RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

ANNEXURE –II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE
AND ADDRESS
(IN BLOCK LETTERS) / Dr. PULIVARTHI SUSHMA
POST GRADUATE STUDENT,
DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY,
RAJA RAJESWARI DENTAL COLLEGE AND HOSPITAL,
#14 RAMOHALLI CROSS,
MYSORE ROAD,BANGALORE-560074.
2 / NAME OF THE INSTITUTION / RAJA RAJESWARI DENTAL COLLEGE
AND HOSPITAL
3 / COURSE OF STUDY AND SUBJECT / MASTER OF DENTAL SURGERY IN
ORAL MEDICINE AND RADIOLOGY
4 / DATE OF ADMISSION OF COURSE / 27th JULY 2013
5 / TITLE OF THE TOPIC :
ASSESSMENT OF PREVALENCE, LOCATION AND MORPHOLOGY OF MAXILLARY SINUS SEPTAE ON REFORMATTED COMPUTERISED TOMOGRAPHY SCANS – A RETROSPECTIVE STUDY.
6
7
8 / BRIEF RESUME OF THE INTENDED WORK :
6.1 NEED FOR THE STUDY :
The maxillary sinus in an adult is a pyramid shaped cavity in the facial skull with its base at the lateral nasal wall and its apex extending into the zygomatic process of the maxilla. The proximity of the maxillary sinus to the alveolar crest is enhanced by sinus pneumatization and resorption of the alveolar ridge due to tooth extraction, trauma and pathology. At the edentate stage of life, the size of the maxillary sinus increases further often filling a large part of the alveolar process leaving a paper-thin bone wall on the lateral and occlusal sides occasionally. This process of pneumatization of the sinus varies greatly from person to person and even from side to side.1
The detailed study of maxillary sinus anatomy and its variations is important especially in surgical interventions such as endoscopic sinus surgery, sinus lift surgery and for placing implants where inadequate bone height is present because these anatomical variations within maxillary sinus such as septa has been reported to increase the risk of sinus membrane perforation and fracture of the septa.1 So to avoid these complications it is necessary to modify the lateral window during sinus lifting procedures.2
Maxillary sinus septa were first described by Underwood in 1910. Hence, they are sometimes referred to as Underwood’s septa. They are walls of cortical bone within the maxillary sinus, their shape has been described as an inverted gothic arch arising from the inferior or lateral walls of the sinus, and may even divide the sinus into two or more cavities.2
Septa are classified either PRIMARY , originating during maxillary development (or) SECONDARY due to differential rates of resorption of adjacent sinus floor areas after tooth loss.2Septa are located in any region of maxillary sinus and their size can vary between 2.5-12.7 mm in mean length.2
Therefore, presence of septae should be evaluated in Computerised Tomography(CT) scan preoperatively. CT scans represent a significant advance in diagnostic imaging of hard tissues. In addition to image quality, there is also greater accuracy in the identification of different structures in the maxillary area. CT scan can obtain a three dimensional and dynamic view of the area of interest, which facilitates the interpretation of results.4
6.2 REVIEW OF LITERATURE :
van Zyl AW,van Heerden WFP.(2009).5 performed study to determine the prevalence of sinus septa and it was found to be 69% (138 patients), with a significant number of these patients showing multiple septa (89/138). The mean age of the patients was 54 ( +_ 14). The prevalence of edentulous patients with septa (71%) was not statistically different from the dentate patients (66%) (P=0.7).
Shahbazian M, Xue D,Hu Y,Cleynenbreuge JV,Jacobs R.(2010).6 performed study and they found anterior and posterior border of the maxillary sinuses were mostly located in the first premolar (49%) and second molar (84%) regions, respectively. Maxillary sinus septa were indentified in 47% of the maxillary antra. Almost 2/3 (66%) of the patients showed major (> 4 mm) mucosal thickening mostly at the level of the sinus floor.
