Middle Meatal Antrostomy Research Articles

Endoscopic antrostomy in the treatment of odontogenic maxillary sinusitis - two cases report

Introduction. Maxillary sinusistis of odontogenic origin is a wellknown condition that occurs due to close relationship of the maxillary posterior teeth to the maxillary sinus. We presented two patients with symptoms and signs of chronic inflammation of the maxillary sinus of odontogenic origin. Case report. In both patients, after clinical examination, microbiological testing, skin prick tests to inhalant allergens, and endoscopy of the nasal cavity, we performed the cone beam computed tomography (CBCT) of paranasal sinuses, which showed thickening of the mucosal lining of the maxillary sinus. The mucosal oedema resulted in obstruction of the osteomeatal complex in both patients. The presence of a foreign body in the right alveolar recess in the first case and in the left osteomeatal complex in the second case were noticed. The both foreign bodies had densities similar to bone. The alveolar recesses in both cases were below the level of the nasal cavity floor. The patients were treated by endoscopic approach, a combination of lower and middle meatal antrostomy. The thickened mucous membrane was removed in the region of the osteomeatal complex, and then the foreign bodies were removed in both cases. Histopathological analysis proved that both foreign bodies were tooth roots. Conclusion. This case report show how be able to successfully surgically remove foreign bodies from the maxillary sinuses using endoscopic approach, a combination of both, lower and middle meatal antrostomy.

Endoscopic View of a Mucocele Obstructing a Middle Meatal Antrostomy

Congenital absence of the cartilaginous nasal septum has been reported just once in the literature. We present a case of a young child, diagnosed by exclusion, with complete agenesis of the cartilaginous septum. We believe it is only the second case worldwide, and the first in South Africa, to be reported.

The measurement of pneumatization of maxillary sinus extended into alveolar process basing on the CT and its clinical significance

Objective:To investigate the significance of pneumatization of maxillary sinus extended into alveolar process.Method:One hundred outpatients encountered were included in this study. The pneumatizations of maxillary sinus extended into alveolar process were observed and classified. Depth of surgical procedure of maxillary sinus in different type was measured.Result:The actual depth of surgical procedure of maxillary sinus of in different types of the alveolar process pneumatization varied greatly. The actual depth of surgical procedure of maxillary sinus in type Ⅲ pneumatization of alveolar process were (32.27±3.48)mm, which were significantly deeper than type Ⅱ (28.35±3.45)mm and type Ⅰ(20.73±3.09)mm (P< 0.05 respectively). Moreover, the actual depth of surgical procedure of maxillary sinus in type Ⅱ was also deeper than type Ⅰ(P< 0.05).Conclusion:The pneumatization of maxillary sinus extended into alveolar process can significantly affect the actual depth of the maxillary sinus in the operation of endoscopic middle meatus antrostomy, which may serve as a reference for the choice of endoscopic maxillary sinus approaches.

Chronic maxillary atelectasis and silent sinus syndrome: two faces of the same clinical entity.

Chronic maxillary atelectasis (CMA) and silent sinus syndrome (SSS) are rare clinical entities characterized by an implosion of the maxillary sinus that may or may not be associated with sinonasal symptoms, and are complicated by ipsilateral enophthalmos. The objective of this article is to discuss the definitions, physiopathology, clinical and radiographic characteristics, and surgical management of these entities. We retrospectively reviewed 18 patients (7 women, 11 men, aged 12-70years) diagnosed and treated in the ear, nose, and throat departments of four Belgian teaching hospitals between 2000 and 2015. Nine patients had a history of sinus disease. In all cases, a computed tomography scan showed downward displacement of the orbital floor, increased orbital volume, and maxillary sinus contraction. Five patients met the criteria for grade II CMA and 13 for grade III CMA. Four patients met the criteria for SSS. All patients underwent wide endoscopic middle maxillary antrostomy. There were no orbital complications and all patients experienced resolution or a dramatic reduction of their symptomatology. Only one patient asked for an orbital floor reconstruction to correct a persisting cosmetic deformity. Although CMA and SSS are usually regarded as different entities in the literature, we believe that they lie on the same clinical spectrum. Treatment for both conditions is similar, i.e., middle meatal antrostomy to halt or even reverse the pathological evolution and reconstruction of the orbital floor in the event of persistent cosmetic deformity.

