Maxillary Sinus Ostium Research Articles

First clinic experience: patient selection and outcomes for ostial dilation for chronic rhinosinusitis

To report outcomes for subjects undergoing balloon dilation in either the operating room (OR) or the clinic and define criteria to identify suitable candidates for local anesthesia procedures. Subjects with medically refractory chronic rhinosinusitis (CRS) underwent de novo surgery via transantral balloon dilation of the maxillary sinus ostium and ethmoid infundibulum. Concomitant nasal or endoscopic sinus surgeries were contraindicated. Technical success, surgical parameters, and long-term outcomes were evaluated through 12-month follow-up. Seventy-one subjects underwent balloon dilation and 94% completed follow-up through 12 months. A total of 132 maxillary ostia were targeted for treatment and 129 were successfully dilated (98%). Almost one-half (33) of the procedures were performed in the OR under local anesthesia with intravenous sedation. Average balloon procedure times for unilateral and bilateral treatment were 28.3 ± 21.1 and 40.2 ± 17.7 minutes, respectively. Thirty-three ostial dilations in 19 subjects were attempted in the clinic. Each ostium was successfully accessed and ballooned under local anesthesia. Patient tolerance was very good with an average self-reported pain level of 2.7 (2 = hurts a little bit) out of 10. Each subject was discharged within 2 hours of the procedure and there was no postoperative bleeding. Symptomatic improvement of the clinic subgroup at 3, 6, and 12 months postprocedure was statistically significant (p ≤ 0.0012) and clinically meaningful and similar in magnitude to improvement seen across all subjects regardless of site of service. Transantral balloon dilation can be performed safely in the clinic and operative settings with symptom improvement sustained through 1 year.

Outcomes of middle meatal antrostomy after different surgical strategies

Conclusion: There was no significant difference in the postoperative outcomes between different surgical options for treating chronic maxillary sinusitis (CMS). Objective: We aimed to compare the improvement in symptoms, and changes in endoscopic and CT grade in patients undergoing different surgical management of the maxillary sinus ostium. Methods: In 32 patients (group A), the pathologic mucosa was radically removed with a power microdebrider. In 28 patients (group B), only part of the pathologic mucosa was removed; gross pathologic lesions were left in situ. In 38 patients (group C), only enlargement of the maxillary ostium was performed. Pre- and postoperative changes in symptoms, endoscopic polyp grade, and Lund-Mackay CT score were compared between groups. Results: In all groups, the symptoms were significantly improved after 1 month and throughout the follow-up period. Patients in groups A and B had meaningful improvement of the endoscopic polyp grade 1 month after surgery. The endoscopic grade of patients in group C at 1 and 3 months after surgery was not significantly different from the preoperative grade; however, there was a meaningful difference after 6 months. At 12 months after surgery, all groups had a significant decrease in the CT score (p < 0.01); however, there was no difference between groups.

Prevalence of pathologic findings in the maxillary sinus in cone-beam computerized tomography

The aim of this study was to assess the prevalence of pathologic findings in the maxillary sinus by using cone-beam computerized tomography (CBCT). One thousand twenty-nine consecutive CBCT scans were retrospectively inspected for pathologic findings in the maxillary sinus by 3 observers. Findings were differentiated by mucosal thickening, partial opacification with liquid accumulation, total opacification, and polypoidal mucosal thickening. Position and diameter of the maxillary sinus ostium were assessed. Correlations for pathologic findings and the factors of age and gender were calculated. Patients with clinical manifestations of sinusitis or total opacification in either sinus were reevaluated. A total prevalence for pathologies in the maxillary sinus of 56.3% was found in this study. The most frequent pathology was mucosal thickening. Patients >60 years of age showed significantly more pathologies in the maxillary sinus (P = .02), and male patients showed significantly more pathologies than female patients (P = .01). Clinical signs of sinusitis could be confirmed on CBCT images for all patients. Pathologies in the maxillary sinus are frequently found in CBCT imaging and have to be treated or followed-up accordingly. CBCT is applicable for diagnosis and treatment planning of clinically present sinusitis.

