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PubMed2002

Correlation between bacteriology of the middle meatus and ethmoid sinus in chronic sinusitis.

In this study we report on the correlation between the bacteriology of the middle meatus and ethmoid sinus in chronic sinusitis. When patients with chronic sinusitis underwent functional endoscopic sinus surgery (FESS), swab specimens were taken from the middle meati before surgery. After removing the ethmoid bullae, swab specimens were taken from the ethmoid sinuses. Between November 1998 and February 2001, 186 pairs of middle meatal and ethmoid sinus specimens were collected from 186 patients. No bacteria were cultured from either specimen in 32 patients. The same bacteria were cultured from both specimens in another 60 patients. The culture results differed between the middle meatal and ethmoid sinus specimens in the remaining 94 patients. There was a significant difference between culture rates of 63.4 per cent for middle meatal specimens and 76.3 per cent for the ethmoid sinus specimens. In analysing bacterial species, significantly more aerobic gram negative bacteria were cultured from the ethmoid sinus specimens than from the middle meatal specimens. This study shows that the bacteriology of the middle meatus was different from that of the ethmoid sinus. