Unilateral Sinus Research Articles

Endoscopic Sinus Surgery for the Treatment of Organized Hematoma of the Maxillary Sinus

Organized hematoma is a benign and non-neoplastic lesion, however, differential diagnosis from neoplastic diseases is always problematic, and patients are often forced to sustain excessive surgical invasion. We retrospectively studied the characteristics of imaging findings of organized hematoma of the maxillary sinus, and estimated the validity and effectiveness of endoscopic sinus surgery for the treatment of this disease. Three patients (2 men and a woman, ranging in age from 50 to 62 years) with organized hematoma of the maxillary sinus who underwent endoscopic sinus surgery were retrospectively analyzed. The diagnosis was provisionally made based on the findings of preoperative computed tomography (CT) and magnetic resonance imaging (MRI), and was confirmed by histopathological examinations of surgical specimens. CT revealed a well-defined expansile mass in the unilateral sinus associated with thinning and expansion of the medial sinus wall in all the cases. On contrast-enhanced images, patchy heterogeneous enhancement was observed. Intermingled low/intermediate/high signal intensity was seen on both T1- and T2-weighted MRI. The lesions were curetted via an endoscopic middle meatal antrostomy with the assistance of a microdebrider. None of the patients received arterial embolization or blood transfusion. Histopathological findings were consistent with those of organized hematoma. Their postoperative courses were uneventful, and all the patients are currently free from disease. We conclude that organized hematoma of the maxillary sinus can be successfully treated by endoscopic sinus surgery under accurate preoperative diagnosis and careful surgical planning.

Effects of Functional Endoscopic Sinus Surgery on Intraocular Pressure

To investigate whether functional endoscopic sinus surgery (FESS) for the treatment of chronic rhinosinusitis will induce changes in intraocular pressure (IOP). Prospective, nonrandomized, preoperative and postoperative study. University-affiliated medical center. Thirty patients who underwent FESS for chronic rhinosinusitis with or without polyps were prospectively enrolled in this study. Patients with diabetes mellitus, hypertension, glaucoma, previous ocular trauma, history of ocular surgery, and previous use of topical corticosteroid eyedrops were excluded. The IOPs were measured by Goldmann tonometry preoperatively, postoperatively on days 1 and 2, and on day 3 after the removal of the nasal packs. Physiological factors such as heart rate and systolic and diastolic blood pressures, which may have some effects on the IOPs, were also recorded. Ten women and 20 men with a mean age of 39.7 years were enrolled in the study. Twenty-one patients had bilateral chronic rhinosinusitis and 9 patients had unilateral sinus disease. The postoperative ocular discomforts were epiphora (13 of 30 [43%]) and eye pressure (6 of 30 [20%]). The mean +/- SD IOP of the eye on the side of the operated-on sinus was 13.63 +/- 2.33 mm Hg preoperatively. Postoperatively, the mean +/- SD IOPs were 14.08 +/- 2.52 mm Hg on day 1, 13.96 +/- 2.64 mm Hg on day 2, and 14.10 +/- 2.91 mm Hg on day 3 after removal of the nasal packs (P = .82). The IOP-related factors of heart rate and systolic and diastolic blood pressures also showed no significant difference. Although FESS may cause variations in the IOP compartment, the changes in IOP are not statistically significant. Therefore, FESS is a safe surgical procedure with respect to ocular physiological function.

Bacterial Infection in Chronic Rhinosinusitis: A Controlled Paired Analysis

The aim of this study was to determine if pathogenic bacteria are involved in the pathogenesis of chronic rhinosinusitis (CRS). A consecutive series of adult patients with unilateral sinus disease determined by unilateral radiographic involvement or unilateral purulent secretions was microbiologically studied. Aerobic and anaerobic bacterial and fungal cultures were obtained during endoscopic sinus surgery from purulent secretions or tissue culture. Positive culture rates were compared between the diseased sinus and the contralateral nondiseased (control) sinus to determine if pathogenic bacteria were more commonly recovered from the diseased sinuses. Forty-nine adult patients completed the study with appropriate microbiological data. Coagulase-negative staphylococci were the most commonly recovered bacteria followed by Staphylococcus aureus from the diseased side of the sinuses with similar findings for the control sinus. Bacterial species were recovered from 87.8% of the diseased side of the sinuses versus 85.7% from the control sinuses (p = 0.50). Reanalysis with coagulase-negative staphylococci considered as nonpathogen showed a 46.9 and 49.0% positive bacterial culture rate in diseased and control groups, respectively (p = 0.50). No significant difference in positive anaerobic culture rates were identified between groups (59.1% diseased versus 55.1% control, respectively, p = 0.61). Antibiotic resistance rates were no different between bacteria cultured from diseased sinuses versus control (p = 0.115). Both aerobic and anaerobic bacterial species may be recovered from both diseased and nondiseased sinuses in patients with CRS. These findings cast some doubt on the exact etiologic role of bacteria in CRS, suggesting other factors or other agents also may be responsible in CRS pathogenesis.

