Palatal extension of middle meatal antrostomy

1992 ◽  
Vol 107 (6_part_1) ◽  
pp. 751-754 ◽  
Author(s):  
William H. Friedman ◽  
George P. Katsantonis ◽  
Alexander London
Keyword(s):  
Surgical Technique ◽  
Maxillary Sinus ◽  
Medial Wall ◽  
Lateral Nasal Wall ◽  
Partial Removal ◽  
Sphenopalatine Artery ◽  
Middle Meatal Antrostomy ◽  
Palatine Bone ◽  
Maxillary Sinuses

The palatine bone is an Important posterior landmark in the performance of ethmoldectomy. This usually unrecognized structure forms the posterior one third of the lateral nasal wall. Resection of a portion of the palatine bone completes the marsupialization of the sphenoethmoidal recess and medial maxilla. It is a major landmark for localization of the sphenopalatine artery at its entrance into the nose. Middle meatal antrostomy is enhanced by removal of the part of the palatine bone that forms the posterior medial wall of the maxillary sinus. In 1110 consecutive sphenoethmoldectomles, marsupialization of the maxillary sinuses has included partial removal of the perpendicular plate of the palatine bone. Patency has been maintained in all of these antrostomies. Pertinent anatomy and surgical technique are reviewed.

Intranasal Sphenoethmoidectomy: An Evolution of Technique

1994 ◽  
Vol 111 (6) ◽  
pp. 781-786 ◽  
Author(s):  
George P. Katsantonis ◽  
William H. Friedman ◽  
Matthew Bruns
Keyword(s):  
Middle Turbinate ◽  
Sinus Disease ◽  
Pterygoid Process ◽  
Primary Indication ◽  
Orbital Wall ◽  
Middle Meatal Antrostomy ◽  
Medial Orbital Wall ◽  
Palatine Bone ◽  
Maxillary Sinuses

Intranasal sphenoethmoldectomy was originally used primarily for the provision of adequate drainage of acute and subacute bacterial sinusitis. However, the spectrum of inflammatory sinus disease has changed dramatically since the popularization of broad-spectrum antibiotics, and chronic hyperplastic rhinosinusitis has replaced acute sinusitis as the primary indication for ethmoidectomy. In such cases total or almost total disease removal is crucial to providing long-term drainage and ventilation. We describe several modifications of the Yankauer sphenoethmoldectomy technique that enable the sinus surgeon to provide clearance of disease and excellent drainage for all sinuses by complete marsupialization of the sphenoid, ethmoid, and maxillary sinuses. These modifications include (1) complete rather than partial removal of the middle turbinate. (2) extended middle meatal antrostomy with palatine bone resection to the pterygoid process with delineation of the inferior and medial orbital wall, and (3) Introduction of operative endoscopes as adjunctive tools in areas inaccessible to conventional visualization. The current technique and results in nearly 2000 procedures are described.

The Maxillary Sinus Ostium: Demystifying Middle Meatal Antrostomy

1995 ◽  
Vol 9 (6) ◽  
pp. 313-320 ◽  
Author(s):  
R. Glen Owen ◽  
Frederick A. Kuhn
Keyword(s):  
Maxillary Sinus ◽  
Uncinate Process ◽  
Sinus Surgery ◽  
Lateral Nasal Wall ◽  
Sinus Disease ◽  
Endoscopic View ◽  
Surgeon Training ◽  
Middle Meatal Antrostomy ◽  
Revision Sinus Surgery ◽  
Sinus Ostium

Locating the maxillary sinus ostium can be a problem in endoscopic middle meatal antrostomy. Patients requiring revision sinus surgery may be found to have the maxillary sinus ostium obstructed, or the previous antrostomy placed in the wrong location. The intricate lateral nasal wall anatomy can be difficult to translate into the two-dimensional endoscopic view. It is therefore understandable how finding the maxillary sinus ostium at times can be tedious. Inability to accurately identify the maxillary sinus ostium may preclude an appropriate middle meatal antrostomy, and predispose the patient to persistent sinus disease. The primary landmarks for identifying the maxillary sinus ostium are the uncinate process and the ethmoid bulla. The initial surgical step in endoscopic ethmoidectomy is uncinectomy. This is usually followed immediately by removal of the bulla, frequently before the maxillary ostium has been accurately identified. After evaluating CT scans of 61 revision sinus surgery patients, and observing a large number of sinus surgeon training in the OR and the dissection lab, we have noted that uncinate removal is often incomplete. An uncinate remnant is commonly left inferiorly. This may lie against the lateral nasal wall obscuring the maxillary sinus ostium. This coupled with loss of the ethmoid bulla, the primary surgical landmark, may make identification of the maxillary ostium quite difficult. We feel that the key to successful middle meatal antrostomy (MMA) and avoidance of persistent maxillary sinus disease is positive visual maxillary ostium identification immediately after removal of the uncinate process. The residual inferior uncinate process typical after incomplete uncinectomy, and its subsequent removal, are demonstrated. An alternate technique is presented for complete uncinate removal, simplifying maxillary ostium identification.

