Indications for the Caldwell-Luc approach in the endoscopic era

OBJECTIVE: Caldwell and Luc described the Caldwell-Luc operation more than 100 years ago as the surgical treatment for maxillary sinus disease. During the last decades less radical interventions using endoscopic approach have mainly replaced the classical procedures done for chronic and recurrent maxillary sinusitis. STUDY DESIGN AND SETTING: Between 1991 and 2002, 62 patients had the Caldwell-Luc approach for different indications. RESULTS: Twenty (32%) patients had chronic sinusitis, 16 (26%) patients had inverted papilloma, 9 (15%) patients had suffered from nasal polyposis, 4 patients (6%) had dentigerous cyst, 4 (6%) patients had fungal ball, and 9 (15%) patients were operated for other indications. CONCLUSIONS: The use of this surgical approach is rational in cases of fungal disease and in endoscopic medial maxillectomy for treating inverted papilloma. In all other cases, the preferred approach should now be endoscopic.

Download Full-text

Antroscopy in maxillary sinus disease associated with nasal polyposis

The Journal of Laryngology & Otology ◽

10.1017/s002221510011031x ◽

1989 ◽

Vol 103 (9) ◽

pp. 861-863 ◽

Cited By ~ 3

Author(s):

J. G. Gilbert

Keyword(s):

Maxillary Sinus ◽

Nasal Polyps ◽

Nasal Polyposis ◽

Maxillary Sinusitis ◽

X Rays ◽

Sinus Disease ◽

High Incidence ◽

Satisfactory Method ◽

Careful Assessment

AbstractAlthough the association of maxillary sinusitis with nasal polyps is widely recognized little has been written on its precise incidence and degree. Antroscopy of 70 antra with ipsilateral polyps showed a high incidence of mucosal abnormalities, retained secretions and ostial narrowing. Comparison of these findings with pre-operative X-rays showed the latter were unreliable in detecting retained antral fluid. It is concluded that in nasal polyposis the antra warrant careful assessment and that antroscopy is a highly satisfactory method for this purpose.

Download Full-text

Reversible Endoscopic Medial Maxillectomy: Endonasal Approach to Diseases of the Maxillary Sinus

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1701267 ◽

2020 ◽

Vol 24 (02) ◽

pp. e247-e252 ◽

Cited By ~ 1

Author(s):

Miguel Soares Tepedino ◽

Ana Clara Miotello Ferrão ◽

Hana Caroline Morais Higa ◽

Leonardo Lopes Balsalobre Filho ◽

Enrique Iturriaga ◽

...

Keyword(s):

Maxillary Sinus ◽

Maxillary Sinusitis ◽

Case Series ◽

Inferior Turbinate ◽

Lateral Wall ◽

Nasolacrimal Duct ◽

Sinus Disease ◽

Patient Series ◽

Medial Maxillectomy ◽

Maxillary Diseases

Abstract Introduction The endoscopic access has reduced the morbidity associated with external approaches in diseases of the maxillary sinus. A reversible endoscopic medial maxillectomy (REMM) is presented as an alternative for treatment of benign maxillary diseases. Objective To describe the REMM technique and report four cases of patients with benign maxillary sinus conditions treated through this approach. Methods The present study was divided into two parts: anatomical and case series. Two cadaveric dissections confirmed the feasibility of the REMM approach. The same technique was performed on four consecutive patients with benign maxillary sinus disease. Results The cadaveric dissections confirmed wide exposure to the maxillary cavity, preserving the anatomy of the maxillary sinus. In the patient series, one patient presented with an antrochoanal polyp, one had a silent sinus syndrome, one had a chronic maxillary sinusitis secondary to a gunshot, and the last one had an inverted papilloma in the maxillary sinus. In all of the cases, the REMM approach provided excellent access and adequate resection, as well as preservation of the inferior turbinate, nasolacrimal duct, and lateral wall of the nose (including its osteomucosal component). Finally, all of the patients had an uneventful postoperative course. Conclusion The REMM technique is an excellent surgical approach to benign conditions of the maxillary sinus. It has few limitations and appears to be associated with less morbidity than conventional techniques.

Download Full-text

Endoscopic Modified Medial Maxillectomy for Resection of an Inverted Papilloma Originating from the Entire Circumference of the Maxillary Sinus

Case Reports in Otolaryngology ◽

10.1155/2015/952923 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6

Author(s):

Kota Wada ◽

Takashi Ishigaki ◽

Yutaro Ida ◽

Yuki Yamada ◽

Sachiko Hosono ◽

...

