[Complications of oral surgery of the maxillary sinus area. Plastic closure in combination with radical surgery of the sinus, sinus mucosa alteration].
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Maxillary Sinus↗
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[Complications during oral surgery in the region of the maxillary sinus. Closure of the maxillary sinus by plastic surgery in combination with radical operation modifying the mucosa of the maxillary sinus].
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Maxillary Sinus↗
Angiographic demonstration of coronary sinus thrombosis: a potential consequence of trauma to the coronary sinus.
Abnormalities of the coronary sinus are rarely encountered. A case is presented demonstrating for the first time the angiographic appearance of coronary sinus thrombosis. This may have been the result of surgical trauma during mitral valve replacement or inadvertent cannulation of the coronary sinus during right heart catheterization or pacemaker insertion. Although the clinical significance of coronary sinus thrombosis is uncertain, obstruction of coronary sinus blood flow should not be deleterious because of multiple anastomoses between the coronary sinus system and the anterior cardiac veins. Difficulty in cannulating the coronary sinus for physiologic studies should suggest the possibility of coronary sinus thrombosis, especially in patients who have undergone mitral valve replacement. This may be confirmed by observing the venous phase of selective left coronary arteriography. Finally, coronary sinus thrombosis may be important as a source of pulmonary emboli. The prevalence of this serious complication requires further study.
Bioprosthesis↗
High-density mapping of left atrial endocardial activation during sinus rhythm and coronary sinus pacing in patients with paroxysmal atrial fibrillation.
INTRODUCTION: This study was designed to record global high-density maps of left atrial endocardial activation during sinus rhythm and coronary sinus pacing. METHOD AND RESULTS: Noncontact mapping of the left atrium was performed in nine patients with paroxysmal atrial fibrillation undergoing pulmonary vein ablation procedures. High-density isopotential and isochronal activation maps were superimposed on three-dimensional reconstructions of left atrial geometry. Mapping was repeated during pacing from sites within the coronary sinus. Earliest left atrial endocardial activation occurred anterior to the right pulmonary veins in seven patients and on the anterosuperior septum in two patients. A line of conduction block was seen in the posterior wall and inferior septum in all patients. The direction of activation in the left atrial myocardium overlying the coronary sinus was different from the electrogram sequence in the coronary sinus catheter in 6 of 9 patients. During coronary sinus pacing, activation entered the left atrium a mean (SD) of 41 (13) ms after the pacing stimulus at a site 12 (10) mm from the endocardium overlying the pacing electrode. Lines of conduction block were present in the posterior wall and inferior septum. CONCLUSION: In patients with paroxysmal atrial fibrillation, lines of conduction block are present in the left atrium during sinus rhythm and coronary sinus pacing. Electrograms recorded in the coronary sinus infrequently correspond to the direction of activation in the overlying left atrial myocardium.
Adult↗
Sinus node recovery time and calculated sinoatrial conduction time in normal subjects and patients with sinus node dysfunction.
In 61 patients sinus node function was tested by programmed (sinoatrial conduction time, SACT) and overdrive atrial pacing (sinus node recovery time, SRT). In the control group (N = 20), mean sinus cycle length was 773 +/- 140.2 msec, mean absolute SRT 1044 +/- 215.8 msec [corrected SRT (CSRT) 270 +/- 112.5 msec; mean +/- SD] and calculated SACT was 82 +/-19.2 msec. The upper limit of normal SACT was defined as 120 msec. In 41 patients with sinus node dysfunction, mean age (55 +/- 14.7 years), mean spontaneous cycle length during the study (1094 +/- 248.0 msec), the lowest heart rate observed (42 +/- 7.5 beats/min), maximal SRT (2110 +/- 1269.1 msec), maximal CSRT (1016 +/- 1182.8 msec), and calculated SACT (126 +/- 47.3 msec) were significantly longer than in the control group. Abnormalities of sinus node function, as evidenced by the degree of spontaneous bradycardia, SRT and calculated SACT were more frequent in patients with bradycardia-tachycardia syndrome or spontaneous sinoatrial block than in those exhibiting isolated sinus bradycardia. We conclude 1) that in patients with sinus node dysfunction both sinus node automaticity and sinoatrial conduction may be abnormal, and 2) that overdrive and programmed premature atrial stimulation can separate patients with sinus node dysfunction according to their clinical presentation.
