Posterior Maxillary Sinus Wall: A Landmark for Identifying the Sphenoid Sinus Ostium

Importance: Safe entry into sphenoid sinus is critical in endoscopic sinus and skull base surgery. A number of surgical landmarks have been used to identify the sphenoid sinus ostium during endoscopic endonasal surgery with variable reliability and intraoperative feasibility. Objective: To determine if the posterior wall of the maxillary sinus is a reliable landmark to determine the depth of the sphenoid sinus ostium during anterior to posterior dissection. Design, Setting, and Participants: Prospective study of adult patients undergoing endoscopic sinus surgery between August 2016 and September 2017. Measurements were made intraoperatively between the depth of the posterior maxillary sinus wall and sphenoid sinus ostium. Main Outcomes and Measures: The primary measurement is the distance between the depth of the posterior maxillary sinus wall and sphenoid sinus ostium. Additional data points included age, gender, surgical indication, and primary versus revision endoscopic sinus surgery. Results: Forty-five patients (38% male, 62% female) with an average age of 56 were enrolled, resulting in 88 operated sides. The average distance between the depth of the posterior wall of the maxillary sinus and the sphenoid ostium was 1.5 mm ± 1.4 mm. The most common position of the sphenoid sinus ostium was posterior to the level of the posterior maxillary sinus wall (54%), followed by same level (23%) and anterior (23%). There was no significant difference between different disease states ( P = .75) and between primary and revision cases ( P = .13). Conclusions and Relevance: The posterior wall of the maxillary sinus serves as an adjunctive intraoperative landmark to determine the depth of the sphenoid sinus ostium. While the posterior wall of the maxillary sinus approximates the depth of the sphenoid sinus ostium, the relative position is variable and can be anterior or posterior.

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Computed tomography findings after endoscopic sinus surgery with preserving or enlarging maxillary sinus ostium surgery

Rhinology Journal ◽

10.4193/rhino10.111 ◽

2011 ◽

Vol 49 (4) ◽

pp. 438-444

Author(s):

J. Myller ◽

P. Dastidar ◽

T. Torkkeli ◽

M. Rautiainen ◽

S. Toppila-Salmi

Keyword(s):

Computed Tomography ◽

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Symptom Relief ◽

Sinus Surgery ◽

Ct Scans ◽

Ct Findings ◽

Middle Meatal Antrostomy ◽

Sinus Ostium ◽

Subjective Outcomes

Endoscopic sinus surgery (ESS) is the main surgical approach in the treatment of chronic rhinosinusitis (CRS) after failure of medical treatment. ESS is based on the theory that obstruction of the maxillary sinus ostium is mainly behind the pathogenesis of CRS. Controversy remains concerning the enlargement of the natural maxillary sinus ostium. The aim of this study was to compare computed tomography (CT) findings after preservation or enlargement of the maxillary sinus ostium. Thirty patients with non-polypous CRS underwent randomized endoscopic sinus surgery with uncinectomy on one side and additional middle meatal antrostomy on the other side. Lund-Mackay (LM) scores and the ostium diameters were analysed from CT scans taken preoperatively and nine months postoperatively, and were used for comparison of the two operative techniques. In addition, the correlation between CT findings and subjective outcomes was studied. Comparison of the preoperative and postoperative CT scans revealed that significant reduction of LM score was achieved on both sides, regardless of the type of procedure performed. The postoperative area of the ostium remained significantly larger on the antrostomy side compared to the uncinectomy side. A large maxillary sinus ostium size seems to associate with lower postoperative LM score, but does not seem to provide superior symptom relief.

