Evaluation Of The Frequency, Localization And Relationship Of Maxillary Sinus Pathologies With Dental Pathologies By Cone Beam Computed Tomography (CBCT)

Emre Haylaz; Gediz Geduk; Çiğdem Şeker

doi:10.16899/jcm.1438173

Araştırma Makalesi

Maksiller Sinüs Patolojilerinin Sıklığı, Lokalizasyonu Ve Dental Patolojiler İle İlişkisinin Konik Işınlı Bilgisayarlı Tomografi (KIBT) İle Değerlendirilmesi

Yıl 2024, Cilt: 14 Sayı: 2, 94 - 110, 28.03.2024

Emre Haylaz Gediz Geduk Çiğdem Şeker

https://doi.org/10.16899/jcm.1438173

Öz

Amaç: Maksiller posterior dişlerin kök uçlarının maksiller sinüse yakınlığı, odontojen kaynaklı enfeksiyonun potansiyel bir maksiller sinüzit kaynağı haline gelmesine neden olmaktadır. Bu çalışmanın amacı, diş patolojileri ile maksiller sinüs anormallikleri arasındaki ilişkiyi konik ışınlı bilgisayarlı tomografi (KIBT) kullanarak değerlendirmektir.

Materyal ve Metod: Bu çalışmada kliniğimize herhangi bir nedenle başvuran 300 hastanın 600 adet maksiller sinüs konik ışınlı bilgisayarlı tomografi görüntüsü retrospektif olarak incelendi. Maksiller sinüs hastalıkları ve diş patolojileri kendi aralarında kategorize edilir.

Bulgular: Hastaların yaşları 18 ile 77 arasında değişmekte olup ortalama yaş 41,38 (±14,39) olarak tespit edildi. İncelenen maksiller sinüslerin 359'unda (%59,8) patoloji saptanmadı ve sağlıklı sinüs olarak değerlendirildi. Görüntüleme alanındaki maksiller sinüslerin 241'inde (%40,2) en sık görülen patoloji mukozal kalınlaşmaydı (MT). Periapikal lezyonlu dişler (PL) ile MT arasında istatistiksel olarak anlamlı bir ilişki tespit edildi (p<0.05). Restoratif uygulamalar, oro-antral fistül (OAF) ve periodontal kemik kaybı (PBL) ile maksiller sinüzit (MS) arasında istatistiksel olarak anlamlı ilişki saptanamadı (p<0,05).

Sonuç: Odontojenik enfeksiyonlar ve inflamatuar olaylar maksiller sinüs patolojilerinin oluşumunda rol oynayabilen nedenlerdir. KIBT, maksiller posterior dişler ve maksiller sinüs arasındaki ilişkinin gösterilmesinde ve odontojen sinüs patolojilerinin tanısında oldukça faydalıdır.

Anahtar Kelimeler

Konik Işınlı Bilgisayarlı Tomografi, Maksiller Sinüs, Mukozal Kalınlaşma, Periapikal Lezyon, Periodontal Hastalık

