Oral Biology and Oral Pathology Commons^™

Odontogenic Myxoma In Maxilla: A Case Report, Deepak Gupta, Ravinder Singh, Nazrana Maqbool B.D.S., Rakashree Chakraborty B.D.S., M.D.S.

The New York State Dental Journal

Odontogenic myxoma (OM) is a rare, benign but locally invasive intraosseous neoplasm. It is known to arise from the mesenchymal portion of the tooth germ. Although it is a slow-growing tumor, maxillary odontogenic myxomas can lead to increased morbidity caused by invasion into the maxillary sinus and middle cranial fossa. Further, it is also important to delineate the margins of OM to achieve a better treatment outcome. Here we present a case of a maxillary odontogenic myxoma in a 26-year-old female patient. The patient presented with swelling on the upper right side of the face. Computed tomography scan revealed a …

Clinical Outcomes Of Adjunctive Use Of Oxygen-Releasing Formula In Non-Surgical Treatment Of Periodontal Abscess Associated With Type 2 Diabetes Mellitus, Anil Kumar Kanakamedala, Laxmi Kavya Gangireddy, Gautami S Penmetsa, Sruthima Gottumukkala, Mohan Kumar Pasupuleti, Konathala Santhosh Venkata Ramesh

Journal of Dentistry Indonesia

Background: This study aimed to evaluate the effectiveness of oxygen-releasing formula (ORF) as an adjunct in the non-surgical management of periodontal abscess in patients with type 2 diabetes mellitus.

Methods: This split-mouth clinical trial was conducted on 14 patients with periodontal abscess with type 2 diabetes mellitus (T2DM), who were divided into a control group, nonsurgical periodontal therapy (NSPT) alone, and a test group (NSPT+ORF). Parameters such as Landry's healing index (HI) were evaluated at 1 week, 2 weeks, and 1 month. Probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing presence or absence (BOP) …

Psychosocial And Functional Impact Of Temporomandibular Disorder Subtypes Among Adults: A Cross-Sectional Study In Indonesia, Ni Luh Dewi, Wita Anggraini, Maria Valiente-Lopez, Carolina Marpaung

Journal of Dentistry Indonesia

Background: Temporomandibular disorders (TMDs) affect psychological, functional, and pain-related aspects of oral health-related quality of life (OHRQoL). However, the differential impact of pain-related and non-pain-related TMDs remains limited. This study aimed to evaluate the impact of different TMD subtypes on psychological distress, jaw function, and OHRQoL in young adults and to determine whether pain-related TMDs exert a greater effect than non-pain-related TMDs.

Methods: In this cross-sectional study, 278 university students (aged 18–24 years) were categorized into no TMD (NT), pain-related TMD (PT), intra-articular TMD (IT), and combined TMD (CT). Diagnoses were made using the 5Ts Questionnaire screening tool …

Adverse Drug Reaction Reporting In Dental Practice And The Importance Of Pharmacovigilance In Dental Education, Radhakrishna Lagishetty, Lakshmi Ramya T, Kvr Barath Raju, Mohan Kumar Pasupuleti

Journal of Dentistry Indonesia

Background: Adverse drug reactions (ADRs) are a critical component of patient safety; however, ADR monitoring remains underutilized in dentistry. This study aimed to assess knowledge, attitudes, and practices regarding ADR reporting among undergraduate and postgraduate students and practicing dentists.

Methods: A cross-sectional observational study was conducted using a structured, validated 19-item questionnaire covering socio-demographics, knowledge (6 items), attitude (4 items), and practice (5 items), which was distributed both in person and online. A total of 258 complete responses were analyzed out of 300 individuals contacted (response rate: 86%). Descriptive statistics and Chi-square tests were applied, with p < 0.05 considered statistically significant.

Results …

Investigation Of Patients' Use Of Non-Pharmacological Substances In Dental Pain Management, Neslihan Yılmaz Çırakoğlu, Özgenur Kaya

Journal of Dentistry Indonesia

Background: Dental pain is a complex condition influenced by biological, biochemical, environmental, and psychological factors. Before seeking professional care, many patients attempt to relieve dental pain using self-administered, non-medical agents. This study aimed to investigate patients’ use of non-pharmacological substances in dental pain management and to identify factors influencing these practices.