Silent sinus syndrome and maxillary sinus atelectasis in children

ObjectiveSilent sinus syndrome (SSS) and chronic maxillary atelectasis (CMA) are unusual conditions having subtle symptoms with a possible progressive evolution. They are particularly infrequent in the pediatric population. Our objective was to review our experience with pediatric patients having SSS or CMA, and to review all cases involving patients under 14 years of age reported in the literature. MethodsA retrospective review of 6 patients diagnosed with SSS or CMA surgically treated from 2001 to 2014 was carried out. All cases reported in literature were reviewed. ResultsAll patients underwent functional endoscopic sinus surgery with an improvement in symptoms after surgery. Diplopia disappeared in two patients who presented with it and enophthalmos improved in all five patients presenting with it. Only one patient out of four presenting with headache had a persistence of the symptoms which were, however, milder than they had been preoperatively. Endoscopic examination demonstrated a reventilated maxillary sinus in all cases. A radiological examination at follow-up was performed in 5 cases and demonstrated a reexpansion of the maxillary sinus as compared to the contralateral side in all patients except one. None of the patients required an orbital floor reconstruction. Eleven similar cases reported in the literature were analyzed and compared. ConclusionEndoscopic uncinectomy and middle meatal antrostomy should be the treatment of choice for these conditions in patients presenting with enophthalmos and/or hypoglobus and symptoms related to it. Orbital floor reconstruction should be performed as a delayed procedure only in selected cases. Chronic maxillary atelectasis or SSS should be considered as a possible cause of persistent headache of unknown origin in pediatric patients.

Concurrent middle and inferior meatus antrostomy for the treatment of maxillary mucoceles.

Background and aimsThis study describes the technique of simultaneous middle and inferior antrostomy and outlines its usefulness in the management of maxillary mucoceles.MethodsThis is a retrospective review of 12 consecutive patients with isolated maxillary mucocele operated on by means of middle and inferior antrostomy technique. We describe the clinical picture, details of the surgical technique and outcomes.ResultsThere were 7 males and 5 females with ages ranging from 20 years to 65 years (mean 42 years). One patient had past trauma to the face and one had a long history of chronic sinusitis. Eight patients had undergone multiple previous sinus operative procedures including Caldwell-Luc approach. All patients underwent middle and inferior antrostomy without complications. Follow-up was between 12 months and 60 months (mean 36 months) with no recurrences to date.ConclusionIn conclusion the results of our small series support the worth of using middle and inferior antrostomy when dealing with maxillary mucoceles.

Nasosinusal polyposis revealing maxillary sinus mucocele

Mucocele is a benign pseudo-cyst formation that rarely develops in the maxillary sinus. Mucocele is secondary to various conditions having in common an inflammation and an obstruction of the sinus ostium. The latter may be primary but it is often secondary to a trauma, tumor, chronic inflammation. Diagnosis is based on imaging. CT scan is essential for assessing osseous changes and for planning endonasal surgery under endoscopic control. MRI allows to specify the relations of mucocele. Therapeutic management of these mucoceles should be based on mucocele marsupialization performed at the same time as the treatment of the local factor involved. We report the case of a 21-year old man with no pathological history presenting with bilateral nasal obstruction associated with anosmia. Clinical examination showed exquisite pain in the anterior maxillary sinus wall, bilateral nasal sinus polyposis and swelling at the level of the hard palate. CT scan of the facial skeleton showed a well-defined homogeneous hypodense mass with no enhancement, involving the entire left maxillary sinus associated with regular bone lysis of its walls and a bilateral opacification of ethmoid cells and nasal cavities. The patient underwent endonasal surgery and functional ethmoidectomy associated with intranasal middle meatus antrostomy allowing the marsupialization of the mucocele. The postoperative course was uneventful and not associated with recurrence.

