Treatment Of Chronic Maxillary Sinusitis Research Articles

Surgically treated chronic maxillary sinusitis: Does the odontogenic etiology alone or in combination with a fungus ball matter?

PurposeTo determine whether odontogenic maxillary sinusitis, either alone (OMSw/oFB) or in combination with fungus ball (OMSwFB), is associated with specific clinical characteristics and treatment outcomes compared to non-odontogenic maxillary sinusitis. Materials and MethodsA retrospective cohort study was performed on patients who underwent surgical treatment for chronic maxillary sinusitis between 2013 and 2021. OMSw/oFB and OMSwFB patients, were selected as the study group, while patients diagnosed with non-odontogenic maxillary sinusitis (non-OMS) were enrolled as the control group. Predictor variables were OMSw/oFB and OMSwFB. Outcomes were clinical presentation, postoperative complications, and treatment outcome. Descriptive, bivariate, and multiple logistic regression statistics were calculated, and the significance level was set at P ≤ 0.05. ResultsThe sample included 200 patients with a mean age of 49.6 ± 20.1 years and 57.5 % were men. Of the 200 patients, 123 (61.5 %) had non-OMS, 55 (27.5 %) had OMSw/oFB, and 22 (11 %) had OMSwFB. Multivariate analysis showed that OMSw/oFB was associated with more successful treatment rates (OR = 8.19, p < 0.01), whereas OMSwFB was associated with a less favorable outcome (OR = 0.27, p = 0.03). Age was associated with an unfavorable outcome in both OMS groups (OR: 0.98, p = 0.03 and p = 0.03, respectively), but no significant associations with other outcomes were found. ConclusionThis study suggests that OMSwFB is a recalcitrant form of OMS associated with a higher risk of persistent symptoms and less favorable outcome. These patients should be informed about the challenging nature of the disease and closely monitored.

ОЦЕНКА ЭФФЕКТИВНОСТИ КОМПЛЕКСНОГО ЛЕЧЕНИИ ХРОНИЧЕСКИХ СИНУСИТОВ У ЖИТЕЛЕЙ ВЫСОКОГОРЬЯ

The purpose of this work was to study the clinical features of the course of chronic maxillary sinusitis in mountainous conditions, as well as the effect of the use of an immunomodulatory drug on the course of the disease. The effectiveness of the drug polyoxidonium was evaluated since it has not only an immunomodulatory effect, but also an antioxidant, which is very important in high altitude conditions. The study included 55 adults with chronic maxillary sinusitis: the main group consisted of 25 patients who were included in the complex therapy with polyoxidonium. The comparison group consisted of 30 people whose complex therapy did not include polyoxidonium. In the study, as criteria for assessing the effectiveness of therapy, the dynamics of symptoms of intoxication, symptoms of inflammation of the nose and sinuses, by the 3rd, 5th and 10th day of treatment, the duration of the fever period was evaluated. Comprehensive treatment of chronic maxillary sinusitis in residents of mountainous areas with the use of the drug polyoxidonium made it possible to reduce the severity of the symptoms of "Nasal discharge" and "Nasal congestion" in the early stages, to double the number of patients with no symptom of "Nasal discharge" by the 5th day therapy, it was possible to reduce the severity of the course of the infectious- inflammatory process.

ОЦЕНКА ЭФФЕКТИВНОСТИ КОМПЛЕКСНОГО ЛЕЧЕНИИ ХРОНИЧЕСКИХ СИНУСИТОВ У ЖИТЕЛЕЙ ВЫСОКОГОРЬЯ

The purpose of this work was to study the clinical features of the course of chronic maxillary sinusitis in mountainous conditions, as well as the effect of the use of an immunomodulatory drug on the course of the disease. The effectiveness of the drug polyoxidonium was evaluated since it has not only an immunomodulatory effect, but also an antioxidant, which is very important in high altitude conditions. The study included 55 adults with chronic maxillary sinusitis: the main group consisted of 25 patients who were included in the complex therapy with polyoxidonium. The comparison group consisted of 30 people whose complex therapy did not include polyoxidonium. In the study, as criteria for assessing the effectiveness of therapy, the dynamics of symptoms of intoxication, symptoms of inflammation of the nose and sinuses, by the 3rd, 5th and 10th day of treatment, the duration of the fever period was evaluated. Comprehensive treatment of chronic maxillary sinusitis in residents of mountainous areas with the use of the drug polyoxidonium made it possible to reduce the severity of the symptoms of "Nasal discharge" and "Nasal congestion" in the early stages, to double the number of patients with no symptom of "Nasal discharge" by the 5th day therapy, it was possible to reduce the severity of the course of the infectious- inflammatory process.