Methods: The questionnaire consisted of four sections addressing demographic characteristics, oral hygiene habits, pain characteristics, and pain-relief agents. Categorical variables were analyzed using Pearson’s chi-square test. Categorical data are presented as frequencies and percentages, while continuous data are expressed as mean ± standard deviation and median values. …

Orthodontic Camouflage Treatment Of A Severe Class Iii Skeletal Pattern With Anterior Open Bite: A Case Report, Dikeledi Maureen Letsholo, Mandla Dominic Nyakale, Mosimane Peter Silas Sethusa

Journal of Dentistry Indonesia

Background: Class III malocclusion combined with anterior open bite (AOB) is one of the most challenging occlusal problems to treat. The objective of this article was to report a case of an adult female patient diagnosed with Class III malocclusion combined with an anterior open bite and a hyperdivergent facial pattern.

Case Report: Camouflage orthodontic treatment with the extraction of maxillary and mandibular first premolars was used to treat the patient. Anterior teeth were retracted maximally against the Nance holding arch and fixed lingual arch appliances, and box elastics were used to close AOB. At the end of …

Diagnostic Challenge: Oral Pathology

Journal IDA

The challenge: We present a case of a 27-year-old female patient who presented to the Fritts Screening Clinic at Indiana University School of Dentistry. She takes metformin for pre-diabetes and levothyroxine for hypothyroidism. Her extraoral exam reveals no pathologies. The intraoral clinical examination reveals a non-wipeable unifocal hyperkeratotic papillary lesion measuring 0.8 x 0.5 cm on the left lateral border of the tongue (Figure 1). The patient reports noticing it approximately a month before the screening appointment; however, she did not experience any pain or other symptoms in the area. An excisional biopsy is performed to obtain a definite diagnosis …

Antibacterial Efficacy Of Resin-Based Dental Composites Modified With Antibacterial Agents Against S. Mutans: A Systematic Review, Ahmad Setiawan Jarigau, Erwin Gunawan, Muhammad Akira Takashi Dharma, Fanny Dinda Nur Aulia, Lenni Indriani Hatta, Nurhayati Natsir

International Arab Journal of Dentistry

Introduction: Dental caries caused by Streptococcus mutans is a leading cause of dental restoration failure. Enhancing composite resins with antibacterial agents aims to inhibit bacterial growth and prolong restoration life.

Objectives: This review evaluates the anti-bacterial agents efficacy of these modified composites against S. mutans and explores their mechanisms and potential clinical benefits.

Methods: A comprehensive literature search was conducted across multiple databases following PRISMA guidelines, focusing on in vitro studies published between 2015 and 2025. Studies evaluating composites with antibacterial additives against S. mutans using standard microbiological assays were included. The quality of eligible studies was assessed using the …

Hypo-Responsiveness Of The Dental Pulp In Patients With Type 2 Diabetes And Hypertension: A Cross-Sectional Study, Kavitha M, Mallolu Anthony Sanjana Vijay, Niveditha B, Fathima A.I, Pavithra D, Vigneshwaran J

International Arab Journal of Dentistry

Introduction: Diabetes mellitus and hypertension, two of the most prevalent metabolic disorders worldwide, exert profound and progressive effects on multiple physiological systems. While their systemic complications are well documented, their subtle yet clinically significant impact on oral structures, particularly the dental pulp, remains underexplored.

Objectives: This study aims to assess the functional responsiveness of dental pulp nerves in individuals with type 2 diabetes mellitus and systemic hypertension, and to compare the findings with responses from healthy individuals, using an Electric pulp tester (EPT) as a diagnostic tool.

Methods: A total of 600 teeth from 75 adult patients (25 diabetic, 25 …

Predictive Analysis For Success And Complications In Dental Implant Therapy Using Artificial Intelligence Models, Vishnu Priya Veeraraghavan, Aysha Jebin A, Isha Dusane, Govind Baheti, Ankita Agarwal, Santosh R Patil

International Arab Journal of Dentistry

Introduction: Dental implant therapy is a predictable treatment for tooth replacement, but its success is influenced by multiple patient, surgical, and systemic factors. Traditional statistical models, such as logistic regression, are limited in capturing nonlinear relationships among these variables. Artificial intelligence (AI) can integrate diverse predictors to enhance clinical risk assessment and improve treatment outcomes.