Unilateral Opacification of Paranasal Sinus CT Scans

The aim of study was to describe the histopathology in patients with unilateral sinus opacification and to identify variables that may predict neoplastic pathology. A retrospective review of paranasal sinus CT scans performed between 2000 and 2003 was conducted to identify patients with unilateral sinus opacification. Twenty-eight of 1118 CT scans showed unilateral sinus opacification. Twelve patients had neoplastic disease, 13 had inflammatory disease. Nasal discharge was more common in inflammatory than neoplastic disease (P = 0.009). A polyp or mass lesion was more common on nasendoscopy in neoplastic than inflammatory disease (P = 0.01). Bony erosion was only identified in malignant disease. A wide variety of pathologies present with unilateral sinus opacification on CT scanning. In our series, neoplastic disease was more associated with a visible polyp or mass lesion and less with nasal discharge. Bony erosion on CT scan was only seen in malignant disease. Histologic confirmation remains obligatory for diagnosis.

Routine histopathology in uncomplicated sinus surgery: Is it necessary?

To evaluate the incidence of occult pathology in routine, uncomplicated endoscopic sinus surgery, and to suggest guidelines for when to send specimens for histopathologic exam. Retrospective analysis of case records of 790 patients who underwent 868 endoscopic sinus surgeries at a tertiary care center from 1986 to 2003. Indications were chronic sinusitis, recurrent acute sinusitis, nasal polyposis, or combinations of these diagnoses. All cases were considered routine and did not involve preoperative suspicion of neoplasm or other complicating factors. Charts were reviewed for surgical indication, patient age, laterality of disease, history of prior sinus surgery, intraoperative suspicion of tumor, and final histopathology. In 868 cases of endoscopic sinus surgery, occult neoplasm was diagnosed in 2 patients (0.23%). In one patient, the initial surgery cured the lesion. Final histopathology of the remaining 866 (99.8%) specimens was consistent with inflammation and/or nasal polyposis. In 121 cases of unilateral sinusitis, none was positive for neoplasm. In 277 cases involving bilateral nasal polyposis and 13 involving unilateral polyposis, no neoplasms were found. Intraoperative suspicion of neoplasm occurred in 12 cases, with all specimens read as consistent with sinusitis and/or polyposis. Histopathologic review of every specimen obtained in routine sinus surgery for sinusitis and/or nasal polyposis is not indicated. Submission of specimen is indicated in routine cases when: 1) there is intraoperative suspicion of tumor, 2) unilateral nasal polyposis is present, 3) unilateral sinus opacification is present, and 4) additional diagnostic information is needed (eg, presence of eosinophils, fungal forms, etc.). Establishes a safe and reasonable standard of care, with potential cost savings and medico-legal ramifications.

Technique for in-office cranial bone harvesting

This is a report of a technique of cranial bone harvesting suitable for the outpatient setting. Bone scrapers are used for the harvesting of cranial bone shavings with the patient under intravenous sedation or general anesthesia. Graft volumes larger than that usually obtainable from intraoral sites and the tibia have been harvested utilizing this technique. In a series of 8 first patients, the largest volume of bone obtained was 14 cc with no complications related to the donor sites. These cases include the following types of pre-implant reconstructive procedures: large unilateral sinus grafting, bilateral sinus grafting/guided-bone regeneration of an entire alveolar ridge, inlay grafting of the alveolus, inlay grafting in association with distraction osteogenesis, subnasal grafting, alveolar cleft grafting, closure of large oroantral defects combined with sinus grafting, and grafting of an grossly atrophic mandible with simultaneous placement of dental implants via the submental approach. This is a safe bone harvesting technique providing an alternative source of autogenous bone graft.

