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

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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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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Reevaluation of Maxillary Sinus Surgery: Experimental Study in Rabbits

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948909801112 ◽

1989 ◽

Vol 98 (11) ◽

pp. 901-906 ◽

Cited By ~ 59

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.

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Predictors of Disease Control After Endoscopic Sinus Surgery Plus Long-Term Local Corticosteroids in CRSwNP

American Journal of Rhinology and Allergy ◽

10.1177/1945892420936196 ◽

2020 ◽

Vol 35 (1) ◽

pp. 77-85

Author(s):

Eugenio De Corso ◽

Stefano Settimi ◽

Laura Tricarico ◽

Dario Antonio Mele ◽

Rodolfo Francesco Mastrapasqua ◽

...

Keyword(s):

Disease Control ◽

Endoscopic Sinus Surgery ◽

Preoperative Assessment ◽

Sinus Surgery ◽

Cumulative Probability ◽

Clinical Factors ◽

Poor Control ◽

Good Disease Control ◽

Endoscopic Score

Background in the era of new biological agents it is important to identify patients who may benefit from conventional therapies such as endoscopic sinus surgery (ESS) plus long-term local corticosteroids from those with patterns of inflammation that are more difficult to control post-operatively and who may benefit from other therapies. Objective determine if preoperative assessment of type and grade of inflammation and clinical factors can predict disease control with ESS plus long-term local corticosteroids in chronic rhinosinusitis with nasal polyps (CRSwNP). Methods Eighty patients treated with ESS plus mometasone-furoate 200 μg BID for CRSwNP and followed for at least 1 year were enrolled (November 2017–December 2018) in this prospective observational study. Type and grade of inflammation were evaluated preoperatively by nasal cytology. Based on cellular pattern, patients were grouped as neutrophilic (n = 20), eosinophilic (n = 38), or mixed eosinophil-neutrophilic (n = 22). SNOT-22 and Lund-Kennedy Endoscopic Score were evaluated at baseline and at 3, 6, 9, and 12 months after surgery and used to define disease control. Results The cumulative probability of remaining free of significant modification of endoscopic score (Lund-Kennedy Endoscopic Score >2) at 3, 6, 9, and 12 months was 0.84, 0.76, 0.71, and 0.68, respectively. At 12-month postoperative evaluation good disease control was observed in 54 of 80 patients (67.5%). Compared to those with good post-operative disease control, those with poor control had a significantly higher pre-operative mean count of eosinophils and neutrophils (p < 0.05). The preoperative inflammatory pattern was associated with relative risk of poor control: neutrophilia (RR: 3.10; CI:1.24–7.71), eosinophilia (RR:8.42; CI:2.72–15.12), and mixed eosinophilic and neutrophilic (RR:25.11; CI:19.41–30.01). We also confirmed that asthma, allergy, blood eosinophilia, and ASA triad could predict poor control. Conclusions The type and load of inflammation evaluated preoperatively and selected clinical factors can predict poor control of CRSwNP treated with ESS and local corticosteroids.

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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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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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Anatomic patterns of maxillary sinus drainage

Romanian Journal of Rhinology ◽

10.1515/rjr-2015-0024 ◽

2015 ◽

Vol 5 (20) ◽

pp. 209-214

Author(s):

Andreea – Ioana Derjac-Arama ◽

Stefania Anca Mihai ◽

Mihai Sandulescu ◽

Mugurel Constantin Rusu

Keyword(s):