Endoscopic Sinus Surgery in Acute and Chronic Pediatric Rhinosinusitis

Submit Manuscript | http://medcraveonline.com their quality of life [3]. Hence, the fact remains that some children, who do not respond to medical treatment, will be referred to the Otorhinolaryngologist, who, in turn, faces the problem of what to recommend. Part of the problem is lying upon the discrepancy in opinions between Otorhinolaryngologist and Pediatricians, regarding the indications for sinus surgery, especially in chronic cases, which can be frequently, summarized in the quote “in chronic sinusitis every effort should be made to avoid operative procedures” [4]. This discrepancy necessitates the least possible variance in the proposed treatment plan by the Otolaryngologist, and his/her adherence to the principles of evidence-based medicine in this domain also, disregarding any dogmatic views. With regard to acute rhinosinusitis, endoscopic sinus surgery is usually reserved for the management of pending or existing complications. Osteomyelitis of the anterior frontal plate (Pott’s puffy tumour) represents such a condition, and should be managed in the majority of cases with an endoscopic frontal sinusotomy (Draf 2a). The procedure should include uncinectomy and middle meatal antrostomy, and complete anterior and posterior ethmoidectomy using the lamina papyracea and skull base as landmarks. The agger nasi as well as any frontal sinus cells obstructing the frontal recess should also be removed [5]. Neurosurgical intervention for the drainage of a co-existing intracranial abscess should be performed in the same session as the endoscopic nasal drainage, when possible [5]. Orbital complications represent the most frequently encountered complications of acute rhinosinusitis, appearing approximately twice as often as the intracranial ones, and followed by osseous involvement (osteomyelitis) [6]. Surgical intervention, preferably endoscopic, is advocated in cases of documented subperiosteal or intraorbital abscess, reduced visual acuity or color vision, affected afferent pupillary reflex or inability to assess the child’s vision. In addition, progressing or not improving orbital signs (diplopia, ophthalmoplegia, proptosis, swelling and chemosis) after 48 hours of intravenous antibiotics, or even progressing or not improving general condition of the child during the same time period also represent indications for prompt surgical exploration and drainage [6]. The procedure usually includes uncinectomy and middle meatal antrostomy, and anterior ethmoidectomy. Skeletonization of the lamina papyracea following probing, and drainage of the subperiosteal or intraorbital pus collection are also required in case of respective abscess formation. By contrast, surgical drainage could be withheld in children aged between 2-4 years old or less with small (< 0.5-1 ml in volume) medially located subperiosteal abscess, demonstrating clear clinical improvement within 24-48 hours of intravenous antibiotics, no decrease in visual acuity, and no significant systemic involvement [7]. As far as chronic rhinosinusitis is concerned, it has become clear in the modern era of endoscopy and imaging that rhinitis and adenoid hypertrophy are not the only reasons of a runny nose in children, as in the majority of cases the sinuses are involved as well. Hence, chronic rhinosinusitis may often be overlooked. Irrespective of difficulties in diagnosis associated with the variability in the clinical presentation of chronic pediatric rhinosinusitis, and/or the frequent inability of children to reliably describe their exact symptoms, chronic rhinosinusitis may have a serious impact on children’s quality of life, and their respective health status.

The incidence of complications after prelacrimal recess approach versus endoscopic sinus surgery of maxillary sinus lesions

Aim of work The aim of the study was to evaluate the incidence of complications after prelacrimal recess approach (PLRA) and compare it with endoscopic sinus surgery for maxillary sinus lesions. Patients and methods This was a prospective study in which 20 patients were recruited between July 2013 and September 2015 from the otorhinolaryngology outpatient clinic of Kasr Al-Ainy Hospital, Cairo University. Patients with bilateral maxillary sinus lesions underwent endoscopic sinus surgery on one side and PLRA on the other side. Postoperative complications during 2-year follow-up were assessed. Results Two patients had epiphora at the PLRA side; one cured spontaneously, and the other was treated accordingly. Four patients had adhesions at the PLRA side, whereas two patients had adhesions at the middle meatal antrostomy side. Two patients developed numbness at the PLRA side, and one patient had persistent facial pain at the PLRA side. Intraoperatively there was excessive bleeding in three patients and an inferior turbinate destabilization in three patients at the PLRA side. Conclusion Our study demonstrated that, although PLRA is a minimally invasive technique, it still carries a risk for complications.

Endoscopic transantral and transnasal repair of orbital floor fracture with the ballooning technique, and classification and characterization of orbital floor fractures.

The level of difficulty during an endoscopic approach for an inferior orbital fracture depends on the fracture pattern and the presence of a ruptured membrane (orbital periosteum and sinus mucosa). The purpose of our study was to examine fracture patterns according to age group and to determine the relationship between the type of fracture and the type of membrane injury. We reviewed the records of 30 patients who, from 2006 to 2010, underwent endoscopic transantral and transnasal approach with a balloon catheter technique to repair orbital floor fracture. The procedure was done through middle or inferior meatal antrostomy and two small antrostomies made in the anterior wall of the maxillary sinus by using an endoscope and specially designed curved dissectors. There were 3 linear, 20 trapdoor-type and 7 blowout fractures. There was a tendency toward a higher incidence of linear fractures at younger ages and of blowout fractures in older patients. All linear fractures had rupture of both membranes, whereas both membranes were intact in 15 of the 20 patients with trapdoor fractures. Among blowout fractures, there was no membrane rupture in five and both membranes were ruptured in two patients. No patient reported diplopia after fracture repair. Rupture of the periosteum, which makes visualization and reduction of orbital tissue difficult for the surgeon during endoscopic repair of the orbital floor fracture, was observed in 3 of 3 linear fractures and 5 of 20 trapdoor fractures. We found that linear fractures were more common in pediatric patients. Care of pediatric orbital floor fracture requires particular caution.

