EXPERIENCE OF DOING ENDOSCOPIC SINUS SURGERY FOR CHRONIC MAXILLARY SINUSITIS WITHOUT PRE-OPERATIVE CT-SCAN IN A PERIPHERAL HOSPITAL

Objective: To determine frequency of our complications of endoscopic sinus surgery without pre-operative CT-Scan and to compare this frequency with other similar studies done with the help of pre-operative CT-Scans. Study Design: Cross sectional study. Place and Duration of Study: ENT Department, Combined Military Hospital Skardu Pakistan, from Jun 2017 to Jun 2019. Methodology: Total 69 patients (116 Sides) were operated under general anesthesia by using 0 and 30 degree endoscopes to address the Maxillary sinusitis. Frequency of complications was compared to other studies by applying chi-square test for goodness of fit. The complications were also correlated to ages of patients by applying Spearman correlation analysis. Results: Mean age was 29.75 ± 10.9 years (range 15-75). Overall complications rate was 4.3% (5 out of 116 sides, 95% confidence interval 4.23-4.4). Peri-orbital ecchymosis and peri-orbital emphysema were most commonly occurring complications (4.3%). This complication rate was compared to few other studies, which proved that difference was not statistically significant. Correlation of occurrences of orbital complications with the age proved that there was no statistically significant correlation (Correlation coefficient r=-0.085, p-value 0.276). Conclusion: Isolated chronic maxillary sinusitis refractory to medical treatment can be treated by endoscopic sinus surgery without pre-operative CT-Scan.

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

Limits of stability among patients with Chronic Maxillary Sinusitis: A Cross-sectional Comparative study

Background: Sinusitis also known as Rhino sinusitis is the inflammation of sinuses that involves one or more cavities that could be due to bacterial or viral infection or even due to allergies. The patients may experience pain and tenderness around eyes, cheeks, nose and forehead, facial swelling, headache may be severe with nasal congestion. The secretions could have an impact on the vestibular apparatus which possibly may cause balance impairment. This study is intended to analyze the effect of chronic maxillary sinusitis (CMS) on balance. Objective: The aim of the study is to analyze the impact of CMS on the limits of stability. Materials and Methods: Thirty participants within the age group 20-40 were selected. Group A consisted of 15 patients with chronic maxillary sinusitis (CMS). Group B were matched controls (n=15) with the same age group, as that of the sinusitis group. Both male and female subjects within the age group of 20-40 years were included. Subjects with any other illness like trigeminal neuralgia, tension type headache, cervicogenic headache and other types of sinusitis were excluded. Functional Reach Test (FRT) between two groups were analysed Results: The mean FRT in patient with CS is 32.5 ± 9.5 cm. While in matched controls is 36.8 ± 7.9 cm. There exists significance difference (p=0.002) between them. Conclusion: Patient with chronic maxillary sinusitis has less functional reaching capability and thereby decreased limits of stability when compared to the matched peers.

Computational fluid dynamic modelling of maxillary sinus irrigation after maxillary antrostomy and modified endoscopic medial maxillectomy

Objective For recalcitrant chronic maxillary sinusitis, modified endoscopic medial maxillectomy has been shown to be clinically beneficial after failed maxillary antrostomy as endoscopic medial maxillectomy may offer improved topical therapy delivery. This study compared irrigation patterns after maxillary antrostomy versus endoscopic medial maxillectomy, using computational fluid dynamic modelling. Case report A 54-year-old female with left chronic maxillary sinusitis underwent maxillary antrostomy, followed by endoscopic medial maxillectomy. Computational fluid dynamic models were created after each surgery and used to simulate irrigations. Results After maxillary antrostomy, irrigation penetrated the maxillary sinus at 0.5 seconds, initially contacting the posterior wall. The maxillary sinus was half-filled at 2 seconds, and completely filled at 4 seconds. After endoscopic medial maxillectomy, irrigation penetrated the maxillary sinus at 0.5 seconds and immediately contacted all maxillary sinus walls. The maxillary sinus was completely filled by 2 seconds. Conclusion Computational fluid dynamic modelling demonstrated that endoscopic medial maxillectomy allowed faster, more forceful irrigation to all maxillary sinus walls compared with maxillary antrostomy.

