PATHOHISTOLOGICAL STUDY OF CHRONIC SINUSITIS

Abstract

Maxillary mucous membrane obtained surgically from 53 patients of chronic sinusitis, aged 10 to 59, was pathohistologically observed with following findings : 1. With characteristic pathohistological features of oedema, fibrosis and inflammatory cell infiltration, all the cases were classified into oedematous type (26 cases), fibrous type (13 cases), infiltrative type (5 cases) and mixed type (9 cases, which could not be classified under any of the first 3 types).In each of these types, purely typical ones w ere infrequent, and many had transitional features.2. All the cases displayed more or less vascular lesions showing no difference between four types. These were 1) Capillary fibrosis, 2) collagenous fibrosis, elastic fiber proliferation, elastic fiber fragmentation and smooth muscle proliferation of vein, and 3) productive endoarteritis. The lesion was more severe in the vein than in the artery.3. Intercellular substance showed increase in AMP in the fibrous type but rather decrease in the oedematous type. Edematous fluid was considered to be derived from blood fluid, and did not indicate mucoid degeneration of collagen disease.4. It is highly possible that there may be some relation between the oedematous type and allergy.But few cases displayed pathohistological feature of the classical allergic inflammation. It is therefore necessary further to make immunological examination.5. In all the cases, the maxillary mucous membrane affected by chronic inflammation, displayed intense thickening, which anatomically resulted in narrorving or closure of maxillary ostium and impediment to secretory discharge, Severe lesion in the vascular system, especially venous system, contributes on the one hand to prolongation of the maxillary mucous lesion and reinfection and on the other makes the effective conservative treatment impossible.