Quantification of maxillary sinus accessibility via a middle meatal antrostomy.

To quantify maxillary sinus volume and mucosal surface area (SA) that is accessible endoscopically via a middle meatal antrostomy and to explore the financial implications of using multiple disposable instruments for this procedure. Eight cadaver maxillary sinuses configured with image guidance software were evaluated. In each sinus, a standard middle meatal antrostomy was created, through which curved microdebriders of 15, 40, 70, and 120° were placed. The SA and volume of the region accessible by each microdebrider tip was calculated. Mean maxillary sinus volume was 16.5 ± 2.5 cm(3) and mean SA was 31.0 ± 2.3 cm(2). The 15, 40, 70 and 120° microdebriders accessed an average of 10, 25, 41, and 66%, respectively, of the SA, and of 2, 9, 17, and 36%, respectively, of the volume. There was a trend toward improved accessibility of the superior half versus the inferior half of the maxillary sinus. When instruments of different degrees were combined to maximize accessibility, 81% of the SA of the sinus could be accessed. Microdebriders with increasing curvatures allowed for greater access of the maxillary sinus mucosa through an middle meatal antrostomy. No single microdebrider curvature or combination of curvatures reached the entirety of the maxillary sinus wall. Knowledge about the area of reach for these blades can lead to lower per procedure costs.

Endoscopic endonasal surgery in orbital decompression and orbital reconstruction

Objectiv The aim of this study was to clarify and evaluate the role and the outcome of endoscopic endonasal surgery in both orbital decompression and orbital reconstruction. Background Traditional external techniques are now known to reduce proptosis significantly, but have the disadvantage of cosmetic morbidity in terms of a cutaneous scar and a high incidence of postoperative complications. Recent advances in endoscopic sinus surgery have extended its applications beyond the nose to the orbit. Orbital decompression, drainage of subperiosteal abscess, optic nerve decompression, and orbital wall reconstruction are performed very safely and effectively by endoscopic intranasal surgery. Patients and methods Fifty-four patients indicated for endoscopic orbital decompression or reconstruction were divided according to the cause into five groups (20 infection, eight inflammatory, eight neoplastic, eight congenital, and 10 traumatic). Preoperative evaluations performed were history taking, physical examination, and computed tomography and MRI of orbit and paranasal sinuses. After creating an endoscopic wide middle meatal antrostomy dealing with the pathology causing extraconal orbital compression and in intraconal compression penetrate the lamina papyracea and periosteum until prolapsed fat fill the ethmoid sinus. Reconstruction was performed by removal of the fractured bone, extraocular muscle reposition with support using Foley's catheter in floor fracture and a silastic sheet with Merocel packing in medial wall fracture. Results There was significant proptosis reduction in all groups, especially in the infection group ( P P Conclusion Endoscopic nasal decompression of the orbit is a safe and effective approach for reducing proptosis and improving vision and ocular motility in cases of orbital compression, which include infection, inflammatory, neoplastic, congenital, and traumatic causes. Endoscopic intranasal reduction of the orbital floor with a Foley's catheter balloon and with a silastic sheet and Merocel packing of the medial orbital wall provided good functional results and definite advantages. Complications were limited.

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.

Variations of lamina papyracea position from the endoscopic view: a retrospective computed tomography analysis.

Accidental injury of lamina papyracea (LP) remains one of the most common complications reported in endoscopic sinus surgery (ESS) even in most recent studies. The purpose of this study was to categorize the LP position radiologically and from an endoscopic perspective. A total of 207 computed tomography (CT) scans (414 sides) including both diseased and control groups were retrospectively reviewed by 2 examiners. Inferior turbinate attachment to the lateral nasal wall and the inferior margin of the planned middle meatal antrostomy (MMA) were identified anteriorly. Position of LP in relation to the vertical line passing through MMA inferior margin was reported. LP was categorized to lie either within 2mm on either side of the MMA inferior margin (type I), more than 2mm medial to the MMA line (type IIa: 2 to 4mm; type IIb: >4mm), or more than 2mm lateral to the MMA line (type IIIa: 2 to 4mm; type IIIb: >4mm). Of the 221 sides in the control group, 69.7% were classified as type I, 24.9% as type II, and 5.5% as type III. Among the 193 diseased operated sides examined, 60.1% were classified as type I, 20.2% as type II, and 13.5% as type III. Weighted kappa coefficient showed good interexaminer reliability. Five sides (2.6%) in the case group had accidental LP penetration intraoperatively, 4 of them were type II and type III LP. This study improves surgeons' awareness of LP variations in the endoscopic field and can be of help for residents in training.

