Endoscopic Middle Meatal Antrostomy Research Articles

Closure of oroantral fistula using platelet rich fibrin with endoscopic middle meatal antrostomy

BackgroundOroantral fistula (OAF) involves pathological, epithelialized, and unnatural communication between the maxillary sinus and oral cavity. Recently, functional endoscopic sinus surgery has provided minimally invasive treatment options with fewer postoperative complications. The aim of the study was to evaluate the one-stage endoscopic middle meatal antrostomy (EMMA) technique with the application of a platelet-rich fibrin membrane (PRF) for OAF closure and maxillary sinusitis relief.Patients and methodsPatients who suffered from OAF with odontogenic sinusitis were included in this study. Complete excision of the epithelial tract and any necrotic tissue was performed with proper curettage. Then, EMMA was performed with simultaneous closure of the OAF by the application of PRF membranes that were fixed by sutures and covered with an acrylic splint. Patients were clinically evaluated for OAF closure, pain level, and symptom relief. Additionally, the size of the bone defect was measured with the aid of computed tomography (CT) preoperatively and after 24 weeks postoperatively.ResultsThis study included nine eligible patients with a mean age of 38 years. The data were collected, tabulated, and statistically analyzed. Soft tissue healing and bone formation occurred in all patients who achieved maxillary sinusitis relief without any complications. Additionally, pain was significantly lower on the 7th postoperative day than on the 1st postoperative day, according to the statistical analysis of the results (p < .001).ConclusionsOne-stage EMMA with the application of PRF membranes and acrylic splint represents a reliable alternative technique for OAF closure and maxillary sinusitis relief that is associated with a lower incidence of complications and minimal postoperative pain.Trial registrationThe trial was registered on 28/02/2024, at clinicaltrials.gov (ID: NCT06281873).

STIMA: Submucosal Temporary Inferior Maxillary Antrostomy: A Modification of Conventional Antrostomy, A Retrospective Review.

Introduction: Maxillary sinus pathology is commonly approached through endoscopic middle meatal antrostomy (MMA). However, MMA does not provide full exposure to certain aspects of the maxillary sinus, such as alveolar, zygomatic, and prelacrimal recesses. In these hidden maxillary sinus niches, a combination approach with MMA is required for better exposure and access. In this article, we present a modification of inferior maxillary antrostomy (IMA) to allow for a temporary intraoperative window with no significant postoperative consequences. Objectives: (1) To describe our modification of IMA. (2) To report the outcome of maxillary sinus disease, postoperative complications, and flap condition. Methods: This is a retrospective chart review study. It was performed on 20 patients where submucosal temporary inferior maxillary antrostomy (STIMA) was indicated in the period from January 1, 2020, and July 1, 2023. All patients were assessed for their demographics, diagnosis, indication for STIMA, maxillary disease outcome, presence of postoperative complications, and flap condition. Result: Total of 18 patients fulfilled our inclusion/exclusion criteria; of them, 13 were males while the remaining were females. Mean age of patients was 33 years; most common diagnosis was chronic sinusitis. Status of maxillary sinus mucosa was healthy in all except 4 patients having polypoidal mucosa while flap condition was intact in all patients except 2 patients with pinpoint defects. Postoperative complications assessment demonstrated no neural, orbital, lacrimal, or dental complications in all patients. Conclusion: This retrospective chart review showed promising technique to address challenging maxillary lesions in difficult-to-access locations where combined approaches are necessary.

The impact of maxillary dimensions on determining surgical approach of fungal ball in the maxillary sinus

Endoscopic middle meatal antrostomy (MMA) is commonly used for maxillary sinus (MS) fungal ball removal. For challenging cases involving anterior or inferior recess, an additional inferior meatal approach (IMA) might be needed. We analyzed the differences in MS dimensions on CT scans according to the surgical approach to suggest preoperative variables that could facilitate an additional IMA. CT scans of 281 adult patients who underwent ESS for the MS fungal ball (139 MMA, 62 MMA & IMA) were evaluated for comparative analysis of 8 MS measurements based on the surgical approach. Complete removal was achieved in all cases. Age and sex didn't differ significantly (p > 0.05). The maximum distances between the anterior–posterior walls, the inferior ostium border to the lateral recess, and the ostium to the inferior wall of the MS were statistically greater in the MMA & IMA group compared to the MMA group (p = 0.003, p = 0.005, and p = 0.010, respectively), especially among females. This study underscores the clinical importance of specific measurements—anterior to posterior wall, medial wall to lateral recess, and ostium to inferior wall of the maxillary sinus—for guiding optimal surgical approaches in MS lesions.