Adult↗
Histopathologic abnormalities of the sinus node compared with electrocardiographic evidence of sinus node dysfunction after the modified Fontan operation: an autopsy study of 14 cases.
Autopsy specimens from 14 patients who had undergone a modified Fontan operation were evaluated to correlate the extent of histopathologic disruption of the sinus node with electrocardiographic findings of sinus node dysfunction. Patients with sinus node dysfunction (n=7) and those without (n=7) were similar in age, complexity of cardiac malformation, and number of postoperative days at time of death. The degree of fibrosis, local hemorrhage, necrosis, lymphocytic infiltration, and focal calcification of the sinus node and perinodal tissue was also similar in both groups. These findings, which showed a comparable amount of sinus node disruption in patients with normal sinus rhythm and in those with sinus node dysfunction, indicate a lack of correlation between the extent of histopathologic abnormality of the sinus node and electrocardiographic evidence of sinus node dysfunction.
Journal Article↗
Coronal CT of the paranasal sinuses before and after functional endoscopic sinus surgery.
Coronal CT of the paranasal sinuses and the ostiomeatal complex (OMC) was performed before and 12 months after bilateral functional endoscopic sinus surgery (FESS) in 30 patients with sinusitis and 12 patients with nasal polyposis. The extent of sinus mucosal thickening was graded, and the patency of the OMC was evaluated. After FESS, the percentage of open OMCs had increased from 42% to 83% in the sinusitis group, and from 8% to 45% in the polyposis group. There was only a small improvement in mucosal score in sinuses with opened OMC, so that the overall extent of sinus opacification before and after FESS was almost the same. Despite this, 91% of the patients reported clinical relief of symptoms. Preoperative coronal CT of the paranasal sinuses serves as an anatomical map for the surgeon, but there is no benefit of routine postoperative CT.
Adult↗
Maxillary sinusitis in the surgical intensive care unit: a study using bedside sinus ultrasound.
PURPOSE: This study investigates the incidence of acute maxillary sinusitis (AMS) in the surgical intensive care unit (SICU). METHODS: One hundred consecutive patients admitted to the SICU were examined in a prospective observational mode. Bedside sinus ultrasound (SUS) was performed on admission and every 48 hours. Patients with sinus fluid by SUS and unexplained sepsis underwent confirmatory sinus aspiration. RESULTS: The development of fluid in the maxillary sinus was identified in 15 patients by SUS. Acute maxillary sinus occurred in only 1 (1%). CONCLUSION: This study shows SUS to be a simple, efficient method for determining the presence of maxillary sinus fluid in the SICU. Acute maxillary sinus was an unusual finding. Our policy of avoidance of nasal instrumentation may have contributed to the low incidence of AMS in this high-risk patient population.
Acute Disease↗
Intranasal immunization with outer membrane protein P6 and cholera toxin induces specific sinus mucosal immunity and enhances sinus clearance of nontypeable Haemophilus influenzae.
Nontypeable Haemophilus influenzae (NTHi) is one of the leading pathogens in sinusitis. One of the outer membrane proteins of NTHi, P6, is a common antigen to all strains and is an attractive candidate for a subunit bacterial vaccine. In this study, we characterized normal sinus mucosa (SM) and investigated the potential of intranasal immunization with P6 and cholera toxin (CT) for induction of mucosal protective immunity against NTHi in the maxillary sinuses of rats. Intranasal immunization induced P6-specific sinus mucosal and systemic immunological responses, mainly of the IgA and IgG isotype. The protective effect of intranasal immunization was demonstrated by enhancement of sinus clearance of NTHi. The present study showed that unilateral intranasal immunization has a capacity to induce protective immunity against NTHi in the bilateral maxillary sinuses. Systemic administration of the vaccine did not affect sinus clearance of NTHi. These findings suggest that a nasal vaccine might be useful for preventing sinusitis.