The role of the maxillary sinus on the voice.

The objective of the study was to determine the effect of the maxillary sinus on the voice. The prospective study was conducted at an academic secondary referral center. A prospective chart review of 43 patients (17 males, 26 females) who conducted a voice recording and survey before and 3 months after middle meatal antrostomy whose lesion was confined to the maxillary sinus. Subjective voice changes were surveyed using a questionnaire. After phonation [∧m ma: the Korean pronunciation of 'mother'], [Nu Na: the Korean pronunciation of 'sister'], we analyzed the nasal consonant [m] of [∧m ma] and nasalized vowel [a] of [∧m ma] and [a] of [Nu Na]. In the poll conducted, the change rates for males and females were 41.1 % (7/17) and 15.4 % (4/26), respectively; of the male patients, 85.7 % (6/7) felt that the sound quality was better and 14.3 % (1/6) that it was worse. However, all the female patients felt it was better. Among of the patients with an improved voice, reduced nasal sound was the most frequent observation. In an objective analysis, a tendency to lowered frequencies was observed for nasalized vowels after surgery. Significant differences were observed at second formant frequencies of [a] of [∧m ma] and first formant frequencies of [a] of [Nu Na] in female subjects (P < 0.005). Our findings indicated that the maxillary sinus plays a role in the modification of voice quality. Preoperative counseling is important for patients concerning expected changes in the voice after maxillary sinus surgery.

Long-term efficacy of inferior meatal antrostomy for treatment of postoperative maxillary mucoceles

PurposeTransnasal endoscopic marsupialization has replaced the conventional Caldwell-Luc operation for managing postoperative maxillary mucoceles. Inferior meatal antrostomy (IMA) may be an easier and more effective method than middle meatal antrostomy (MMA) because of anatomical and structural changes of the maxillary sinus. We evaluated the long-term efficacy and technical simplicity of both methods. MethodsThis study included 21 and 32 patients who underwent MMA and IMA, respectively. They were diagnosed with a unilateral postoperative maxillary mucocele, and medical records were reviewed for history, clinical presentation, radiographic findings, surgical intervention, complications, and outcomes. During follow-up, the size of the opening and stenosis or obstruction of the antrostomy site were evaluated. ResultsPreoperative symptoms and mean follow-up period were similar in both groups. All patients in the IMA group received the operation as planned, whereas in four MMA patients, the attempt to create an opening failed because of thick bones and anatomical changes from the previous operation; in these patients, IMA was performed. The opening remained large enough for ventilation and drainage between the mucocele and the nasal cavity in both groups. There were no major complications, such as profuse bleeding, wound infection, or orbital or nasolacrimal duct injury. ConclusionsAlthough both surgical procedures seem to be effective for managing postoperative maxillary mucoceles, IMA is easier to perform, and no instances of failure to create antrostomy openings occurred. We recommend IMA as the surgical technique of choice, but providing an opening of sufficient size is necessary to ensure long-term efficacy.

Variable extent of nasoantral window for resection of antrochoanal polyp: selection of the optimum endoscopic approach.

The aim of this study is to evaluate the long-term results of endoscopic sinus surgery in the treatment of antrochoanal polyps and the role of extending the middle meatal antrostomy on the expense of the inferior meatus in providing wide exposure and accessibility within the maxillary sinus to ensure complete removal of its antral portion. Thirty-six patients were reviewed. Two groups were identified: Group A including patients with antrochoanal polyps that were resected endoscopically through a classical wide middle meatal antrostomy and Group B which included those who underwent endoscopic removal via an extension of the antrostomy inferiorly through submucosal resection of the lateral bony skeleton of the inferior meatus. There were 13 female and 23 male patients with a mean age of 28 ± 9.4 years. The mean follow-up period was 20.4 ± 6.7 months. Six patients were recurrent after previous endoscopic surgery. Group A included 17 patients and the remaining 19 patients were assigned to Group B. Two patients from Group A developed symptomatic recurrence and were cured with revision extended antrostomy. Three patients showed endoscopic evidence of a developing cystic lesion within the maxillary sinus that was punctured through the wide antrostomy. Endoscopic resection is considered the main treatment modality of antrochoanal polyps. Modification of the technique through removal of the lateral bony skeleton of the inferior meatus with downward displacement of the inferior turbinate provided accessibility to the inferior and prelacrimal recesses of the maxillary sinus.