Prelacrimal Recess Approach in Unilateral Maxillary Sinus Lesions: What Is the Impact and Efficacy?

Background and Objectives: Chronic sinusitis is a commonly encountered diagnosis for otorhinolaryngologists. The profound negative effect of rhinosinusitis on patients' quality of life is frequently overlooked, and surgical lines of treatment are numerous. The aim of the study was to assess the comparative efficacy of endoscopic middle meatal antrostomy with the endoscopic prelacrimal recess approach, combined with middle meatal antrostomy in the treatment of unilateral chronic maxillary sinus lesion. Materials and Methods: Thirty patients with unilateral chronic maxillary sinus lesions enrolled in the study at Alahsa hospital. Patients were divided into two groups: 15 treated through a middle meatal antrostomy and 15 treated via a combined middle meatal antrostomy and prelacrimal recess approach. Demographic and clinical information of the patients, including the medical history, CT scan findings, diagnosis, recurrence, and complications, were gathered and analyzed. Pre- and postoperative clinical findings were graded utilizing the Lund-Kennedy Endoscopic Scoring System. Results: The enrolled patients varied in age from 18 to 56, with 60% being male and 40% being female. Antrochoanal polyp, maxillary sinus mucocele, and unilateral allergic fungal sinusitis were among the pathological diagnoses. The follow-up period averaged 14.3 months. Following surgery, two patients in Group II encountered nasal discomfort, which included synechia and epiphora. The success rate for preserving a patient's disease-free condition was 86.7%. A statistically significant difference in disease-free incidence was observed among the patients in group II. In group I, recurrence was identified in 26.7% of the patients. The postoperative symptoms diminished considerably, and the VAS score was reduced substantially. In Group II patients, however, there was no significant difference in scarring. Clinically significant differences were observed in the mean total Lund-Kennedy Endoscopic scores when compared to their preoperative values. Conclusions: Achieving endoscopic access to the sinus's anterior, lateral, inferior, and inferomedial regions is facilitated by operating via the prelacrimal recess, which is the most advantageous approach. This approach facilitates rapid mucosal healing by maintaining the integrity of the nasolacrimal duct and mucosal covering. The specific pathology, surgical objectives, surgeon expertise, and equipment accessibility influence the choice of endoscopic surgical technique.

STIMA: Submucosal Temporary Inferior Maxillary Antrostomy: A Cadaveric Controlled Study of a Modification of the Conventional Antrostomy.

Introduction: Inferior meatal antrostomy (IMA) is a safe and easy approach to the maxillary sinus. However, studies have shown disadvantages of conventional IMA, such as disruption of mucociliary transport and injury of the nasolacrimal duct (NLD). Endoscopic middle meatal antrostomy (MMA) has become the standard of care for addressing various maxillary pathologies. It is more functional and physiological but offers limited exposure to certain areas of the maxillary sinus, such as the prelacrimal recess, alveolar recess, and zygomatic recess. We proposed submucosal temporary inferior maxillary antrostomy (STIMA) to improve visualization and accessibility to such difficult-to-access locations. Objectives: To describe our proposed modification, to compare the degree of visualization and ease of accessibility between MMA and STIMA. Methods: This is a descriptive cadaveric study. It was performed on 4 fresh frozen human cadavers, and 8 maxillary sinuses were used to achieve the study's objectives. Different angled rigid nasal endoscopes and suction tubes were used to score the degree of visualization and ease of accessibility between the MMA and STIMA. Result: We demonstrated the superiority of the STIMA over the MMA in the degree of visualization and ease of accessibility in these difficult-to-access locations (P-value was significant, <.05). We did not encounter orbital injury or injury to the NLD in our specimens. Conclusion: STIMA is a relatively easy and safe modification of conventional IMA. It improves the degree of visualization and ease of accessibility to difficult-to-access maxillary sinus locations without the potential complications of conventional IMA.