Lee WJ,Lee SJ,Kim HS.(2010).7 A study was performed in terms of location, septa were found in 18 cases (27.3%) in the anterior, in 33 cases (50%) in the middle and in 15 cases (22.7%) in the posterior regions.
Orhan K,Seker BK,Aksoy S,Bayindir H,Berberoglu A,Seker E.A(2013).1study was conducted to determine the prevalence of maxillary sinus segments with septa was 58%. The location of septa observed in all study groups demonstrated a greater prevalence (69.1%) in the middle region than in the anterior and posterior regions. No statistically significant differences were observed with regard to gender or age, for septum height (p 1 0.05). However, maxillary sinus septa are higher in partially edentulous patients than edentate and CE ones(p < 0.05).
Palma VC,Rosa A,Semenoff TADV,deMusis CR,Bueno MR,Porto AN, et al (2010).4: study shows the frequency of septa in the maxillary sinus was 37.80% (n = 183). No significant difference was observed among the five age groups (P > 0.05); additionally, there was no significant difference in septa frequency (P > 0.05) – analysis of variance (ANOVA), Tukey’s. Univariate and multivariate ANOVA showed a significant interaction between tooth loss and age (P < 0.05).
6.3 AIMS OF THE STUDY:
1.  To determine the prevalence of maxillary sinus septae.
2.  To ascertain the location, morphology of maxillary sinus septae.
3.  To correlate the morphology with age and gender.
4.  To correlate the morphology with the presence or absence of teeth.
6.4 OBJECTIVES OF THE STUDY:
1.  To facilitate appropriate implant placement.
2.  Knowledge of maxillary sinus septae will aid in maxillary sinus lifting procedures.
3.  To avoid risk of perforation of schneiderian membrane.
MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
The study will enroll a total of 100 Computed Tomographic images out of which 50 are male and 50 are of female in the age group 20-70 years from Department of Radiodiagnosis in Raja Rajeswari Medical College And Hospital, Bangalore, Karnataka.
INCLUSION CRITERIA
1.  The CT images which were recorded at 130kvp, 35mA with an axial slice thickness of 0.6mm.
2.  Appropriate CT image of maxillary sinus – ‘visible septae’.
3.  No signs of maxillary sinus involvement.
4.  Both genders are taken.
5.  Age 20-70 years.
EXCLUSION CRITERIA:
1.  Patient with history of pathologies in maxillary sinus region.
2.  Patient who underwent surgical procedures involving floor of maxillary sinus.
3.  Patient who are less than 20 years of age.
7.2 METHOD OF COLLECTION OF DATA:
Sample size:
100 Computed Tomographic images
Method of collection of data:
ARMAMENTARIUM:
Specification of CT machine:
Siemens Somatom Perspective 128
Specification of CT software:
Syngo CT 2012 A
Specification of image:
It generates 3D view(axial, coronal and sagittal planes)
Specification of viewer:
Windows : 5.2(build 3790, service pack 2)
METHODOLOGY:
For study purpose, a total of 100 Computed Tomographic images out of which, 50 are of male and 50 are of female in the age group 20-70years.
OBTAINING AN IMAGE:
The obtained images were recorded at 130kvp, 35mA using with an axial slice thickness of 0.6mm and then 3 dimensional images were reconstructed.
INTERPRETATION OF THE IMAGE:
The prevalence of septa will be calculated based on the number of sinuses which have septa.2 Sinuses are analysed on the reformatted CT first for the presence of septa and once septae are identified they are measured using the measuring tool of the software.5 According to UNDERWOOD, the sinus floor is frequently divided into 3 basins. A SMALL ANTERIOR ONE over the premolar region. A LARGE MEDIAN ONE between roots of first and second molars. A SMALL POSTERIOR ONE corresponding to third molar region.2 The
height of the septa is measured in three regions along the course of the septa across the sinus floor the LATERAL, MIDDLE AND MEDIAL ASPECTS. The mean of these is set as the final measurements. The angle between the direction of the septa and median palatine suture is also measured using axial images.1The Hounsefield unit scale is used to confirm the maxillary bony height of each septum.5 All septa identification and measurements will be verified by two observers (2 Senior Radiologists).