Usefulness of partial uncinectomy in patients with localized maxillary sinus pathology

PurposeConventional total uncinectomy may be unnecessary in localized maxillary sinus lesion. Partial removal of the uncinate process and middle meatal antrostomy would be sufficient to eradicate the pathological condition. Therefore, we aimed to evaluate the efficacy of partial uncinectomy versus total removal of the uncinate process in patients with localized maxillary sinus disease. MethodsIn total, 25 patients were assigned randomly to partial and total uncinectomy groups. Preoperative computed tomography established that all patients had localized pathology in the maxillary sinus. The lower half of the uncinate process was removed in the partial uncinectomy group, while the total uncinectomy group underwent the conventional surgery. Time required for the uncinectomy, healing period for the uncinectomy site, incidence of lamina papyracea or nasolacrimal duct injury, obstruction or stenosis of the frontal recess, and incidence of synechia formation in the middle meatus were compared between the groups. ResultsAll patients completed the follow-up and were included in the analysis. Surgical indications included chronic maxillary sinusitis, fungal sinusitis, antrochoanal polyp, and odontogenic sinusitis. Operation durations and healing periods were significantly shorter in the partial uncinectomy group. One patient had a minor injury to the lamina papyracea and two patients showed partial synechia formations in the total uncinectomy group. However, other parameters did not differ significantly between the groups. ConclusionsPartial uncinectomy may be useful in patients with pathological conditions confined to the maxillary sinus. Shorter operation duration, more rapid healing, and lower incidence of complications are advantages over a conventional total uncinectomy.

The role of local rotational flaps in minimizing sphenoidal and maxillary sinuses ostium stenosis

IntroductionThere are several reasons for endoscopic surgery failure; some of the major causes are adhesion formation and osteal stenosis. The commonest anatomic finding in revision endoscopic surgery is an obstructed or stenosed ostium. Adhesion and stenosis after surgery are usually due to scar tissue or granulation formation during the tissue recovery process. The patency and the size of the sinus ostium and limiting cicatricial fibrosis are two significant factors in the evaluation of a successful endoscopic sinus surgery. To limit the spontaneous closure rate; several methods were used to prevent re-stenosis of the sinuses ostium such as the application of mitomycin C which inhibits fibroblast formation after surgery, or placement of a stent or balloon catheter dilatation at the middle meatus. ObjectivesThe aim of this study is to evaluate the effect of local rotational flap insertion in maxillary and sphenoid sinus ostia in minimizing postoperative ostium stenosis. Study designA prospective study is done on 160 patients diagnosed as having chronic maxillary and/or sphenoid sinusitis patients who are divided into two equal groups, a study and a control group. All patients in the study group will undergo rotational flap coverage of the ostia and the control group arm will undergo middle meatal antrostomy and sphenoid ostium enlargement without flaps. ResultsSignificant reduction in re-stenosis rate after 9months of follow up. ConclusionMiddle meatal antrostomy and sphenoidotomy by this technique have a higher patency rate than the standard techniques after 9months of surgery.

Surgical management of paediatric chronic rhinosinusitis: review of 10 years' experience

To assess the outcome of children with chronic rhinosinusitis who were managed surgically, over a 10-year study period. From January 1999 to December 2008 inclusive, 136 children diagnosed with chronic rhinosinusitis underwent surgery following unsuccessful medical treatment. The operations ranged from adenoidectomy to functional endoscopic sinus surgery. The surgical procedures performed were: adenoidectomy (n=69), antral washouts (n=54), middle meatal antrostomy (n=82), endoscopic ethmoidectomy (n=66), nasal septal reconstruction (n=10), and inferior turbinate outfracture (n=23) or inferior turbinate reductions (n=55). Follow-up duration ranged from 6 months to 9 years (average 3.2 years). Three patients required revision surgery: adenoidectomy in two patients and adenoidectomy with turbinate reductions in another. This study demonstrates the benefits of focused surgical treatment for paediatric chronic rhinosinusitis. Surgical treatment can be an appropriate and effective option for children with chronic rhinosinusitis when medical management is unsuccessful.