Impact of chronic rhinosinusitis on work productivity through one‐year follow‐up after balloon dilation of the ethmoid infundibulum

Although multiple clinical trials have demonstrated that balloon dilation of sinus ostia in patients diagnosed with chronic rhinosinusitis (CRS) results in sustained symptomatic improvement, less data are available to measure the effects of sinusitis on worker productivity. The objective of our research was to analyze work and activity impairment before and after transantral, endoscopically-guided balloon dilation of the maxillary sinus ostia and ethmoid infundibulum. Subjects diagnosed with CRS and computed tomography (CT) evidence of disease in the maxillary sinuses alone, or maxillary and anterior ethmoid sinuses, completed the Work Productivity and Activity Impairment (WPAI) questionnaire and the Work Limitation Questionnaire (WLQ) before treatment and at 3, 6, and 12 months postprocedure. A total of 56 subjects were enrolled and 53 completed the 1-year follow-up. The lost productivity composite score computed from the WLQ improved by 73% (9.0 to 2.4; p < 0.0001) at 1-year follow-up whereas lost productivity at work as measured by the WPAI improved by approximately 76% (38.3 to 9.2; p < 0.0001) 12 months after treatment. These results indicate that sinus-related health problems impose a substantial burden on work productivity and physical/mental activity levels. Treatment of CRS by dilating the maxillary sinus ostium and ethmoid infundibulum can significantly improve quality of life (QOL) and work productivity.

Antral computerized tomography pre-operative evaluation: relationship between mucosal thickening and maxillary sinus function

to assess the correlation between maxillary sinus inferior mucosal thickening and sinus outflow obstruction. the study included 280 computerized tomography (CT) scans (560 maxillary sinuses). CT aimed to assess sinusitis; trauma to the face and intubated patients were excluded. Mucosal thickening was graded as < 5 mm (1), < 10 mm (2), < 15 mm (3), < 20 mm (4) and > 20 mm (5), and classified by appearance as normal, rounded, circumferential, irregular, or complete. Maxillary sinus outflow was classified as patent or obstructed. mucosal thickening was found in 36.1% of the maxillary sinuses, graded as 31.2% (1), 34.2% (2), 12.9% (3), 5.4% (4) and 16.3% (5), and classified as rounded (11.8%), irregular (10.4%), circumferential (8.8%) and complete (5.2%). Sinus outflow was obstructed in 15% of the scans. Mucosal thickening of < 5 mm (11.1%), < 10 mm (36.2%) and > 10 mm (74.3%) was associated with sinus obstruction (P<0.0001). Rounded (6.1%), circumferential (55.2%), irregular (38.8%) and complete (100%) mucosal appearances were associated with sinus obstruction (P<0.001). When statistically combined, a substantial risk for sinus obstruction was observed with irregular mucosal appearance of > 5 mm (56.5% for grade 2 up to 82.6% for grades 3-5) and circumferential appearance (21.4% for grade 1 up to 100% for grades 3-5). A low risk for obstruction was found with the rounded appearance (mean 6.1%). irregular (> 5 mm), circumferential and complete mucosal appearance are associated with an increased risk for sinus outflow obstruction and an ENT consultation is recommended. A rounded mucosal appearance of any grade is associated with a low risk for sinus obstruction. Routine CT scans, including the maxillary sinus ostium, are recommended.

The Location of Maxillary Sinus Ostium and Its Clinical Application

The endoscopic sinus surgeons must have a detailed knowledge of inconsistent location of maxillary sinus openings in any interventional maxillary sinus surgeries as it relates to the orbital floor, ethmoid infundibulum and the nasolacrimal duct. Forty cadaver head and neck specimens had been cut sagittally through the nose, such that the lateral nasal wall had been preserved. The findings were documented with an emphasis on location of the maxillary sinus openings. In the present study maxillary sinus ostium opened more commonly into posterior third of the hiatus semilunaris. Accessory maxillary ostium was another variation seen in nearly three-fourths of the cases which opened into membranous meatus inferior to the uncinate process.

