A Study of Postoperative Healing Process of Chronic Sinusitis

Abstract

Chronic sinusitis is one of the most prevalent nasal disease in Japan. Conservative or surgical treatment has long been accepted as effective treatment for chronic sinusitis, but conservative treatment is of little value in some of these cases. Even surgical treatment is not always satisfactory.To practise the pathogenesis of chronic sinusitis, the present study was attempted to identify the relation between preoperative mucosal findings in maxillary sinus and postoperative healing process of chronic sinusitis. Clinical histopathological examination of the healing process in maxillary sinus was performed in 133 patients with chronic sinusitis from one week to six months postoperatively.After surgical treatment we had good prognosis for headache and nasal discharge, but bad for postnasal dropping. Subjectively their complaint was improved except 23% of patients who underwent operation. During 3 or 6 months recurrent sinusitis was found 60% of operated patients who discharged, but 18% over one year. Many cases of good intranasal findings after operation were macroscopically fibrotic type in both maxillary and ethmoidal sinus, the second edematous type, and the third polypous type. Also, those which retained secretion showed good intranasal finding. On the other hand, in the cases of polypous type with pus retension in maxillary sinus and edematous type with pus retention in ethomoidal sinus, intranasal findings after operation were poor. Though there were not significant difference between prognosis and histopathological changes of mucosa in maxillary sinus before operation, in ethomoidal sinus edematous type macroscopically showed unfavourable prognosis. While, there were clear correlation between histological changes of mucosal regeneration and intranasal finding postoperatively.Those results suggested that postoperative healing process was intimately related to histopathological changes of mucosa in both maxillary and ethomoidal sinus before operation. When aftertreatment is based on a clear understanding of the postoperative process and the effects of the various operative methods on the healing process, we considered that the best results might be got.