Routine histopathology in endoscopic sinus surgery: Is it necessary?

Objectives: To evaluate the need for routine histopathologic review of specimens obtained in uncomplicated endoscopic sinus surgery, and to suggest guidelines for obtaining histopathology. Methods: We reviewed the medical records of 790 patients who underwent 868 endoscopic sinus surgeries at this institution from 1986–2003. Indications for surgery were chronic sinusitis, recurrent acute sinusitis, nasal polyposis, or combinations of these diagnoses. All cases were considered routine, had failed medical therapy, and did not involve preoperative suspicion of neoplasm or other complicating factors (eg, encephalocele, prior sinonasal malignancy/mass lesion, infections with extranasal complications). All cases were reviewed for patient age, indications, laterality of disease, intranasal anatomy in unilateral cases, history of prior ESS, intraoperative suspicion of tumor, and final histopathology. Results: In 868 cases of endoscopic sinus surgery in which pathology was sent, neoplasm was found in 2 patients (lymphoma, inverted squamous papilloma). Final histopathology of all other specimens (99.77%) was consistent with inflammation and/or nasal polyposis. In 121 cases of unilateral disease, none were positive for neoplasm. Neoplasm was suspected intraoperatively in 12 cases, with all specimens demonstrating sinusitis and/or polyposis. In 277 cases involving bilateral nasal polyposis and 13 involving unilateral polyposis, no neoplasms were found. Conclusions: Based on our data and a review of the literature, histopathologic review of all specimens obtained in routine sinus surgery for polyposis and/or sinusitis is not indicated. Histopathologic exam should be conducted when: 1) there is intraoperative suspicion of tumor, 2) unilateral polyposis is present, 3) unilateral sinus opacification is present, 4) additional diagnostic information is needed (e.g. cultures, staging).

Unilateral opacification of paranasal sinus ct scans

Objectives: CT scanning of the paranasal sinuses is a routine investigation for patients with sinonasal symptoms. The presence of unilateral opacification on CT scanning is regarded as suspicious and demands further investigation such as biopsy. We report our recent experience with unilateral opacification on CT. Methods: We reviewed all paranasal CT scans performed in our department from December 2000 to September 2003 to identify those scans with entirely unilateral opacification. Data from these patients were collected that included histology, presenting symptoms, evidence of bony erosion and endoscopic findings. These data were analyzed using Chi-Square and Fisher’s Exact tests where appropriate. Results: Of the 1118 scans performed in this period, we identified 28 patients with unilateral opacification. There were 20 male and 8 female with mean age 59.4 years (range 30 to 89). Twelve (42.9%) had neoplastic disease while 13 (46.4%) had inflammatory disease; no histology was available for 3 (10.7%). Of those with neoplastic disease, 6 (50%) were malignant. Patients with inflammatory disease were significantly more likely to complain of nasal discharge compared to patients with neoplastic disease ( P = 0.009). Likewise patients with neoplasia demonstrated a mass lesion on nasendoscopy more than those with inflammatory disease ( P = 0.01). Of the 6 patients with proven malignancy, 5 had evidence of bony erosion while no patients with benign neoplastic or inflammatory disease had bone erosion. Conclusions: A wide variety of conditions can present with unilateral sinus opacification on CT scanning although in our series the majority were benign. Patients with clinically visible mass lesions were more likely to have neoplastic disease. Bony erosion was only associated with malignant disease. Histological confirmation remains obligatory for diagnosis.