A Case of Maxillary Sinusitis after Sinus Floor Augmentation

Sinus floor augmentation is essential for successful dental implantation in patients with alveolar bone height less than 10 mm. However, maxillary sinusitis has been reported to occur in 8-20% of patients after sinus floor augmentation. We present a case of maxillary sinusitis due to seques-trum of bone cement fragment into the maxillary sinus ostium after sinus floor augmentation.

Technique and Results of the Anterior-to-Posterior-to-Anterior Approach in Revision Endoscopic Sinus Surgery

Objective: To perform the anterior-to-posterior-to-anterior technique in revision endoscopic sinus surgery, and to assess the effects and safety of this technique in treating recurrent chronic sinusitis and nasal polyps. Methods: One hundred and thirteen patients with recurrent chronic sinusitis and nasal polyps received anterior-to-posterior-to-anterior revision endoscopic sinus surgery. This surgical technique has 5 important steps, including exposing the choana, enlarging the maxillary sinus ostium, opening the sphenoid sinus and posterior ethmoid sinus anteriorly to posteriorly, resecting the ethmoid sinus posteriorly to anteriorly, and opening the frontal sinus posteriorly to anteriorly. The choana, maxillary sinus ostium, middle turbinate remnant, and the roof and lateral wall of the sphenoid sinus are 4 stable anatomic reference points. Results: Twelve months postoperatively, the mean SNOT-22 score had improved by 18.48 and 100 (88.50%) patients had an improvement in nasal obstruction; thick nasal discharge, loss of smell or taste, and facial pain/pressure improvements were noted in 102 (90.27%), 64 (56.64%) and 76 (67.26%) patients, respectively. Postoperative endoscopic evaluation after 12 months indicated that 29 (25.66%), 12 (10.62%), 5 (4.42%), 6 (5.31%), and 2 (1.77%) patients had mucosal edema, nasal discharge, synechiae, polyps, and crusting, respectively. No severe complications were observed. Conclusion: The anterior-to-posterior-to-anterior technique is an effective and safe approach to revision endoscopic sinus surgery. The 4 stable anatomic reference points are helpful for preventing severe complications in total ethmoidectomy.

Revision endoscopic sinus surgery in children

Revision endoscopic sinus surgery (ESS) in children is uncommon. Causes of failure, however, are not very well delineated. The purpose of this study was to evaluate surgical causes of failure in children after ESS. A retrospective review of children who had ESS at a tertiary children's referral center between 1993 and 2005 for chronic rhinosinusitis. ESS was performed on 243 children. Children with cystic fibrosis, immune deficiency/suppression, and ciliary abnormalities were excluded because the reasons of failure in those children are well known. Data were available on 176 children with at least one year of follow-up. Twenty-three (13%) children required revision. The most common finding was adhesions in 57%, followed by maxillary sinus ostium stenosis or missed maxillary sinus ostium in 52% of the cases. In 39% of the cases, there was recurrent disease in the sinuses that were operated on initially. Interestingly, however, we found that in 26% surgery was needed because of disease that was present in nonoperated sinuses during the primary ESS. A deviated septum and a mucocele were the cause of failure in 17% and 13% of the patients, respectively. Presence of asthma and younger age contributed to the failure in some of these children. Adhesions and a scarred, narrow maxillary sinus ostium were the most common cause of failure in children after ESS. Steps taken during surgery may be required to help reduce the need for revision in particular for younger asthmatic children. Laryngoscope, 2009.

Surgical anatomy of the nasolacrimal duct on the lateral nasal wall as revealed by serial dissections

The anatomy of the nasolacrimal duct (NLD) in relation with the lateral nasal wall was studied in 15 half-heads of human adult cadavers by serial photographs of the dissection of the lateral nasal wall. The aim of the study was to determine the intranasal anatomical relationships of the NLD with the lateral nasal wall for surgical reference during endoscopic dacryocystorhinostomy. Following removal of the nasal mucosa anterior to the uncinate process, the exposed bone was removed by drilling. The entire NLD was exposed intranasally. The relationships of the NLD with the maxillary sinus ostium and anterior nasal spine were determined, and the length of the NLD was measured. The morphology of the NLD opening was observed, and its distance from several landmarks were measured. There were three types of intranasal orifice: pin-point, triangular and slit-like. The NLD is located, on average, 24.6 +/- 3.56 mm posterior to the anterior nasal spine. The nearest distances between the opening of the NLD and the nasal floor and between the opening of the NLD and the most anterior attachment of the inferior nasal concha were 13.7 +/- 3.15 and 14.3 +/- 2.05 mm, respectively. The length of the NLD was 21.9 +/- 2.03 mm on average. The nearest distances between the NLD and the maxillary sinus ostium was 3.9 +/- 0.88 mm. Cadaver dissections and the photographs of the fine dissections provide a more accurate description of the lateral nasal wall anatomy. These data provide valuable anatomical information to the surgeon performing endonasal dacryocystorhinostomy.

