Intranasal Antrostomy Research Articles

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.

A Clinical Study of Different Modalities for the Management of Chronic Maxillary Sinusitis

Background: Chronic maxillary sinusitis is a very common presentation in otorhinolaryngology clinics. It has diverse aetiology and varied symptoms at presentation. Its treatment requires a comprehensive approach for successful outcomes. We in the present study tried to evaluate the aetiology of chronic maxillary sinusitis and outcomes of treatment of chronic maxillary sinusitis. Methods: Patients presenting with clinical features of Chronic rhinosinusitis of all age groups and sexes were included in the study. The patients were subjected to general examination from head to toe which included the examination of the Respiratory system and cardiovascular system. ENT examination along with head neck was done. X-Ray (Water's view), C.T Scan PNSCoronal, and Sagittal sections for selected patients. Results: Antibiotics, antihistamines, decongestants, steam inhalations, and in some cases intranasal steroids (Budesonide, Beclomethasone, Fluticasone). Surgery: Antral wash n=16 cases, Intranasal Antrostomy n=2 cases, Caldwell Luc n=2 cases, Maxillary sinoscope n=2 cases, FESS n=38 cases involvinguncinectomy, middle meatal antrostomy, anterior ethmoidectomy, posterior ethmoidectomy, sphenoidotomy, frontal sinus infundibulotomy, and polypectomy. Conclusion: The commonest organism responsible was streptococcus pneumoniae. Improvement in the diagnostic techniques and availability of nasal endoscopy and CT scan which can show clearly the anatomy of osteomeatal complex has led to better management of the disease. Nasal endoscopes have allowed a meticulous delicate removal of the diseased mucosa which preserving the normal mucosa and structures consequently the postoperative complications are very few and most of the cases get relief from the symptoms of the disease

Multi-disciplinary Approach in Management of Rhino-orbito-cerebral Mucormycosis in Resource-poor Setting in Sub-saharan Africa: A Case Report

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon acute aggressive fungal infection occurring in several immunocompromised states including diabetes which is the most common predisposing factor. In this case report we present the clinical finding, therapeutic challenges and outcome in a 44 years old male type II diabetic patient. Patient first presented to the ortorhinolaryngologist with complaints of nasal discharge, postnasal drip, cough, hyposmia, facial pains, and intermittent nasal obstruction. He had bilateral intranasal antrostomy, upon X-ray confirmation of homogenious opacity of the left maxillary antrum and mucosal thickening of the right antrum. Fungal study of the specimen revealed mucormycosis. Six months later he presented with perception of light (PL) vision in the right eye and non-perception of light (NPL) in the left eye. There was mild lid edema in the right eye. There was marked proptosis associated with external ophthalmoplegia suggestive of orbital apex syndrome. The conjunctiva was keratinized and the cornea necrotic and opaque. The left eye enucleation and nasal exploration were done. The patient objected to taking amphotericn B, the drug of choice for this condition because of his previous adverse reaction experience to the drug. Posacornazole, the second line drug could not be assessed, posing a great therapeutic challenge in the effective management of this case. The patient was later referred for neurosurgical management but was reported to have died at a tertiary health facility in Abuja.

Multi-disciplinary Approach in Management of Rhino-orbito-cerebral Mucormycosis in Resource-poor Setting in Sub-saharan Africa: A Case Report

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon acute aggressive fungal infection occurring in several immunocompromised states including diabetes which is the most common predisposing factor. In this case report we present the clinical finding, therapeutic challenges and outcome in a 44 years old male type II diabetic patient. Patient first presented to the ortorhinolaryngologist with complaints of nasal discharge, postnasal drip, cough, hyposmia, facial pains, and intermittent nasal obstruction. He had bilateral intranasal antrostomy, upon X-ray confirmation of homogenious opacity of the left maxillary antrum and mucosal thickening of the right antrum. Fungal study of the specimen revealed mucormycosis. Six months later he presented with perception of light (PL) vision in the right eye and non-perception of light (NPL) in the left eye. There was mild lid edema in the right eye. There was marked proptosis associated with external ophthalmoplegia suggestive of orbital apex syndrome. The conjunctiva was keratinized and the cornea necrotic and opaque. The left eye enucleation and nasal exploration were done. The patient objected to taking amphotericn B, the drug of choice for this condition because of his previous adverse reaction experience to the drug. Posacornazole, the second line drug could not be assessed, posing a great therapeutic challenge in the effective management of this case. The patient was later referred for neurosurgical management but was reported to have died at a tertiary health facility in Abuja.