Kaynakça

1. Nascimento EH, Pontual ML, Pontual AA, Freitas DQ, Perez DE, Ramos-Perez FM. Association between odontogenic conditions and maxillary sinus disease: a study using cone-beam computed tomography. J Endod. 2016;42:1509-15. https://doi.org/10.1016/j.joen.2016.07.003 2. Ruprecht A and Lam EWN. Paranasal Sinus Diseases. In: White SC ve Pharoah MJ, editors. Oral Radiology Principles and Interpretation. 7th Ed. St. Louis, Mosby. 2014;472-89.
3. Lu Y, Liu Z, Zhang L, Zhou X, Zheng Q, Duan X, et al. Associations between maxillary sinus mucosal thickening and apical periodontitis using cone-beam computed tomography scanning: a retrospective study. J Endod. 2012;38:1069-74. https://doi.org/10.1016/j.joen.2012.04.027
4. Mahasneh SA, Al-Hadidi A, Hassona Y, Sawair FA, Al-Nazer S, Bakain Y, et al. Maxillary sinusitis of odontogenic origin: prevalence among 3d imaging—a retrospective study. Appl Sci. 2022;12:3057. https://doi.org/10.3390/app12063057
5. Shanbhag S, Karnik P, Shirke P, Shanbhag V. Association between periapical lesions and maxillary sinus mucosal thickening: a retrospective cone-beam computed tomographic study. J Endod. 2013;39:853-7. https://doi.org/10.1016/j.joen.2013.04.010
6. Brüllmann DD, Schmidtmann I, Hornstein S, Schulze RK. Correlation of cone beam computed tomography (CBCT) findings in the maxillary sinus with dental diagnoses: a retrospective cross-sectional study. Clin Oral Investig. 2012;16:1023-9. https://doi.org/10.1007/s00784-011-0620-1
7. Phothikhun S, Suphanantachat S, Chuenchompoonut V, Nisapakultorn K. Cone-beam computed tomographic evidence of the association between periodontal bone loss and mucosal thickening of the maxillary sinus. J Periodontol. 2012;83:557-64. https://doi.org/10.1902/jop.2011.110376
8. Vallo J, Suominen-Taipale L, Huumonen S, Soikkonen K, Norblad A. Prevalence of mucosal abnormalities of the maxillary sinus and their relationship to dental disease in panoramic radiography: results from the health 2000 health examination survey. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:e80-7. https://doi.org/10.1016/j.tripleo.2009.10.031
9. Connor SE, Chavda SV, Pahor AL. Computed tomography evidence of dental restoration as aetiological factor for maxillary sinusitis. J Laryngol Otol. 2000;114:510-3. https://doi.org/10.1258/0022215001906255 10. Jung JH, Choi BH, Jeong SM, Li J, Lee SH, Lee HJ. A retrospective study of the effects on sinus complications of exposing dental implants to the maxillary sinus cavity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(5):623-5. https://doi.org/10.1016/j.tripleo.2006.09.024
11. Abi Najm S, Malis D, El Hage M, Rahban S, Carrel JP, Bernard JP. Potential adverse events of endosseous dental implants penetrating the maxillary sinus: long-term clinical evaluation. Laryngoscope. 2013;123:2958-61. https://doi.org/10.1002/lary.24189
12. van den Bergh JP, ten Bruggenkate CM, Disch FJ, Tuinzing DB. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res. 2000;11:256-65. https://doi.org/ 10.1034/j.1600-0501.2000.011003256.x
13. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;23:1-298. https://doi.org/10.4193/Rhino13.217
14. Brook I. Sinusitis of odontogenic origin. Otolaryngol Head Neck Surg. 2006;135:349-55. https://doi.org/10.1016/j.otohns.2005.10.059
15. Hauman CH, Chandler NP, Tong DC. Endodontic implications of the maxillary sinus: a review. Int Endod J. 2002;35:127-41. https://doi.org/10.1046/j.0143-2885.2001.00524.x
16. Wippold FJ 2nd. Head and neck imaging: the role of CT and MRI. J Magn Reson Imaging. 2007;25:453-65. https://doi.org/10.1002/jmri.20838
17. Oliveira LD, Carvalho CA, Carvalho AS, Alves Jde S, Valera MC, Jorge AO. Efficacy of endodontic treatment for endotoxin reduction in primarily infected root canals and evaluation of cytotoxic effects. J Endod. 2012;38:1053-7. https://doi.org/10.1016/j.joen.2012.04.015