Administration, Intranasal↗
Absence of pulmonary aspiration of sinus contents in patients with asthma and sinusitis.
The frequent association of asthma and paranasal sinusitis has been ascribed to a nasobronchial reflex, aspiration of sinus secretions, or enhanced beta-adrenergic blockade. We investigated possible pulmonary aspiration in a pilot study (eight patients) and follow-up study (13 patients) by means of a radionuclide technique. In the pilot study, the aim was to demonstrate aspiration as well as visibility of the radionuclide in the thorax during a period of 24 hours. The radionuclide was initially placed bronchoscopically in the bronchial tree in four patients and was still clearly visible in the same position after 24 hours in three patients. Aspiration from the nasopharynx was unequivocally demonstrated in two of four patients with depressed consciousness. The follow-up study population consisted of four patients with maxillary sinusitis only and nine patients with sinusitis and asthma. The radionuclide was placed in a maxillary sinus during therapeutic puncture. In the patients with only sinusitis as well as patients with asthma and sinusitis the radionuclide could be demonstrated in the maxillary sinus, nasopharynx, esophagus, and lower gastrointestinal tract during a 24-hour period. However, no pulmonary aspiration of radionuclide could be demonstrated in any patient. We conclude that seeding of the lower airways by mucopurulent secretions is unlikely to account for coexistent pulmonary disease. The association is probably related to generalized mucosal disease affecting both upper and lower airways.
Asthma↗
Management of sphenoid sinus cerebrospinal fluid rhinorrhea: making use of an extended approach to the sphenoid sinus.
OBJECTIVES: Specific information addressing the management of cerebrospinal fluid (CSF) fistulas that originate from within the sphenoid sinus remains scant. The objective of this study was to review the cause and management of CSF rhinorrhea arising from the sphenoid sinus. STUDY DESIGN AND SETTING: This is a retrospective chart review of 12 cases of CSF rhinorrhea arising from the sphenoid sinus that occurred in 11 patients. All patients were treated at a single institution between 1994 and 1999. RESULTS: All patients were managed surgically with sphenoid sinus fat obliteration using an endoscopic sublabial, transseptal approach. This approach was successful for all 12 cases, with median duration of follow-up of 18 months. CONCLUSIONS: Endoscopically assisted transseptal repair of CSF fistulas that originate within the sphenoid sinus offers an alternate approach to previously described methods of repair in this region. Advantages include wide access to the entire sphenoid sinus, improved access to laterally pneumatized regions within the sphenoid sinus, and rostral mucosal closure over the repair within the sinus.
Adult↗
Aspergillosis of the maxillary sinus as a complication of overfilling root canal material into the sinus: report of two cases.
Aspergillosis of the maxillary sinus is a relatively rare disease in nonimmunocompromised patients. In recent years a number of cases of aspergillosis of the maxillary sinus have been reported in association with overextension of root canals fillings with certain root canal cements. It has been suggested that zinc oxide-based root canal cements might promote the infection with the Aspergillus species. In particular Aspergillus fumigatus has been found to be associated with the maxillary sinus infection. Radiographically the unique appearance of a dense opacity foreign body reaction in the maxillary sinus was considered a characteristic finding in maxillary sinus aspergillosis. Because this association of overfilling of root canal cements and aspergillosis of the maxillary sinus is not too well known we report two cases of young healthy female patients with the characteristic findings, both radiographically and clinically. In both patients the first maxillary molar was involved. Patients were symptomless and the diagnosis was made accidently. However at surgical inspection both patients revealed aspergillomas, including the overextended root canal cement. The surgical procedure is described as are the microscopic findings in both cases showing the characteristic branching hyphae and conidophores typical of Aspergillus. Overextension into the maxillary sinus with root canal cements has to be avoided; material has to be removed from the sinus because otherwise aspergillosis infection may ensue.
Adult↗
Canine fossa puncture and clearance of the maxillary sinus for the severely diseased maxillary sinus.