Multi-disciplinary Approach in Management of Rhino-orbito-cerebral Mucormycosis in Resource-poor Setting in Sub-saharan Africa: A Case Report

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon acute aggressive fungal infection occurring in several immunocompromised states including diabetes which is the most common predisposing factor. In this case report we present the clinical finding, therapeutic challenges and outcome in a 44 years old male type II diabetic patient. Patient first presented to the ortorhinolaryngologist with complaints of nasal discharge, postnasal drip, cough, hyposmia, facial pains, and intermittent nasal obstruction. He had bilateral intranasal antrostomy, upon X-ray confirmation of homogenious opacity of the left maxillary antrum and mucosal thickening of the right antrum. Fungal study of the specimen revealed mucormycosis. Six months later he presented with perception of light (PL) vision in the right eye and non-perception of light (NPL) in the left eye. There was mild lid edema in the right eye. There was marked proptosis associated with external ophthalmoplegia suggestive of orbital apex syndrome. The conjunctiva was keratinized and the cornea necrotic and opaque. The left eye enucleation and nasal exploration were done. The patient objected to taking amphotericn B, the drug of choice for this condition because of his previous adverse reaction experience to the drug. Posacornazole, the second line drug could not be assessed, posing a great therapeutic challenge in the effective management of this case. The patient was later referred for neurosurgical management but was reported to have died at a tertiary health facility in Abuja.

Multi-disciplinary Approach in Management of Rhino-orbito-cerebral Mucormycosis in Resource-poor Setting in Sub-saharan Africa: A Case Report

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon acute aggressive fungal infection occurring in several immunocompromised states including diabetes which is the most common predisposing factor. In this case report we present the clinical finding, therapeutic challenges and outcome in a 44 years old male type II diabetic patient. Patient first presented to the ortorhinolaryngologist with complaints of nasal discharge, postnasal drip, cough, hyposmia, facial pains, and intermittent nasal obstruction. He had bilateral intranasal antrostomy, upon X-ray confirmation of homogenious opacity of the left maxillary antrum and mucosal thickening of the right antrum. Fungal study of the specimen revealed mucormycosis. Six months later he presented with perception of light (PL) vision in the right eye and non-perception of light (NPL) in the left eye. There was mild lid edema in the right eye. There was marked proptosis associated with external ophthalmoplegia suggestive of orbital apex syndrome. The conjunctiva was keratinized and the cornea necrotic and opaque. The left eye enucleation and nasal exploration were done. The patient objected to taking amphotericn B, the drug of choice for this condition because of his previous adverse reaction experience to the drug. Posacornazole, the second line drug could not be assessed, posing a great therapeutic challenge in the effective management of this case. The patient was later referred for neurosurgical management but was reported to have died at a tertiary health facility in Abuja.

Multi-disciplinary Approach in Management of Rhino-orbito-cerebral Mucormycosis in Resource-poor Setting in Sub-saharan Africa: A Case Report