18. Rôças IN, Neves MA, Provenzano JC, Siqueira JF Jr. Susceptibility of as-yet-uncultivated and difficult-to-culture bacteria to chemomechanical procedures. J Endod. 2014;40:33-7. https://doi.org/10.1016/j.joen.2013.07.022
19. Eggesbø HB. Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses. Eur Radiol. 2006;16:872-88. https://doi.org/10.1007/s00330-005-0068-2
20. Hansen AG, Helvik AS, Nordgård S, Bugten V, Stovner LJ, Håberg AK, et al. Incidental findings in MRI of the paranasal sinuses in adults: a population-based study (HUNT MRI). BMC Ear, Nose Throat Disord. 2014;14:13. https://doi.org/10.1186/1472-6815-14-13
21. Kanwar SS, Mital M, Gupta PK, Saran S, Parashar N, Singh, A. Evaluation of paranasal sinus diseases by computed tomography and its histopathological correlation. Dentomaxillofac Radiol. 2017;5:46. https://doi.org/10.4103/jomr.jomr_11_17
22. Horwitz Berkun R, Polak D, Shapira L, Eliashar R. Association of dental and maxillary sinus pathologies with ear, nose, and throat symptoms. Oral Dis. 2018;24:650-56. https://doi.org/10.1111/odi.12805
23. Raghav M, Karjodkar FR, Sontakke S, Sansare K. Prevalence of incidental maxillary sinus pathologies in dental patients on cone-beam computed tomographic images. Contemp Clin Dent. 2014;5:361-5. https://doi.org/0.4103/0976-237X.137949
24. Ritter L, Lutz J, Neugebauer J, Scheer M, Dreiseidler T, Zinser MJ, Rothamel D, Mischkowski RA. Prevalence of pathologic findings in the maxillary sinus in cone-beam computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:634-40. https://doi.org/10.1016/j.tripleo.2010.12.007
25. Brüllmann DD, Schmidtmann I, Hornstein S, Schulze RK. Correlation of cone beam computed tomography (CBCT) findings in the maxillary sinus with dental diagnoses: a retrospective cross-sectional study. Clin Oral Investig. 2012;16:1023-9. https://doi.org/10.1007/s00784-011-0620-1
26. Sheikhi M, Pozve NJ, Khorrami L. Using cone beam computed tomography to detect the relationship between the periodontal bone loss and mucosal thickening of the maxillary sinus. Dent Res J (Isfahan). 2014;11:495-501.
27. Ferguson M. Rhinosinusitis in oral medicine and dentistry. Aust Dent J. 2014;59:289-95. https://doi.org/10.1111/adj.12193
28. Little RE, Long CM, Loehrl TA, Poetker DM. Odontogenic sinusitis: A review of the current literature. Laryngoscope Investig Otolaryngol. 2018;3:110-4. https://doi.org/10.1002/lio2.147
29. Lee KC, Lee SJ. Clinical features and treatments of odontogenic sinusitis. Yonsei Med J. 2010;51:932-7. https://doi.org/10.3349/ymj.2010.51.6.932
30. Bomeli SR, Branstetter BF 4th, Ferguson BJ. Frequency of a dental source for acute maxillary sinusitis. Laryngoscope. 2009;119:580-4. https://doi.org/10.1002/lary.20095
31. Costa F, Emanuelli E, Robiony M, Zerman N, Polini F, Politi M. Endoscopic surgical treatment of chronic maxillary sinusitis of dental origin. J Oral Maxillofac Surg. 2007;65:223-8. https://doi.org/10.1016/j.joms.2005.11.109
32. Akhlaghi F, Esmaeelinejad M, Safai P. Etiologies and treatments of odontogenic maxillary sinusitis: a systematic review. Iran Red Crescent Med J. 2015;17:e25536. https://doi.org/10.5812/ircmj.25536
33. Yeung AWK, Tanaka R, Khong PL, von Arx T, Bornstein MM. Frequency, location, and association with dental pathology of mucous retention cysts in the maxillary sinus. A radiographic study using cone beam computed tomography (CBCT). Clin Oral Investig. 2018;22:1175-83. https://doi.org/10.1007/s00784-017-2206-z
34. Curi FR, Pelegrine RA, Nascimento MDCC, Monteiro JCC, Junqueira JLC, Panzarella FK. Odontogenic infection as a predisposing factor for pathologic disorder development in maxillary sinus. Oral Dis. 2020;26:1727-35. https://doi.org/10.1111/odi.13481
35. Nunes CA, Guedes OA, Alencar AH, Peters OA, Estrela CR, Estrela C. Evaluation of periapical lesions and their association with maxillary sinus abnormalities on cone-beam computed tomographic images. J Endod. 2016;42:42-6. https://doi.org/10.1016/j.joen.2015.09.014