Objective: To identify key predictors of dental implant success and develop AI-based models capable of accurately forecasting implant outcomes using clinical and surgical parameters.

Methods: This retrospective cohort study analyzed data from 172 patients (219 implants) placed between 2020 and 2021. Patient demographics, systemic health …

Correlation Between Maxillary Sinus Volume And Maxillomandibular Size, Position, And Dental Occlusion: A Cbct Retrospective Study, Philip Villanueva Punzalan

UNLV Theses, Dissertations, Professional Papers, and Capstones

This investigation used cone beam computed tomography (CBCT) based three dimensional imaging to evaluate correlations between maxillary sinus volume and maxillomandibular skeletal size, position, and dental occlusion in an adult orthodontic population. A retrospective sample of 107 pretreatment CBCT scans (40 males and 67 females), aged 18–59 years, was analyzed. Right and left maxillary sinuses were segmented independently using semi-automatic volumetric segmentation in ITK-SNAP software, and total sinus volume was calculated in cubic millimeters (mm³). Linear and angular skeletal measurements of the maxilla and mandible were obtained using Anatomage TxSTUDIOViewer application software. Patients were categorized according to anteroposterior (A-P) skeletal …

Exploring Stem Cell-Based Approaches To Ameloblast-Like Cell Development: Progress And Limitations In Enamel Formation, Ava L. Abruzzese

Honors Scholar Theses

Enamel is one of the most critical structural components of the tooth. As the outermost layer, it serves as a protective barrier, shielding the underlying dentin and dental pulp from physical trauma and mechanical forces. The formation and mineralization of enamel are regulated by specialized cells known as ameloblasts. Once enamel maturation is complete, these cells undergo apoptosis. Consequently, enamel lacks the capacity for natural regeneration after damage or erosion, which can result from various environmental factors. When enamel is compromised, current clinical interventions focus on preventing further deterioration rather than true regeneration. These approaches include the use of remineralizing …

Time And Dose Dependent Effects Of Adipose-Derived Stromal Vascular Fraction Exosomes On Human Dental Pulp Stem Cell Proliferation, Sylva Dinie Alinda, Anggraini Margono, Indah Julianto, Dini Asrianti Bagio

Journal of Dentistry Indonesia

Background: Cell proliferation is essential for tissue repair and immunomodulation in regenerative dentistry. Adipose-derived stromal vascular fraction (AD-SVF) is a promising autologous source for tissue engineering. Its exosomes (AD-SVF Exo), as cell-free products stable under ischemic conditions, represent an ethical and attractive modality for dental tissue regeneration and broader regenerative applications. Prior study indicates that AD-SVF Exo can enhance human dental pulp stem cell (hDPSC) migration and proliferation, particularly at low concentrations, but their detailed time- and dose-dependent proliferative effects remain unclear. This study aimed to investigate the time- and dose-dependent effects of low-concentration AD-SVF Exo on hDPSC proliferation …

In Silico Model Of Musa Acuminata Stem As An Anticancer On Oral Squamous Cell Carcinoma Against Egfr, Nevrila Dewi Rachmayani, Amy Nindia Carabelly, I Wayan Arya Krishnawan Firdaus, Maharani Laillyza Apriasari, Juliyatin Putri Utami

Journal of Dentistry Indonesia

Background: Oral squamous cell carcinoma (OSCC) is characterized by overexpression of the epidermal growth factor receptor (EGFR). Citral, eucalyptol, and caffeic acid phenethyl ester (CAPE), which are derived from Musa acuminata, have shown anticancer activity. This study evaluated the potential of citral, eucalyptol, and CAPE from Musa acuminata as anticancer agents for OSCC by targeting EGFR using an in silico approach.

Methods: Potential biological activity was predicted using Prediction of Activity Spectra for Substances (PASS) Online. Molecular docking was conducted with AutoDock Vina, and BIOVIA Discovery Studio was used to analyze binding affinity, interaction types, and bond …

Micro-Ct Evaluation Of Root Canal Transportation And Centering Ability In Mesial Canals Of Mandibular First Molars, Selen Ince Yusufoglu, Esma Saricam, Mert Ocak, Ferhat Geneci, Burak Bilecenoğlu

Journal of Dentistry Indonesia

Background: This study aimed to evaluate canal transportation, centering ability, structure model index (SMI), surface area, and root canal volume changes in the mesial canals of mandibular first molars using micro-CT.