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The Influence of the Size of the Maxillary Sinus Ostium on the Nasal and Sinus Nitric Oxide Levels

American Journal of Rhinology ◽

10.1177/194589240201600508 ◽

2002 ◽

Vol 16 (5) ◽

pp. 261-264 ◽

Cited By ~ 36

Author(s):

Ravi K.D.R.A. Kirihene ◽

Guy Rees ◽

Peter-John Wormald

Keyword(s):

Nitric Oxide ◽

Nasal Cavity ◽

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Antibacterial Properties ◽

Topical Steroid ◽

Recurrent Infection ◽

Sinus Surgery ◽

Breath Holding ◽

Sinus Ostium

Background Nitric oxide (NO) is produced in significant quantities in the nasal sinuses and is thought to have a beneficial effect on the mucociliary transport of the sinuses and nose and to have significant antibacterial properties that contribute to the health of the sinuses. Recently, the concept of “mini-functional endoscopic sinus surgery” has been introduced where the uncinate is removed without enlargement of the maxillary ostium. Although no scientific evidence has been published, enlargement of the ostium is thought to possibly disrupt the mucociliary pathway and decrease the concentration of NO in the nose and sinuses. The aim of this study was to establish the effect of enlargement of the maxillary ostium on sinus and nasal NO. Methods Twenty-nine patients who were post-endoscopic sinus surgery were included with 52 who were maxillary sinus ostia cannulated. There were 22 large maxillary sinus ostia and 30 small ostia. Smoking, allergy status, and topical steroid use were recorded. NO levels were measured in the nose and maxillary sinus after decongestion with patients mouth breathing and breath holding. Results This study shows that enlargement of the maxillary sinus ostium above its normal size (20 mm2) produces a significant decrease in both the maxillary sinus and the nasal cavity NO levels. In addition, the size of the ostium showed a significant correlation to the sinus NO level. Use of topical nasal steroid sprays and topical decongestants were shown to effect NO levels in the sinuses and nasal cavity. The lowered levels of NO were found irrespective of the technique of measurement of the NO. Conclusions The effect of this lowered NO level on the susceptibility of the maxillary sinuses to recurrent infection is yet to be determined.

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Accessory ostium of the maxilar sinus

ORL ro ◽

10.26416/orl.30.1.2016.520 ◽

2016 ◽

Vol 1 (1) ◽

pp. 14-16

Author(s):

C. Ioniţă ◽

I. Bulescu ◽

Alexandra Schnaider ◽

B. Mocanu ◽

Vlad Andrei Budu ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Middle Meatus ◽

Endoscopic Anatomy ◽

Sinus Drainage ◽

Sinus Ostium

Maxillary sinus ostium may be located anywhere along the ethmoid infundibulum (middle meatus). In rhinosinusal pathology we may find an accessory ostium of the maxillary sinus due to chronic inflammations or after previous endoscopic sinus surgery. Existence of the accessory ostium leads to a recirculation mechanism of sinus secretions and a very difficult to treat rhinosinusal simptomatology. For every patient with this pathology we performed an endoscopic exam of the nose and a rhinosinusal CT scan. Treatment is strictly surgical by creating a unique ostium (consisting of both primary and accessory ostium). Endoscopic anatomy of the ostiomeatal unit should be well understood by the surgeon in order to perform a correct endoscopic sinus surgery, obtaining a proper sinus ventilation and avoiding complications. The presence of an accessory maxillary sinus ostium has only an endoscopic surgical treatment for ensuring sinus drainage and increasing the quality of life of our patients. Keywords:

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Endoscopic Sinus Surgery with Antrostomy Has Better Early Endoscopic Recovery in Comparison to the Ostium-Preserving Technique

ISRN Otolaryngology ◽

10.5402/2012/189383 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Annika Luukkainen ◽

Jyri Myller ◽

Tommi Torkkeli ◽

Markus Rautiainen ◽

Sanna Toppila-Salmi

Keyword(s):