Outfracture of the Inferior Turbinate: A Computed Tomography Study

BACKGROUND: Various surgical treatment modalities are available for inferior turbinate (IT) hypertrophy. Each is related with well-established complications, but still there is a lack of consensus on the optimal technique. Outfracture of the IT is thought to be a minimal destructive procedure among all other reductive turbinate interventions. Our aim was to assess the long term effects of IT outfracture technique in patients with mild or moderate IT hypertrophies. METHODS: Twenty ITs in 10 patients were outfractured during a septoplasty procedure. The distance of the IT bone to the lateral nasal wall was compared at 3 different levels of the nasal passage before and after (at 9 months) surgery with computed tomography scans of each patient at (1) the first section in which the IT bone could be seen entirely (anterior portion), (2) the level of the maxillary sinus ostium (middle portion), (3) the last section in which the IT bone could be seen entirely (posterior portion). RESULTS: A statistically significant degree of lateralization was observed at all levels in all patients. The mean lateralization rates were 15%, 26%, and 23% for the right side, and 26%, 29%, and 25% for the left side at first, second, and third levels, respectively. There was no bleeding, edema, or crusting due to the outfracture procedure in any patient. CONCLUSIONS: Our results suggest that outfracture of the IT is an effective and durable technique, which can be performed easily to enlarge the nasal airway in mild and moderate IT hypertrophies with minimal morbidity.

Mucosal Eosinophils and L-Selectin Ligands are Associated with Invasive and Noninvasive Sinus Surgery Outcomes

Chronic rhinosinusitis (CRS) is characterized by persistent inflammation of the nasal and paranasal mucosa with numerous emigrated leukocytes. L-Selectin on leukocytes and its endothelial glycosylated ligands initiate leukocyte infiltration into inflamed tissues. Endoscopic sinus surgery (ESS) is the major approach for restoring sinus physiology after failure of conservative therapy; however, the effect of enlarging the maxillary sinus ostium is still unknown. Here, we compared two histological markers of local inflammation, the number of mucosal eosinophils, and the expression of endothelial L-selectin ligands, with clinical outcomes after enlarging or saving the maxillary sinus ostium. Twenty-three patients with CRS underwent uncinectomy on one side and additional middle meatal antrostomy on the other side. Maxillary sinus mucosa biopsy specimens from these patients and nine healthy subjects were taken for immunohistochemical evaluations of the number of mucosal eosinophils and endothelial L-Selectin ligands. Also, symptoms and mucociliary clearance were measured. The postoperative reduction of the endothelial L-Selectin ligands was independent of the operation technique. There was a correlation between postoperative number of mucosal eosinophils and symptom score, which was also independent of the surgical technique. The postoperative decrease of mucosal eosinophils, as well as the correlation of the intraoperative eosinophils with the postoperative symptom score, was found only on antrostomy side. ESS decreases the expression of endothelial L-Selectin ligands, which might lead to decreased eosinophil traffic into maxillary sinus mucosa, putatively more when enlarging the maxillary sinus ostium. Both intra- and postoperative low number of eosinophils seem to be indicators of good subjective recovery.