Comparison of conventional and extended middle meatal antrostomy for the treatment of antrochoanal polyps

ObjectiveThe objective was to compare the recurrence rate and complications between endoscopic middle meatal antrostomy (MMA) and extended MMA for the treatment of antrochoanal polyps (ACPs).Methods and materials95 ACPs were prospectively enrolled to undergo MMA (n = 48) or extended MMA (n = 47). The recurrence rate and complications were compared between these groups.ResultsAll patients completed 24 months of follow-up. The recurrence of ACP was demonstrated by only endoscope at 6 and 12 months postoperatively but at 24 months postoperatively by endoscope and CT. Rates of recurrence of ACP differed between groups and significance at postoperative month 6 (7/48 patients in the MMA group and 0/47 patients in the extended MMA group, P = 0.02), month 12 (16/48 vs. 2/47, P < 0.01) and month 24 (21/48 vs. 3/47, P < 0.01). No MMA closure was found in any group, 19.15% (9/47) patients complained of cheek numbness in the extended MMA group, however, no major complications were observed in both groups.ConclusionsExtended MMA via antidromic extended medial wall of MS may effectively reduce the recurrence of ACP with lower complications.

Noninvasive fungal rhinosinusitis: a case series

Introduction:Fungal rhinosinusitis (FRS) remains a rare disease. The noninvasive forms are hard to diagnose. The management protocols remain controversial. We aim to describe the clinical, radiological and pathological features of noninvasive FRS and present our management protocol and follow-up results. Patients and methods:This descriptive study was conducted in the ear-nose-throat department of the university hospital, Taher Sfar in Mahdia, Tunisia. All patients who responded to the definition of noninvasive FRS (fungal balls and allergic fungal sinusitis) were included. The study was conducted over a three year period (May 2017 - April 2021). Results:Eleven patients were included in this study: four cases of fungal balls and seven cases of allergic fungal sinusitis. Patients presented with symptoms of chronic recurrent rhinosinusitis with no response to conventional treatments. Computed tomodensitometry scan showed opacification of the paranasal sinuses in all patients. Other signs were heterogeneous opacities, local calcifications and thinning of the bony walls of the sinuses. Histopathological findings were inflammatory polyps in all cases of allergic FRS with the presence of fungal hyphae in 42.8% of the cases. All patients underwent surgery after a median delay of 12 [6-24] months of the symptom's onset. The used procedures were endoscopic middle meatal antrostomy for all patients, ethmoidectomy (81.8%) and sphenoidotomy (36.4%). None received systemic antifungals or corticosteroids with a favorable outcome in all cases. Conclusion:Symptoms of noninvasive FRS are nonspecific. The scan images contribute to the diagnosis, but the perioperative findings and the histopathological results remain crucial. The management is mainly surgical.

Comparison between intranasal antrostomy and middle meatal antrostomy in the management of isolated maxillary sinusitis in the Rural Population: A prospective study

Abstract OBJECTIVE. To compare the outcomes of Intranasal Antrostomy (INA) with Nasoantral Window-Plasty and endoscopic Middle Meatal Antrostomy (MMA) in patients with isolated chronic maxillary sinusitis using an elaborate and detailed set of parameters. MATERIAL AND METHODS. All patients with clinically diagnosed chronic maxillary rhinosinusitis (unilateral/bilateral) were assessed based on radiological (Lund-Mackay Scoring System) and endoscopic evidence (Lund-Kennedy Scoring System). The Visual Analogue Scale was used to understand the severity of symptoms. Strict inclusion and exclusion criteria were used. One hundred patients were included in the study and divided into two equal groups of fifty each. Group 1 of patients underwent Intranasal Antrostomy with Nasoantral Window-Plasty and Group 2 underwent endoscopic Middle Meatal Antrostomy. All the surgeries were done in the same environment, under local anaesthesia and by the same surgeon. The parameters were noted before surgery and 8 weeks after surgery. RESULTS. MMA did about 6.82% better than INA in relieving symptoms, had 1.08% better CT image and 4.58% better in regards of nasal endoscopy findings. CONCLUSION. Although endoscopic Middle Meatal Antrostomy is a newer and more non-invasive procedure, the age-old Intranasal Antrostomy with Nasoantral Window-Plasty is still relevant in the management of chronic maxillary sinusitis in this modern age in our rural area.

