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.

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.

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

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.

The Effects of Sinus Surgery on Midfacial Growth in the Rabbit

1995 ◽  
Vol 9 (2) ◽  
pp. 115-124 ◽  
Author(s):  
D. Randall Pinkston ◽  
Andrew J. Schubkegel ◽  
M. Bridget Zimmerman ◽  
Richard J.H. Smith
Keyword(s):  
Maxillary Sinus ◽  
Animal Studies ◽  
Uncinate Process ◽  
Sinus Surgery ◽  
Dorsal Approach ◽  
Group 4 ◽  
Group 3 ◽  
Group 5 ◽  
Sinus Ostium ◽  
Process Group

The effects of pediatric sinus surgery on craniofacial growth have not been established. This study was designed to determine whether sinus surgery influences midfacial growth in New Zealand white rabbits. Surgery was performed on five groups of six rabbits each: Group 1—bilateral external dorsal approach to the maxillary sinus with enlargement of the sinus ostium and removal of the uncinate process; Group 2—bilateral external dorsal approach to the maxillary sinus; Group 3—unilateral external dorsal approach to the maxillary sinus with enlargement of the sinus ostium and removal of the uncinate process; Group 4—unilateral external dorsal approach to the maxillary sinus; Group 5—no operation. Rabbits were killed as adults, and dried skull measurements were performed using a Polhemus 3-space digitizer. Statistically significant regional restriction of midfacial growth was demonstrable when comparing Groups 1–4 with Group 5, and between sides in Groups 3–4. Enlargement of the sinus ostium and uncinectomy caused foreshortening of the snout on the operated side in Group 3. This effect was not observed following the approach alone in Group 4. These results suggest that midfacial growth is affected by sinus surgery in rabbits. Further animal studies should be done to test this hypothesis, and in the interim, a conservative approach to sinus surgery in children would be prudent.

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

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
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.

Maxillary Sinus Atelectasis with Enophthalmos

1998 ◽  
Vol 107 (1) ◽  
pp. 34-39 ◽  
Author(s):  
James H. Boyd ◽  
Karen Yaffee ◽  
John Holds
Keyword(s):  
Bone Resorption ◽  
Maxillary Sinus ◽  
Maxillary Sinusitis ◽  
Endoscopic Technique ◽  
Orbital Floor ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Middle Meatal Antrostomy ◽  
Chronic Maxillary Sinusitis ◽  
Sinus Ostium

Chronic maxillary sinusitis may present as atelectasis of the sinus with changes to surrounding structures. Several mechanisms have been proposed for this problem. Chronic obstruction of the sinus ostium, with resultant retention of secretions and osteitic bone resorption, may account for these changes. Enophthalmos is one manifestation that may require corrective treatment. Titanium micromesh reconstruction of the orbital floor, with or without onlay concha cartilage, has reliably resolved the enophthalmos. Reconstruction of the orbital floor and ventilation of the obstructed sinus ostium may be carried out relatively safely in a single operation. The standard endoscopic technique of uncinate removal and middle meatal antrostomy should be modified to prevent orbital penetration. This report reviews our series of 6 patients with this problem, as well as a comprehensive review of the literature. Recommendations for management of both the obstruction and the secondary orbital manifestations are presented.

Enophthalmos secondary to maxillary sinus disease: single-stage operative management

1995 ◽  
Vol 109 (9) ◽  
pp. 868-870 ◽  
Author(s):  
N. J. P. Beasley ◽  
N. S. Jones ◽  
R. N. Downes
Keyword(s):  
Maxillary Sinus ◽  
Endoscopic Sinus Surgery ◽  
Operative Management ◽  
Single Stage ◽  
Sinus Surgery ◽  
Orbital Floor ◽  
Sinus Disease

AbstractMaxillary sinus disease can lead to dehiscence of the orbital floor. Using endoscopic sinus surgery it is possible to simultaneously reconstruct the orbital floor and to assess and treat underlying sinus disease.

