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

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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Aerodynamic Characteristics inside the Rhino-Sinonasal Cavity after Functional Endoscopic Sinus Surgery

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2011.25.3669 ◽

2011 ◽

Vol 25 (6) ◽

pp. 388-392 ◽

Cited By ~ 20

Author(s):

Xiao Bing Chen ◽

Heow Pueh Lee ◽

Vincent Fook Hin Chong ◽

De Yun Wang

Keyword(s):

Nasal Cavity ◽

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Airflow Rate ◽

Nasal Airflow ◽

Cfd Simulations ◽

Inertia Effects ◽

The Right

Background The aim of this study was to evaluate effects of functional endoscopic sinus surgery (FESS) on transient nasal aerodynamic flow patterns using computational fluid dynamics (CFD) simulations. Methods A three-dimensional model of the nasal cavity was constructed from CT scans of a patient with FESS interventions on the right side of the nasal cavity. CFD simulations were then performed for unsteady aerodynamic flow modeling inside the nasal cavity as well as the sinuses. Results Comparisons of the local velocity magnitude and streamline distributions inside the left and right nasal cavity and maxillary sinus regions were presented. Because of the FESS procedures in the right nasal cavity, existences and distributions of local circulations (vortexes) were found to be significantly different for the same nasal airflow rate but at different acceleration, deceleration, or quiet phases in the maxillary sinus region on the FESS side. Because of inertia effects, local internal airflow with circulation existences was continuous throughout the whole respiration cycle. With a larger peak inspiration flow rate, the airflow intensity inside the enlarged maxillary sinus increased significantly. Possible outcomes on functional performances of the nose were also examined and discussed. Conclusion Surgical enlargements of natural ostium of the maxillary sinus will change the aerodynamic patterns inside the main nasal cavity and maxillary sinus regions, which may affect normal nasal physiological functions. Local inertia effects play more important roles for the internal nasal airflow pattern changes and thus such conventional FESS procedures should be carefully planned.

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

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418816725 ◽

2018 ◽

Vol 128 (3) ◽

pp. 215-219 ◽

Cited By ~ 1

Author(s):

Raj D. Dedhia ◽

Tsung-yen Hsieh ◽

Yecenia Rubalcava ◽

Paul Lee ◽

Peter Shen ◽

...

Keyword(s):

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Sphenoid Sinus ◽

Average Distance ◽

Posterior Wall ◽

Sinus Surgery ◽

Endoscopic Endonasal ◽

Sinus Wall ◽

Significant Difference ◽

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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Two Case Reports of Antrorhinoliths

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1171 ◽

2014 ◽

Vol 6 (3) ◽

pp. 118-120 ◽

Cited By ~ 1

Author(s):

Santosh Kumar Swain ◽

Ranjan Kumar Sahoo ◽

Mahesh Chandra Sahu

Keyword(s):

Nasal Cavity ◽

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Histopathological Examination ◽

Case Reports ◽

Radiological Examination ◽

Sinus Surgery ◽

Nasal Discharge ◽

Ostiomeatal Complex ◽

Bony Mass

ABSTRACT Antrorhinolith is an uncommon nasal mineralized mass of nasal cavity invading into maxillary sinus. Most antrorhinoliths are small and asymptomatic, caused by calcification of a nidus and are detected incidentally on radiological examination. Sometimes they present symptoms like pain and foul smelling nasal discharge. Here, we are presenting two cases of antrorhinoliths. One was found after endoscopic sinus surgery and second one was seen in patient with prolonged use of topiramate medication. In all these two cases, radiological examination revealed a discrete bony density in the nasal cavity and maxillary sinus which was blocking the ostiomeatal complex. The bony mass was removed endoscopically from the nasal cavity and maxillary sinus with drainage of discharge and debris from the sinuses. Histopathological examination revealed an antrolith with bony nidus and calcium deposited around it. How to cite this article Swain SK, Sahoo RK, Sahu MC. Two Case Reports of Antrorhinoliths. Int J Otorhinolaryngol Clin 2014;6(3):118120.

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A Numerical Model of the Influence of Maxillary Sinus Ostium Size on the Distribution of Nitric Oxide Concentration in the Nasal Cavity and Sinuses.

10.21203/rs.3.rs-269159/v1 ◽

2021 ◽

Author(s):

YAN GUO ◽

SHEN YU ◽

JIZHE WANG ◽

WEN JIN ◽

YUYUE CUI ◽

...

Keyword(s):

Nitric Oxide ◽

Numerical Model ◽

Nasal Cavity ◽

Maxillary Sinus ◽

Concentration Gradient ◽

Computed Tomography Images ◽

Sinus Cavity ◽

Exhaled Air ◽

The Impact ◽

Sinus Ostium

Abstract ObjectiveUsing a numerical model, we aimed to study the influence of maxillary sinus ostium size variation on nitric oxide (NO) concentration distribution in the nasal cavity and sinuses and to determine the impact of differing sinus ostium size on sinusitis development and recurrence following sinus ostium opening surgery.MethodsWe obtained high-resolution computed tomography images of the nasal sinuses of a volunteer, following which we established a numerical model, determined NO concentration and air volume in the maxillary sinus on one side, then changed the maxillary sinus ostium size on that side, and finally established five models of sinus ostium of different sizes. Two sizes of sinus numerical models were established to determine effect of differing ostium size on the maxillary sinus cavity NO concentration distributions.ResultsA smaller sinus ostia size corresponded to lower NO concentration in nasal cavity and exhaled air; moreover, a concentration gradient was formed from sinus ostium to nasal cavity. A larger sinus ostia size demonstrated a lower NO concentration surrounding sinus ostium in the sinus cavity and formed a concentration gradient from ostium to cavity.ConclusionConstriction of the sinus cavity can lead to changes in NO concentration. Detection of NO concentration in nasally exhaled air can be used as an index to detect the patency of the maxillary sinus ostium. An excessive opening of sinus ostium leads to a decrease in NO concentration around sinus ostium, which is one of the main causes of persistent or recurrent inflammation in the maxillary sinus