COMPLEX APPROACH TO TREATMENT METHODS OF CHRONIC MAXILLARY SINUSITIS AFTER COVID-19 IN PATIENTS WITH RESPIRATORY PATHOLOGY

The research aimedto introduce this unique natural remedy in the complex treatment of chronic maxillary sinusitis (CMS) in patients with chronic obstructive pulmonary disease. In dynamics of the carried out complex of treatment including therapy with the tablet. GA againstBT's background, a significant improvement of microcirculation and the degree of restoration of periodontal trophic disorders of the teeth was established.Key words:chronic sinusitis, chronic obstructive pulmonary disease, condition after COVID-19, glycerosin

Surgical Ciliated Cysts in Orthognathic Surgery.

Surgical ciliated cysts (SCC) are rare entities that were first described in the Japanese literature after treatment for chronic maxillary sinusitis. Classically associated with surgery to the maxillary sinus, they have also been reported in association with orthognathic surgery, bone grafting, and trauma. These lesions can develop from a few months up to several years after the surgical procedure. The authors report 2 new cases of SCC after a LeFort I osteotomy for class III dentofacial deformity correction. One of them presented with bilateral lesions and suffered from a recurrence after 5 years, 2 rare events associated with SCC.A review of the literature of the past 5 years was undertaken, in order to ascertain the reported time of follow-up and recurrence. A PubMed search retrieved a total of 15 articles with 17 cases reported. Nine cases were associated with orthognathic surgery, 4 with Caldwell-Luc procedures, 2 with sinus lift and 2 with trauma. The mean follow-up after removal of the SCC was of 8.6 months. Four cases did not specify the follow up time; 1 case was lost to follow-up. No relapses were reported.Like what happens with the primary lesion, a recurrence can take place several years after removal. It is the authors' opinion that adequate long-term follow-up must be granted for a timely diagnosis and treatment of relapsed SCC.

Multidisciplinary treatment of patients with chronic odontogenic maxillary sinusitis: A case series

Introduction. The treatment of chronic odontogenic maxillary sinusitis remains an important problem for medicine due to the presence of numerous available techniques, number of complex surgical approaches, performed by an ENT or maxillofacial surgeon or both. This study aims to analyse different methods of treatment of chronic maxillary sinusitis by several specialists for the choice of the optimal treatment technique. Outline of cases. We describe two clinical cases of multidisciplinary treatment of patients with chronic odontogenic maxillary sinusitis with the involvement of different specialists ? the ENT and the maxillofacial surgeon. One patient was treated with endoscopic technique, and other underwent classic open sinusotomy using local tissues and xenogenic collagen membrane for removing an oroantral fistula. For assessing the condition before and after the treatment, clinical examination and computed tomography were used. Conclusion. According to the results of our study, the endoscopic technique is the preferred method of treatment of patients with chronic maxillary sinusitis when there is no connection with the oral cavity. If an oroantral fistula is present, it is necessary to perform an open operation by a maxillofacial surgeon.

Irrigation of Maxillary Sinus through Middle Meatus versus Inferior Meatus: A Randomized Controlled Trial

Objective: To stimulate interest in irrigation of maxillary sinus through middle meatus and to compare this new technique of irrigation with antral wash through the inferoir meatus regarding it’s efficacy and complications. Methods: A total of 40 patients of chronic maxillary sinusitis or unresolved acute maxillary sinusitis were selected, 20 for middle meatus and 20 for inferior meatus irrigation, patients were randomly selected, middle meatal puncture was done by Karl Storz antrum sucker nozzle using 0 degree telescope and inferior meatus by Litzwiz antrum trocher and cannula. Any difficulties or complications were noted Results: The age of the patients ranged from 12-55 years, with mean age 34.9 years in middle meatal group and 38.7 years in inferior meatal group. There were 25 male and 15 female patients with male female ratio 1.67:1. No difficulties or any comlications were noted in middle meatus group whereas mispuncture, failure of puncture, haemorrhage and check swelling were noted in some patients of inferior meatus group. Conclusion: It is concluded that this new technique of puncturing the middle meatus is a safe, easy and effective procedure of irrigation of the maxillary sinus instead of antral wash out via the inferior meatus for the treatment of chronic maxillary sinusitis

Intraoral Dual Wavelength Laser Diode Therapy for Chronic Maxillary Sinusitis.