Third window approach assisted middle meatal antrostomy: prospective cohort study of the two ports technique in management of hard to reach maxillary sinus pathology

2020 ◽  
Vol 134 (7) ◽  
pp. 636-641
Author(s):  
M O Tomoum ◽  
M H Askar ◽  
A H Hamad ◽  
A El-Naggar ◽  
M Amer
Keyword(s):  
Maxillary Sinus ◽  
Nasolacrimal Duct ◽  
Antrochoanal Polyp ◽  
Arabic Version ◽  
Middle Meatal Antrostomy ◽  
Safe Technique ◽  
Window Approach ◽  
Maxillary Sinus Pathology ◽  
Maxillary Sinuses

AbstractObjectiveThis study aimed to assess the outcomes of a prelacrimal recess approach assisted middle meatal antrostomy in the management of hard to reach maxillary sinus pathologies.MethodTwenty-five patients with maxillary sinus pathology underwent prelacrimal recess approach assisted middle meatal antrostomy (with a prelacrimal recess width of more than 3 mm). Patients were prospectively evaluated using both the Arabic version of the Sino-Nasal Outcome Test-22 and nasal endoscopy at least 6 months post-operatively.ResultsOur study included 25 maxillary sinuses (13 with antrochoanal polyps, 10 with maxillary fungal ball and 2 with a migrated part of a tooth). At a mean follow-up period of 10.9 months, all patients showed significant improvement in total mean Sino-Nasal Outcome Test-22 score. There was recurrence of one case with antrochoanal polyp and two cases with asymptomatic synechia. Injury to the nasolacrimal duct was not reported.ConclusionA prelacrimal recess approach assisted middle meatal antrostomy is a reliable and safe technique to manage pathologies in hard to reach regions within the maxillary sinus.

Endonasal endoscopic surgery with combined middle and inferior meatal antrostomies for fungal maxillary sinusitis

2015 ◽  
Vol 129 (S2) ◽  
pp. S52-S55 ◽  
Author(s):  
M Sawatsubashi ◽  
D Murakami ◽  
T Umezaki ◽  
S Komune
Keyword(s):  
Maxillary Sinus ◽  
Maxillary Sinusitis ◽  
Sinus Surgery ◽  
Control Group ◽  
Fungus Ball ◽  
Non Invasive ◽  
Middle Meatal Antrostomy ◽  
Mucosal Thickening ◽  
Fungus Balls ◽  
Maxillary Sinuses

AbstractObjective:The purpose of this study was to evaluate the effectiveness of the combination of inferior and middle meatal antrostomies for treatment of a maxillary sinus fungus ball by functional endoscopic sinus surgery.Methods:A retrospective analysis including 28 patients with non-invasive fungal maxillary sinusitis was performed. Fourteen patients underwent FESS with both middle and inferior meatal antrostomies (combined group). The remaining 14 patients were treated with FESS through only the middle meatal antrostomy (control group).Results:Post-operative computed tomography showed normal maxillary sinuses in all patients in the combined group. In contrast, in the control group, five patients (36 per cent) exhibited a normal maxillary sinus, seven (50 per cent) showed maxillary mucosal thickening and two (14 per cent) had persistent fungus balls in the maxillary sinus.Conclusion:FESS with a combination of middle and inferior meatal antrostomies proved more effective for treating fungal maxillary sinusitis.

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

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.

scholarly journals Association between Odontogenic and Maxillary Sinus Conditions: A Retrospective Cone-Beam Computed Tomographic Study

2021 ◽  
Vol 10 (13) ◽  
pp. 2849
Author(s):  
Piotr Kuligowski ◽  
Aleksandra Jaroń ◽  
Olga Preuss ◽  
Ewa Gabrysz-Trybek ◽  
Joanna Bladowska ◽  
...  
Keyword(s):  
Bone Loss ◽  
Maxillary Sinus ◽  
Mucous Membrane ◽  
Maxillary Sinusitis ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Odontogenic Infections ◽  
Computed Tomographic ◽  
Periodontal Bone Loss ◽  
Maxillary Sinuses