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Radiologic Findings ◽

Ostiomeatal Complex ◽

Middle Meatal Antrostomy ◽

Computed Tomography Scans ◽

Endoscopic Score ◽

Sinus Ostium

Background. Endoscopic sinus surgery (ESS) is considered for chronic rhinosinusitis (CRS) after failure of conservative therapy. Objective. The aim of this study was to evaluate endoscopically ostium patency and mucosal recovery after ESS, with either maxillary sinus ostium-preserving or -enlarging techniques. Materials and Methods. Thirty patients with non-polypous CRS were enrolled. Uncinectomy-only and additional middle meatal antrostomy were randomly and single-blindly performed for each side. Pre- and postoperative endoscopic scores were semi-quantitatively determined according to findings in the ostiomeatal complex area. Adhesions, maxillary sinus mucosal swelling, secretions, and ostium obstruction were also endoscopically evaluated. In addition, symptoms were asked and computed tomography scans were taken preoperatively and 9 months postoperatively. Results. At 16 days postoperatively, a better endoscopic score and a less obstructed ostium were found with antrosomy. At 9 months postoperatively the endoscopic score improved significantly and identically with both procedures, however, obstructed ostia and sinus mucosal swelling/secretions were insignificantly more frequently found on the uncinectomy-only side. Endoscopic and radiologic findings of the maxillary sinus mucosa and ostium correlated significantly 9 months postoperatively. Conclusion. There was a good long-term mucosal recovery with both surgical procedures. In terms of early mucosal recovery and ostium patency, antrostomy might be slighly superior.

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Development of the Paranasal Sinuses in Children

American Journal of Rhinology ◽

10.2500/105065897781751857 ◽

1997 ◽

Vol 11 (3) ◽

pp. 203-210 ◽

Cited By ~ 14

Author(s):

Javier Medina ◽

Hector Hernandez ◽

Lawrence W.C. Tom ◽

Larissa Bilaniuk

Keyword(s):

Computed Tomography ◽

Maxillary Sinus ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Developmental Anatomy ◽

Diagnosis And Management ◽

Standard Deviations ◽

Sinus Ostium

The development of computed tomography and functional endoscopic sinus surgery has improved diagnosis and management of sinusitis. It has also renewed interest in the developmental anatomy of the paranasal sinuses. There are significant differences between adult and pediatric sinus anatomy, and to safely perform functional endoscopic sinus surgery in children, the surgeon must be aware of these differences. To define the developmental anatomy of the paranasal sinuses, we analyzed 145 computed tomograms from patients under 18 years of age. The study emphasized landmarks at the level of the maxillary sinus ostium. In addition, distances and angles from the nasal spine to various points in the sinuses were determined. The structures were identified and traced on a digitizing tablet. Means and standard deviations were calculated for each measure as a function of age. This study can aid a better understanding of sinus development in children and provide guidance to the endoscopic sinus surgeon.

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Axial Triangle of the Maxillary Sinus, and its Surgical Implication With the Position of Maxillary Sinus Septa During Sinus Floor Elevation: A CBCT Analysis

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-18-00229 ◽

2020 ◽

Vol 46 (4) ◽

pp. 415-422

Author(s):

Junho Jung ◽

Jung Soo Park ◽

Seoung-Jin Hong ◽

Gyu-Tae Kim ◽

Yong-Dae Kwon

Keyword(s):

Maxillary Sinus ◽

Surgical Techniques ◽

Lateral Sinus ◽

Sinus Floor Elevation ◽

Second Molar ◽

Sinus Wall ◽

Posterior Maxilla ◽

Significant Difference ◽

Sinus Floor ◽

Molar Region

The aim of this study was to measure the convexity of the lateral wall of the maxillary (Mx) sinus and identify the locational distribution of antral septa in relation to the zygomaticomaxillary buttress (ZMB), in order to suggest another anatomical consideration and surgical modification of sinus floor elevation procedures. This study was designed as a cross-sectional study, and a total of 134 patients and 161 sinuses containing edentulous alveolar ridges were analyzed. The angle between the anterior and lateral walls of the Mx sinus (lateral sinus angle [LSA]), and the angle between the midpalatal line and the anterior sinus wall (anterior sinus angle [ASA]) were measured. Mean LSAs and ASAs were 105.9° ± 9.86° and 58.4° ± 6.43°, respectively. No significant difference between left and right sides was found (LSA, P = .420; right = 105.5° ± 9.27°; left = 105.5° ± 9.27° and ASA, P = .564; right = 57.9° ± 6.80°; left = 58.8° ± 6.02°). The prevalence of septa was 37.3%, and it was most frequently noted in the second molar region (32.8%), followed by the first molar (20.9%), retromolar (16.4%), and second premolar regions (14.9%). Septa were most frequently located posterior to the ZMB (49.2%), while ZMB was mostly located in the first molar region (66.4%). Narrow LSAs may complicate the surgical approach to the posterior maxilla, especially when sinus elevation should be used in the second molar region. Considering the occasional presence of antral septa, membrane elevation may be complicated when a septum is encountered during the procedure. These results suggest that 3-dimensional examination of the convexity of the Mx sinus should be performed preoperatively to choose proper surgical techniques and minimize surgical complications.