Methods: Twenty-four mandibular first molars with two separate mesial canals and moderate curvature were included. Teeth were scanned using micro-CT before instrumentation and randomly divided into three groups (N = 8). Root canals were prepared using OneShape, OneCurve, and Rotate file systems, followed by post-instrumentation micro-CT scanning (10µm/pixel resolution). Changes in canal volume, surface area, transportation, centering ability, and SMI were analyzed at the apical, middle, and …

Evaluation Of An Audiovisual Educational Tool With Reinforcement Messages For Orthodontic Patients: A 6-Month Randomized Controlled Trial, Laura Restrepo Quijano, Maria Paula Vasco Gomez, Natalia Hurtado Velasquez, Luis Fabian Benitez Moreno

Journal of Dentistry Indonesia

Background: Orthodontic treatment increases the risk of bacterial plaque accumulation; therefore, oral hygiene education is essential to prevent complications, but its impact is usually limited when it is not reinforced with effective tools. This study aims to evaluate an audiovisual educational tool with reinforcement messages, compared with a verbal explanation about the proper use of the orthodontic oral hygiene kit.

Methods: This was a randomized controlled trial that included 62 patients randomly assigned to an intervention group: 31 patients who received an educational video plus three reinforcement messages via WhatsApp, and a control group: 31 patients who received …

Antibacterial And Antibiofilm Effects Of Ziziphus Mauritiana Leaf Extract Against Staphylococcus Aureus, Wiwiek Poedjiastoeti, Irvan Septrian Syah Putra Rasad, Felicia Klarissa Tanzil, Indrayadi Gunardi, Armelia Sari Widyarman

Journal of Dentistry Indonesia

Background: Tooth extraction is a common dental procedure often complicated by postoperative infections, with Staphylococcus aureus as a key opportunistic pathogen. Rising antibiotic resistance and side effects of conventional antiseptics like chlorhexidine highlight the need for natural alternatives. This study evaluated the antibacterial and antibiofilm potential of 96% ethanol extract from Ziziphus mauritiana leaves against S. aureus.

Methods: The extract was prepared by maceration and tested in vitro using microdilution for minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against S. aureus ATCC 25923. Antibiofilm activity was assessed via crystal violet staining on mature biofilms, with …

Correlation Between Maxillary Morphology And Sinus Dimensions In Skeletal Class I, Ii, And Iii Subjects: A Comparative Study, Nida Shaikh, Dipti Shastri, Pradeep Tandon, Gyan Prakash Singh

Journal of Dentistry Indonesia

Background: This study aimed to evaluate variations in maxillary and sinus morphology and their correlations with skeletal malocclusion patterns using CBCT.

Methods: This retrospective study analyzed CBCT records of 70 subjects aged 17–40 years, divided into three groups: Skeletal Class I (N = 25), Class II (N = 25), and Class III (N = 20). Five maxillary skeletal and four sinus parameters were assessed. Intergroup comparisons were performed using one-way analysis of variance (ANOVA) followed by Tukey’s post hoc test. Correlations were evaluated using Pearson’s correlation test. Intra-observer reliability was assessed by re-measuring 8 randomly selected CBCT scans …

Contribution Of The M1 Vs M2 Phenotype Toward Macrophage Interactions With Streptococcus Mutans, The Dominant Bacteria In The Oral Cavity, Isabelle K. Wintz

Honors Thesis

We are all exposed to numerous pathogens every day. One of the sites for pathogens to interact with our body is in the mouth. To better understand these interactions between bacteria and host immune cells, I developed an assay to study the oral bacteria Streptococcus mutans and inflammatory macrophages. Our hypothesis was that the cytokines IL-4 and IFN-y would alter macrophage phenotypes with IL-4 reducing inflammatory responses and IFN-y increasing inflammation.  To test this, we performed experiments in cell culture as a first step toward understanding the severity of the host response at the cellular and molecular levels. Our results …

Inhibitory Effects Of Novel Compounds On Biofilm Formation In Streptococcus Mutans, Graysen S. Jones

Create@State

Inhibitory Effects of Novel Compounds on Biofilm Formation in Streptococcus mutans

Case Study: Unique Presentation Of Odontogenic Keratocyst (Okc), Austin J. Davies, Ladan Daly, Jesse M. Fa, Bernadette Alvear Fa

Oral Health

Optimized patient centered care in complex surgical cases requires comprehensive preparation through both clinical examination and radiographic interpretation. Our case demonstrates how diagnostic imaging can reveal critical radiographic findings that alter treatment approach. Pre-operative preparation involving thorough clinical and radiographic examination, in combination with excellent clinician rapport, leads to a biopsychosocial approach to dental treatment, emphasizing whole patient care.