Endoscopic Inferior Meatal Antrostomy for Antrochoanal Polyps: A Long-Term Follow-Up

Background: Endoscopic middle meatal antrostomy (EMMA) is considered the standard approach for surgical management of antrochoanal polyps (ACPs). Recently, an endoscopic inferior meatal antrostomy (EIMA) approach for clearing lesions in the maxillary sinus was described. In this study, we compared the long-term outcome of patients with ACP following surgical treatment using one of these 2 approaches (EIMA or EMMA). Methods: The medical charts of all patients treated for ACPs in our institution between January 1, 2009, and July 1, 2020, were reviewed retrospectively. Patients were invited to complete a long-term follow-up assessment. Results: Thirty-eight patients were included in the study: EIMA was the only procedure performed in 25 patients (66%) and EMMA was the only procedure performed in 7 patients (18%). Both procedures were performed in 6 patients (16%): 2 patients (5%) underwent simultaneous EMMA and EIMA for better access and visualization and 4 patients (10.5%) underwent surgical revision consisting of EIMA secondary to failed EMMA at other institutions. Median follow-up was 44 months (range, 6 months–11 years). No evidence of recurrent ACPs, recirculation, synechiae, nasolacrimal duct injury, or bleeding was observed in any of our patients. Small nonobstructing cysts were observed in 2 patients (8%) following EIMA. Conclusions: EIMA prevents violation of the ostiomeatal complex. It provides access to the anteroinferior aspect of the maxillary sinus and should be considered as an alternative to EMMA in patients with ACPs.

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.

This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation. The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for making recommendations. The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI); an increase in lowest oxygen saturation (LSAT) and sleep quality; and an improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI and an increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, and ODI and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggested that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. Kent D, Stanley J, Aurora RN, etal. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(12):2507-2531.

Value of Inferior Meatal Window with Mucosal Flap as an Adjuvant to Middle Meatal Antrostomy in Managing Maxillary Sinus Lesions: A Randomized Controlled Trial

Background: Several approaches for the maxillary sinus were described. Currently, endoscopic Middle Meatal Antrostomy (MMA) is the gold standard for managing maxillary sinus lesions. Unfortunately, there are some limitations especially in hidden areas. This research elucidates the advantages and disadvantages of adding IMF to the MMA for managing maxillary sinus lesions.Patients and Methods: This study was a randomized controlled trial, conducted on sixty patients, divided into 2 groups: Group (A) included 30 patients underwent IMF after MMA, while group (B) involved 30 patients subjected to MMA only for managing the maxillary sinus. Patients were assessed for the accessibility of the antero-inferior area of the maxillary sinus, residual lesion after performing IMF and evidence of recurrence.Results: The antero-inferior area accessibility in group (A) was difficult in 10 patients (33%) compared to 20 patients (66%) of group (B) (P =0.004). Residual was detected after performing the IMF in 12 patients (40%). Postoperative 1 year Lund Mackay score comparison between both groups was statistically insignificant (P=0.6). Recurrence was noted in 4 cases of group (A) and 2 cases of group (B), (P=0.7).Conclusion: Inferior meatal window with mucosal flap is helpful approach to maxillary sinus hidden areas when added to standard MMA. It is best suited for complete removal of small hidden lesions (e.g. foreign bodies, fungal ball and odontogenic cysts) which could be hardly handled through MMA.

Treatment and evaluation of recurrence for antrochoanal polyps by endoscopic large middle meatal antrostomy, clinical case series of 25 patients

IntroductionThe Endoscopic approach for complete removal of antrochoanal polyp is considered a safe and effective procedure with the best control of the attachments of antrochoanal polyps.The mains of our study are to review the clinical features and evaluate the recurrence in the patients affected by antrochoanal polyps (ACPs) and surgically treated by endoscopic middle meatal antrostomy. MethodsThe present research is a retrospective study. it includes the clinical data of subjects affected by ACPs, and referred to ENT Department, Face and Neck Surgery, Hospital 20 August 1953, between January 2016 and January 2019. ResultsAll patients have been treated surgically with endoscopic middle meatal antrostomy under general anesthesia. Recurrence occurred in 3 cases (12%), in these three recurrent cases, the site of attachment originated from the lateral wall. ConclusionFESS was the first-choice treatment for APCs in the present series; our recurrence rate was encouraged for the practice of the endonasal endoscopic approach. A focus on the detection of the exact origin of the polyp and the resection of the periostium on the point of attachment considered the key to prevent recurrence.