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Pattern of symptom improvement following endoscopic sinus surgery for chronic rhinosinusitis

BMC Surgery ◽

10.1186/s12893-021-01269-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Salma S. Al Sharhan ◽

Mohammed H. Al Bar ◽

Shahad Y. Assiri ◽

Assayl R. AlOtiabi ◽

Deemah M. Bin-Nooh ◽

...

Keyword(s):

Surgical Outcomes ◽

Endoscopic Sinus Surgery ◽

T Test ◽

Sinus Surgery ◽

Symptom Improvement ◽

P Value ◽

Psychological Dysfunction ◽

Significant Difference ◽

The Mean ◽

Snot 22

Abstract Background Chronic rhinosinusitis (CRS) is a common inflammation of the nose and the paranasal sinuses. Intractable CRS cases are generally treated with endoscopic sinus surgery (ESS). Although the effect of ESS on CRS symptoms has been studied, the pattern of symptom improvement after ESS for CRS is yet to be investigated. The aim of this study was to determine the magnitude and sequence of symptom improvement after ESS for CRS, and to assess the possible preoperative factors that predict surgical outcomes in CRS patients. Methods This was a longitudinal prospective study of 68 patients who had CRS (with or without nasal polyps). The patients underwent ESS at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was used for assessment at four time points during the study: pre-ESS, 1-week post-ESS, 4 weeks post-ESS, and 6 months post-ESS. Results The difference between the mean scores recorded for the five SNOT-22 domains pre-ESS and 6 months post-ESS were as follows: rhinologic symptoms (t-test = 7.22, p-value = < 0.001); extra-nasal rhinologic symptoms (t-test = 4.87, p-value = < 0.001); ear/facial symptoms (t-test = 6.34, p-value = < 0.001); psychological dysfunction (t-test = 1.99, p-value = 0.049); and sleep dysfunction (t-test = 5.58, p-value = < 0.001). There was a significant difference between the mean scores recorded for the five domains pre-ESS and 6 months post-ESS. Rhinologic symptoms had the largest effect size (d = 1.12), whereas psychological dysfunction had the least effect size (d = 0.24). The only statistically significant difference in the SNOT-22 mean scores recorded 4 weeks post-ESS was observed between allergic and non-allergic patients (t = − 2.16, df = 66, p = 0.035). Conclusion Understanding the pattern of symptom improvement following ESS for CRS will facilitate patient counselling and aid the optimization of the current treatment protocols to maximize surgical outcomes and quality of life. Level of evidence Prospective observational.

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Evaluating Endoscopic Ipsilateral Endonasal Corridor Approaches to the Anterolateral Wall of the Maxillary Sinus: A Computerized Tomography Study

International Archives of Otorhinolaryngology ◽

10.1055/s-0041-1724092 ◽

2021 ◽

Author(s):

Navarat Vatcharayothin ◽

Pornthep Kasemsiri ◽

Sanguansak Thanaviratananich ◽

Cattleya Thongrong

Keyword(s):