Computed Tomography Evaluation of Unilateral Chronic Maxillary Sinusitis With Osteitis

Background: Computed tomography (CT) is the preferred noninvasive method for the evaluation of osteitis in chronic sinusitis. Some scholars believe that the bone changes associated with chronic sinusitis always show high attenuation (high density) and are positively correlated with the severity of the disease. However, sinus bone remodeling is a complex process that may cause high or low attenuation. There have been few reports on the spread of osteitis. Therefore, additional research on sinus CT is necessary. Objective: To observe bony changes in chronic maxillary sinusitis (CMS) by CT and reveal the mechanism. Methods: A retrospective study was conducted in 45 patients with unilateral CMS with bony changes in the sinus walls. The patients’ clinical data and CT results were analyzed and compared between the affected and normal sides. We propose the location, involvement, attenuation, and thickness method to evaluate CMS with osteitis. Results: Of the 45 patients, 40 (88.9%), 2, 12, and 7 had posterior external, medial, anterior, and superior lesions, respectively. The nasal region, sphenoid bone, palatine bone, and zygomatic arch were involved in 3, 12, 8, and 18 (40%) patients, respectively. Computed tomography indicated high attenuation in 30 (75.0%) and low attenuation in 10 (25.0%) patients; 6 (15.0%) showed new bone marrow cavities. The bone thickness was significantly different between the affected and normal sides in 40 patients ( P < .001), including members of both the high- and low-attenuation groups (high-attenuation group: P < .001; low-attenuation group: P < .01). However, there was no significant difference in the thickness of the affected side between the high- and low-attenuation groups ( P > .05). Conclusions: Chronic rhinosinusitis with bony changes may occur in the maxillary sinus walls and spread to adjacent bones. Both increased and decreased attenuation may occur in these circumstances. Analyzing the CT features of bone changes in unilateral CMS can improve the accuracy of disease diagnosis.

COMPLEX APPROACH TO TREATMENT METHODS OF CHRONIC MAXILLARY SINUSITIS AFTER COVID-19 IN PATIENTS WITH RESPIRATORY PATHOLOGY

The research aimedto introduce this unique natural remedy in the complex treatment of chronic maxillary sinusitis (CMS) in patients with chronic obstructive pulmonary disease. In dynamics of the carried out complex of treatment including therapy with the tablet. GA againstBT's background, a significant improvement of microcirculation and the degree of restoration of periodontal trophic disorders of the teeth was established.Key words:chronic sinusitis, chronic obstructive pulmonary disease, condition after COVID-19, glycerosin

Microbiology, Histopathology, and Radiographic Findings in Silent Sinus Syndrome

Background The histopathology and microbiology associated with silent sinus syndrome (SSS) have not been well described. Objective This study details the histopathological and microbiological characteristics in addition to radiographic findings of SSS in comparison to those of chronic maxillary sinusitis (CRS). Methods 42 patients diagnosed with SSS at Mayo Clinic Hospital in Arizona were identified. Paranasal computed tomography scans of the 42 SSS patients as well as 42 matched CRS patients were analyzed in order to assess differences in the prevalence of septal spurs/deviation. 20 of the SSS patients and 19 of the matched CRS patients also had histopathology and microbiology reports, which were compiled and summarized. Additionally, 19 SSS and 19 matched CRS patients were contacted via phone survey for a more complete patient history regarding maxillary dental disease/surgery. Results SSS patients have a significantly higher prevalence of septal spurs/deviation than CRS patients. The microbiomes of SSS patients more closely resemble those of healthy controls than those of CRS patients. Analysis of the histopathology of SSS reveals chronic, non-specific inflammation similar to that seen in non-eosinophilic CRS without polyps. SSS patients were significantly more likely to have a history of maxillary dental disease requiring surgery. Conclusion These data support the hypothesis that the pathogenesis of SSS is more likely due to anatomical/mechanical factors than inflammatory/microbiological factors.