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon acute aggressive fungal infection occurring in several immunocompromised states including diabetes which is the most common predisposing factor. In this case report we present the clinical finding, therapeutic challenges and outcome in a 44 years old male type II diabetic patient. Patient first presented to the ortorhinolaryngologist with complaints of nasal discharge, postnasal drip, cough, hyposmia, facial pains, and intermittent nasal obstruction. He had bilateral intranasal antrostomy, upon X-ray confirmation of homogenious opacity of the left maxillary antrum and mucosal thickening of the right antrum. Fungal study of the specimen revealed mucormycosis. Six months later he presented with perception of light (PL) vision in the right eye and non-perception of light (NPL) in the left eye. There was mild lid edema in the right eye. There was marked proptosis associated with external ophthalmoplegia suggestive of orbital apex syndrome. The conjunctiva was keratinized and the cornea necrotic and opaque. The left eye enucleation and nasal exploration were done. The patient objected to taking amphotericn B, the drug of choice for this condition because of his previous adverse reaction experience to the drug. Posacornazole, the second line drug could not be assessed, posing a great therapeutic challenge in the effective management of this case. The patient was later referred for neurosurgical management but was reported to have died at a tertiary health facility in Abuja.

Distal Nasolacrimal Duct Showing the Valve of Hasner

Recognition of the location of the nasolacrimal duct opening is important to prevent its damage while performing an intranasal inferior meatal antrostomy or creating a window transantrally in the inferior meatal wall during a Caldwell-Luc procedure.

Caldwel-Luc operation without intranasal antrostomy

Introduction: Sub-labial antrostomy also known as Caldwel-Luc operation is a well-accepted procedure to remove any diseased mass, organic tissue or non-organic foreign body from maxillary antrum. The proceedings of this operation are though complex but not complicated if done by an expert hand. In addition to sub-labial approach this procedure is followed by an intranasal antrostomy to facilitate future drainage and through which the antral pack is introduced and removed post-operatively.Methods: In our series of 30 patients, we performed the same procedure through sub-labial approach only. No intranasal antrostomy were done. Also we opened the antrum by a small hole made over antero-lateral wall of the antrum.Results: The adopted method decreased the post-operative morbidity and also reduced the period of healing. No patient developed any major complication like oro-antral fistula either on immediate or long term follow-up up to one year. Only one (3.33%) patient had a temporary obstruction in drainage of collection in antrum even after not performing the intranasal antrostomy.Conclusion: Thus we conclude that this modification of Caldwel-Luc operation only through sub-labial approach without performing intranasal antrostomy could be accepted as an innovative procedure for better outcome of the patients as well as its cost-effectiveness DOI: http://dx.doi.org/10.3329/bjo.v18i2.12007 Bangladesh J Otorhinolaryngol 2012; 18(2): 156-160

Intra-antral application of an anti-fungal agent for recurrent maxillary fungal rhinosinusitis: a case report

IntroductionFungal infection of the paranasal sinuses is an increasingly recognized entity both in immunocompetent and immunocompromised individuals. Treatment has been via use of either surgical or medical modalities, or a combination of the two. Here, we present a case of utilization of intra-antral application of an anti-fungal agent in the management of recurrent fungal sinusitis in an indigent Nigerian patient.Case presentationWe present the case of a 30-year-old West African Yoruba man, an indigent Nigerian clergyman, who presented to our facility with a history of recurrent nasal discharge (about one year), recurrent nasal blockage (about five months), and right facial swelling (about one week). After intra-nasal antrostomy for debulking with a systemic anti-fungal agent, our patient had a recurrence after four months. Our patient subsequently had an intra-antral application of flumetasone and clioquinol (Locacorten®-Vioform®) weekly for six weeks with improvement of symptoms and no recurrence after six months of follow-up.ConclusionsWe conclude that topical intra-antral application of anti-fungal agents is effective in patients with recurrent fungal maxillary sinusitis after surgical debulking.

Surgical Considerations in the Management of Tumours of the Nose and Paranasal Sinuses in a Northern Nigerian Teaching Hospital