Confidence Interval ◽

Maxillary Sinus ◽

Inferior Turbinate ◽

Radial Access ◽

Sinus Wall ◽

Nasal Floor ◽

Significant Difference ◽

Anterolateral Wall ◽

The Mean ◽

Maxillary Sinuses

Abstract Introduction The endoscopic access to lesions in the anterolateral wall of the maxillary sinus is a challenging issue; therefore, the evaluation of access should be performed. Objective To assess the accessibility of three endoscopic ipsilateral endonasal corridors. Methods Three corridors were created in each of the 30 maxillary sinuses from 19 head cadavers. Accessing the anterolateral wall of the maxillary sinus was documented with a straight stereotactic navigator probe at the level of the nasal floor and of the axilla of the inferior turbinate. Results At level of the nasal floor, the prelacrimal approach, the modified endoscopic Denker approach, and the endoscopic Denker approach allowed mean radial access to the anterolateral maxillary sinus wall of 42.6 ± 7.3 (95% confidence interval [CI]: 39.9–45.3), 56.0 ± 6.1 (95%CI: 53.7–58.3), and 60.1 ± 6.2 (95%CI: 57.8–62.4), respectively. Furthermore, these approaches provided more lateral access to the maxillary sinus at the level of the axilla of the inferior turbinate, with mean radial access of 45.8 ± 6.9 (95%CI: 43.3–48.4) for the prelacrimal approach, 59.8 ± 4.7 (95% CI:58.1–61.6) for the modified endoscopic Denker approach, and 63.6 ± 5.5 (95%CI: 61.6–65.7) for the endoscopic Denker approach. The mean radial access in each corridor, either at the level of the nasal floor or the axilla of the inferior turbinate, showed a statistically significant difference in all comparison approaches (p < 0.05). Conclusions The prelacrimal approach provided a narrow radial access, which allows access to anteromedial lesions of the maxillary sinus, whereas the modified endoscopic Denker and the endoscopic Denker approaches provided more lateral radial access and improved operational feasibility on far anterolateral maxillary sinus lesions.

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Evaluating the Role of Anesthesia on Intraoperative Blood Loss and Visibility during Endoscopic Sinus Surgery: A Meta-analysis

American Journal of Rhinology and Allergy ◽

10.1177/1945892421989155 ◽

2021 ◽

pp. 194589242198915

Author(s):

David C. Moffatt ◽

Robert A. McQuitty ◽

Alex E. Wright ◽

Tawanda S. Kamucheka ◽

Ali L. Haider ◽

...

Keyword(s):

Heart Rate ◽

Blood Loss ◽

Endoscopic Sinus Surgery ◽

Average Rate ◽

Meta Analysis ◽

Sinus Surgery ◽

Total Blood Loss ◽

Total Blood ◽

Intraoperative Bleeding ◽

Significant Difference

Background Previous studies and meta analyses have led to incongruent and incomplete results respectively when total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) are compared in endoscopic sinus surgeries in regards to intraoperative bleeding and visibility. Objective To perform a more comprehensive meta-analysis on randomized controlled trial (RCTs) comparing TIVA with IA in endoscopic sinus surgery to evaluate their effects on intraoperative bleeding and visibility. Methods A systematic review and meta-analysis of studies comparing TIVA and IA in endoscopic sinus surgery for chronic rhinosinusitis was completed in May 2020. Utilizing databases, articles were systematically screened for analysis and 19 studies met our inclusion criteria. The primary outcome included intraoperative visibility scores combining Boezaart, Wormald and Visual Analogue Scale (VAS). Secondary outcomes included rate of blood loss (mL/kg/min), estimated total blood loss (mL), Boezaart, Wormald scores, VAS, heart rate, and mean arterial pressure (MAP). Results 19 RCTs with 1,010 patients were analyzed. TIVA had a significantly lower intraoperative bleeding score indicating better endoscopic visibility (Boezaart, VAS, and Wormald) than IA (−0.514, p = 0.020). IA had a significantly higher average rate of blood loss than TIVA by 0.563 mL/kg/min (p = 0.016). Estimated total blood loss was significantly lower in TIVA than IA (−0.853 mL, p = 0.002). There were no significant differences between TIVA and IA in the mean heart rate (−0.225, p = 0.63) and MAP values (−0.126, p = 0.634). The subgroup analyses revealed no significant difference between TIVA and IA when remifentanil was not utilized and whenever desflurane was the IA agent. Conclusion TIVA seemed to have superior intraoperative visibility scores and blood loss during endoscopic sinus surgery when compared to IA. However, the results are not consistent when stratifying the results based on the use of remifentanil and different inhaled anesthetics. Therefore, the conclusion cannot be made that one approach is superior to the other.

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