Endoscopic endonasal prelacrimal recess approach for antrochoanal polyp

BackgroundThe purpose of this study was to assess the effectiveness of endoscopic transnasal prelacrimal recess approach (ETPRA) in preventing the recurrence of antrochoanal polyps.Patients and methodsA total of 32 patients with antrochoanal polyp were divided into two equal groups: group 1 included 16 patients who underwent endoscopic middle meatal antrostomy (EMMA), and group 2 included 16 patients who underwent a combined surgical technique using EMMA together with ETPRA. They were followed up from 24 to 36 months. Success rates for visualization of the origin of the polyps, surgical complications, and recurrence were evaluated.ResultsThe most common symptoms were nasal obstruction (100%), snoring (75%), rhinorrhea (59.38%), headache (96.88%), and hyposmia (53.13%). The study found that postoperative complications varied between both groups. Recurrence was found in 18.75% in EMMA group and 0% in ETPRA group. They were statistically significant (P<0.05). However, nasolacrimal duct injury was found in two patients in ETPRA group, and postoperative lacrimation presented in only one (6.25%) patient of the same group. They were statistically insignificant (P>0.05).ConclusionRecurrence rate of antrochoanal polyp has been reduced with the usage of ETPRA in comparison with EMMA alone.

Closure of Oroantral Fistula With Buccal Fat Pad Flap and Endoscopic Drainage of the Maxillary Sinus.

Oroantral fistula (OAF) is a pathologic communication between the oral cavity and the maxillary sinus. It is usually associated with maxillary sinusitis, where drainage of sinus infection is a mandatory step during closure of the fistula. The flap used for closure of OAF should be tension free, broadly based and well vascularized. The aim of this study was to assess the effectiveness of closure of OAF using buccal fat pad (BFP) flap with concomitant endoscopic middle meatal antrostomy for maxillary sinus drainage. Nineteen patients with chronic OAF were included in the study. Closure was performed using BFP with endoscopic middle meatal antrostomy. Preoperative and postoperative assessments were carried out. Patients were followed up for at least 1 year postoperatively. Complete closure of all OAFs was achieved with no recurrence or dehiscence. In conclusion, closure of OAF with BFP flap and concomitant endoscopic drainage of the maxillary sinus through the middle meatus is an effective, easy, and simple method. It has a high success rate with no effect on the vestibular depth or mouth opening.

Three cases of organized hematoma of the maxillary sinus: clinical features and immunohistological studies for vascular endothelial growth factor and vascular endothelial growth factor receptor 2 expressions.

Objectives. Organized hematoma (OH) is a rare, nonneoplastic, hemorrhagic lesion causing mucosal swelling and bone thinning, mainly in the maxillary sinus. We aimed to clarify the clinical presentation and treatment of OH. Methods. Three cases of maxillary sinus OH and a literature review are presented. Results. Three men aged 16–40 years complained of nasal obstruction, frequent epistaxis, and/or headache. Clinical and radiological examinations revealed a maxillary sinus OH. They were cured in a piecemeal fashion via endoscopic middle meatal antrostomy. Furthermore, vascular endothelial growth factor and its receptor were expressed in the lesion. Conclusions. The pathogenesis of OH is unclear and it presents various histological and imaging findings; however, it is not difficult to rule out malignant tumors. Minimally invasive surgery such as endoscopic sinus surgery can cure it completely. Thus, it is important to determine the diagnosis using CT and MRI and to quickly provide surgical treatment.

Silent Sinus Syndrome: A Case Report and Review of Literature

ABSTRACT Silent sinus syndrome is a rare condition affecting the maxillary sinus, resulting in spontaneous collapse of the sinus walls causing facial asymmetry and unilateral enophthalmos. The exact etiology of this condition is unknown. We report a case of a 20-year-old male presented with facial asymmetry with depression of right cheek associated with heaviness over right cheek, without any disturbance of vision or eye movement. Computed tomography (CT) scan of the paranasal sinus showed a relatively smaller and opacified right maxillary sinus with inward retraction of the roof, medial and posterolateral walls. He underwent endoscopic middle meatal antrostomy. On follow-up, patient is free of symptoms and the CT scan showed well-ventilated sinuses with arrest of the disease progression. How to cite this article Saldanha M, Bhat V, Bhandary BSK, Scaria ST. Silent Sinus Syndrome: A Case Report and Review of Literature. Clin Rhinol An Int J 2013;6(3):144-148.