Medial fracturing of the inferior turbinate: effect on the ostiomeatal unit and the uncinate process

It is apparently a common practice to fracture the inferior turbinate medially and superiorly to facilitate the fenestration of the inferior meatus, and to fracture medially and lateralize the inferior turbinate during turbinoplasty. However, it is also known that medial fracturing of the inferior turbinate may induce lateral displacement of the uncinate process. We investigated medial fracturing of the inferior turbinate to see whether it had any effect on changing the position of the uncinate process. A retrospective study was done on 23 patients who underwent medial fracturing of the inferior turbinate during submucosal turbinoplasty or turbinectomy from January 2004 through September 2006. By analyzing ostiomeatal-unit computed tomography, we measured the angle of the uncinate process, the minimal width of the ethmoid infundibulum, and the size of the maxillary sinus ostium. The angle of the uncinate process was 14.19-32.45 degrees , the minimal width of the ethmoid infundibulum was 0.61-2.45 mm, and the size of the maxillary sinus ostium was 2.14-6.77 mm. After the surgery, the angle of the uncinate process was 15.56-32.51 degrees , the minimal width of the ethmoid infundibulum was 0.53-2.52 mm, and the size of the maxillary sinus ostium was 2.18-7.01 mm. Pathologic change in the ostiomeatal-unit was not observed for an average period of 14.9 months (range 10.3-21.8 months) follow-up period. Our report suggests that the medial fracturing of the inferior turbinate does not alter the position of the uncinate process and the size of the maxillary sinus ostium. Clinically, it does not seem to affect normal physiology of the sinus function nor does it cause sinusitis.

Imaging anatomy of the infraorbital ethmoid cells on multislice CT

Objective To study the anatomic characteristics of the infraorbital ethmoid cells on muhislice CT(MSCT)and explore the relationship between the infraobital ethmoid cells and mueosal swelling of sinuses.Methods Two hundred sixty patients(520 sides) of consecutive axial scans by GE HisDeed VCT and the multiplunar reformation(MPR),virtual endoscopy(VE)reconstruction images by GE AW 4.2 workstation were reviewed retrospectively.The following CT features were assessed:(1)the anatomic characteristics of the infraobital ethmoid ceils,including the frequency of identification,origin,classification.(2)presence of mucosal swelling of sinuses,(3)the maximal transversal diameter of the inflraobital ethmoid cells in ostium of maxillary sinus(perpendicular to the uncinate process),and the diameter of the ostium of maxillary sinus,(4)presence of infraobital ethmoid ceils inflammatory findings and a contact between the mucosal surface of the ostium of maxillary sinus.The results were analyzed by using Chi-square test and logistic regression analysis with the statistical software SPSS 11.5.Results (1) UniLateral infraobital ethmoid cells were f10und in 68 patients(26.1%),and bilateral infraobital ethmoid cells were found in 81 patients(31.2%).Infraobital ethmoid ceHs were found in 230 sides on left Bide (120 sides)and right side(110 sides).(2)Infraobital ethmoid cells originated from the anterior ethmoid cells in 124 sides(53.9%)and from posterior ethmoidal cells in 62 sides(27%),originated from both the anterior ethmoidal cells and the posterior ethmoidal cells in 44 sides(19.1%).(3)The classification of the infraobital ethmoid cells included three types.Infraobital ethmoid cells with different origination differed significantly in theirtypes(x2=193.433,P 0.05).The maximal transversal diameter of the infraobital ethmoid cells in ostium of maxillary sinus did not differ significantly between the cases with or without mucosal swelling of sinuses(t=0.273,P>0.05).and the diameter of the ostium of maxillary sinus were not significantly related with mucosal swelling of sinuse8 (Wald=2.534,P>0.05).Presence of infraobital ethmoid cells inflammatory findings (Wald=10.817. P<0.01,OR=4.125)and a contact between the mucosal surface of the ostium of maxillary sinus (Wald= 6.640,P<0.01,OR=3.728)were significantly related to mucosal swelling of 8inuses. Conclusions (1)MSCT scan could clearly demonstrate the detailed information of infraobital ethmoid ceIIs.(2)The presence of infraobtial ethmoid cells Was not a risk factor for chronics sinusitis. When we assess inflraobtial ethmoid cells as a possible etiologic factor in chronics sinusitis we should observe presence of infraobital ethmoid cells inflammatory findings and a contact between the mucosal surface of the ostium of maxillary sinud. Key words: Ethmoid Sinus; Anatomy; Tomography.X-ray computed