Tumours of the nose and paranasal sinuses in sub-Saharan Africa are generally characterised by late presentation posing management challenges to the otorhinolaryngologists in the sub-region. To appraise surgical considerations in the management of tumours of the nose and paranasal sinuses in a developing nation from the experiences of an Ear, Nose, and Throat Department of a Nigerian Teaching Hospital. This was a chart review of patients with tumours of the nose and paranasal sinuses who underwent various surgical operations over a period of four and a half years.The patients were referred by other physicians or health care workers. They were assessed clinically, backed by laboratory and radiological investigations. A total number of 55 patients underwent 64 surgical operations. There were 31 (56.4%) males and 24 (43.6%) females, giving a male to female ratio of 1.3:1. They were aged between four years and 70 years. In 46(83.6%) patients the tumours had extended beyond the nasal cavity or one sinus cavity to contiguous structures. The surgical operations carried out were lateral rhinotomy in 37(57.8%), intranasal clearance and intranasal antrostomy in 16(25%), total maxillectomy in seven(11%), and anterior craniofacial resection in two (3.1%) patients.The histological examination showed that 43 (78.2%) cases were benign, while 12 (21.8%) cases were malignant. These malignant cases needed radiotherapy and chemotherapy. Majority of the cases were characterised by late presentation, requiring surgical approaches such as lateral rhinotomy, total maxillectomy or craniofacial resection depending on the extent of the tumour. Poverty, ignorance, inadequate funding and administration challenges of health resources are factors militating against proper clinical management of tumours of the nose and paranasal sinuses in developing nations. Provision of free medical care and modern facilities for early diagnosis, treatment, and health education are needed to reverse the trend.

Silent Sinus Syndrome Secondary to a Radix Relicta in the Antrum

The case of a 57-year-old man with a radix relicta in the maxillary sinus causing a chronic maxillary sinusitis with secondary alteration of orbit and maxillary sinus, compatible with the silent sinus syndrome, is presented. The patient was treated with intranasal antrostomy in which the underlying dental cause of the inflammation was also removed. Initial antrostomy of the affected maxillary sinus may be a good therapy for unilateral enophthalmos with underlying chronic sinusitis, which can lead to spontaneous reduction or even resolution of the enophthalmos.

Variation in day‐case nasal surgery – why cannot we improve our day‐case rates?

The NHS plan states that 75% of all elective operations should be performed as day-cases. We set out to evaluate day surgery rates in sinonasal surgery and to identify factors limiting current practice. Prospective multicentre cohort study. 3128 patients undergoing sinonasal surgery during 2000 and 2001. Same day discharge, complication and readmission rates. There is potential selection bias due to the non-random selection of NHS Trusts and patients in this study. However, as results are similar to Hospital Episode Statistics data such bias is probably small. Only 15.5% of all procedures are performed as day surgery. We are achieving day-case rates of 18, 20 and 6% for nasal polypectomy, intranasal antrostomy and extensive FESS respectively, compared with recently published targets of 90%, 80% and 50%. Factors significantly associated with overnight admission were use of packs, extensive surgery, excess post-operative bleeding and high ASA grade. There was considerable unexplained variation in day-case rates and the use of packs between different surgeons. A third of consultants pack all patients post-operatively. More than 51% of consultants admit all patients, while 5% discharge all patients on the day of surgery. There were no excess adverse events or readmissions amongst the day surgery patients. However, only 17% of in-patients would have liked to be discharged on the day of surgery. Both patient and surgeon must overcome resistance to day case surgery before targets can be reached. Strategies for improving day-case rates in sinonasal surgery. All ASA grade 1 and 2 patients could be considered for day-case surgery, but particularly those with less extensive disease on radiography, and those planned to undergo less extensive procedures. Excess peri-operative bleeding was reported in 6% of patients. There must therefore be provision for overnight admission if required. Greater utilisation of day-case units, selective use of packs, and earlier removal may increase the proportion of patients managed as day-cases. There remains considerable variation in practice at both consultant and trust levels. Units should continue to audit their own figures and compare them against national rates in order to reduce nationwide variation in practice.

An unusual complication of intranasal antrostomi

Intranasal antrostomies are performed for treating maxillary simusitis. Here we present a rare case, who developed maxillary simusitis as a complication of the previous inferior meatal intranasal antrostomy. This case also proves the current concept that even though the inferior meatal antrostomy opening may be patent, the drainage is through the natural ostium.

An Unusual Case of Actinomycosis

We describe an unusual case of actinomycosis that appeared as a nasal mass. The diagnosis was established when Actinomyces viscosus was isolated from pus obtained from the right maxillary antrum by intranasal antrostomy. The patient was treated with intravenous crystalline penicillin and made an uneventful recovery within 10 days.