Histomorphometry of human sinus floor augmentation using a porous β‐tricalcium phosphate: a prospective study

Tricalcium phosphate (TCP) has been historically a well-accepted material for bone augmentation. We examined the use of a porous beta-TCP (100%) in a split mouth model for sinus floor augmentation. Five patients were treated bilaterally, receiving 1-2 mm-sized beta-TCP particles (Cerasorb) on one side (test side) and autologous chin bone particles on the other (control) side. Four other patients were treated with a unilateral sinus floor augmentation using 100% beta-TCP (no controls). Biopsies of the augmented sites were taken at 6 months. Histomorphometry measurements were carried out in order to quantify bone augmentation at test and control sides. The average bone volume (BV) formed in the augmented sinus at the control side was 41% (32-56%) and 17% (9-27%) in the test side when all nine patients were included (statistically significant, P=0.04). When only the five bilateral patients were included, mean BV of the test side was 19% (13-27%), which was also significantly different from the control side (P=0.009). Osteoid formation tended to be higher in the test side biopsies (1.3%) than in the controls (0.3%) (marginally significant, P=0.1), indicating ongoing bone formation in the TCP material. The amount of lamellar bone at the test side was less than half the amount in the control side, indicating that remodelling had only recently started in the TCP-augmented side. The resorption surface, however, did not differ significantly between the two sides. These histological results indicate that Cerasorb is an acceptable bone substitute material for augmentation of the maxillary sinus. Due to the osteoconductive, but not osteoinductive properties of this material, the rate of bone formation is somewhat delayed in comparison to autologous bone.

Impact of Resection of the Turbinates and the Lateral Nasal Wall on Particle Deposition

The aim of the investigation was to determine the influence of complete resection of the turbinates and the lateral nasal wall on nasal deposition of particulate matter with an aerodynamic diameter of 10 microm or less (pm10) and its relation to nasal patency and geometry. Retrospective study. Eight patients were enrolled in the study after unilateral sinus surgery for a unilateral inverted papilloma of the sinuses. Particle deposition from the inhaled and exhaled air was measured by means of a laser particle counter in the nasal valve area and the nasopharynx during nose-only breathing and nose-in, mouth-out breathing. The data on deposited fraction for the operated side were compared with the data for the untreated, healthy side. Rhinomanometry and acoustic rhinometry were performed. Particle deposition did not differ significantly between the operated and untreated sides of the nose at both detection sites. No correlation between the deposited fraction and rhinomanometric and rhinometric values was found. Radical resection of the turbinates does not seem to disturb particle deposition (pm10) measured in the nose to a significant degree. Factors other than impaction and sedimentation onto the mucosal surface of the turbinates seem to be sufficient for effective particle deposition after radical removal of the turbinates.

Histologic findings at augmented bone areas supplied with two different bone substitute materials combined with sinus floor lifting

This case report is focused on the histologic findings of bone tissue supplied with two different hydroxyapatites (HAs) used for maxillary sinus floor grafting in the same patient after various healing intervals. An insufficient unilateral sinus floor grafting with Bio-Oss biomaterial was followed by an additional grafting procedure with Algipore biomaterial performed 4 years later. Bone samples obtained during second-stage dental implantation contained the interesting combination of Bio-Oss, a bovine anorganic bone substitute, and Algipore, a porous algae-derived HA, in close vicinity, yet after different healing periods. Light microscopy exhibited satisfactory osseointegration of both grafting materials. However, Bio-Oss biomaterial showed no evidence of substantial remodeling after a healing period of 4.5 years. On the other hand, Algipore particles demonstrated signs of remodeling by being locally resorbed and partially replaced with newly formed bone already within 6 months.

Impact of unilateral sinus surgery with resection of the turbinates by means of midfacial degloving on nasal air conditioning.

One of the most important functions of the nose is the climatization of inspired air. The aim of the investigation was to determine the influence of radical sinus surgery with complete resection of the turbinates and the lateral nasal wall by means of midfacial degloving as treatment for inverted papilloma on the nasal humidification and heating of inspired air. Retrospective study. Humidity and temperature were measured in the nasopharynx during normal respiration by means of a miniaturized thermocouple device and a humidity sensor for continuous detection. Eight patients after prior unilateral sinus surgery by means of midfacial degloving for a one-sided inverted papilloma were enrolled into the study. The humidity and temperature data of the surgically treated side were compared to the values of the healthy side that was not surgically treated. Active anterior rhinomanometry and acoustic rhinometry were performed. At the end of inspiration, absolute humidity and temperature values in the nasopharynx were statistically significantly lower on the surgically treated side compared with the side that was not surgically treated. Radical sinus surgery with resection of the turbinates by means of midfacial degloving seems to disturb the climatization of the inspiratory air in the nasal cavity. Reduced absolute humidity and temperature may contribute to crusting, bleeding, and nasal dryness as frequent complaints of patients after aggressive sinus surgery with resection of the turbinates.

