Endoscopic Inferior Meatal Antrostomy for Antrochoanal Polyps: A Long-Term Follow-Up

<b><i>Background:</i></b> Endoscopic middle meatal antrostomy (EMMA) is considered the standard approach for surgical management of antrochoanal polyps (ACPs). Recently, an endoscopic inferior meatal antrostomy (EIMA) approach for clearing lesions in the maxillary sinus was described. In this study, we compared the long-term outcome of patients with ACP following surgical treatment using one of these 2 approaches (EIMA or EMMA). <b><i>Methods:</i></b> The medical charts of all patients treated for ACPs in our institution between January 1, 2009, and July 1, 2020, were reviewed retrospectively. Patients were invited to complete a long-term follow-up assessment. <b><i>Results:</i></b> Thirty-eight patients were included in the study: EIMA was the only procedure performed in 25 patients (66%) and EMMA was the only procedure performed in 7 patients (18%). Both procedures were performed in 6 patients (16%): 2 patients (5%) underwent simultaneous EMMA and EIMA for better access and visualization and 4 patients (10.5%) underwent surgical revision consisting of EIMA secondary to failed EMMA at other institutions. Median follow-up was 44 months (range, 6 months–11 years). No evidence of recurrent ACPs, recirculation, synechiae, nasolacrimal duct injury, or bleeding was observed in any of our patients. Small nonobstructing cysts were observed in 2 patients (8%) following EIMA. <b><i>Conclusions:</i></b> EIMA prevents violation of the ostiomeatal complex. It provides access to the anteroinferior aspect of the maxillary sinus and should be considered as an alternative to EMMA in patients with ACPs.

A Clinical Study of Different Modalities for the Management of Chronic Maxillary Sinusitis

Background: Chronic maxillary sinusitis is a very common presentation in otorhinolaryngology clinics. It has diverse aetiology and varied symptoms at presentation. Its treatment requires a comprehensive approach for successful outcomes. We in the present study tried to evaluate the aetiology of chronic maxillary sinusitis and outcomes of treatment of chronic maxillary sinusitis. Methods: Patients presenting with clinical features of Chronic rhinosinusitis of all age groups and sexes were included in the study. The patients were subjected to general examination from head to toe which included the examination of the Respiratory system and cardiovascular system. ENT examination along with head neck was done. X-Ray (Water's view), C.T Scan PNSCoronal, and Sagittal sections for selected patients. Results: Antibiotics, antihistamines, decongestants, steam inhalations, and in some cases intranasal steroids (Budesonide, Beclomethasone, Fluticasone). Surgery: Antral wash n=16 cases, Intranasal Antrostomy n=2 cases, Caldwell Luc n=2 cases, Maxillary sinoscope n=2 cases, FESS n=38 cases involvinguncinectomy, middle meatal antrostomy, anterior ethmoidectomy, posterior ethmoidectomy, sphenoidotomy, frontal sinus infundibulotomy, and polypectomy. Conclusion: The commonest organism responsible was streptococcus pneumoniae. Improvement in the diagnostic techniques and availability of nasal endoscopy and CT scan which can show clearly the anatomy of osteomeatal complex has led to better management of the disease. Nasal endoscopes have allowed a meticulous delicate removal of the diseased mucosa which preserving the normal mucosa and structures consequently the postoperative complications are very few and most of the cases get relief from the symptoms of the disease

Noninvasive fungal rhinosinusitis: a case series

Introduction: Fungal rhinosinusitis (FRS) remains a rare disease. The noninvasive forms are hard to diagnose. The management protocols remain controversial. We aim to describe the clinical, radiological and pathological features of noninvasive FRS and present our management protocol and follow-up results. Patients and methods: This descriptive study was conducted in the ear-nose-throat department of the university hospital, Taher Sfar in Mahdia, Tunisia. All patients who responded to the definition of noninvasive FRS (fungal balls and allergic fungal sinusitis) were included. The study was conducted over a three year period (May 2017 – April 2021). Results: Eleven patients were included in this study: four cases of fungal balls and seven cases of allergic fungal sinusitis. Patients presented with symptoms of chronic recurrent rhinosinusitis with no response to conventional treatments. Computed tomodensitometry scan showed opacification of the paranasal sinuses in all patients. Other signs were heterogeneous opacities, local calcifications and thinning of the bony walls of the sinuses. Histopathological findings were inflammatory polyps in all cases of allergic FRS with the presence of fungal hyphae in 42.8% of the cases. All patients underwent surgery after a median delay of 12 [6–24] months of the symptom’s onset. The used procedures were endoscopic middle meatal antrostomy for all patients, ethmoidectomy (81.8%) and sphenoidotomy (36.4%). None received systemic antifungals or corticosteroids with a favorable outcome in all cases. Conclusion: Symptoms of noninvasive FRS are nonspecific. The scan images contribute to the diagnosis, but the perioperative findings and the histopathological results remain crucial. The management is mainly surgical.

Trans-antral endoscopic assisted excision of odontogenic maxillary cyst

Key points: • Intraoral, sublabial, and transnasal endoscopic approachs are used to manage odontogenic maxillary cysts. • Transnasal endoscopic approach includes inferior meatal antrostomy, middle meatal antrostomy, and endoscopic medial maxillectomy approach. • Trans-antral endoscopic assisted excision of odontogenic maxillary cyst approach have the advantage of direct lesion access of the sublabial approach as well as the advantages of better illumination, magnification, and small access of endoscopic approach. • The trans-antral endoscopic assisted approach co-morbitity seems to be the least comparing to the benefit of complete excision of the cyst within its entire wall in all the cases with minimal injury of the unaffected maxillary sinus mucosa as well as avoidance of injury of any nearby structure if there is defect in the sinus wall.

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

ObjectiveThis 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.

Evaluation of Recurrent Maxillary Sinusitis due to Middle Meatal Antrostomy Site Stenosis

Objective: This study was performed to evaluate the incidence, timing, and factors contributing to recurrent maxillary sinusitis due to middle meatal antrostomy (MMA) site stenosis after endoscopic sinus surgery (ESS). Methods: The medical records and endoscopic photographs of 288 patients with chronic rhinosinusitis who underwent ESS were evaluated. Patients visited the clinic with similar schedule after ESS; recurrent maxillary sinusitis due to MMA site stenosis was investigated, including in terms of the incidence and timing. The preoperative computed tomography (CT) scans, intraoperative findings, and possible factors contributing to MMA site stenosis were examined. Results: Recurrent maxillary sinusitis due to MMA site stenosis occurred in 10 patients. Most had unilateral sinusitis and stenosis was observed within 6 months postoperatively. All patients had severe inflammation, pus retention, and thick mucosal hypertrophy in the maxillary sinus on preoperative CT; intraoperative findings confirmed these conditions. In most patients, extensive trimming of the hypertrophied mucosa was performed intraoperatively through canine fossa trephination. Conclusions: MMA site stenosis is a rare condition after ESS. We hypothesized that rapid shrinkage and fibrosis of the sinus mucosa after extensive trimming thereof may be the main causes of stenosis. Residual mucosal inflammation, granulation formation, and persistent sinus crust and debris may also be contributing factors. Therefore, conservative trimming, meticulous dressing, and removal of sinus crust and granulation tissue near the MMA site should be performed in patients with MMA site stenosis.