Abstract
IntroductionChronic maxillary atelectasis (CMA) is traditionally described as a rare, acquired condition of persistent and progressive antral wall collapse causing a reduction in maxillary sinus volume. In a handful of cases, CMA has been identified in patients with previously normal computed tomography (CT) imaging. However, maxillary atelectasis occurring rapidly after pituitary surgery, despite a normal pre-operative CT scan, has not previously been described in the literature. Presentation of caseA 29-year-old male presented two months post endoscopic transnasal, transsphenoidal excision of a Rathke’s cleft cyst with facial pain and pressure, unresponsive to medical treatment. CT of the paranasal sinuses at five months post-operatively demonstrated evidence of a left CMA, which was not present on pre-operative imaging. He underwent endoscopic uncinectomy and middle meatal antrostomy with complete resolution of symptoms. DiscussionTo our knowledge, this is the first case in the literature describing acute development of maxillary atelectasis. While lateralisation of the middle turbinate causing ostiomeatal obstruction may lead to sinus atelectasis, it is typically a slow process and often seen in the context of chronic disease. Review of the literature demonstrates six cases of documented rapid-onset atelectasis of maxillary sinuses. Four of these cases were post-operative, with one involving direct surgery on the affected sinus. ConclusionThis case represents the first in the literature of acute, post-operative unilateral maxillary atelectasis following pituitary surgery, where the affected sinus was not directly involved in the initial operation. Consideration should be made to incorporate acute cases into the current classification system.
Highlights
Chronic maxillary atelectasis (CMA) is traditionally described as a rare, acquired condition of persistent and progressive antral wall collapse causing a reduction in maxillary sinus volume
Maxillary atelectasis is a rare condition that describes a reduction in the volume of the maxillary sinus secondary to inward bowing of the antral walls
Maxillary atelectasis is traditionally described as a chronic, progressive entity
Summary
Chronic maxillary atelectasis (CMA) is traditionally described as a rare, acquired condition of persistent and progressive antral wall collapse causing a reduction in maxillary sinus volume. Maxillary atelectasis occurring rapidly after pituitary surgery, despite a normal pre-operative CT scan, has not previously been described in the literature. CT of the paranasal sinuses at five months post-operatively demonstrated evidence of a left CMA, which was not present on pre-operative imaging. He underwent endoscopic uncinectomy and middle meatal antrostomy with complete resolution of symptoms. Review of the literature demonstrates six cases of documented rapid-onset atelectasis of maxillary sinuses Four of these cases were post-operative, with one involving direct surgery on the affected sinus. CONCLUSION: This case represents the first in the literature of acute, post-operative unilateral maxillary atelectasis following pituitary surgery, where the affected sinus was not directly involved in the initial operation. Consideration should be made to incorporate acute cases into the current classification system
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