofac Implants 2013;28:158–162

Concerning the Article ‘’Neutrophil-Lymphocyte Ratio: A New Predictive and Prognostic Factor in Patients With Bell Palsy” To the Editor: In our study entitled ‘’Neutrophil-to-lymphocyte ratio as a novel-potential marker for predicting prognosis of Bell palsy,”1 the 54 patients, who were followed up because of Bell palsy for a period of 1 to 3 years, were scanned and classified according to the House-Brackmann grading system. At posttreatment period, the patients with House-Brackmann grades I and II were regarded as satisfactory recovery, and those with House-Brackmann grades III to VI were regarded as ‘’nonsatisfactory.” The mean neutrophil-to-lymphocyte ratio (NLR) and neutrophil values in patients with Bell palsy were significantly higher than the control group (P = 0.001 and P < 0.001, respectively). In addition, NLR levels were higher in nonsatisfactory recovered patients compared with satisfactory recovered ones (P < 0.001).


We agree with you, while evaluating Bell palsy patients, that NLR might be taken into account as a novel potential marker to predict the patients’ prognosis. We thank the authors for their valuable contributions and opinions. Abdulkadir Bucak, MD Department of Otorhinolaryngology, Faculty of Medicine Afyon Kocatepe University Afyonkarahisar, Turkey [email protected]

REFERENCE 1. Bucak A, Ulu S, Oruc S, et al. Neutrophil-to-lymphocyte ratio as a novel-potential marker for predicting prognosis of Bell palsy. Laryngoscope 2014;124:1678–1681

Endoscopic Sinus Surgery and Intraoral Approaches in Sinus Oral Pathology To the Editor: Because our group has been treating sinus oral pathology for more than 10 years and supporting the use of nasal endoscopy, it has been both a pleasure and a personal gratification seeing how maxillofacial colleagues embraced endoscopic surgery. Therefore, we read the article by Giovannetti and colleagues1 with keen interest and peculiar attention. We especially appreciated the comprehensive point of view over what the authors call “sinus oral pathology,” an emerging group of conditions loosely related to the traditional nosologic entity of “odontogenic sinusitis.” Nevertheless, if we consider the whole broad spectrum of sinonasal complications of dental disease or treatment (SCDDTs), we think that the article would greatly take advantage of including other relevant etiologies, such as periimplantitis,2 pulpitis and failed endodontics,3 as well as periodontitis,4 which affect a conspicuous number of patients. The authors did propose sound therapeutic options, although they did not specify which protocols should be adopted in each different clinical scenario. Our group already published a comprehensive article on this subject.5 Unfortunately, the authors, despite citing our other works, did not compare their approach with our indications: a comparison between the 2 groups' experiences and results could have been interesting and useful. A major point that would take advantage from a direct comparison is combining endoscopic endonasal techniques and oral approach in selected SCDDT scenarios. Indeed, even if most available data show that ESS is superior in terms of results to more traditional oral approaches, even when treating chronic sinusitis limited to the maxillary sinus,6 we strongly believe that multidisciplinary treatment coupling endoscopic endonasal techniques and oral approaches is pivotal both in diagnosing and treating odontogenic sinonasal conditions. In contrast to what Giovannetti and colleagues say, in our hands, oral accesses prove effective in particular conditions such as displacement of implants into the maxillary sinus, where there is no inflammatory reaction to control (exclusive oral access), and pivotal in granting a complete visualization of the maxillary alveolar recess (combined approach), © 2014 Mutaz B. Habal, MD

Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.

The Journal of Craniofacial Surgery • Volume 26, Number 1, January 2015

for example, when dealing with maxillary sinus augmentation complications. Combining Caldwell-Luc approaches to the maxillary sinus with endoscopic sinus surgery in carefully selected cases granted excellent results in our hands: tailoring the approach to each specific case following a precise protocol allowed us to reach an overall success rate of 98.8% of 257 treated patients; our results are therefore comparable with those of Giovannetti and colleagues published for exclusive endoscopic approaches. Last but not least, we would like to remember that, considering the widening scientific relevance SCDDTs are gaining, there is a growing corpus of ancillary techniques that might be useful when treating particular complications such as implant displacement into the maxillary sinus: among these, we would like to cite the bone flap on mucosa pedicle,7 the double barrel technique,8 and the antral retriever.9 We would very much appreciate if the authors could provide a clear management protocol to motivate result comparison and share their thoughts on management of SCDDT patients. Alberto Maria Saibene, MD Otolaryngology Department San Paolo Hospital Università degli Studi di Milano Milan, Italy [email protected] Paolo Lozza, MD Otolaryngology Department San Paolo Hospital Università degli Studi di Milano Milan, Italy

