Antrolith: radiological diagnosis and surgical treatment – presentation of clinical cases
Vlachopanos Zois-Panagiotis, Impas Christos, Venetis Athanasios, Liappis Evangelos, Papadeli Chrysi, Delantoni Antigoni
Department of Dentoalveolar Surgery, Implantology and Oral Radiology, School of Dentistry, Aristotle University
of Thessaloniki
DOI: 10.54936/haoms2513141
Abstract:
Introduction: Antrolith is a pathological calcified mass located in the paranasal sinuses, commonly in the maxillary sinus. When it is found in the vicinity or into the nasal cavity, it is also called rhinolith. In most of the cases, antroliths are incidentally identified through dental patients’ radiological examination. This fact underlines the need of antroliths’ detection in radiographs even by the general dentist.
Objective: This paper aims to discuss the clinical and radiological diagnosis of antrolith, as well as its therapeutic methods, through the presentation of two clinical cases.
Materials – Methods: Clinical cases, diagnosed with dental panoramic radiographs, radiographs of paranasal sinuses (Water’s view) and cone beam computed tomography (CBCT), are presented. Moreover, there has been conducted a review of the recent literature with scientific papers published in databases PubMed and Google Scholar.
Results: Antrolith is usually an asymptomatic clinical feature, but painful symptomatology is rarely observed. Radiologically, it is mainly diagnosed with accuracy using orthopantomography and CBCT. As a pathological mass, antrolith should be differentiated from dental dysplasias, inflammatory calcifications, foreign bodies, even neoplasms in case of sizeable antroliths. The treatment choices of antroliths, depending on the severity of every clinical case, include frequent medical observation without any intervention or surgical excision techniques, most commonly the endoscopic sinus surgery or the removal through intraoral access. This article refers to two clinical cases of antroliths, one asymptomatic and one painful case, with all the diagnostic and management methodology being discussed.
Conclusions: The radiological diagnosis of antroliths in conjunction with the endoscopic sinus surgery for its removal provide with the opportunity to treat and relieve patients with painful symptomatology. It is important not to be missed by the general dentist, as it may appear incidentally when evaluating panoramic radiographs. The assessment of antroliths is crucial for the differential diagnosis and its therapeutic management requires cooperation with a specialist.
KEY WORDS: Antrolith, CBCT, endoscopic sinus surgery, maxillary sinus, orthopantomography
REFERENCES
1. Shenoy V, Maller V, Maller V. Maxillary antrolith: a rare cause of the recurrent sinusitis. Case Rep Otolaryngol. 2013;2013:1–4.
2. Cho BH, Jung YH, Hwang JJ. Maxillary antroliths detected by cone-beam computed tomography in an adult dental population. Imaging Sci Dent. 2019;49(1):59–63.
3. Nair S, James E, Dutta A, Goyal S. Antrolith in the maxillary sinus: An unusual complication of endoscopic sinus surgery. Indian J Otolaryngol Head Neck Surg. 2010;62(1):81–3.
4. Tan YLT, Zhang Y, Hui BCS. Case report of a maxillary antrolith. Int J Surg Case Rep. 2020;74:128–31.
5. Aoun G, Nasseh I. Maxillary Antroliths: A Digital Panoramic-based Study. Cureus. 2020;12(1):e6686.
6. Yeung AWK, Hung KF, Li DTS, Leung YY. The Use of CBCT in Evaluating the Health and Pathology of the Maxillary Sinus. Diagnostics (Basel). 2022;12(11):2819.
7. Syam S, Maheswari U. Prevalence of Incidental Findings in Maxillary Sinus Using Cone Beam Computed Tomography – A Retrospective Study. Pharmacophore. 2022;13(6):9–13.
8. Chen HH, Yi CA, Chen YC, Huang HH. Anatomical characteristics of maxillary sinus antroliths and their influence on sinus membrane thickness: a retrospective cone beam computed tomography analysis. Int J Oral Maxillofac Surg. 2021;50(8):1107–12.
9. Herreira-Ferreira M, Souza-Pinto GN, Tolentino ES, ChicareLli M, Iwaki LCV. Differential diagnosis for an unusual calcification in the maxillary sinus: case report. Rev Gaúch Odontol. 2022;70:e20220022.
10. Manning N, Wu P, Preis J, Ojeda-Martinez H, Chan M. Chronic sinusitis-associated antrolith. IDCases. 2018;14.
11. Chatziavramidis A, Kondylidou-Sidira A, Stefanidis A, Soldatou S. Longstanding rhinolith leading to anatomical alterations of the ipsilateral inferior nasal meatus and turbinate. BMJ Case Rep. 2010;2010:bcr0720103155.