Keyword(s):

Maxillary Sinus ◽

Surgical Approach ◽

Staging System ◽

Inferior Turbinate ◽

Nasolacrimal Duct ◽

Inverted Papilloma ◽

Sinonasal Inverted Papilloma ◽

Medial Maxillectomy ◽

Magnetic Resonance Imaging Mri ◽

Modified Medial Maxillectomy

For treatment of a sinonasal inverted papilloma (IP), it is essential to have a definite diagnosis, to identify its origin by computed tomography (CT) and magnetic resonance imaging (MRI), and to select the appropriate surgical approach based on the staging system proposed by Krouse. Recently, a new surgical approach named endoscopic modified medial maxillectomy (EMMM) was proposed. This approach can preserve the inferior turbinate and nasolacrimal duct. We successfully treated sinonasal IP with EMMM in a 71-year-old female patient. In this patient, the sinonasal IP originated from the entire circumference of the maxillary sinus. EMMM is not a difficult procedure and provides good visibility of the operative field. Lacrimation and empty nose syndrome do not occur postoperatively as the nasolacrimal duct and inferior turbinate are preserved. EMMM is considered to be a very favorable approach for treatment of sinonasal IP.

Download Full-text

Functional endoscopic sinus surgery (FESS) in unilateral sinus disease

Otolaryngologia Polska ◽

10.5604/01.3001.0010.5314 ◽

2017 ◽

Vol 71 (5) ◽

pp. 29-35 ◽

Cited By ~ 2

Author(s):

Daniela Mielcarek-Kuchta ◽

Karolina Simon ◽

Dawid Kondratowicz ◽

Zofia Łukomska ◽

Aleksandra Rybak-Korytowska

Keyword(s):

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Malignant Tumors ◽

Inverted Papilloma ◽

Sinus Surgery ◽

Malignant Degeneration ◽

Sinus Disease ◽

Choanal Polyp ◽

Medial Maxillectomy ◽

Extensive Surgery

Background: Unilateral sinus disease (USD) occurs in 23 % of all cases. It is believed that it is mainly associated with cancer development. Retrospective data from large rhinological centers show that the most common USD is chronic rhinosinusitis (CRS), followed by mycosis, inverted papilloma and finally cancer, but only in a small percent of cases. The aim of the study: The analysis of USD in the group of patients who underwent FESS at the secondary referral center. Material and Method: The retrospective study of patients treated for USD in the Department of Otolaryngology in the Provincial Hospital in Poznan between June 2014 and June 2016. The analysis includes age, sex, the localization of lesions, histopathological and microbiological results, an extension of the surgery and treatment results. Results: Over the analyzed period of time, 415 FESS for chronic sinusitis were performed. In this group, 83 patients underwent surgery for USD. There were 35 women and 48 men.CRS was found in 48 cases, mycosis in nine cases, 12 patients were operated for non-malignant tumors, such as inverted papilloma (9), osteoma (2) and fibrosis tumor(1); seven patients had a choanal polyp and two of them had a foreign body in maxillary sinus – a tooth root lying loose. Four patients were diagnosed with a hypoplastic maxillary sinus and one patient suffered from frontal sinus pyocele. One side endoscopic opening of all sinuses was performed in the group with CRS, endoscopic medial maxillectomy was conducted in patients with inverted papilloma, and an isolated opening of the affected sinus was performed in the cases with mycosis. Conclusions: USD must be always suspected of malignant degeneration until proven otherwise. Endoscopic sinus surgery with the use of angled scope allows for the removal of even very extensive lesions. In our opinion, the extent of operation is determined by the nature of pathology. While extensive surgery is recommended in patients with inverted papilloma, a limited procedure should be performed in those with isolated mycosis.

Download Full-text

Paranasal Sinus Development in Chronic Sinusitis, Cystic Fibrosis, and Normal Comparison Population: A Computerized Tomography Correlation Study

American Journal of Rhinology ◽

10.2500/105065897781446676 ◽

1997 ◽

Vol 11 (4) ◽

pp. 275-282 ◽

Cited By ~ 48

Author(s):

Hung Jeff Kim ◽

Ellen M. Friedman ◽

Marcelle Sulek ◽

Newton O. Duncan ◽

Charles McCluggage

Keyword(s):

Cystic Fibrosis ◽

Maxillary Sinus ◽

Paranasal Sinus ◽

Chronic Sinusitis ◽

Correlation Study ◽

Uncinate Process ◽

Ct Scans ◽

Lateral Nasal Wall ◽

Transverse Diameter ◽

Sinus Disease

Chronic sinus disease in patients with and without cystic fibrosis may have an impact on the pattern of paranasal sinus pneumatization. Arrest of pneumatization has been reported in both of these conditions. To assess the development of the paranasal sinuses in relationship to chronic sinusitis and cystic fibrosis (CF), a retrospective review of coronal CT scans of the age-matched patients with no previous sinus disease, patients with chronic sinusitis, and cystic fibrosis patients was conducted. The patients’ ages ranged from 4 to 17 years. The maxillary sinus volume, anteroposterior diameter, and greatest transverse diameter and height were determined using image analysis software after the coronal CT scans were scanned into Macintosh computer. The size of the maxillary sinus increased with advancing age in the control and chronic sinusitis group, but not in the patients with cystic fibrosis. The patients with cystic fibrosis had a statistically significant smaller maxillary sinus size. Approximately 50% of the patients with chronic sinusitis had anatomic anomalies, the most common being paradoxical middle turbinates. The CT scans of CF patients were characterized by uncinate process demineralization and medial displacement of the lateral nasal wall in the middle meatus, and decreased maxillary sinus pneumatization.