Evaluation Of The Frequency, Localization And Relationship Of Maxillary Sinus Pathologies With Dental Pathologies By Cone Beam Computed Tomography (CBCT)

Yıl 2024, Cilt: 14 Sayı: 2, 94 - 110, 28.03.2024

Emre Haylaz Gediz Geduk Çiğdem Şeker

https://doi.org/10.16899/jcm.1438173

Öz

Background: The proximity of the root tips of the maxillary posterior teeth to the maxillary sinus causes odontogenic infection to become a potential source of maxillary sinusitis. This study aims to evaluate the relationship between dental pathologies and maxillary sinus abnormalities using cone beam computed tomography (CBCT).

Material and Method: In this study, 300 patients who applied to our clinic for any reason 600 maxillary sinus cone beam computed tomography images of the patient were analyzed retrospectively. Maxillary sinus diseases and dental pathologies categoized among themselves.

Results: The age of all patients ranged between 18 and 77 years, with a mean age of 41.38 (±14.39) years. No pathology was detected in 359 (59.8%) of the maxillary sinuses examined which were considered healthy sinuses. The most common pathology in 241 (40.2%) of the maxillary sinuses in the imaging area was mucosal thickening (MT). A statistically significant relationship was detected between teeth with periapical lesions (PL) and MT (p<0.05). No statistically significant relationship was found between restorative applications, oro-antral fistula (OAF), periodontal bone loss (PBL), and maxillary sinusitis (MS) (p<0.05).

Conclusion: Odontogenic infections and inflammatory events are the causes of maxillary sinus pathologies and may play a role in their formation. CBCT, maxillary posterior teeth and maxillary sinüs in demonstrating the relationship between and in the diagnosis of odontogenous sinus pathlogies is quite useful.

Anahtar Kelimeler

Cone Beam Computed Tomography, Maxillary Sinus, Mucosal Thickening, Periapical Lesion, Periodontal Disease

Etik Beyan

This study was reviewed by the Clinical Research Ethics Committee of Zonguldak Bülent Ecevit University and was decided to be ethically appropriate (2021/12).