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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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Drug delivery in the nasal cavity after functional endoscopic sinus surgery: a computational fluid dynamics study

The Journal of Laryngology & Otology ◽

10.1017/s0022215112000205 ◽

2012 ◽

Vol 126 (5) ◽

pp. 487-494 ◽

Cited By ~ 13

Author(s):

X B Chen ◽

H P Lee ◽

V F H Chong ◽

D Y Wang

Keyword(s):

Nasal Cavity ◽

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Particle Deposition ◽

Particle Diameter ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Airflow Rate ◽

Sinus Cavity ◽

The Right

AbstractBackground:Intranasal medication is commonly used for nasal disease. However, there are no clear specifications for intranasal medication delivery after functional endoscopic sinus surgery.Methods:A three-dimensional model of the nasal cavity was constructed from computed tomography scans of an adult Chinese male who had previously undergone functional endoscopic sinus surgery in the right nasal cavity. Computational fluid dynamic simulations modelled airflow and particle deposition, based on discrete phase models.Results:In the right nasal cavity, more particles passed through the upper dorsal region, around the surgical area, and streamed into the right maxillary sinus region. In the left cavity, particles were distributed more regularly and uniformly in the ventral region around the inferior turbinate. A lower inspiratory airflow rate and smaller initial particle velocity assisted particle deposition within the right maxillary sinus cavity. In the right nasal cavity, the optimal particle diameter was approximately 10−5 m for maxillary sinus cavity deposition and 3 × 10−6 m for bottom region deposition. In the right nasal cavity, altered back head tilt angles enhanced particle deposition in the top region of the surgical area, and altered right side head tilt angles helped enhance maxillary sinus cavity deposition.Conclusion:This model indicates that a moderate inspiratory airflow rate and a particle diameter of approximately 10−5 m should improve intranasal medication deposition into the maxillary sinus cavity following functional endoscopic sinus surgery.

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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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Efficacy and Safety of Long-Term Low-Dose Clarithromycin in Patients With Refractory Chronic Sinusitis After Endoscopic Sinus Surgery: A Prospective Clinical Trial

Ear Nose & Throat Journal ◽

10.1177/01455613211032020 ◽

2021 ◽

pp. 014556132110320

Author(s):

Han Chen ◽

Bing Zhou ◽

Qian Huang ◽

Cheng Li ◽

Yubin Wu ◽

...

Keyword(s):

Oral Administration ◽

Nasal Cavity ◽

Endoscopic Sinus Surgery ◽

Low Dose ◽

Continuous Treatment ◽

Sinus Surgery ◽

Efficacy And Safety ◽

Endoscopic Findings ◽

Before And After

Objective: To observe the efficacy and safety of postoperative long-term low-dose oral administration of clarithromycin in patients with refractory chronic rhinosinusitis (RCRS), to explore the characteristics of postoperative microbiota in the nasal cavity in patients with RCRS, and to compare the differences and changes in microbiota in the nasal cavity before and after medication. Methods: This was a prospective, self-controlled study. Eighteen patients with RCRS who had persistent symptoms after endoscopic sinus surgery and standard therapy with normal immunoglobulin E and eosinophil level were included. Low dose (250 mg, once daily) clarithromycin was orally administrated for 12 weeks. Symptom severity and endoscopic findings were evaluated before, after 4 weeks, and 12 weeks of treatment, and nasal cavity microbiota was analyzed simultaneously. Results: A total of 18 patients with RCRS were enrolled and 17 patients completed the study. Four weeks after oral administration of clarithromycin, significant improvement was observed in subjective symptoms including nasal congestion, rhinorrhea, postnasal drip, and general discomfort, as well as endoscopic findings including general surgical cavity condition, rhinedema, and rhinorrhea ( P < .05). After continuous treatment to the 12th week, symptoms showed significant improvement compared with baseline, and endoscopic score showed significant improvement compared with both baseline and 4 weeks after treatment. Analysis of middle nasal meatus flora revealed a significant decrease of Streptococcus pneumoniae after 12 weeks of clarithromycin treatment ( P < .05), while the richness, composition, and diversity were similar before and after treatment. Patients enrolled experienced no adverse drug reaction or allergic reaction, nor clinical significant liver function impairment observed. Conclusion: Postoperative low-dose long-term oral administration of clarithromycin in patients with RCRS can improve the clinical symptoms and facilitate the mucosal epithelialization, with good tolerance and safety. The efficacy of clarithromycin in patients with RCRS may be related to its regulatory effect on nasal cavity microbiota.

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