Clinical presentation of allergic fungal sinusitis in children.

To compare the differences in the clinical and radiographic presentation of allergic fungal sinusitis in children and adults. Retrospective chart and computed tomography review. The settings included a tertiary care children's hospital, adult academic private hospital, and academic affiliated county hospital. All patients with documented allergic fungal sinusitis who underwent computed tomography evaluation and had surgical treatment of their disease from 1988 to 1999 were included in the study. In total, 151 patients aged 5 to 75 years; 44 of these patients were less than or equal to 17 years of age (children) and 107 were greater than 17 years of age (adults). Main outcome measures included 1) the presence of obvious bony facial abnormalities on presentation, 2) bilateral or unilateral sinus disease on presentation, 3) the presence of asymmetrical disease on presentation, 4) the presence of bony extension on computed tomography scan, and 5) type of fungus present. Fifteen of 36 (42%) pediatric patients and 10 of 103 (10%) adult patients had obvious alteration of their facial skeleton (proptosis, telecanthus, or malar flattening) on presentation (P <.05). Proptosis was the most common facial abnormality in both groups and was seen more often in children (8 of 36 [22%]) than in adults (9 of 103 [9%]) (P <.05). Twenty-eight of 40 (70%) pediatric patients and 37 of 100 (37%) adult patients presented with unilateral sinus disease (P <.05). Thirty-five of 40 (88%) pediatric patients and 58 of 100 (58%) adults presented with asymmetrical disease (P <.05). Computed tomography scans showed that 10 of 40 (25%) pediatric patients and 23 of 100 (23%) adult patients had bony erosion with extension of disease into surrounding structures (P >.05). Cultures from both adults and children showed mainly Bipolaris and Curvilaria species in equal amounts (P >.05). Adults had a greater incidence of Aspergillus species. Presentation in pediatric patients with allergic fungal sinusitis is different from that in adults, with children having obvious abnormalities of their facial skeleton, unilateral sinus disease, and asymmetrical disease more often. Findings on computed tomography scan show an equal amount of bony erosion with extension of disease. The types of fungus cultured in the sinus cavities are similar in both groups.

Quantitative impact of pediatric sinus surgery on facial growth.

To quantitatively evaluate the long-term impact of sinus surgery on paranasal sinus development in the pediatric patient. Longitudinal review of eight pediatric patients treated with unilateral sinus surgery for periorbital or orbital cellulitis with an average follow-up of 6.9 years. Control subjects consisted of two groups, 9 normal adult patients with no computed tomographic evidence of sinusitis and 10 adult patients with scans consistent with sinusitis and a history of sinus-related symptoms extending to childhood. Application of computed tomography (CT) volumetrics, a technique allowing for precise calculation of volumes using thinly cut CT images, to the study and control groups. Paired Student t test analyses of side-to-side volume comparisons in the normal patients, patients with sinusitis, and patients who had surgery revealed no statistically significant differences. Comparisons between the orbital volumes of patients who did and did not have surgery revealed a statistically significant increase in orbital volume in patients who had surgery. Only minimal changes in facial volume measurements have been found, confirming clinical impressions that sinus surgery in children is safe and without significant cosmetic sequelae.

上顎洞血りゅう腫の３症例

We describe three cases of blood boils of the maxillary sinus that were suspected to be malignant tumors. The patients were a 27-year-old female, a 52-year-old male and a 24-year-old male. The chief complaints in all cases were unilateral nasal obstruction and nasal bleeding. CT examination showed that the tumors occupied the entire unilateral maxillary sinus, and expanded with maxillary bone thinning. Biopsies performed through the nasal cavity revealed the tumorous masses to be benign. Ultimately, the tumorous masses were surgically extirpated without any transfusion, and the histopathological diagnosis turned out not to be the more typical hemangioma, but rather so called blood boil.

Morphometry of paranasal sinus anatomy in chronic rhinosinusitis: a pilot study.

