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Войти в исследования Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2026
Riding the Mucociliary Escalator: A Risk-Stratified Approach to Maxillary Sinus Foreign Body Management.
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Zhang Shenrong, Su Kai, Lao Xiaomei
Аннотация
BACKGROUND: The management of maxillary sinus (MS) foreign bodies (FBs) currently lacks a standardized framework, leading to inconsistent decision-making regarding observation versus surgery.
PURPOSE: This study aimed to identify predictors of spontaneous passage (SP) of MS FBs and propose a risk-stratified management algorithm.
STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study combined one institutional case (conducted at the Hospital of Stomatology, Sun Yat-sen University) with cases from a literature review. Patients with multiple FBs that involved not only the MS or with uncontrolled severe systemic disease were excluded.
PREDICTOR VARIABLE: The predictor variables were FBs physical characteristics, specifically size (≤5 mm vs > 5 mm), morphology (regular vs irregular), and material composition.
OUTCOME VARIABLE: The outcome variable was the clearance method: SP or operative retrieval.
COVARIATES: Covariates included sex, age, duration of FBs retention, presence or absence of oroantral communication, clinical symptoms, and sinusitis.
ANALYSES: Data were analyzed using Fisher's exact tests for categorical variables, Mann-Whitney U tests for continuous variables, and multivariable log-linear Poisson regression with robust sandwich variance estimators. Significance was set at P < .05.
RESULTS: The sample was composed of 55 subjects (1990 and 2025) with a mean age of 41.0 (SD, 16.6) years and 16 (30.8%) were female. The overall SP frequency was 16.4% (9/55). A shorter retention duration was statistically associated with SP (median: 7 vs 180 days; P < .001), with 50% of SP events occurring within the first week. Foreign body size (≤5 mm) showed a marginal trend toward SP (P = .05). In the multivariable model, only retention duration remained independently significant (adjusted relative risk = 0.95, P = .01), representing a 5% daily decrease in clearance likelihood. Other physical properties were not independently significant (P > .05).
CONCLUSIONS AND RELEVANCE: Not all MS FBs constitute surgical emergencies. Spontaneous clearance is tightly restricted to an early opportunity window. Active surveillance may be considered for asymptomatic, small (≤5 mm) objects within the first week, whereas immediate surgical retrieval remains the standard for high-risk objects.
PURPOSE: This study aimed to identify predictors of spontaneous passage (SP) of MS FBs and propose a risk-stratified management algorithm.
STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study combined one institutional case (conducted at the Hospital of Stomatology, Sun Yat-sen University) with cases from a literature review. Patients with multiple FBs that involved not only the MS or with uncontrolled severe systemic disease were excluded.
PREDICTOR VARIABLE: The predictor variables were FBs physical characteristics, specifically size (≤5 mm vs > 5 mm), morphology (regular vs irregular), and material composition.
OUTCOME VARIABLE: The outcome variable was the clearance method: SP or operative retrieval.
COVARIATES: Covariates included sex, age, duration of FBs retention, presence or absence of oroantral communication, clinical symptoms, and sinusitis.
ANALYSES: Data were analyzed using Fisher's exact tests for categorical variables, Mann-Whitney U tests for continuous variables, and multivariable log-linear Poisson regression with robust sandwich variance estimators. Significance was set at P < .05.
RESULTS: The sample was composed of 55 subjects (1990 and 2025) with a mean age of 41.0 (SD, 16.6) years and 16 (30.8%) were female. The overall SP frequency was 16.4% (9/55). A shorter retention duration was statistically associated with SP (median: 7 vs 180 days; P < .001), with 50% of SP events occurring within the first week. Foreign body size (≤5 mm) showed a marginal trend toward SP (P = .05). In the multivariable model, only retention duration remained independently significant (adjusted relative risk = 0.95, P = .01), representing a 5% daily decrease in clearance likelihood. Other physical properties were not independently significant (P > .05).
CONCLUSIONS AND RELEVANCE: Not all MS FBs constitute surgical emergencies. Spontaneous clearance is tightly restricted to an early opportunity window. Active surveillance may be considered for asymptomatic, small (≤5 mm) objects within the first week, whereas immediate surgical retrieval remains the standard for high-risk objects.