12. Özcan C, Vaysoǧlu Y, Görür K. Sinolith: A rare isolated sphenoid sinus lesion. J Craniofac Surg. 2013;24(2):e104–6.
13. Das D, Garg A, Suri N, Mehta A. Maxillary antrolith: A probable cause of chronic sinusitis – A case report and review. Indian J Dent Sci. 2018;10:45–7.
14. Bowerman JE. The maxillary antrolith. J Laryngol Otol. 1969;83(9):873–82.
15. Ishiyama T. Maxillary Antrolith: Report of a Case. Auris Nasus Larynx. 1988;15(3):185–9.
16. Mittal Y, Singh T, Mehak. Maxillary antrolith: a case report. Eur J Mol Clin Med. 2022;9(8):2415–18.
17. Rosado LPL, Barbosa IS, Nascimento SA, Junqueira RB, Verner FS. Dental students’ ability to detect maxillary sinus abnormalities: A comparison between panoramic radiography and cone-beam computed tomography. Imaging Sci Dent. 2019;49(3):191–9.
18. Jamahar A, Maragathavalli G. Maxillary Sinus Pathologies in Orthopantomography. Int J Dentistry Oral Sci. 2021;8(8):3738–42.
19. Rodrigues BTG, De-Lucas RA, Lopes CF, Maciel RM, Israel MS. Maxillary antrolith: an incidental radiographic finding. Oral Diag. 2020;05:e20200021.
20. Block MS, Dastoury K. Prevalence of sinus membrane thickening and association with unhealthy teeth: a retrospective review of 831 consecutive patients with 1,662 cone-beam scans. J Oral Maxillofac Surg. 2014;72(12):2454–60.
21. Moreira-Souza L, Michels M, Lagos de Melo LP, Oliveira ML, Asprino L, Freitas DQ. Brightness and contrast adjustments influence the radiographic detection of soft tissue calcifications. Oral Dis. 2019;25(7):1809–14.
22. Güler N, Duygu G. Progressive swelling and radiopaque mass in maxillary sinus: formation of stone. Kulak Burun Bogaz Ihtis Derg. 2012;22(3):181–5.
23. Rahpeyma A, Khajehahmadi S. Removal of maxillary sinus antrolith and concomitant intrasinus augmentation. J Craniofac Surg. 2018;29(4):e430–2.
Department of Dentoalveolar Surgery, Implantology and Oral Radiology, School of Dentistry, Aristotle University
of Thessaloniki
DOI: 10.54936/haoms2513141
Abstract:
Introduction: Antrolith is a pathological calcified mass located in the paranasal sinuses, commonly in the maxillary sinus. When it is found in the vicinity or into the nasal cavity, it is also called rhinolith. In most of the cases, antroliths are incidentally identified through dental patients’ radiological examination. This fact underlines the need of antroliths’ detection in radiographs even by the general dentist.
Objective: This paper aims to discuss the clinical and radiological diagnosis of antrolith, as well as its therapeutic methods, through the presentation of two clinical cases.
Materials – Methods: Clinical cases, diagnosed with dental panoramic radiographs, radiographs of paranasal sinuses (Water’s view) and cone beam computed tomography (CBCT), are presented. Moreover, there has been conducted a review of the recent literature with scientific papers published in databases PubMed and Google Scholar.
Results: Antrolith is usually an asymptomatic clinical feature, but painful symptomatology is rarely observed. Radiologically, it is mainly diagnosed with accuracy using orthopantomography and CBCT. As a pathological mass, antrolith should be differentiated from dental dysplasias, inflammatory calcifications, foreign bodies, even neoplasms in case of sizeable antroliths. The treatment choices of antroliths, depending on the severity of every clinical case, include frequent medical observation without any intervention or surgical excision techniques, most commonly the endoscopic sinus surgery or the removal through intraoral access. This article refers to two clinical cases of antroliths, one asymptomatic and one painful case, with all the diagnostic and management methodology being discussed.
Conclusions: The radiological diagnosis of antroliths in conjunction with the endoscopic sinus surgery for its removal provide with the opportunity to treat and relieve patients with painful symptomatology. It is important not to be missed by the general dentist, as it may appear incidentally when evaluating panoramic radiographs. The assessment of antroliths is crucial for the differential diagnosis and its therapeutic management requires cooperation with a specialist.
KEY WORDS: Antrolith, CBCT, endoscopic sinus surgery, maxillary sinus, orthopantomography
REFERENCES
1. Shenoy V, Maller V, Maller V. Maxillary antrolith: a rare cause of the recurrent sinusitis. Case Rep Otolaryngol. 2013;2013:1–4.
