The clinical and histopathological studies on the window operation for the chronic maxillary sinusitis

Abstract

I. The author performed the window operation for the chronic maxillary sinusitis and investigated the relation between the postoperative course and the histopathological findings of the maxillary mucous membranes which were removed from the cases. Ninety-two cases of chronic maxillary sinusitis were selected for the study. For the maxillary sinusitis accompanied by the ethmoidal sinusitis and /or septal deviation, the endonasal ethmoidectomy and /or submucous resection of the septum were performed.Part of the maxillary mucous membrane removed during the operation was stained with haematoxylin-eosin and other staining techniques. The postoperative courses of the cases were followed up for 1/2-2 years. They were classified into 4 groups in 6 months postoperatively, namely, good after effect, fair after effect, no change and worse. The results were: 48%, 32%, 16% and 4%, respectively.II. The histopathological findings were classified into four types, i. e., edematous, infiltrating, fibrous and mixed. Each type was observed as with grade of, low and high. The results were summarized as follows:2) For the fibrous type, the higher was the pathology of mucous membrane, the better the postoperative cure showed after window operation. This suggested that the fibrous type was also indication of the operation.3) For the mixed type there was no significant relationship between the pathology and clinical course after operation. It was difficult to determine the indication of the maxillary window operation for this type.III. Following the above date, the special connective tissue stainings were performed for 20 selected cases of the fibrous or mixed types of mucous membrane. The following results were obtained.1) Elastic fibers were fourd distributed in the wall of vessels or cystically expanded glands without any mutual relation between the histopathological types and the degree of elastic fiber distribution.2) The distribution of reticular fibers were more dense in mixed type than in fibrous type. The reticular fibers might grow to the collagen fibers.3) In the advanced fibrous type, mature collagen fibers increased, while the capillaries decreased. This suggested that the inflammatory process was ceasing and the repairing mechanisms started to proceed.