Chronic sinusitis is one of the most common chronic diseases involving different age groups. The different etiological factors and difficult diagnostic procedures contribute to misdiagnosis and chronicity of sinusitis. There is no standard treatment for sinusitis. Long term use of corticosteroids and antibiotics may lead to numerous adverse side effects. Laser therapy has been suggested as a non-invasive treatment for sinusitis. It has anti-inflammatory and antibacterial effects. When considering maxillary sinusitis, discharge tends to collect in the sinus base due to its anatomy and altered physiology. To improve penetration of laser into the maxillary sinus, intraoral laser at the vestibule depth of the maxilla may be more effective. Thirty-four patients with chronic maxillary sinusitis were assigned into two groups. All were assessed before and after treatment. Group A received laser radiation plus standard medical treatment and group B received medical treatment only. The treatment plan was performed in 12 sessions using a Diode laser with a wavelength of 810 nm and 980nm. The SNOT-22 questionnaire and Computed Tomography were used to evaluate patients. A p-value < 0.05 was considered statistically significant. Both groups showed a significant improvement in symptoms following treatment (p < .001), however, the laser therapy group demonstrated greater improvements for all variables in response to treatment as compared to the traditional treatment group (p < .001). Using high intensity intra-oral laser therapy with medical treatment is more effective than using medical treatment only for treatment of chronic maxillary sinusitis.

Evaluation of Odontogenic Maxillary Sinusitis with Cone Beam Computed Tomography: A Retrospective Study with Review of Literature.

Aim and Objectives:The purpose of this study was to describe the radiographic characteristics of odontogenic maxillary sinusitis as seen on cone beam computed tomography (CBCT) scans and determine whether any tooth or any tooth root, was more frequently associated with this disease.Materials and Methods:The present study included 500 CBCT images that included the entire maxillary sinus of both the sides in all the three planes. The modified classification of Abrahams and Glassberg was used to assess maxillary sinusitis of odontogenic origin. Furthermore, the proximity of the tooth root to the sinus floor, periapical pathology, and the septae within the maxillary sinus were also assessed.Results:In the present study, 1000 hemimaxillas were analyzed. Majority of the cases (74.9%) the apex of either tooth was touching the floor of the sinus. While 16.9% were in close relationship to the sinus while 8.2% of the cases, the apices were present within the sinus. Furthermore, in the present study, 38 of the total cases had an odontogenic cause of maxillary sinusitis, whereas 273 of them had a nonodontogenic cause, 96 have an undetermined cause, and the rest 593 cases had healthy sinus.Conclusion:The incidence of odontogenic sinusitis is likely under-reported in the available literature. The introduction of low-dose CBCT is particularly useful to establish a definitive diagnosis to augment in the treatment of chronic maxillary sinusitis of odontogenic origin.

Efficacy analysis on pediatric balloon sinuplasty via intubation in the treatment of chronic maxillary sinusitis of 98 cases

Efficacy analysis on pediatric balloon sinuplasty via intubation in the treatment of chronic maxillary sinusitis of 98 cases

Balloon sinuplasty as a present-day minimum invasion surgery method of treatment of the patients with chronic suppurative maxillary sinusitis

The article presents the literature and the authors’ own data on diagnostics of chronic suppurative maxillary sinusitis. The authors describe in details a method of balloon sinuplasty in the treatment of chronic maxillary sinusitis and present the criteria of selection of patients, short-term and long-term treatment results.

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.

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.

