{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T10:54:01Z","timestamp":1783421641806,"version":"3.54.6"},"reference-count":39,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T00:00:00Z","timestamp":1666742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Applied Basic Research Project of Sichuan Province","award":["2020YJ0278"],"award-info":[{"award-number":["2020YJ0278"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This study aimed to determine the incidence of maxillary sinus pathology in patients with a midfacial fracture who underwent osteosynthesis surgery and evaluate the associated risk factors. We conducted a retrospective case-control analysis of patients with midfacial fractures involving a maxillary sinus wall who were treated with open reduction and internal fixation (ORIF) between January 2015 and December 2020. Fracture reduction, the number of screws implanted in the maxillary sinus, and the number of screws penetrating the maxillary sinus, etc., were examined as potential risk factors. Maxillary sinus pathology on postoperative CT was considered the primary outcome for case-control analysis. Binary logistic regression was used to identify variables associated with postoperative maxillary sinus pathology. Thereafter, propensity score matching (PSM) was used to extract confounding factors. A total of 262 patients (totaling 372 maxillary sinuses) were included for analysis. PSM yielded 178, 246, and 70 matched sinuses, respectively, depending on the potential risk factors. Postoperative maxillary sinus pathology was visualized in 218 of the 372 maxillary sinuses (58.60%). The risk factors for postoperative maxillary sinus pathology included the number of screws penetrating the maxillary sinus (odds ratio (OR), 1.124; p = 0.007), an imperfect maxillary sinus wall fracture reduction (OR, 2.901; p = 0.021), and the number of sinus walls involved (OR, 1.383; p = 0.011). After PSM, postoperative maxillary sinus pathology was still more prevalent in sinuses with multiple maxillary sinus wall fractures (64.04% vs. 48.31%, p = 0.034), sinuses with more screws penetrating the maxillary sinus (64.23% vs. 50.41%, p = 0.028), and sinuses with an imperfect reduction (80% vs. 51.43%, p = 0.012). In conclusion, maxillary sinus pathology is common after the ORIF of midfacial fractures. Patients with a fracture of multiple maxillary sinus walls require a close follow-up. Screw penetration of the maxillary sinus should be avoided to prevent maxillary sinus pathology after a midfacial fracture ORIF.<\/jats:p>","DOI":"10.3390\/jcm11216299","type":"journal-article","created":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T07:17:48Z","timestamp":1666768668000},"page":"6299","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Risk Factors for Maxillary Sinus Pathology after Surgery for Midfacial Fracture: A Multivariate Analysis"],"prefix":"10.3390","volume":"11","author":[{"given":"Linli","family":"Jiang","sequence":"first","affiliation":[{"name":"State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China"},{"name":"Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9784-9681","authenticated-orcid":false,"given":"Mengsong","family":"Wu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6841-2229","authenticated-orcid":false,"given":"Hui","family":"Li","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayu","family":"Liang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0320-6755","authenticated-orcid":false,"given":"Jinlong","family":"Chen","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5309-1979","authenticated-orcid":false,"given":"Lei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.sdentj.2018.10.001","article-title":"Patterns of maxillofacial fractures in Hofuf, Saudi Arabia: A 10-year retrospective case series","volume":"31","author":"Salma","year":"2019","journal-title":"Saudi Dent. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.jormas.2020.11.009","article-title":"Epidemiology of Maxillofacial Traumatisms in French Alps Metropole (Grenoble) Specificity for the mountain sports and evolution in the last 40 years","volume":"122","author":"Gelin","year":"2021","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1111\/edt.12662","article-title":"Characteristics of pediatric maxillofacial fractures in Kuwait: A single-center retrospective study","volume":"37","author":"AlAli","year":"2021","journal-title":"Dent. Traumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.bjps.2013.10.022","article-title":"Epidemiology and management of maxillofacial fractures