Biopsy returned from oral pathology with diagnosis of odontogenic keratocyst (OKC). At the time of publication, the patient is nearing definitive treatment of the cystic lesion with enucleation and removal of tooth #16. In our case, thorough radiographic interpretation, the professional …

Pebbly Gingival Nodule In An Older Male, Victoria L. Scarpa D.D.S., M.S., Yussra O. Mahmud M.P.H., B.S., Daria Vasilyeva D.D.S., Ph.D.

The New York State Dental Journal

We herein present a case of a giant cell fibroma in an older adult male that clinically has a pebbly or bosselated surface architecture, mimicking a squamous papilloma. The giant cell fibroma is a fibrous tumor distinct from the common irritation fibroma and may easily be mistaken for a papilloma based on clinical features. This case is reported to provide diagnostic value to the general practitioner.

Electronic Cigarette Use And Clinically Assessed Oral Mucosal Lesions In Adults: A Systematic Review, Kevin K. Zhang, Kamran Awan

Annual Research Symposium

Abstract

Background: Electronic cigarette (e-cigarette) use among adults has risen rapidly over the past decade, prompting concern about potential adverse effects on oral health. Although the systemic consequences of e-cigarette exposure have been increasingly studied, effects on the oral mucosa remain less clearly defined. Existing investigations describe a range of oral mucosal findings, but reported outcomes and assessment methods are inconsistent, making it difficult to draw clear conclusions.

Objectives: To systematically review the available evidence examining the association between electronic cigarette use and oral mucosal lesions/alterations in adults, compared with non-users or other tobacco exposure groups.

Methods: A systematic literature …

From Image To Chairside Decision-Making: Unsupervised Morphological Clustering Of Carious Lesions Aligned With Clinical Severity, Bailey Axelrad, Shilpa Bhandi, Shankargouda Patil, Sydney Sorensen

Annual Research Symposium

No abstract provided.

Salivary Protein Quantity, Ionic Value, And Protein Movement In Stunted And Non-Stunted Children In Indonesia, Munifah Abdat, Sri Rezeki, Putri N. Zulkifli, Mela R. Adinda, Ardiansyah S. Pawinru, Eka Setyawardana

Journal of Dentomaxillofacial Science

Objective: This study aimed to analyze total salivary protein quantity, ionic activity, and protein molecular movement in children with and without stunting.

Material and Method: Saliva samples were collected from 30 children aged 4-6years (15stunted and15 non-stunted). Proteins were extracted using 0.1 M HCI. The total protein quantity was determined using the Bradford assay and Fourier Transform Infrared (FTIR) spectroscopy. Salivary ionic activity (dissolved oxygen, conductivity, and total dissolved solids) and salivary viscosity were measured using an ionic meter and an Ostwald viscometer, respectively. Statistical analyses included independent t-tests, Kruskal-Wallis tests, and Spearman correlation analyses (a=0.05).

Results: Stunted children had …

Oral Streptococcus And Vitamin B12 Deficiency In E-Cigarette Users: A Microbial–Nutrient–Neurotransmitter Axis Linking To Mood Disturbances, Maryam Sabah Naser, Ali Jabbar Abd Al-Hussain Alkawaz, Ali Abbas Hashim Almusawi, Ali Jalil Obaid, Hasanain Ayed Mohammed Al-Khafaji, Reihaneh Sabbaghzadeh

Karbala International Journal of Modern Science

Background: With the rising popularity of e-cigarettes, questions have emerged regarding their broader influence on oral ecology, nutrient absorption, and psychological health. Disruptions in the oral microbiome may alter vitamin B12 dynamics. This, in turn, may indirectly influence serotonin biosynthesis and mood regulation.

