Simultaneous inferior and middle meatus antrostomies in the treatment of the severely diseased maxillary sinus

Abstract

Although the majority of the maxillary pathology can be eradicated through the enlarged middle meatus antrostomy (MMA), some patients have extensive disease that is difficult to cope with. The aim of this study was to estimate the usefulness of simultaneous middle and inferior meatal antrostomies (MIMAs) in cases with severely diseased maxillary sinus by comparing the subjective and objective outcomes between patients that underwent MIMA and those who experienced maxillary clearance through conventional MMA. A prospective study was performed on patients with nasal polyps and severely diseased maxillary sinus (Lund-Mackay CT score = 2). All diseased sinuses were addressed with the same endoscopic sinus surgery technique; the only difference consisted of the management of the maxillary sinus: 34 patients underwent MIMAs and in 38 cases maxillary sinus was approached solely through the MMA. After 12 months of follow-up, outcomes consisted of the visual analog scale (VAS) for the main symptoms, the Lund-Mackay and maxillary sinus endoscopic scores, and the percent of airspace occluded by inflammatory mucosal thickening on CT. Subjective improvement in VAS scores for nasal obstruction, facial pain, and nasal discharge/retronasal drip was significantly better in the MIMA group. The mucosal thickening as expressed by the CT scan and maxillary endoscopic score was significantly reduced in the MIMA group. The MIMA technique is useful for removing severe disease that can not be reached through the MMA and yields both better subjective and better objective outcomes. The additional inferior antrostomy most likely improves drainage and ventilation in the postoperative period.