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[Acquired enophthalmos associated with hypoplasia of the maxillary sinus and asymptomatic chronic maxillary sinusitis].

BACKGROUND: We report a case of progressive enophthalmos, maxillary sinus hypoplasia and radiological signs of sinusitis in a young woman. CASE REPORT: The patient had no history of sinus surgery or facial trauma. There were no signs of sinusitis. Functional endoscopic sinus surgery was proposed to restore the communication between the nose and the antrum. DISCUSS: The particular aspects of asymptomatic maxillary sinus and causes of maxillary sinus hypoplasia are discussed. We suggest that obstruction of the osteomeatal complex causes negative pressure in the maxillary sinus provoking bone alterations. These alterations cause the maxillary sinus hypoplasia and the enophthalmos.

Adult↗

[Clinical feature of odontogenic maxillary sinusitis--symptomatology and the grade in development of the maxillary sinus in cases of dental maxillary sinusitis].

Odontogenic maxillary sinusitis may occur by draining of an apical dental root abscess into the maxillary sinus. It has been reported that the disease is usually frequent in cases aged of the second and third decades. In most of them, either the first or second molar tooth is assumed to be the origin of the disease. As clinical characteristic symptoms, it is mentioned that an acute unilateral sinusitis appears since the onset and the patient complains a fetid purulent nasal discharge from an early stage. The symptom and its clinical time course in 43 cases with dental maxillary sinusitis, who had been treated by surgical procedures in ENT Clinic in Kitasato University Hospital during past 14 years from 1972 to 1985, were studied retrospectively. The size of the affected maxillary sinus in each case of the disease was measured from the X-ray films. An influence of development of the maxillary sinus to the occurrence of dental sinusitis was discussed by comparing the sizes of the maxillary sinuses in both the group of the disease and the group of simple unilateral maxillary sinusitis.

Adolescent↗

Antibiotics for acute maxillary sinusitis.

OBJECTIVES: For adults seeking care in ambulatory practices, sinusitis is the most common diagnosis treated with antibiotics. We examined whether antibiotics are indicated for acute sinusitis, and if so, which antibiotic classes are most effective. SEARCH STRATEGY: Relevant studies were identified from searches of MEDLINE and EMBASE in October 1998, contacts with pharmaceutical companies and bibliographies of included studies. SELECTION CRITERIA: Randomized trials were eligible that compared antibiotic to control or antibiotics from different classes for acute maxillary sinusitis. Additional criteria were diagnostic confirmation by radiograph or sinus aspiration, outcomes that included clinical cure or improvement and a sample size of 30 or more adults. Of 1784 potentially relevant studies, two or more reviewers identified 32 studies meeting selection criteria. DATA COLLECTION AND ANALYSIS: Data were abstracted independently by 2 persons and synthesized descriptively. Some data were analyzed quantitatively using a random effects model. Primary outcomes were a) clinical cure and b) clinical cure or improvement. Secondary outcomes were radiographic improvement, relapse rates, and dropouts due to adverse effects. MAIN RESULTS: Thirty-two trials, involving 7,330 subjects evaluated antibiotic treatment for acute maxillary sinusitis. Major comparisons were antibiotic vs. control (n=5); newer, non-penicillin antibiotic vs. penicillin class (n=10); and amoxicillin-clavulanate vs. other extended spectrum antibiotics (n=10). Most trials were conducted in otolaryngology settings. Only 5 trials described adequate allocation and concealment procedures; 10 were double-blind. Compared to control, penicillin improved clinical cures [relative risk (RR) 1.72, 95% CI 1.00 to 2.96]. Treatment with amoxicillin did not significantly improve cure rates (RR 2.06; 95% CI 0.65 to 6.53), but there was significant variability between studies. Radiographic outcomes were improved by antibiotic treatment. Comparisons between classes of antibiotics showed no significant differences: newer non-penicillins vs. penicillins (RR for cure 1.07; 95% CI 0.99 to 1.17); newer non-penicillins vs. amoxicillin-clavulanate (RR for cure 1.01, 95% CI 0.97 to 1.04). Compared to amoxicillin-clavulanate, dropouts due to adverse effects were significantly lower for cephalosporin antibiotics. Relapse rates within one month of successful therapy were 5%. REVIEWER'S CONCLUSIONS: For acute maxillary sinusitis confirmed radiographically or by aspiration, current evidence is limited but supports penicillin or amoxicillin for 7 to 14 days. Clinicians should weigh the moderate benefits of antibiotic treatment against the potential for adverse effects.