Kaynakça

1. Nascimento EH, Pontual ML, Pontual AA, Freitas DQ, Perez DE, Ramos-Perez FM. Association between odontogenic conditions and maxillary sinus disease: a study using cone-beam computed tomography. J Endod. 2016;42:1509-15. https://doi.org/10.1016/j.joen.2016.07.003 2. Ruprecht A and Lam EWN. Paranasal Sinus Diseases. In: White SC ve Pharoah MJ, editors. Oral Radiology Principles and Interpretation. 7th Ed. St. Louis, Mosby. 2014;472-89.
3. Lu Y, Liu Z, Zhang L, Zhou X, Zheng Q, Duan X, et al. Associations between maxillary sinus mucosal thickening and apical periodontitis using cone-beam computed tomography scanning: a retrospective study. J Endod. 2012;38:1069-74. https://doi.org/10.1016/j.joen.2012.04.027
4. Mahasneh SA, Al-Hadidi A, Hassona Y, Sawair FA, Al-Nazer S, Bakain Y, et al. Maxillary sinusitis of odontogenic origin: prevalence among 3d imaging—a retrospective study. Appl Sci. 2022;12:3057. https://doi.org/10.3390/app12063057
5. Shanbhag S, Karnik P, Shirke P, Shanbhag V. Association between periapical lesions and maxillary sinus mucosal thickening: a retrospective cone-beam computed tomographic study. J Endod. 2013;39:853-7. https://doi.org/10.1016/j.joen.2013.04.010
6. Brüllmann DD, Schmidtmann I, Hornstein S, Schulze RK. Correlation of cone beam computed tomography (CBCT) findings in the maxillary sinus with dental diagnoses: a retrospective cross-sectional study. Clin Oral Investig. 2012;16:1023-9. https://doi.org/10.1007/s00784-011-0620-1
7. Phothikhun S, Suphanantachat S, Chuenchompoonut V, Nisapakultorn K. Cone-beam computed tomographic evidence of the association between periodontal bone loss and mucosal thickening of the maxillary sinus. J Periodontol. 2012;83:557-64. https://doi.org/10.1902/jop.2011.110376
8. Vallo J, Suominen-Taipale L, Huumonen S, Soikkonen K, Norblad A. Prevalence of mucosal abnormalities of the maxillary sinus and their relationship to dental disease in panoramic radiography: results from the health 2000 health examination survey. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:e80-7. https://doi.org/10.1016/j.tripleo.2009.10.031
9. Connor SE, Chavda SV, Pahor AL. Computed tomography evidence of dental restoration as aetiological factor for maxillary sinusitis. J Laryngol Otol. 2000;114:510-3. https://doi.org/10.1258/0022215001906255 10. Jung JH, Choi BH, Jeong SM, Li J, Lee SH, Lee HJ. A retrospective study of the effects on sinus complications of exposing dental implants to the maxillary sinus cavity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(5):623-5. https://doi.org/10.1016/j.tripleo.2006.09.024
11. Abi Najm S, Malis D, El Hage M, Rahban S, Carrel JP, Bernard JP. Potential adverse events of endosseous dental implants penetrating the maxillary sinus: long-term clinical evaluation. Laryngoscope. 2013;123:2958-61. https://doi.org/10.1002/lary.24189
12. van den Bergh JP, ten Bruggenkate CM, Disch FJ, Tuinzing DB. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res. 2000;11:256-65. https://doi.org/ 10.1034/j.1600-0501.2000.011003256.x
13. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;23:1-298. https://doi.org/10.4193/Rhino13.217
14. Brook I. Sinusitis of odontogenic origin. Otolaryngol Head Neck Surg. 2006;135:349-55. https://doi.org/10.1016/j.otohns.2005.10.059
15. Hauman CH, Chandler NP, Tong DC. Endodontic implications of the maxillary sinus: a review. Int Endod J. 2002;35:127-41. https://doi.org/10.1046/j.0143-2885.2001.00524.x
16. Wippold FJ 2nd. Head and neck imaging: the role of CT and MRI. J Magn Reson Imaging. 2007;25:453-65. https://doi.org/10.1002/jmri.20838
17. Oliveira LD, Carvalho CA, Carvalho AS, Alves Jde S, Valera MC, Jorge AO. Efficacy of endodontic treatment for endotoxin reduction in primarily infected root canals and evaluation of cytotoxic effects. J Endod. 2012;38:1053-7. https://doi.org/10.1016/j.joen.2012.04.015
18. Rôças IN, Neves MA, Provenzano JC, Siqueira JF Jr. Susceptibility of as-yet-uncultivated and difficult-to-culture bacteria to chemomechanical procedures. J Endod. 2014;40:33-7. https://doi.org/10.1016/j.joen.2013.07.022
19. Eggesbø HB. Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses. Eur Radiol. 2006;16:872-88. https://doi.org/10.1007/s00330-005-0068-2