In Reference to the Article A Comparative Study Between Endoscopic Middle Meatal Antrostomy and Caldwell-Luc Surgery in the Treatment of Chronic Maxillary Sinusitis

Dear Editor I read with grave concern the article by K. Joe Jacob et al. discussing the comparative efficacy and complications of endoscopic sinus surgery and Caldwell-Luc in the treatment of chronic sinusitis. As rightly noted by authors themselves Caldwell-Luc is fairly abandoned in the treatment of chronic sinusitis for various reasons including—(a) Increased incidence of complications when compared to endoscopic sinus surgeries [1], (b) decreased cure rates when compared to endoscopic sinus surgeries [2]. Endoscopic sinus surgery is more physiological because it adheres to the principles of mucosal clearance and hence mucosal preservation is emphasized. The complications and morbidity associated with Caldwell-Luc range for 10–40% [3].Hence endoscopic sinus surgery is now the ‘standard of care’ worldwide for the management of chronic sinusitis. Now this raises an ethical question in the study design used by the authors. When endoscopic sinus surgery is available at the authors disposition, offering Caldwell-Luc as a treatment option to the patients is unethical as there is considerable evidence in literature already showing increased morbidity and decreased efficacy of Caldwell-Luc when compared to endoscopic sinus surgery. If a true informed consent was obtained explaining the risks, benefits and the outcomes of both treatment options, it is very difficult to understand how a consent for Caldwell-Luc could be obtained. The authors findings are definitely valid, but similar findings have been demonstrated more than a decade and half earlier [1, 2] and this study is like “reinventing the wheel” at the expense of patients who did not receive the ‘standard of care’ even when that was available. The authors should have done a thorough review of literature before conducting a study when considerable morbidity is associated with one treatment option compared to the other. There appears no need to conduct prospective randomized comparative study when the benefit of one option both in terms of increased efficacy and decreased complications appear overwhelming clear [4]. The authors could just have compared their results from endoscopic sinus surgery with results of Caldwell-Luc surgery already found in literature.

Endoscopic maxillary antrostomy: Not just a simple procedure

The endoscopic middle meatal maxillary antrostomy is one of the most commonly performed endoscopic procedures. Despite this, at our tertiary institution, we commonly see failed antrostomies requiring revision surgery. Accordingly, we describe in a stepwise fashion strategies helpful in creating a patent and naturally function maxillary antrostomy.

A Comparative Study Between Endoscopic Middle Meatal Antrostomy and Caldwell-Luc Surgery in the Treatment of Chronic Maxillary Sinusitis

Functional endoscopic sinus surgery (FESS) has almost completely replaced the radical Caldwell-Luc approach. About 20years after its origin of FESS a comparative study with Caldwell-Luc Surgery (C-L) definitely should be on cards to validate the previous results. To compare the effectiveness of endoscopic middle meatal antrostomy and Caldwell-Luc's surgery in the management of Chronic Maxillary Sinusitis. This is a prospective randomized comparative study based on the analysis of eighty patients who were diagnosed to have chronic, unilateral, maxillary sinusitis and underwent surgery, after a failed trial of conservative management. One year after surgery 44% of the C-L patients and 89% of the FESS patients reported distinct improvement of their symptoms. Both are effective in the management of chronic sinusitis. Endoscopic middle meatal antrostomy is superior to Caldwell-Luc in intraoperative and postoperative parameters.

Pituitary apoplexy following endoscopic sinus surgery

To highlight the possibility of pituitary apoplexy after functional endoscopic sinus surgery for elimination of sinonasal infection, an important preparatory step for safe trans-sphenoidal access to the pituitary fossa. A 67-year-old man with a known pituitary macroadenoma developed headache, diplopia and reduced vision after endoscopic middle meatal antrostomy and ethmoidectomy for rhinosinusitis with polyps. Magnetic resonance imaging showed pituitary haemorrhage. The patient underwent emergency endoscopic trans-sphenoidal resection of the tumour, with significant symptomatic improvement. Despite mild right eyelid ptosis and persistent diabetes insipidus, the patient resumed normal activities in a few weeks. To our knowledge, this is the first report of pituitary apoplexy after a nasal operation. Pituitary apoplexy is a rare and potentially life-threatening event in high risk patients with pituitary adenomas; it may occur spontaneously or after surgical procedures. Early, combined surgical intervention by rhinologists and neurosurgeons is recommended. The endoscopic trans-sphenoidal approach is a safe and effective technique for the acute management of pituitary apoplexy.