Acute Disease↗

Microbial flora of nose and paranasal sinuses in chronic maxillary sinusitis.

Nasal secretions, maxillary sinus aspirates and specimens of the maxillary sinus mucosa were collected in 44 patients aged between 25 and 60 affected by mono- or bilateral chronic maxillary sinusitis, in order to establish the best sampling technique for microbiological purposes, the most frequently involved bacteria and the physiopathological mechanism underlying chronic maxillary disease. The sinusal mucosa resulted to be the most reliable sample as it reduces contamination and microbial variability. Anaerobic bacteria were isolated in nasal swab (15.6%), in maxillary sinus aspirates (30.4%) and in maxillary sinus mucosa (36.4%) of maxillary sinusitis patients. In controls anaerobic bacteria were isolated only in one nasal swab (2.3%), while they could not be isolated in maxillary sinus aspirates and in maxillary sinus mucosa. The presence of anaerobic bacteria in chronic maxillary sinusitis patients and their absence in controls seem to confirm that anaerobic microorganisms represent the main pathogenetic agents of chronic maxillary sinusitis. The possible physiopathological mechanisms underlying chronic maxillary sinus disease are finally discussed.

Adolescent↗

Maxillary antral mucocele and its relevance for maxillary sinus augmentation grafting: a case report.

Paranasal sinus mucoceles are benign, locally expansile cyst-like masses that are filled with mucus and lined with epithelium. Most occur in the frontal sinus. Maxillary sinus mucoceles are presumably uncommon in the United States and European countries, although they have been frequently reported in Japan, particularly following Caldwell-Luc surgery. Clinical symptoms may not appear for at least 10 years postoperatively. Chronic sinus inflammation and allergic disease are also common causes of paranasal mucoceles. This paper provides an overview of maxillary sinus mucoceles and presents a case study involving a 62-year-old Latin male whose asymptomatic maxillary sinus mucocele was not revealed until he presented for maxillary sinus grafting and implant placement.

Bone Transplantation↗

Endoscopic sinus surgery for maxillary sinus mucoceles.

BACKGROUND: Maxillary sinus mucoceles are relatively rare among all paranasal sinus mucoceles. With the introduction of endoscopic sinus surgical techniques, rhinologic surgeons prefer transnasal endoscopic management of sinus mucoceles. The aim of this study is to describe the clinical presentation of maxillary sinus mucoceles and to establish the efficacy of endoscopic management of sinus mucoceles. METHODS: Between 2003 and 2005, 14 patients underwent endoscopic sinus surgery for maxillary sinus mucocele. The presenting sign and symptoms, radiological findings, surgical management and need for revision surgery were reviewed. RESULTS: There were eight males and six females with an age range of 14 to 65. Ten patients complained of nasal obstruction, five of nasal drainage, five of cheek pressure or pain and one of proptosis of the eye and cheek swelling. The maxillary sinus and ipsilateral ethmoid sinus involvement on computed tomographic studies was seen in 4 patients. Four patients had history of endoscopic ethmoidectomy surgery for ethmoid sinusitis and one had Caldwell-Luc operation in the past. Ethmoidectomy with middle meatal antrostomy and marsupialization of the mucocele was performed in all patients. Postoperative follow-up ranged between 8 to 48 months. All patients had a patent middle meatal antrostomy and healthy maxillary sinus mucosa. No patients need revision surgery. CONCLUSION: The most common causes of mucoceles are chronic infection, allergic sinonasal disease, trauma and previous surgery. In 64% of the patients of our study cause remains uncertain. Endoscopic sinus surgery is an effective treatment for maxillary sinus mucoceles with a favorable long-term outcome.

Adolescent↗

Effects of maxillary sinus floor elevation surgery on maxillary sinus physiology.