scholarly journals Endoscopic View of an Obstructing Polyp of the Maxillary Sinus Ostium Viewed through an Accessory Ostium

2004 ◽  
Vol 83 (11) ◽  
pp. 734-735
Author(s):  
Joseph P. Mirante ◽  
Dewey A. Christmas ◽  
Eiji Yanagisawa
Keyword(s):  
Maxillary Sinus ◽  
Endoscopic View ◽  
Sinus Ostium

Reevaluation of Maxillary Sinus Surgery: Experimental Study in Rabbits

1989 ◽  
Vol 98 (11) ◽  
pp. 901-906 ◽  
Author(s):  
David W. Kennedy ◽  
Hisham Shaalan
Keyword(s):  
Maxillary Sinus ◽  
Complex Disease ◽  
Mucociliary Clearance ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Control Group ◽  
Ostiomeatal Complex ◽  
The Status ◽  
Sinus Ostium ◽  
Sinus Mucosa

Functional endoscopic sinus surgery concentrates primarily on the removal of ostiomeatal complex disease. When required, maxillary sinus ostioplasty is performed. However, surgical widening of a sinus ostium is contrary to common precepts. A study therefore was performed to reevaluate the effects of antrostomies and of intrasinus mucosal removal. Widening of the natural ostium, a separate antrostomy at some distance from the ostium, or radical mucosal removal was performed on 30 rabbits. Fifteen sinuses were used as controls. After 6 to 8 weeks the status of the sinus mucosa and mucociliary clearance was studied. The study confirmed that mucociliary clearance continued toward the natural ostium following inferior antrostomy. Following widening of the natural ostium, mucociliary clearance through the ostium redeveloped in 11 of 18 sinuses but was typically imperfect. There were no cases of ostial closure; however, the incidence of infection was significantly higher in all three experimental groups than in the control group.

Maxillary Sinus Ostioplasty versus Nasal-Antral Window in Maxillary Sinusitis: An Experimental Study

1996 ◽  
Vol 10 (6) ◽  
pp. 357-364 ◽  
Author(s):  
Mohammed H. Hassab ◽  
David W. Kennedy
Keyword(s):  
Maxillary Sinus ◽  
Animal Studies ◽  
Clinical Observation ◽  
Mucociliary Clearance ◽  
Maxillary Sinusitis ◽  
Middle Turbinate ◽  
Short Term ◽  
Middle Meatal Antrostomy ◽  
Sinus Ostium ◽  
New Zealand Rabbits

The performance of a maxillary antrostomy through the natural ostium of the maxillary sinus has been debated in the literature over the years. However, much of the argument against middle meatal antrostomy has been based primarily upon animal studies in which there was a patent maxillary sinus ostium. A detailed study was therefore undertaken to evaluate the effects of both ostioplasty and nasal antral window in an animal model with maxillary sinus ostial obstruction. Twenty Pasteurella-free White New Zealand Rabbits underwent unilateral ostial occlusion with Histoacryl®. The sinuses were reexplored after 2 weeks. In 10 sinuses a nasal antral window was performed. In the remaining 10, two variations of ostioplasty were performed. Half underwent circumferential widening by removal of the root of the middle turbinate and half underwent a limited antero-inferior widening of the ostium. The opposite maxillary sinus in each animal was kept as a control. A second exploration was performed at 6 weeks. Significant evidence of inflammation was not found in any of the sinuses with limited widening of the maxillary sinus ostium, but was present in 10% of the sinuses with nasal antral windows and 40% of the sinuses with circumferential ostial widening. Normal mucociliary clearance was present in 80% of the sinuses with limited ostioplasty, 60% of the sinuses with circumferential ostioplasty, and 40% of those with nasal antral window. These findings support the clinical observation that limited widening of the natural ostium of the maxillary sinus is an effective treatment for inflammation secondary to ostial obstruction. However, they also suggest that circumferential widening of the maxillary sinus ostium, at least in the short term, predisposes to infection.

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

2002 ◽  
Vol 16 (5) ◽  
pp. 261-264 ◽  
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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