2. Cho BH, Jung YH, Hwang JJ. Maxillary antroliths detected by cone-beam computed tomography in an adult dental population. Imaging Sci Dent. 2019;49(1):59–63.
3. Nair S, James E, Dutta A, Goyal S. Antrolith in the maxillary sinus: An unusual complication of endoscopic sinus surgery. Indian J Otolaryngol Head Neck Surg. 2010;62(1):81–3.
4. Tan YLT, Zhang Y, Hui BCS. Case report of a maxillary antrolith. Int J Surg Case Rep. 2020;74:128–31.
5. Aoun G, Nasseh I. Maxillary Antroliths: A Digital Panoramic-based Study. Cureus. 2020;12(1):e6686.
6. Yeung AWK, Hung KF, Li DTS, Leung YY. The Use of CBCT in Evaluating the Health and Pathology of the Maxillary Sinus. Diagnostics (Basel). 2022;12(11):2819.
7. Syam S, Maheswari U. Prevalence of Incidental Findings in Maxillary Sinus Using Cone Beam Computed Tomography – A Retrospective Study. Pharmacophore. 2022;13(6):9–13.
8. Chen HH, Yi CA, Chen YC, Huang HH. Anatomical characteristics of maxillary sinus antroliths and their influence on sinus membrane thickness: a retrospective cone beam computed tomography analysis. Int J Oral Maxillofac Surg. 2021;50(8):1107–12.
9. Herreira-Ferreira M, Souza-Pinto GN, Tolentino ES, ChicareLli M, Iwaki LCV. Differential diagnosis for an unusual calcification in the maxillary sinus: case report. Rev Gaúch Odontol. 2022;70:e20220022.
10. Manning N, Wu P, Preis J, Ojeda-Martinez H, Chan M. Chronic sinusitis-associated antrolith. IDCases. 2018;14.
11. Chatziavramidis A, Kondylidou-Sidira A, Stefanidis A, Soldatou S. Longstanding rhinolith leading to anatomical alterations of the ipsilateral inferior nasal meatus and turbinate. BMJ Case Rep. 2010;2010:bcr0720103155.
12. Özcan C, Vaysoǧlu Y, Görür K. Sinolith: A rare isolated sphenoid sinus lesion. J Craniofac Surg. 2013;24(2):e104–6.
13. Das D, Garg A, Suri N, Mehta A. Maxillary antrolith: A probable cause of chronic sinusitis – A case report and review. Indian J Dent Sci. 2018;10:45–7.
14. Bowerman JE. The maxillary antrolith. J Laryngol Otol. 1969;83(9):873–82.
15. Ishiyama T. Maxillary Antrolith: Report of a Case. Auris Nasus Larynx. 1988;15(3):185–9.
16. Mittal Y, Singh T, Mehak. Maxillary antrolith: a case report. Eur J Mol Clin Med. 2022;9(8):2415–18.
17. Rosado LPL, Barbosa IS, Nascimento SA, Junqueira RB, Verner FS. Dental students’ ability to detect maxillary sinus abnormalities: A comparison between panoramic radiography and cone-beam computed tomography. Imaging Sci Dent. 2019;49(3):191–9.
18. Jamahar A, Maragathavalli G. Maxillary Sinus Pathologies in Orthopantomography. Int J Dentistry Oral Sci. 2021;8(8):3738–42.
19. Rodrigues BTG, De-Lucas RA, Lopes CF, Maciel RM, Israel MS. Maxillary antrolith: an incidental radiographic finding. Oral Diag. 2020;05:e20200021.
20. Block MS, Dastoury K. Prevalence of sinus membrane thickening and association with unhealthy teeth: a retrospective review of 831 consecutive patients with 1,662 cone-beam scans. J Oral Maxillofac Surg. 2014;72(12):2454–60.
21. Moreira-Souza L, Michels M, Lagos de Melo LP, Oliveira ML, Asprino L, Freitas DQ. Brightness and contrast adjustments influence the radiographic detection of soft tissue calcifications. Oral Dis. 2019;25(7):1809–14.
22. Güler N, Duygu G. Progressive swelling and radiopaque mass in maxillary sinus: formation of stone. Kulak Burun Bogaz Ihtis Derg. 2012;22(3):181–5.
23. Rahpeyma A, Khajehahmadi S. Removal of maxillary sinus antrolith and concomitant intrasinus augmentation. J Craniofac Surg. 2018;29(4):e430–2.
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