REFERENCES 1. Giovannetti F, Priore P, Raponi I, et al. Endoscopic sinus surgery in sinus-oral pathology. J Craniofac Surg 2014;25:991–994 2. Jensen OT, Adams M, Cottam JR, et al. Occult peri-implant oroantral fistulae: posterior maxillary peri-implantitis/sinusitis of zygomatic or dental implant origin. Treatment and prevention with bone morphogenetic protein-2/absorbable collagen sponge sinus grafting. Int J Oral Maxillofac Implants 2013;28:e512–e520 3. Pokorny A, Tataryn R. Clinical and radiologic findings in a case series of maxillary sinusitis of dental origin. Int Forum Allergy Rhinol 2013;3:973–979 4. Brüllmann DD, Schmidtmann I, Hornstein S, et al. Correlation of cone beam computed tomography (CBCT) findings in the maxillary sinus with dental diagnoses: a retrospective cross-sectional study. Clin Oral Investig 2012;16:1023–1029 5. Felisati G, Chiapasco M, Lozza P, et al. Sinonasal complications resulting from dental treatment: outcome-oriented proposal of classification and surgical protocol. Am J Rhinol Allergy 2013;27:e101–e106 6. Joe Jacob K, George S, Preethi S, et al. A comparative study between endoscopic middle meatal antrostomy and Caldwell-Luc surgery in the treatment of chronic maxillary sinusitis. Indian J Otolaryngol Head Neck Surg 2011;63:214–219 7. Biglioli F, Goisis M. Access to the maxillary sinus using a bone flap on a mucosal pedicle: preliminary report. J Craniomaxillofac Surg 2002;30:255–259 8. Albu S. The “double-barrel” approach to the removal of dental implants from the maxillary sinus. Int J Oral Maxillofac Surg 2013;42:1529–1532 9. Mantovani M, Pipolo C, Messina F, et al. Antral retriever and displaced dental implants in the maxillary sinus. J Craniofac Surg 2011;22:2275–2277


Brooke-Spiegler Syndrome Clinically Misdiagnosed as Neurofibromatosis Type 1 To the Editor: Hereditary tumor syndromes such as BrookeSpiegler syndrome (BSS; Online Mendelian Inheritance in Man [OMIM] 605041) and neurofibromatosis type 1 (NF-1; OMIM 162200) cover a wide phenotypic spectrum and have been associated with cutaneous findings that may facilitate diagnostic interpretation.1 However, different clinical entities have been misdiagnosed as NF-1.2–5 Here, we report an adult patient with BSS, clinically misdiagnosed and misinterpreted as NF-1, to highlight the need to sustain a broad differential and an appropriate diagnostic workup when evaluating any patient with multiple cutaneous long-lasting lesions and positive familial history. A 56-year-old woman with a history of multiple craniofacial cutaneous lesions since adolescence was evaluated. Her mother had a similar phenotype. She had undergone numerous surgical resections at different general practice units during the last 15 years, always being designated as NF-1. In the last 2 years, the auricular lesions reached their largest size, leading to progressive bilateral hearing loss. She was then referred to our craniofacial unit with the presumed diagnosis of NF-1 described in her medical records; it was carefully reviewed to clarify this diagnosis, but the data provided were incomplete and there was no histopathologic report. Upon physical examination, multiple, firm, rubbery, skin-colored, painless nodules of the forehead, the scalp, and the ears as well as multiple, skin-colored facial papules were revealed (Fig. 1). The remainder of the examination was unremarkable. Because NF-1 was a bare clinical possibility (presence of multiple cutaneous longlasting lesions and positive family history but absence of further clinical features of NF-1 such as café au lait spots, axillary or inguinal freckling, and/or Lisch nodules), other clinical hypotheses including isolated neurofibromas, granulomas, dermoid cysts, lipomas, and hemangiomas were formulated, and BSS was not considered as a diagnostic possibility. Therefore, the bilateral meatus externus lesions were surgically excised because of functional impairment and for a definite diagnosis. There were no complications in the postoperative period, and the patient reported bilateral hearing improvement. Histopathologic analysis revealed bilateral spiradenocylindroma, with follicular differentiation foci sometimes reminiscent of trichoepithelioma, without signs of malignancy (Fig. 2). These microscopic findings in combination with the clinical presentation were consistent with BSS. Follow-up care was

FIGURE 1. Clinical photographs of the patient showing multiple skin-colored nodules and papules primarily of the forehead and the ears with almost complete obstruction of the meatus externus.

© 2014 Mutaz B. Habal, MD

Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.


Endoscopic sinus surgery and intraoral approaches in sinus oral pathology.

Endoscopic sinus surgery and intraoral approaches in sinus oral pathology. - PDF Download Free
611KB Sizes 3 Downloads 12 Views