20. Hansen AG, Helvik AS, Nordgård S, Bugten V, Stovner LJ, Håberg AK, et al. Incidental findings in MRI of the paranasal sinuses in adults: a population-based study (HUNT MRI). BMC Ear, Nose Throat Disord. 2014;14:13. https://doi.org/10.1186/1472-6815-14-13
21. Kanwar SS, Mital M, Gupta PK, Saran S, Parashar N, Singh, A. Evaluation of paranasal sinus diseases by computed tomography and its histopathological correlation. Dentomaxillofac Radiol. 2017;5:46. https://doi.org/10.4103/jomr.jomr_11_17
22. Horwitz Berkun R, Polak D, Shapira L, Eliashar R. Association of dental and maxillary sinus pathologies with ear, nose, and throat symptoms. Oral Dis. 2018;24:650-56. https://doi.org/10.1111/odi.12805
23. Raghav M, Karjodkar FR, Sontakke S, Sansare K. Prevalence of incidental maxillary sinus pathologies in dental patients on cone-beam computed tomographic images. Contemp Clin Dent. 2014;5:361-5. https://doi.org/0.4103/0976-237X.137949
24. Ritter L, Lutz J, Neugebauer J, Scheer M, Dreiseidler T, Zinser MJ, Rothamel D, Mischkowski RA. Prevalence of pathologic findings in the maxillary sinus in cone-beam computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:634-40. https://doi.org/10.1016/j.tripleo.2010.12.007
25. Brüllmann DD, Schmidtmann I, Hornstein S, Schulze RK. Correlation of cone beam computed tomography (CBCT) findings in the maxillary sinus with dental diagnoses: a retrospective cross-sectional study. Clin Oral Investig. 2012;16:1023-9. https://doi.org/10.1007/s00784-011-0620-1
26. Sheikhi M, Pozve NJ, Khorrami L. Using cone beam computed tomography to detect the relationship between the periodontal bone loss and mucosal thickening of the maxillary sinus. Dent Res J (Isfahan). 2014;11:495-501.
27. Ferguson M. Rhinosinusitis in oral medicine and dentistry. Aust Dent J. 2014;59:289-95. https://doi.org/10.1111/adj.12193
28. Little RE, Long CM, Loehrl TA, Poetker DM. Odontogenic sinusitis: A review of the current literature. Laryngoscope Investig Otolaryngol. 2018;3:110-4. https://doi.org/10.1002/lio2.147
29. Lee KC, Lee SJ. Clinical features and treatments of odontogenic sinusitis. Yonsei Med J. 2010;51:932-7. https://doi.org/10.3349/ymj.2010.51.6.932
30. Bomeli SR, Branstetter BF 4th, Ferguson BJ. Frequency of a dental source for acute maxillary sinusitis. Laryngoscope. 2009;119:580-4. https://doi.org/10.1002/lary.20095
31. Costa F, Emanuelli E, Robiony M, Zerman N, Polini F, Politi M. Endoscopic surgical treatment of chronic maxillary sinusitis of dental origin. J Oral Maxillofac Surg. 2007;65:223-8. https://doi.org/10.1016/j.joms.2005.11.109
32. Akhlaghi F, Esmaeelinejad M, Safai P. Etiologies and treatments of odontogenic maxillary sinusitis: a systematic review. Iran Red Crescent Med J. 2015;17:e25536. https://doi.org/10.5812/ircmj.25536
33. Yeung AWK, Tanaka R, Khong PL, von Arx T, Bornstein MM. Frequency, location, and association with dental pathology of mucous retention cysts in the maxillary sinus. A radiographic study using cone beam computed tomography (CBCT). Clin Oral Investig. 2018;22:1175-83. https://doi.org/10.1007/s00784-017-2206-z
34. Curi FR, Pelegrine RA, Nascimento MDCC, Monteiro JCC, Junqueira JLC, Panzarella FK. Odontogenic infection as a predisposing factor for pathologic disorder development in maxillary sinus. Oral Dis. 2020;26:1727-35. https://doi.org/10.1111/odi.13481
35. Nunes CA, Guedes OA, Alencar AH, Peters OA, Estrela CR, Estrela C. Evaluation of periapical lesions and their association with maxillary sinus abnormalities on cone-beam computed tomographic images. J Endod. 2016;42:42-6. https://doi.org/10.1016/j.joen.2015.09.014

Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Ağız, Diş ve Çene Radyolojisi
Bölüm	Orjinal Araştırma
Yazarlar	Emre Haylaz 0000-0001-7330-9525 Gediz Geduk 0000-0002-9650-2149 Çiğdem Şeker 0000-0001-8984-1241
Yayımlanma Tarihi	28 Mart 2024
Gönderilme Tarihi	17 Şubat 2024
Kabul Tarihi	18 Mart 2024
Yayımlandığı Sayı	Yıl 2024 Cilt: 14 Sayı: 2

Kaynak Göster

AMA	Haylaz E, Geduk G, Şeker Ç. Evaluation Of The Frequency, Localization And Relationship Of Maxillary Sinus Pathologies With Dental Pathologies By Cone Beam Computed Tomography (CBCT). J Contemp Med. Mart 2024;14(2):94-110. doi:10.16899/jcm.1438173

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