Odontogenic infections can directly trigger maxillary sinusitis. CBCT is an excellent choice for precise examination of maxillary sinuses and hard tissues within the oral cavity. The objective of this retrospective and the cross-sectional study was to analyze the influence of odontogenic conditions on the presence and intensity of maxillary sinus mucous membrane thickening using CBCT imaging. Moreover, periodontal bone loss and anatomic relationship between adjacent teeth and maxillary sinuses were assessed to evaluate its possible impact on creating maxillary thickening. The study sample consisted of 200 maxillary sinuses of 100 patients visible on CBCT examination with a field of view of 13 × 15 cm. The presented study revealed a significant influence of periapical lesions, inappropriate endodontic treatment, severe caries, and extracted teeth on the presence of increased thickening of maxillary sinus mucous membrane. In addition, an increase in the distance between root apices and maxillary sinus floor triggered a significant reduction of maxillary sinus mucous membrane thickening. The presence of periodontal bone loss significantly increases maxillary sinus mucous membrane thickening.

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

1997 ◽  
Vol 11 (4) ◽  
pp. 275-282 ◽  
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.

Radiography and Ultrasonography in Paranasal Sinusitis

1987 ◽  
Vol 28 (1) ◽  
pp. 31-34 ◽  
Author(s):  
C. Jensen ◽  
C. von Sydow
Keyword(s):  
Maxillary Sinus ◽  
Maxillary Sinusitis ◽  
Screening Method ◽  
Clinical Signs ◽  
Paranasal Sinusitis ◽  
Reasonable Degree ◽  
Degree Of Confidence ◽  
Sinus Radiography ◽  
Maxillary Sinuses

In order to analyze whether ultrasonography with a reasonable degree of confidence can replace radiography in the diagnosis of sinusitis, 138 patients with clinical signs of sinusitis were examined with both methods. It was found that maxillary sinus fluid was recognized ultrasonographically with a confidence that increased with the amount of fluid, judged from radiographic examinations. In a sub-group of 45 cases, fluid confirmed by maxillary sinus puncture was detected by ultrasonography in 35/45 sinuses (78%) and by radiology in 38/45 sinuses (84%). In patients with radiographically normal maxillary sinuses, the correlation to ultrasound was good. However, mucosal swelling and polyps or cysts observed at radiography were poorly demonstrated by ultrasonography. In addition, the ultrasound method was not reliable for frontal sinus diagnosis. It was concluded that ultrasonography can be recommended in maxillary sinusitis for follow-up of treatment and as a screening method before sinus radiography.

A Comparative Study between Endoscopic Prelacrimal Approach and Middle Meatal Antrostomy for Maxillary Sinus Pathologies

2021 ◽  
Author(s):  
Venugopal Mohankumar ◽  
D. Senthamarai Kannan ◽  
Veerasigamani Narendrakumar ◽  
Saravanan Kuppuswamy ◽  
Arya N Baby
Keyword(s):  
Comparative Study ◽  
Maxillary Sinus ◽  
Middle Meatal Antrostomy

scholarly journals A paradigm shift: “Defect of the fontanel” instead of “Accessory ostium” and classified nasal septal deformities instead of “septal deviation”

2018 ◽  
Vol 8 (32) ◽  
pp. 219-223
Author(s):  
Ranko Mladina ◽  
Neven Skitarelić ◽  
Cemal Cingi ◽  
Nuray Bayar Muluk
Keyword(s):  
Maxillary Sinus ◽  
Paradigm Shift ◽  
Nasal Septum ◽  
Septal Deviation ◽  
Point Of View ◽  
Lateral Nasal Wall ◽  
Clinical Issues ◽  
Normal Finding

Abstract OBJECTIVES. The purpose of this article is to highlight some terms which have been ingrained in the rhinosinusology literature. MATERIAL AND METHODS. It regards the term “accessory ostium” and the term “septal deviation”. The well-known and deeply ingrained term “accessory ostium” has been widely used for decades, but essentially it is absolutely incorrect. “Septal deviation” is an inadequate term for the changes of the nasal septum form. RESULTS. From the linguistic point of view, “accessory” means something (or someone) which (or who) helps someone or gives support (to something or someone) in some process. We recommend the use of the term “defect of the fontanel” instead of “accessory ostium”. The use of the term “septal deformity” (from Latin: de forma, meaning the change in the shape) is etymologically much more appropriate. Septal deformities appear in man in several, well defined shapes and, therefore, can be correctly classified. The classification contributes to the further scientific conversations regarding the clinical issues connected to the changes of the nasal septum form. CONCLUSION. The usual term “accessory ostium” suggests almost a normal finding on the lateral nasal wall, but, on the contrary, it clearly signalizes that the respective maxillary sinus is chronically inflamed. The usual term “septal deviation” is not at all specific and only suggests that something is wrong with the position of the nasal septum. It does not at all imply any of the six well known types of septal deformities in man.

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