In a prospective study, the effects of elevation surgery of the maxillary sinus floor on maxillary sinus physiology were assessed. Seventeen consecutive patients without preoperative anamnestic, clinical and radiological signs of maxillary sinusitis underwent sinus floor elevation surgery with iliac crest bone grafts. All patients were subjected to unilateral endoscopic examination of the maxillary sinus, taking of a biopsy specimen from the sinus floor mucosa, and collection of a sinus lavage-fluid aspirate. This triad of evaluations was performed immediately preceding the elevation procedure, and 3 months (at implant insertion) and 9 months (at uncovering of implants) postoperatively. All procedures were performed under general anesthesia. Preoperatively, three out of 17 patients showed pre-existing mucosal pathology endoscopically, while the 3- and 9-month results revealed the presence of mucosal pathology in four and two patients, respectively. The 3-month microbiological evaluation showed a significant increase in cultures with bacterial growth, while the 9-month culture results were comparable to the preoperative status of the maxillary sinus. Morphologically, neither fibrosis nor an altered inflammatory response or thickening of the epithelium and lamina propria was observed postoperatively. The number of goblet cells in the epithelial layer was increased. From this study it is concluded that the effect of maxillary sinus floor elevation surgery with autogenous bone grafts does not appear to have clinical consequences in patients without signs of pre-existing maxillary sinusitis.

Adult↗

[Chronic unilateral maxillary sinusitis caused by foreign bodies in the maxillary sinus].

Chronic maxillary sinusitis is a common condition. The disease is most often caused by blockage of the sinus ostia or presence of an oroantral fistula. We report two cases of unilateral chronic maxillary sinusitis associated with foreign bodies in the maxillary sinus. In the first case the foreign body consisted of dental amalgam, in the second case of two silastic sponges left behind from a former operation because of "blowout" fracture. In the case of benign chronic maxillary sinusitis and foreign bodies, functional endoscopic sinus surgery (FESS) preceded by a CT-scan is an excellent approach, by which diagnosis as well as treatment can be achieved with minimal surgical trauma.

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↗

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↗

Effects of functional endoscopic sinus surgery on maxillary sinus mucosa.

OBJECTIVE: To compare the preoperative and postoperative changes on ciliary surface of maxillary sinus mucosa in patients treated with functional endoscopic sinus surgery. DESIGN: The maxillary mucosa of both the superolateral wall and the ostium were sampled during the operation and 6 to 12 months (mean duration, 7.6 months) after the operation. Ciliary surface was determined using scanning electron microscopy in combination with an image analyzer and was expressed in terms of ciliary area, which is the percentage of mucosal surface occupied by cilia. SETTING: The samples were taken at a hospital-based clinic. An electron microscopic study was performed at Mie University School of Medicine, Mie, Japan. PATIENTS: Sixteen patients (20 maxillary sinuses) undergoing functional endoscopic sinus surgery for treatment of chronic sinusitis. RESULTS: The mean (+/-SD) ciliary area before the surgery was 60.7%+/-28.8% and 39.9%+/-21.5% in the superolateral wall of the maxillary sinus and the ostium of the maxillary sinus, respectively. The ciliary area of the superolateral wall was significantly higher than that of the ostium (P<.001). The mean (+/-SD) postoperative ciliary area value was 74.3%+/-22.6% in the superolateral wall and 51.3%+/-16.1% in the ostium. These postoperative values were significantly higher than the preoperative values (P<.001). CONCLUSIONS: This study showed that the maxillary sinus mucosa in chronic sinusitis is capable of regeneration, and the damaged ciliated epithelium could return toward normal with the improvement of ventilation and drainage of the maxillary sinus following functional endoscopic sinus surgery.

Adolescent↗

The usefulness of irrigation of the maxillary sinus in children with maxillary sinusitis on the basis of the Water's X-ray.

The authors studied 80 children with sinusitis, all treated with amoxycillin and a decongestive preparation. The authors reached the conclusion that in 30 out of 80 children the third standard X-ray becomes normal without further treatment. In the remaining 50 children the usefulness of irrigation of the maxillary sinus was studied: one group was treated with antroscopy and sinuscopy while the second group did not receive this treatment (control). In both groups control X-rays were performed after three weeks. There was no significant difference between the two groups, which indicates that irrigation does not lead to a better cure. A correlation of 71% was found between X-ray findings and antroscopic findings. As a first treatment antibiotics are recommended.

Anti-Bacterial Agents↗