OBJECTIVES: To assess the impact of canine fossa puncture (CFP) with clearance of the maxillary sinus during endoscopic sinus surgery on the subjective and objective outcomes as defined by quality of life questionnaires, endoscopic findings, endoscopic aspirate for culture and sensitivity, and magnetic resonance imaging (MRI) evaluation. STUDY DESIGN: Retrospective, cross-sectional study. METHODS: Twenty-five patients who had undergone canine fossa were compared to 12 patients who had undergone routine endoscopic middle meatal clearance of the maxillary sinus. At an average postoperative time point of 19.9 months, all patients were administered the chronic sinusitis survey (CSS) and a visual analogue scale (VAS). At this visit, patients underwent nasendoscopy, sampling of the ostial region for bacterial and fungal cultures, and MRI of the sinuses. RESULTS: There were 42 sides for analysis from 25 patients on the study arm; the control arm comprised 12 patients with completely opacified maxillary sinuses and 17 sides for analysis. The CSS symptom subscore was better in the CFP group (Mann-Whitney test, P = .02). The overall VAS score was less in the CFP group (Mann-Whitney test, P = .01), indicating better symptom control. No opacification was evident in 61.9% of patients in the CFP group compared with 11.8% in the control arm (chi, P < .001). CONCLUSION: CFP is a useful technique to address the severely diseased maxillary sinus and is associated with significantly better symptom control compared with the transnasal middle meatal antrostomy clearance of the maxillary sinus.
Adult↗
Invasive fungal sinusitis of isolated sphenoid sinus in immunocompetent subjects.
Invasive fungal sinusitis of the paranasal sinuses in a healthy immunocompetent person is uncommon. Isolated involvement of any paranasal sinus, particularly sphenoid sinus is rare. In this study, five immunocompetent patients who had no nasal complaints but obscure symptoms of headache and orbital symptoms such as diplopia, retro-orbital pain and loss of vision were diagnosed to be having fulminant fungal sinusitis of the sphenoid sinus. Three patients had aspergillosis and two patients had mucormycosis. These patients initially presented to neurologists and ophthalmologists because they had no ENT complaints. The diagnosis was made on endoscopy, radiology and histopathology. They were treated aggressively according to the standard protocols. The purpose of this paper is to bring to light the changing clinical spectrum of invasive fungal sinusitis. It can occur in immunocompetent patients and in the form of isolated sphenoid sinus involvement.
Adolescent↗
A clinical study of endoscopic sinus surgery for sinusitis in patients with bronchial asthma.
BACKGROUND: An association between bronchial asthma and sinusitis has long been suspected. Our aim is to study the clinical features of chronic sinusitis associated with bronchial asthma as two manifestations of one airway disease. METHODS: We conducted a prospective analysis of the outcome of 88 patients, with or without bronchial asthma, who underwent endoscopic sinus surgery (ESS) for chronic sinusitis. Patients were divided into two groups by the presence or absence of asthma and were evaluated. One surgeon performed the ESS, and the same postoperative treatment was given to both groups. The postoperative outcomes of symptoms and objective findings related to sinusitis were evaluated numerically, with a maximum score of 2 points for each examination item. Twenty-eight patients with asthma symptoms were assessed before and after surgery, using peak flow (liter/second) and medication scores (according to US Food and Drug Administration) to determine whether bronchial asthma was improved by first-time ESS. RESULTS: The outcomes of ESS were significantly worse in the asthma group, especially the endonasal findings. Patients suffering from chronic sinusitis and bronchial asthma showed improvement following ESS in terms of their asthma symptoms, peak flow and medication score. Patients with a good ESS result tended to have the greatest improvement in their asthma. CONCLUSIONS: We conclude that sinusitis and asthma are closely related to each other, acting as two manifestations of one airway disease. We recommend treating cases of sinusitis complicated by asthma as a single disease of the entire respiratory tract.
Adult↗
Temporary nasosinusal drainage and lavage in chronic maxillary sinusitis. Statistical study on 847 maxillary sinuses.