Download Full-text

A Comparison of Near-Infrared Imaging and Computerized Tomography Scan for Detecting Maxillary Sinusitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211060623 ◽

2021 ◽

pp. 000348942110606

Author(s):

Mehdi Abouzari ◽

Brooke Sarna ◽

Joon You ◽

Adwight Risbud ◽

Kotaro Tsutsumi ◽

...

Keyword(s):

Maxillary Sinus ◽

Computerized Tomography ◽

Sensitivity And Specificity ◽

Near Infrared ◽

Maxillary Sinusitis ◽

Tertiary Care ◽

Pixel Intensity ◽

Sinus Disease ◽

Nir Imaging ◽

Average Pixel Intensity

Objective: To investigate the use of near-infrared (NIR) imaging as a tool for outpatient clinicians to quickly and accurately assess for maxillary sinusitis and to characterize its accuracy compared to computerized tomography (CT) scan. Methods: In a prospective investigational study, NIR and CT images from 65 patients who presented to a tertiary care rhinology clinic were compared to determine the sensitivity and specificity of NIR as an imaging modality. Results: The sensitivity and specificity of NIR imaging in distinguishing normal versus maxillary sinus disease was found to be 90% and 84%, normal versus mild maxillary sinus disease to be 76% and 91%, and mild versus severe maxillary sinus disease to be 96% and 81%, respectively. The average pixel intensity was also calculated and compared to the modified Lund-Mackay scores from CT scans to assess the ability of NIR imaging to stratify the severity of maxillary sinus disease. Average pixel intensity over a region of interest was significantly different ( P < .001) between normal, mild, and severe disease, as well as when comparing normal versus mild ( P < .001, 95% CI 42.22-105.39), normal versus severe ( P < .001, 95% CI 119.43-174.14), and mild versus severe ( P < .001, 95% CI 41.39-104.56) maxillary sinus disease. Conclusion: Based on this data, NIR shows promise as a tool for identifying patients with potential maxillary sinus disease as well as providing information on severity of disease that may guide administration of appropriate treatments.

Download Full-text

Comparison of the Frequency of Detection of Some Radiological Signs in Chronic Maxillary Sinusіtis of Fungal and Non-Fungal Origin

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs05.06.202 ◽

2020 ◽

Vol 5 (6) ◽

pp. 202-207

Author(s):

Ya. V. Shkorbotun ◽

◽

Keyword(s):

Computed Tomography ◽

Maxillary Sinus ◽

Chronic Rhinosinusitis ◽

Chronic Sinusitis ◽

Maxillary Sinusitis ◽

Biologically Active ◽

Differential Diagnostics ◽

Diagnostic Significance ◽

Fungal Ball ◽

The One

The one of the most informative method of preoperative diagnosis of fungal paranasal sinuses is computed tomography. The radiological marker that allows to identify chronic sinusitis of fungal origin is an eclipse with hyperintensive inclusions. The sensitivity of this criterion for fungal ball is about 80%. In addition, a sign of recalcitrant chronic sinusitis is the presence of reactive changes in the bone wall of the sinus – "osteitis". The purpose of the work was to study the frequency of radiological signs of osteitis and areas of increased radiological density in the maxillary sinuses of the patients with chronic sinusitis of fungal and non-fungal etiology, to clarify the diagnostic significance of these symptoms in the differential diagnostics. Material and methods. The results of a retrospective study of computer tomography data of 60 people with chronic rhinosinusitis (intraoperative was verified fungal ball in the maxillary sinus space of 30 patients, other 30 patient had no signs of fungal etiology). Results and discussion. In patients with chronic rhinosinusitis of non-fungal nature, hyperintensive inclusions in the sinus were found in 13.3%, and signs of osteitis were detected in 36.7%, which was significantly less common than in patients with fungal processes, 83.3% and 80,0% respectively (p <0,05). The presence of both of the radiological symptoms was observed in 63.3% of patients from the group of chronic rhinosinusitis in the presence of a fungal body in the space of the sinus and in 6.7% of cases the chronic rhinosinusitis of non-fungal etiology. The severity of osteitis according to KOS, in patients with a fungal body in the sinus was 0.71 ± 0.15 points, and 0.55 ± 0.2 points in patients without a fungus. The pathogenesis of osteitis in the cases of sinusitis with fungal origin is a violation of bone trophism, which develops due to periostitis after the influence of biologically active substances secreted by the fungus. The increase of radiation density in areas of osteitis indicates the predominance of osteogenesis over osteolysis in the inflammatory focus of the bone wall of the maxillary sinus. Conclusion. The frequency of detecting radiological signs of osteitis in patients with chronic rhinosinusitis of the maxillary sinus with fungal bodies was 80%, that was comparable to the frequency of detecting hyperintense inclusions in the lumen of the sinus in these patients (83.3%), and was significantly more than in patients with chronic sinusitis nonfungal etiology. The presence of radiological signs of osteitis of the bone wall of the maxillary sinus in computed tomography should be regarded as an additional symptom in the differential diagnosis of maxillary sinusitis of fungal origin