Functional endoscopic sinus surgery as an adjunctive treatment for closure of oroantral fistulae: a retrospective analysis

The objective of this study was to report results of functional endoscopic sinus surgery (FESS) for treatment of chronic maxillary sinusitis of dental origin in a series of patients with oroantral fistulae (OAF). Fourteen patients were treated by FESS and OAF closure by local flap. Data on severity of symptoms, diagnostic endoscopy, and coronal CT scan findings, as well as intraoperative course and complications, were recorded. The follow-up period lasted up to 2 years, comprising clinical examinations and control CT scans. All OAF healed uneventfully. All patients reported improvement in severity of sinusitis symptoms, which was confirmed through results of clinical examinations and control CT scans. No significant complications were recorded. No revision surgery was needed in any case. These results indicate that FESS, combined with OAF closure by buccal flap, might be an effective and safe option for treatment of selected cases of chronic odontogenic sinusitis with OAF.

FESS in the Management of Chronic Maxillary Sinusitis

Functional endoscopic sinus surgery (FESS) is the minimally invasive procedure to clear the disease process from nose and pansnasal sinuses like chronic maxillary sinusitis and to restore aeration and normal nutcocilliary function of sinuses. FESS has recently become a popular technique among the otolatyngologists of Bangladesh. The use of endoscope during FESS improves visualization, enables greater preservation of normal structures and reduces the necessity for wide exposure of operation fields. The result suggests that FESS is a safe and effective method in the treatment of chronic maxillary sinusitis. This study of 50 cases was done front January 2007 to December 2007 at Holy Family Red Crescent Medical College Hospital where FESS is routinely done for the management of chronic maxillary sinusitis. In this study, 76% (38) were completely free from symptom, 16% (08) improved, 4% (02) encountered recurrence of symptom and persistence of symptom observed in another 4% (02) cases. Most of the patients (62%) in this series of FESS were operated without facing any difficulties. Majority of the patients (94%) were released from the hospital within two days of FESS. No post-operative complication was found in 62% patients. FESS for inflammatory sinus diseases is now well established but one should be cautious about the complications associated with Otis technique.

Beidseitige, von infraturbinalen Kieferhöhlenfenstern ausgehende Choanalpolypen

We present the first reported case of simultaneously occurring bilateral antrochoanal polyps in a 49-year-old female patient, originated from previously performed inferior antrostomies as a treatment for chronic maxillary sinusitis. The antrochoanal polyps were removed by endoscopic surgery with combined approach through the inferior and middle meatal antrostomies. Microscopic analysis of the specimens showed benign inflammatory antrochoanal polyps. Follow-up appointment 6 months postoperatively showed patent antrostomies and no recurrence of the disease. Endoscopic treatment with middle meatal antrostomy is the recommended technique in most cases of antrochoanal polyps as the greater portion of the antral part of the polyp can be removed with the healthy antral mucosa left intact promoting epithelialization and mucociliary clearance of the antrum. Inferior antrostomy can be an additional part of the operation in selected cases.

Endoscopic Surgical Treatment of Chronic Maxillary Sinusitis of Dental Origin

Chronic maxillary sinusitis of dental origin (CMSDO) is a common disease that requires treatment of the sinusitis as well as of the odontogenic source. We present our surgical experience performing contemporary treatment of the odontogenic source and endoscopic sinus surgery (ESS) in patients with CMSDO. Seventeen patients with CMSDO underwent contemporary treatment of the odontogenic source and ESS. Five patients presented chronic oroantral fistula (OAF); 5 patients presented odontogenic cysts occupying the maxillary sinus; 2 patients had inflammatory cysts of the molars; 2 patients had maxillary sinus infection secondary to peri-implantitis; 3 patients had foreign bodies pushed through the root canal into the sinus. The first surgical step was the treatment of the odontogenic source. The second step was ESS with opening and calibration of the maxillary natural ostium. Foreign bodies were extracted from the sinuses through the endonasal approach. No major complications after ESS were observed. The average time for ESS was +/-25 minutes. Good distant results without symptoms and complete closure of the fistula were obtained in all patients. When significant sinus disease is found, an endoscopic approach to drainage in all of the involved sinuses can promote predictably successful closure of OAF. The endoscopic approach to chronic maxillary sinusitis of dental origin is a reliable method associated with less morbidity and lower incidence of complications.