We report on 498 patients suffering from chronic maxillary sinusitis verified by sinusoscopy through the inferior meatus and by computed tomography of the sinuses, which permitted also the diagnosis of coexisting chronic ethmoidal sinusitis. The patients were treated by temporary drainage through a polyethylene drain tube left in place at the end of the antroscopy for daily lavage with saline solution and daily instillation in the sinus of thiamphenicol glycinate hydrochloride (similar to chloramphenicol) and N-acetyl-L-cysteine. We followed up 847 maxillary sinuses during the lavages according to 2 parameters: 1) recovery of a clean washout product at the macroscopic examination and 2) recovery of normal ostial patency as measured by sinusomanometry. We concluded that 1) the association with ethmoidal sinusitis does not significantly modify the treatment duration, and 2) fewer than 4% of the maxillary sinuses are likely to recover normal parameters after the 23rd day of lavage, and it is therefore useless to continue this treatment much longer. Of the maxillary sinuses, 36.25% were not submitted to any surgery. The results gained by the lavage technique have to be protected from recurrence by the treatment of general, focal, or local causes.
Acetylcysteine↗
Treatment of chronic paranasal sinus pain with minimal sinus disease.
A common problem for otolaryngologists are patients who present with recurrent, persistent sinus pain that appears out of proportion to the findings on physical examination. Often these patients have a history of recurrent sinusitis that required antibiotics or surgical intervention. Many have had repeated surgical procedures because of this pain. Other common past medical histories may include allergic rhinitis, facial trauma, or dental disease. Patients who have experienced documented acute sinusitis in the past will often present de novo with similar symptoms, but lack any objective evidence of a new active sinus infection. However, the diagnosis of sinusitis is not clearly removed from the patient's or clinician's mind, and the patient is further frustrated by the lack of adequate diagnosis, treatment, and resolution of symptoms. These patients may or may not be experiencing an upper respiratory tract infection or allergy with nasal drainage. Often, they are emotionally distraught from recurrent and persistent pain, the lack of resolution of their symptoms, dependency on narcotics and other analgesics, multiple consultations with a variety of clinicians, and the impingement of their symptoms on employment, interpersonal relationships, and societal and family obligations. If sinusitis is not found to be present, the otolaryngologist must help the patient understand this point, reassure him or her that the otolaryngologist will still be vigilant for the development of sinusitis, and refocus the history and workup for some other cause of the recurrent and persistent paranasal pain. We review various treatment approaches to paranasal pains that are not the result of sinusitis.
1-Naphthylamine↗
Selective venous sampling from the cavernous sinuses is not a more reliable technique than sampling from the inferior petrosal sinuses in Cushing's syndrome.
The purpose of this study was to compare ACTH levels in unstimulated samples obtained from the cavernous sinuses (CS) to unstimulated and CRH-stimulated samples obtained from the inferior petrosal sinuses (IPS) in 15 patients with surgically proven Cushing's disease. After unstimulated samples were obtained through 5-French catheters placed in both IPS, tracker catheters were introduced into both cavernous sinuses, and unstimulated samples were obtained within 5 min of the initial set. The Tracker catheters were removed, CRH was administered, and CRH-stimulated samples were obtained from the IPS. We compared the central to peripheral ACTH ratios in unstimulated samples from the cavernous sinuses to unstimulated and CRH-stimulated samples from the IPS as a basis for distinguishing pituitary from ectopic ACTH production. In addition, we compared the ability of the intercavernous and interpetrosal ACTH ratios to correctly predict the site of the microadenoma. Unstimulated levels of ACTH in the cavernous sinuses were generally higher than unstimulated levels of ACTH in the petrosal sinuses. However, 3 of 15 patients failed to show central to peripheral ACTH ratios greater than 2 in unstimulated samples from the cavernous sinuses and were thus falsely negative for the diagnosis of Cushing's disease (test sensitivity, 80%). By comparison, the test sensitivity for the petrosal sinus samples was 87% for the unstimulated samples and 100% for the CRH-stimulated samples. Lateralization was correct in 6 of 15 patients based on CS samples and in 9 of 15 patients based on IPS samples. Because of the 20% false negative rate, CS sampling without CRH stimulation is not recommended for the differential diagnosis of ACTH-dependent hypercortisolism.
Adenoma↗