in an Australian trauma centre","volume":"67","author":"Cabalag","year":"2014","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jcms.2014.10.011","article-title":"European Maxillofacial Trauma (EURMAT) project: A multicentre and prospective study","volume":"43","author":"Boffano","year":"2015","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Ehrenfeld, M., Manson, P.N., and Prein, J. (2012). Principles of Internal Fixation of the Craniomaxillofacial Skeleton: Trauma and Orthognathic Surgery, Thieme Medical Publishers, Inc.","DOI":"10.1055\/b-002-85491"},{"key":"ref_7","first-page":"14","article-title":"Trauma of the midface","volume":"14","author":"Kuhnel","year":"2015","journal-title":"GMS Curr. Top. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1097\/SCS.0000000000006675","article-title":"An Update on Maxillary Fractures: A Heterogenous Group","volume":"31","author":"Cohn","year":"2020","journal-title":"J. Craniofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/j.joms.2003.12.034","article-title":"Evaluation of maxillary sinus after treatment of midfacial fractures","volume":"62","author":"Top","year":"2004","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_10","unstructured":"Lenkeit, C.P., Lofgren, D.H., and Shermetaro, C. (2021). Maxillary sinus fracture. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1002\/alr.22309","article-title":"Symptom importance, patient expectations, and satisfaction in chronic rhinosinusitis","volume":"9","author":"Mattos","year":"2019","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1177\/1945892419841317","article-title":"Somatization, Depression, and Anxiety Disorders in a Rhinology Practice","volume":"33","author":"Alam","year":"2019","journal-title":"Am. J. Rhinol. Allergy."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1002\/lary.29405","article-title":"Pain Catastrophizing and Quality of Life in Adults with Chronic Rhinosinusitis","volume":"131","author":"Kazi","year":"2021","journal-title":"Laryngoscope"},{"key":"ref_14","first-page":"17","article-title":"Chronic maxillary sinusitis: Clinical and microbiological evaluation","volume":"7","author":"Shrestha","year":"2011","journal-title":"J. Coll. Med. Sci."},{"key":"ref_15","first-page":"1","article-title":"European Position Paper on Rhinosinusitis and Nasal Polyps 2020","volume":"58","author":"FFokkens","year":"2020","journal-title":"Rhinology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.injury.2009.09.032","article-title":"Maxillary sinusitis in patients ventilated for a severe head injury and with nostrils free of any foreign body","volume":"42","author":"Cengiz","year":"2011","journal-title":"Injury"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1097\/SCS.0b013e318163f2ea","article-title":"The importance of the primary reconstruction of the traumatized anterior maxillary sinus wall","volume":"19","author":"Ballon","year":"2008","journal-title":"J. Craniofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.joms.2010.07.038","article-title":"Incidence of maxillary sinusitis following Le Fort I osteotomy: Clinical, radiographic, and endoscopic study","volume":"69","author":"Gabrielli","year":"2011","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.jcms.2017.01.027","article-title":"Evaluation of maxillary sinus after Le Fort I osteotomy using various fixation materials","volume":"45","author":"Ueki","year":"2017","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s40902-019-0195-3","article-title":"Prognostic factors for maxillary sinus mucosal thickening following Le Fort I osteotomy: A retrospective analysis","volume":"41","author":"Iwamoto","year":"2019","journal-title":"Maxillofac. Plast. Reconstr. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s10006-016-0568-z","article-title":"Experimental study on penetration of dental implants into the maxillary sinus at different depths","volume":"20","author":"Elhamruni","year":"2016","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1164\/ajrccm.150.3.8087352","article-title":"Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill","volume":"150","author":"Rouby","year":"1994","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1288\/00005537-199504000-00010","article-title":"Techniques for outcomes research in chronic sinusitis","volume":"105","author":"Gliklich","year":"1995","journal-title":"Laryngoscope"},{"key":"ref_24","first-page":"e419","article-title":"CT maxillary sinus evaluation\u2014A retrospective cohort study","volume":"20","author":"Vaz","year":"2015","journal-title":"Med. Oral Patol. Oral Cir. Bucal."