To test the null hypothesis that there is no relationship between anatomical variations around the ostiomeatal complex and a predisposition to chronic rhinosinusitis and to define such variations with increased precision. Case-control study of anatomical variations in diseased and normal sinuses. Eight homologous landmarks defining the ostiomeatal complex were located on coronal computed tomographic scans, and their x and y coordinates were digitized using image analysis. Ten patients with unilateral sinus disease and 10 subjects without sinus disease (scanned for facial pain) who were selected retrospectively by case-note analysis. Logistic regression showed that the only significant spatial change predictive of a person with rhinosinusitis was the vertical position of the middle turbinate (P=.04), although this was not confirmed by Wilcoxon testing (P>.10). When examined by sinus, however, the horizontal position of the uncinate process was more laterally placed in persons with rhinosinusitis (P=.01), confirmed on Wilcoxon testing (P=.04), but there was no significant difference when compared with sinuses in persons without rhinosinusitis. Our findings suggest that there are no anatomical differences within the ostiomeatal complex between patients with and without rhinosinusitis. Patients with rhinosinusitis, however, are more likely to develop it in the side with a more laterally positioned uncinate process. Further studies, with more patients and more advanced techniques, including thin-plate spline analysis, are indicated.

편측성 부비동 질환의 수술례에 대한 임상적 고찰

편측성 부비동 질환의 수술례에 대한 임상적 고찰

Unilateral right lower lip sinus associated with an ipsilateral cleft of the lip and palate

Unilateral right lower lip sinus associated with an ipsilateral cleft of the lip and palate

Carotid sinus reflexes during postural changes, naturally elicited fighting behaviour, and phases of sleep in the cat.

Reflex responses of mean blood pressure and of heart rate to either bilateral common carotid occlusion (CO) or unilateral carotid sinus dilatation (CSD) during rest and different behaviours have been compared in conscious cats. Unloading and loading the carotid sinus receptors elicited equal reflex responses both of mean blood pressure and of heart rate during control immobile behaviour (CO: +34 +/- 6 mmHg and +35 +/- 6 beats . min-1; CSD: -37 +/- 4 mmHg and -52 +/- 11 beats . min-1), standing on the hindlimbs (CO: +36 +/- 5 mmHg and +29 +/- 5 5 beats . min-1; CSD: -40 +/- 6 mmHg and -61 +/- 10 beats . min-1), fighting against an attacking animal (CO: +34 +/- 5 mmHg and +31 +/- 5 beats . min-1; CSD: -37 +/- 5 mmHg and -56 +/- 10 beats . min-1), quiet wakefulness (CO: +37 +/- 5 mmHg and +38 +/- 4 beats . min-1; CSD: -34 +/- 4 mmHg and -53 +/- 8 beats . min-1) and synchronised sleep (CO: +36 +/- 5 mmHg and +37 +/- 4 beats . min-1; CSD: -36 +/- 4 mmHg and -52 +/- 6 beats . min-1). Desynchronised sleep was associated with an identical response to CSD (-30 +/- 4 mmHg and -51 +/- 7 beats . min-1) but with a reduced (p less than 0.01) reflex response to CO (+18 +/- 3 mmHg These data indicate that carotid sinus baroreflexes largely maintain their ability to modulate pressure upwards and downwards when blood pressure has been reset at somewhat higher levels by standing and fighting and at somewhat lower levels by synchronised sleep. The selective depression of carotid occlusion responses during desynchronised sleep suggests a central or peripheral shift of the baroreflex stimulus-response curve or a selective central inhibition of the reflex response to baroreceptor unloading.

CT images of unilateral sinus lesions

Computed tomographic images of 49 cases of unilateral sinus lesions were examined, and 4 findings were obtained as follows;1) On the C. T. images of malignant tumors, detection of bone destruction was easy, but its early erosion was difficult.2) Fungus infections and papilloma of paranasal sinuses demonstrated bone thickness as well as destruction, and this finding would serve as a differential point from malignant diseases.3) From the C. T. values of soft tissue shadows in the maxillary sinus, it was impossible to differentiate malignant from benign lesions. However, a calcified or non-homogenous soft tissue shadow was seen only in cases of fungus infections and maxillary adenocarcinoma in malignant tumors, and it would be clinically a very important differential point.4) Many of the unilateral sinus lesions will prove to be indications for surgery, except acute and allergic sinusitis. The paranasal C. T. examinations should be performed if the case does not respond to a conservative therapy over a month, and a case showing bone destruction by the C. T. images would require an exploratory Caldwell-Luc operation.