The effect of maxillary sinus surgery on its development

Conclusion. The study showed that surgery in the maxillary sinus can affect its development. Objective. To quantitatively evaluate the long-term impact of sinus surgery on its development in the rabbit. Materials and methods. This was an experimental study performed at an academic tertiary medical center using 20 4-week-old New Zealand white rabbits. The rabbits underwent unilateral right maxillary sinus surgery. The contralateral maxillary sinus used as a control did not undergo the operation. The maxillary sinus ostium was enlarged on the operated side. Volumetric analysis of the maxillary sinus was performed 1 year post-surgery. The maxillary sinus volumes of both sides were calculated using Multidedector CT and the volumetric measurements of the operated side were compared with the non-operated side. Results. Maxillary sinus development was significantly reduced on the surgical side. Maxillary sinus growth on the surgical side was determined as 87% compared with the non-surgical side.

Progressive Maxillary Sinus Hypoplasia With Open Ostium

Maxillary sinus hypoplasia (MSH) is an uncommon clinical entity that represents a persistent decrease in sinus volume resulting from a centripetal retraction of the maxillary sinus walls. Pathophysiology of MSH is still controversial. Obstruction of the maxillary sinus ostium and negative pressure in the sinus has been mostly implicated in the development of MSH in most of the reported cases. We present a case of progressive unilateral MSH, which has an open ethmoid infundibulum and also presence of an open accessory ostium on the same side. Based on these findings, we propose that ventilatory dysfunction resulting from ostial obstruction alone cannot be accepted as the primary and sole etiologic factor in the pathogenesis of MSH.

The role of functional sinus surgery for treatment of antrochoanal polyp

Antrochoanal polyp (ACP) is a benign lesion which arises from the mucosa of maxillary sinus, fills it and expands through natural ostium towards choana protruding in the epipharynx. to present our experience in endoscopic surgery of ACP. prospective study included 24 patients operated at the Institute of Otorinolaryngology and Maxillofacial surgery, Clinical Center of Serbia, Belgrade, in the period 2002-2004. Subjective symptoms, endoscopic and CT findings were evaluated postoperatively, following up the patients in the period 12-20 months. Subjective difficulties of patients were tested by 100mm-analogue scale, while endoscopic and CT findings were demonstrated by three-stage scale from 0 to 2. Applying the technique of ACP extraction in Trendelenburg's position and approaching the part which protrudes in the epipharynx, we successfully removed the endonasal part by means of curved forceps for epipharyngeal biopsy. By endoscopic middle meatotomy, the natural ostium of maxillary sinus was expanded and pathological process from the very sinus was successfully removed. only one female patient had the majority of symptoms after the operation, while all others had no complaints. Endoscopic and CT findings were normal in all patients at the latest control, without any signs of ACP recurrence. There were no intraoperative or postoperative complications. minimal damage to sinus mucosa due to forceps is lesser problem than complications developed upon creating even the miniature opening in the canine fossa. Using this technique, a dexterous surgeon may successfully extract patho-logical process with minimal incidence of recurrence, and, more important, with no complications and maximally fast recovery of patients.

An Animal Model for the Study of Topical Medications in Sinusitis

Rhinosinusitis after functional endoscopic sinus surgery often is recalcitrant to conventional medical management. Topical therapies have been popularized as a method to deliver powerful medications to diseased mucosa while limiting systemic toxicity. The aim of this study was to develop an animal model that will provide objective data in studying the efficacy of topical medications and establish a platform for translation to human clinical trials. The maxillary sinus ostium of white rabbits was obstructed with a pledget through an antrostomy created in the anterior face of the maxilla. The sinus was inoculated with Pseudomonas aeruginosa (PAO1) and 7 days later the antrostomy was reopened, the ostial obstruction was removed, and a single lumen catheter was placed. Normal saline was irrigated through the catheter for 7 days in one group of rabbits while a control group received no irrigation. At the end of 7 days, the rabbits were euthanized, analyzed under light microscopy, and bacterial counts of the nasal lavage were determined. Sinusitis was confirmed in all rabbits 7 days after inoculation. Purulence, mucosal, and underlying bony inflammation persisted in both the control and the saline irrigation groups at study end. Nasal lavage bacterial counts were persistently elevated throughout the study period, indicative of bacterial viability. An animal model has been created for the study of topical medications in sinusitis. A novel catheter delivery system within an unoccluded maxillary sinus is described that will aid in efficacy studies of topical medications in the management of recalcitrant rhinosinusitis.