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1002\/bimj.4710190413","article-title":"Multivariate Analysis. Charles Griffin b Co. LTD. London, High Wycombe 1975. 210 s., 9 Abb., 27 Tab., 1 Anhang, \u00a3 6,80","volume":"19","author":"Weber","year":"1977","journal-title":"Biom. J."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Moons, K.G., de Groot, J.A., Bouwmeester, W., Vergouwe, Y., Mallett, S., Altman, D.G., Reitsma, J.B., and Collins, G.S. (2014). Critical appraisal and data extraction for systematic reviews of prediction modelling studies: The CHARMS checklist. PLoS Med., 11.","DOI":"10.1371\/journal.pmed.1001744"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1097\/ID.0000000000000485","article-title":"Characterization of the Maxillary Sinus Using Cone Beam Computed Tomography. A Retrospective Radiographic Study","volume":"25","author":"Boracchia","year":"2016","journal-title":"Implant Dent."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1002\/lary.20095","article-title":"Frequency of a dental source for acute maxillary sinusitis","volume":"119","author":"Bomeli","year":"2009","journal-title":"Laryngoscope"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/S0278-2391(96)90107-X","article-title":"Analysis of treatment for isolated zygomaticomaxillary complex fractures","volume":"54","author":"Ellis","year":"1996","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"495","DOI":"10.2147\/CIA.S352736","article-title":"Relationship Between Preoperative Hypoalbuminemia and Postoperative Pneumonia Following Geriatric Hip Fracture Surgery: A Propensity-Score Matched and Conditional Logistic Regression Analysis","volume":"17","author":"Tian","year":"2022","journal-title":"Clin. Interv. Aging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1097\/ID.0b013e31829d1a20","article-title":"Prevalence of maxillary sinus pathology in patients considered for sinus augmentation procedures for dental implants","volume":"22","author":"Manji","year":"2013","journal-title":"Implant Dent."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/ID.0000000000000902","article-title":"Prevalence of Maxillary Sinus Pathology Based on Cone-Beam Computed Tomography Evaluation of Multiethnicity Dental School Population","volume":"28","author":"Hsiao","year":"2019","journal-title":"Implant Dent."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.tripleo.2010.02.038","article-title":"Late signs and symptoms of maxillary sinusitis after sinus augmentation","volume":"110","author":"Manor","year":"2010","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s00784-018-2418-x","article-title":"Association between odontogenic conditions and maxillary sinus mucosal thickening: A retrospective CBCT study","volume":"23","author":"Aksoy","year":"2019","journal-title":"Clin. Oral Investig."},{"key":"ref_35","first-page":"e34","article-title":"Association between maxillary sinus pathology and odontogenic lesions in patients evaluated by cone beam computed tomography. A systematic review and meta-analysis","volume":"25","author":"Bagan","year":"2020","journal-title":"Med. Oral Patol. Oral Cir. Bucal."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.tripleo.2006.09.024","article-title":"A retrospective study of the effects on sinus complications of exposing dental implants to the maxillary sinus cavity","volume":"103","author":"Jung","year":"2007","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"202.e1","DOI":"10.1016\/j.joms.2020.08.034","article-title":"Evaluation of the Midface by Statistical Shape Modeling","volume":"79","author":"Hierl","year":"2021","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"221","DOI":"10.18869\/acadpub.beat.5.4.499","article-title":"Le Fort Fractures: A Collective Review","volume":"5","author":"Phillips","year":"2017","journal-title":"Bull. Emerg. Trauma"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1093\/ejcts\/ezy167","article-title":"Statistical primer: Propensity score matching and its alternatives","volume":"53","author":"Benedetto","year":"2018","journal-title":"Eur. J. Cardiothorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/21\/6299\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:03:05Z","timestamp":1760144585000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/21\/6299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,26]]},"references-count":39,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["jcm11216299"],"URL":"https:\/\/doi.org\/10.3390\/jcm11216299","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,26]]}}}