Complications of Acute Sinusitis in Children

Acute sinusitis is often a mild, self-limiting disease. However, in some cases, especially among children, sinusitis may become a severe, even life-threatening, disease. To examine the nature of complications of acute sinusitis, we studied the cases of children treated at the Helsinki University ENT Hospital, because of a complication caused by acute sinusitis from January 1997 to September 1998. There were 12 children (4 girls, 8 boys), whose ages ranged from 16 months to 16 years. One child had an epidural abscess, one got meningitis and cavernous sinus thrombosis, five had orbital cellulitis, one of whom lost her vision permanently in one eye, and five had preseptal cellulitis. All the children were treated with intravenous antibiotics and all, except the youngest, were treated with a direct sinus puncture. An operation (intranasal antrostomy, orbital drainage, functional endoscopic sinus surgery or adenoidectomy) was performed on six patients. In the majority of children, acute sinusitis is a mild self-limiting disease. However, severe complications still exist. When a complication of sinusitis is suspected, it is of utmost importance that the child be sent immediately to a hospital for proper diagnosis and treatment.

Infraorbital nerve dehiscence: the anatomic cause of maxillary sinus "vacuum headache"?

Vacuum disorders of the paranasal sinuses are well described. Patients with facial pain in the distribution of the infraorbital nerve are often labelled as suffering from a "vacuum maxillary sinusitis" and empirically treated by intranasal antrostomy. A variety of mechanisms have been postulated for the production of symptoms in this condition, but all ignore the fact that the maxillary sinus is a relatively insensitive structure. This article introduces a dehiscence of the bony infraorbital nerve canal within the antrum as an anatomic variant and suggests that it may provide the anatomic basis for vacuum sinusitis in the presence of a small natural ostium. Definitive diagnosis is made by outpatient antroscopy, and surgical treatment takes the form of a middle or inferior meatal antrostomy. Persistent symptoms may benefit from an infraorbital neuropexy to provide added protection to the exposed nerve.

Root agenesis in developing canines as a complication of intranasal antrostomy

A case is reported in which the roots of both maxillary canines failed to develop, a defect that could be traced to antral surgery when the patient was 8 years of age. The differential diagnosis of such a finding is proffered. The maxillary antrum is described, and aspects of the surgical procedure, the nasal antrostomy, used in this patient are discussed. A brief outline of current thought on the mechanisms of eruption of teeth is appropriate, and treatment of the symptomatic tooth is mentioned.

Nasolacrimal Obstruction After Inferior Meatus Nasal Antrostomy

Transient epiphora following rhinoplasty or intranasal procedures is a common occurrence. Permanent nasolacrimal duct obstruction, however, is rare. This article documents four cases of nasolacrimal duct obstruction following intranasal antrostomy. Three patients were cured by dacryocystorhinostomy and a fourth refused surgery. The anatomy of the nasolacrimal duct in the inferior meatus has considerable variation. Although the duct typically opens in the inferior meatus immediately under the insertion of the inferior turbinate, the orifice can be a single hole, a slit, multiple holes, or a trough, and can be located anywhere from 30 to 40 mm dorsal to the anterior nares. We review the embryology and anatomy of the nasolacrimal orifice in the nose and make recommendations for safe surgery in the inferior meatus.

Fundamental considerations of the design and function of intranasal antrostomies.

The natural history of intranasal antrostomy is poorly understood despite the popularity of the procedure. Researches have been conducted to examine this and in particular to establish factors which might be responsible for closure. A complete appraisal of the anatomy of the inferior meatus has been undertaken to determine factors which limit the dimensions of an antrostomy. Retrospective and prospective studies have been performed on patients undergoing the operation to assess patency and size. The results of these studies demonstrate that initial size is important in determining long-term patency in adults, and if an antrostomy is open at one year it usually remains open in the long-term unless infection supervenes; in children, however, antrostomies appear to close more rapidly.