Methods: An observational cross-sectional study involved 150 young adults segregated into groups of 50 each as vapers, smokers, or non-users. Streptococcus sanguinis and vitamin B12 metabolism-related variable statuses methylmalonic acid and holotranscobalamin were quantified in samples, along with inflammatory markers interleukin-6, kynurenine/tryptophan ratio, and serotonin. Statistical techniques, including ANOVA and the Kruskal-Walli’s test, correlation, and serial mediation …

Effect Of Remineralization And Resin Infiltration On Microhardness, Mineral Content And Cervical Leakage Of Restored Demineralized Enamel., Caroline Maged Massieh, Sarah Adel Botros

Dentistry

Purpose: To evaluate the effect of remineralization and resin infiltration on microhardness, mineral content and microleakage in artificially-induced cervical enamel lesions. Materials and Methods: 50 human central incisors were assigned to 5 study groups (n=10) according to different surface intervention: Group 1: Positive Control (sound teeth not subjected to demineralization); Group 2: Negative Control (teeth subjected to demineralization); Group 3: CPP-ACP paste (remineralization of demineralized lesions with CPP-ACP, Tooth Mousse, GC); Group 4: HAp toothpaste (remineralization of demineralized lesions subjected with HAp, Herbadent Remin); Group 5: Resin infiltration (resin infiltration of demineralized lesions with ICON, DMG). Microhardness (MH) was evaluated …

Dual Regulation Of Osteogenesis And Inflammation By Pomegranate (Punica Granatum L.) Extract In Periodontal Ligament-Derived Stem Cells: Implications For Regenerative Medicine, Mai Hafez

Dentistry

Objectives

This article aims to compare the osteogenic along with anti-inflammatory activity of different concentrations of pomegranate extract (PG) on human periodontal ligament-derived stem cells (hPDLSCs) in vitro.

Materials and Methods

hPDLSCs were acquired from the root surface of removed molars, cultured, and then distinguished by flow cytometry analysis and several lineage differentiation potentials. To identify the effect of PG on hPDLSCs' viability, an MTT assay was performed. hPDLSCs were maintained in osteogenic induction medium with varying concentrations of PG. At the end of the induction period, osteogenesis was assessed using Alizarin Red staining, ALP assay, and qRT-PCR to determine …

Oral Pathogens Reprogram Endothelial Barrier And Angiotensin-Converting Enzyme2/Endothelial Nitric Oxide Synthase-Nitric Oxide Signaling To Promote Blood Pressure Dysregulation, Ming-Shou Hsieh, Tung-Nien Hsu, Chin-Sheng Huang, Ting-Yi Renn, Kuang-Tai Kuo, Kuo-Yao Lin, Wei Jen Chang

Journal of Dental Sciences

Background/purpose: Although periodontal disease is associated with an increased risk of hypertension, the endothelial mechanisms linking oral inflammation to vascular dysfunction remain unclear. We investigated whether Porphyromonas gingivalis lipopolysaccharide (Pg-LPS) can directly disturb endothelial homeostasis and whether macrophage–endothelial crosstalk further worsens endothelial injury.

Materials and methods: Human umbilical vein endothelial cells (HUVECs) were exposed to Pg-LPS alone or co-cultured (transwell system) with Pg-LPS-primed human monocytic cells -derived macrophages. Endothelial dysfunction was assessed through nitric oxide (NO) production, endothelial nitric oxide synthase (eNOS) phosphorylation, inflammatory and adhesion molecule expression, as well as junctional and cytoskeletal changes. Macrophage …

Nasal Polyp With Ossification In The Right Maxillary Sinus: Differential Diagnosis Of Radiopaque Lesions In Maxillary Sinus Region, Ssu-Li Li, Shan-Ju Chou, Yang-Che Wu, Chun-Yu Ho

Journal of Dental Sciences

Nasal polyps are soft, droplet-like lumps that develop on the inner lining of the nose or sinuses due to long-term inflammation in those areas. Nasal polyps are common lesions, however, the occurrence of osseous metaplasia within them is relatively rare. Besides, without a CT scan, relying solely on plain X-ray films to assist clinical diagnosis can easily be misleading due to the uncertainty of the lesion’s location. In this report, our treatment steps were described as medical image analysis, removing the lesion, confirming the pathological result, and regularly follow-up. The Caldwell-Luc approach rather than endoscopic surgery was performed due to …