Small and large middle meatus antrostomies in the treatment of chronic maxillary sinusitis

Objective The study goal was to compare the postoperative endoscopic appearance of the middle meatus antrostomy with symptomatic relief in patients undergoing endoscopic endonasal sinus surgery for chronic maxillary sinusitis. Study design We conducted a prospective randomized study encompassing 133 patients with chronic rhinogenic maxillary sinusitis who underwent endoscopic ethmoid surgery and middle meatal antrostomies. One of the tasks was to compare small-sized (less than 6 mm) antrostomies with large-sized (more than 16 mm) antrostomies in relieving the symptoms of chronic maxillary sinusitis. During follow-up an attempt was made to correlate endoscopic findings with symptomatic failure. Results We could not demonstrate a statistically significant correlation between the degree of improvement of the main sinusitis symptoms (obstruction, headache, and nasal discharge) and the postoperative size of the antrostomy. Nevertheless, persistent accessory maxillary ostia, scarring within the ethmoid were statistically significant predictors of poor surgical outcome. Conclusion We conclude from this study that the size of the middle meatal antrostomy has no influence on the outcome of endonasal surgery for chronic rhinogenic maxillary sinusitis.

An Assessment of Concentrations of Soluble CD4 and CD8 Receptors in Serum before and after Surgical Treatment in Patients with Chronic Maxillary Sinusitis

The aim of this study was to assess the concentrations of soluble CD4 (sCD4) and sCD8 receptors in serum of patients before and after surgical treatment of chronic maxillary sinusitis. We examined 57 patients, aged 20-63 years (mean age, 41 +/- 0.5 years), and divided them into four groups: group I, 14 patients with chronic maxillary sinusitis without allergy; group II, 15 patients with chronic maxillary sinusitis with allergy; group III, 16 patients with cyst of maxillary sinuses without allergy (control); and group IV, 12 patients with cyst of maxillary sinuses with allergy (control). The assay of sCD4 and sCD8 receptor concentrations was performed by means of enzyme-linked immunosorbent assay method. The concentrations of sCD4 and sCD8 receptors before and after 30 days of surgical treatment of maxillary sinuses were examined. In our studies the increase of concentration of sCD4 in groups I and II in comparison with the concentration in control groups were statistically significant. The differences between mean concentrations of sCD8 in groups I and II and in the control groups were not statistically significant. After surgical treatment of chronic maxillary sinusitis, a significant decrease in values of sCD4 and sCD8 in comparison with the results before surgical treatment suggest that the measurement of cell suppression product concentration can be used to assess the extirpation of the inflammatory process and the effectiveness of the operation method. Changes in concentration of sCD4 and sCD8 manifest activation or suppression of cells with particular receptor expression.

Chronic maxillary sinusitis of dental origin: is external surgical approach mandatory?

The study evaluated a minimally invasive endoscopic shaver-assisted technique for treatment of chronic maxillary sinusitis of dental origin. A retrospective multicenter chart review was performed at two clinics of all patients who had a diagnosis of chronic maxillary sinusitis of dental origin and were treated using the technique. The patients were divided into two main groups: patients with and without chronic oral antral fistula. Data from the patients were collected and analyzed. Seventy patients aged 16 to 62 years had surgery using the endoscopic technique. Thirty-nine patients presented with oral antral fistula of different locations, the most common being third molar fistula (26 cases). Foreign bodies were found in 21 sinuses, among them teeth roots (in 11), dental fillings (in 7), and packs (in 3). Fungal ball was found in six sinuses. The surgical technique included retrograde resection of the uncinate process, enlargement of the natural maxillary ostium posteriorly, and removal of the polyps and foreign bodies from the sinus through the middle meatal antrostomy window. Approach through the oral antral fistula facilitated additional access to the alveolar recess. Removal of polyps from the alveolar recess was performed using the microdebrider, which was introduced through the fistula under endoscopic control through the nasoantral window. The fistula was closed in two layers. Good results were obtained in all but four patients in terms up to 3 years. No complications occurred. Overall recovery rate after primary surgery was 94.7%. Endoscopic approach to chronic maxillary sinusitis of dental origin is a new, reliable method associated with less morbidity and lower incidence of complications.