Paranasal Sinusitis Following Orbital Decompression in Patients with Graves' Ophthalmopathy

Purpose: To investigate the incidence, management, and outcome of paranasal sinusitis following orbital decompression in patients with Graves' ophthalmopathy. Design: Retrospective review study. Participants: A total of 144 patients received orbital decompression between December 1988 and October 2004. Ninety-four patients were available for follow up. Methods: We reviewed the clinical records of all patients who underwent orbital decompression and used telephone interviews. The orbital decompression operation we performed was transfornicial floor and transcaruncular medial wall and/or lateral wall decompression. If a patient had any symptoms associated with sinusitis, we would ask the patient to return to the hospital to have computed tomography (CT) scan examination and an ENT consultation. Results: Three patients were excluded because they had sinusitis before the decompression operation. Of the 91 remaining patients, 11 (12.1%) had definite diagnosis of sinusitis. Eight (72.7%) patients' symptoms subsided after antibiotics and 3 (27.3%) patients received FESS operation. Conclusion: The number of patients with sinusitis was higher than anticipated. Occlusion of the maxillary sinus ostium by prolapsed orbital contents was the most common cause of post-decompression sinusitis. Preventing prolapsed orbital contents from obstructing the maxillary sinus ostium or performing a wide middle meatal antrostomy during the initial operation can prevent post-decompression sinusitis.

Pólipo antrocoanal: uma revisão de dezesseis casos

INTRODUÇÃO: O pólipo antrocoanal ou pólipo de Killian é uma lesão polipóide solitária benigna, que acomete principalmente crianças e adultos jovens. Estudos demonstram que o pólipo de Killian representa entre 4-6% de todos os pólipos nasais da população em geral. Contudo, na população pediátrica, esta porcentagem atinge 33%. Origina-se de uma hipertrofia da mucosa do antro do seio maxilar próximo ao óstio e desenvolve-se, por estímulo desconhecido, através do óstio do seio maxilar para a cavidade nasal e em direção a coana e parte posterior da nasofaringe, podendo estender-se até a orofaringe. OBJETIVO: Avaliar o resultado do tratamento cirúrgico em pacientes atendidos no Serviço de Otorrinolaringologia do Hospital Universitário Walter Cantídio da Faculdade de Medicina da Universidade Federal do Ceará, principalmente em relação à técnica cirúrgica empregada e a eficácia de cada técnica no controle da doença. MATERIAL E MÉTODO: Trata-se de um trabalho retrospectivo, realizado através da análise dos prontuários dos pacientes submetidos à polipectomia por pólipos de Killian ou por outros pólipos nasais, atendidos no período de 01.03.1991 a 30.04.2001, no Setor de Otorrinolaringologia do Hospital Universitário Walter Cantídio da Universidade Federal do Ceará. RESULTADOS: Nove pacientes (56,6%) eram do sexo masculino e 7 (43,8%) do sexo feminino. Onze (68,75%) pacientes encontravam-se na faixa etária entre 8 e 20 anos de idade. Os sintomas predominantes foram obstrução nasal unilateral (81,3%) e rinorréia purulenta (43,8%). A cirurgia mais comumente empregada foi a abordagem combinada externa e endonasal em 87,5% dos casos. A cirurgia do pólipo antrocoanal correspondeu a 21,6% de todos os procedimentos cirúrgicos realizados no mesmo período para remoção de pólipos nasais. Houve uma taxa de recidiva pós-operatória de 12,5%. CONCLUSÕES: Pólipo antrocoanal foi uma afecção que predominou entre crianças e adultos jovens. O acesso combinado externo e endonasal foi a abordagem cirúrgica mais empregada. Apesar da abordagem da origem do pólipo no seio maxilar, há a possibilidade de recidiva pós-operatória.