PLACE OF STUDY:
RAJA RAJESWARI MEDICAL COLLEGE AND HOSPITAL, KAMBIPURA, MYSORE ROAD, BANGALORE, KARNATAKA.
ANALYSIS OF DATA:
The data collected will be analyzed by using Chi square test and Students t- Test.
The result obtained will be predicted by using SPSS software.
7.3 DOES THIS STUDY REQUIRE ANY INVESTIGATIONS OR OTHER INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR HUMANS OR ANIMALS?
IF SO PLEASE DESCRIBE BRIEFLY.
NO.
7.4 HAS THE ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION AS IN CASE OF 7.3?
YES.
LIST OF REFRENCES:
1.  Orhan K,Seker BK,Aksoy S,Bayindir H,Berberoglu A,Seker E. Cone Beam CT Evaluation Of Maxillary Sinus Septa Prevalence, Height, Location and Morphology In Children And An Adult Population. Med Princ Pract 2013;22:47-53.
2.  Ferrin LM,Gil SG,Serrano MR,Diago MP,Oltra DP. Maxillary Sinus Septa:A Systemic Review. Med Oral Patol Oral Cir Bucal 2010;15(2):383-6.
3.  Cakur B,Sumbullu MA,Durna D. Relationship Among Schneiderian Membrane, Underwood’s Septa And The Maxillary Sinus Inferior Border. Clinical Implant Dentistry and Related Research 2013;15(1):83-7.
4.  Palma VC,Rosa A,Semenoff TADV,deMusis CR,Bueno MR,Porto AN, et al.Evaluation Of Septa Frequency In The Maxillary Sinuses With Edentulous And Dentulous Areas Through Computed Tomography. Oral Surgery 2013;67-72.
5.  van Zyl AW,van Heerden WFP. A Retrospective Analysis Of Maxillary Sinus Septa On Reformatted Computerised Tomography Scans. Clin. Oral Impl 2009;1398-1401.
6.  Shahbazian M, Xue D,Hu Y,Cleynenbreuge JV,Jacobs R. Spiral Computed Tomography Based Maxillary Sinus Imaging In Relation To Tooth Loss, Implant Placement And Potential Grafting Procedure. J Oral Maxillofac Res 2010;1:e7
7.  Lee WJ,Lee SJ,Kim HS. Analysis Of Location And Prevalence Of Maxillary Sinus Septa. J Periodontal Implant Sci 2010;40;56-60.
9 / SIGNATURE OF THE CANDIDATE
10 /

REMARKS OF THE GUIDE

/
11 / 11.1. NAME & DESIGNATION
OF THE GUIDE (in block letters) / Dr. M.B.SOWBHAGYA.
M.D.S.,
READER,
DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY
RAJA RAJESWARI DENTAL COLLEGE AND HOSPITAL, BANGALORE-74
11.2 SIGNATURE OF GUIDE
11.3. CO-GUIDE (If any) / Dr. PRAVIN G.U.
MDRD.,
PROFESSOR AND HEAD,
DEPARTMENT OF RADIODIAGNOSIS,
RAJARAJESWARI MEDICAL COLLEGE AND HOSPITAL, BANGALORE-60.
11.4. SIGNATURE
11.5 HEAD OF THE
DEPARTMENT / Dr. BALAJI P.
M.D.S.,
PROFESSOR AND HEAD
DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY
RAJARAJESWARI DENTAL COLLEGE AND HOSPITAL, BANGALORE-74
11.6. SIGNATURE
12 / 12.1.REMARKS OF THE CHAIRMAN & PRINCIPAL
12.2. SIGNATURE