Download Full-text

Case Report: retained gutta-percha as a cause for persistent maxillary sinusitis and pain

F1000Research ◽

10.12688/f1000research.3791.2 ◽

2014 ◽

Vol 3 ◽

pp. 81 ◽

Cited By ~ 1

Author(s):

Benjamin L. Hodnett ◽

Berrylin Ferguson

Keyword(s):

Case Report ◽

Oral Cavity ◽

Maxillary Sinus ◽

Chronic Sinusitis ◽

Maxillary Sinusitis ◽

Gutta Percha ◽

Sources Of Infection ◽

Chronic Maxillary Sinusitis

Dental sources of infection can produce acute and chronic maxillary sinusitis. In some cases, the source of the infection may be related to the presence of endodontic materials in the oral cavity. In this article, we report a case of retained gutta-percha in the maxillary sinus resulting in chronic sinusitis.

Download Full-text

Maxillary sinusitis of odontogenic origin in relation to ectopic 2.8 associated with follicular dentigerous cyst: Combined transnasal and oral endoscopic approach, a case report

Global Dentistry ◽

10.36879/god.20.000131 ◽

2020 ◽

pp. 1-3

Keyword(s):

Oral Cavity ◽

Maxillary Sinus ◽

Maxillary Sinusitis ◽

Dentigerous Cyst ◽

Amorphous Material ◽

Fungal Spores ◽

Lateral Wall ◽

Healing Time ◽

Vestibular Cortex ◽

Follicular Cyst

Purpose of the study: To describe the management of orosinusal pathology by combined transnasal endoscopy and oral combined. Methods: The 54-year-old patient underwent a dental and otolaryngological evaluation for left odontogenic maxillary sinusitis in relation to plausible dental follicular cyst of ectopic element 2.8. The symptoms reported at the time of access to the hospital were nasal obstruction and nocturnal rhonchopathy. To the ENT evaluation in videorinoscopy with rigid optics, complex deviation of the nasal septum was relevated with not any evident formations or pathological secretions. While on inspection of the oral cavity the mucous membranes appeared unscathed. Alveolus of 1.6 previosuly extracted was evident. The radiological examination, facial CT, revealed the left maxillary sinus almost completely occupied by a cystic appearance, with thin calcified walls and homogeneous content that has a dental element, probably the 2.8, which fenestrates the vestibular cortex of the lateral wall of the maxillary sinus. This lesion erodes the medial wall of the sinus, obliterating the ostio-meatal complex and imprinting the ipsilateral ethmoidal cells. Biohumoral tests showed normal coagulation parameters, indices of renal function, liver and ionemia. The patient under general anesthesia and oral intubation with a combined intervention of the left anterior FESS, intrasulcular flap from dental elements 2.7 to 2.3 with mesial releasing incision, moderate osteotomy, ectopic 2.8 extraction and enucleation of the cystic lesion with simultaneous closure of the orosinusal communication with advancement of the Bichat adipose bolla and closure by first intention. In the same session, the ENT moment is carried out trans nasally for total left uncinectomy, medium antrostomy with the union of the natural ostium and the accessory ostium. Bilateral lower turbinoplasty with bipolar forceps. The patient was then controlled after 15 days and six months, showing good healing and no signs of recurrence at the rhinoscopic check on the physical examination of the oral cavity. Results: based on the clinical and radiological aspect, the diagnosis of a follicular dentigerous cyst (WHO 2017) covered by a multi-layered non-keratinized paving epithelium, with moderate chronic inflammation, including gigantocellular and cholesteric crystals, is reached from the microbiological and histological examination. Necrotic amorphous material coexists including rare hyphae and fungal spores, with therefore mycotic and actinomycotic super infection. Conclusions: The combined oral and nasal intervention, allowed by the collaboration between the oral surgeon and ENT, has made it possible to shorten the healing time and to resolve the pathology without any sign of recurrence.

Download Full-text