Maxillary Sinus ◽

Drainage System ◽

Sinus Surgery ◽

Type I ◽

Type Iv ◽

Ostiomeatal Complex ◽

Sinus Drainage ◽

Type V ◽

Air Cells ◽

Sinus Ostium

AbstractBackground. Functional endoscopic sinus surgery may be indicated when certain anatomic variations impede the normal drainage of the paranasal sinuses through the ostiomeatal complex. We aimed at studying the drainage system of the maxillary sinus which consists of the maxillary infundibulum, the main ostium of the maxillary sinus, the ethmoidal infundibulum and the hiatus semilunaris inferior.Material and methods. The study was performed retrospectively on cone beam computed tomography (CBCT) scans of 60 subjects (N=120 maxillary sinuses). The anatomical pattern of the maxillary sinus drainage was studied on coronal scans.Results. As related to different morphological possibilities in the supero-lateral limit of the maxillary sinus drainage system, five different patterns were defined: in type I (55%) there was no pneumatization in that situs, in type II (18%) there was an infraorbital recess of the maxillary sinus placed above the sinus ostium, in type III (14%) an ethmoidal recess of the maxillary sinus was expanded within the ethmoid bone, above the ethmoidal infundibulum, in type IV (3%) there were Haller cells above the sinus ostium, while in type V (10%) there were non-infraorbital ethmoid air cells above and draining into the ethmoidal infundibulum.Conclusion. It appears that CBCT is a reliable tool to make an anatomical distinction of the variable pattern of pneumatization impeding a normal drainage of the maxillary sinus, between maxillary sinus- and ethmoid-derived air-filled spaces.

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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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Indications of the Caldwell-Luc procedure in the era of endoscopic sinus surgery

Romanian Journal of Rhinology ◽

10.2478/rjr-2020-0017 ◽

2020 ◽

Vol 10 (39) ◽

pp. 78-84

Author(s):

Andreea Bajan ◽

Codrut Sarafoleanu ◽

Violeta-Gabriela Melinte ◽

Roxana Decuseara

Keyword(s):

Maxillary Sinus ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Malignant Tumors ◽

Surgical Techniques ◽

Lateral Wall ◽

Sinus Surgery ◽

Maxillary Artery ◽

Vidian Canal

AbstractSurgical treatment of chronic rhinosinusitis is indicated after failure of correctly conducted maximal drug therapy or the occurrence of complications. Radical maxillary sinus surgery has been abandoned nowadays, to the detriment of endoscopic sinus surgery, for several reasons, such as: increased incidence of complications, decreased healing rate compared to the endoscopic technique. The literature cites many situations in which the Caldwell-Luc procedure is used as a first-line surgical technique: recurrent chronic rhinosinusitis, malignant tumors of the maxillary sinus extending to the lateral wall of the nasal fossa and the pterygomaxillary space, the cases where an extensive approach to the pterygopalatine fossa is required – for ligation of the internal maxillary artery or the approach of the vidian canal in vidian neurectomy.The authors highlight the use of Caldwell-Luc procedure in endoscopic sinus surgery era, by reviewing the complications rates, indications and long-term effectiveness of the two surgical techniques.

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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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Spontaneous silent sinus syndrome (imploding antrum syndrome): case series of 16 patients

Rhinology Journal ◽

10.4193/rhino10.103 ◽

2011 ◽

Vol 49 (3) ◽

pp. 315-317

Author(s):

H. Babar-Craig ◽

H. Kayhanian ◽

D.J. De Silva ◽

G.E. Rose ◽

V.J. Lund

Keyword(s):

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Case Series ◽

Sinus Surgery ◽

Orbital Floor ◽

Silent Sinus Syndrome ◽

Ostiomeatal Complex ◽

Sinus Drainage ◽

Ophthalmic Hospital

INTRODUCTION: Silent sinus syndrome (SSS) is a rare idiopathic collapse of the maxillary sinus and orbital floor. We present the second largest series of sixteen patients with SSS and describe their management. METHODS: A cohort of 16 patients with spontaneous SSS between 1999 and 2009 were reviewed at the Royal National Throat Nose and Ear Hospital. All patients were initially referred from a postgraduate ophthalmic hospital, Moorfields Hospital. RESULTS: Fourteen patients required endoscopic sinus surgery to re-establish maxillary sinus drainage and the remaining two settled with intranasal medical therapy consisting of steroids and decongestions. Follow- up ranged from 6 months to 4 years with a mean of 2.6 years. An improvement in enophthalmos and was seen in all surgically treated patients with a mean improvement of 2.2mm and range 0.5-4mm. DISCUSSION: SSS arises from congestion of the ostiomeatal complex resulting in negative pressure within the maxillary sinus and a gradual implosion of the antral cavity. Endoscopic sinus surgery successfully re-establishes maxillary aeration in our series and leads to clinical and aesthetic improvement in the degree of enophthalmos and has avoided the need for orbital floor repair in all but two cases.

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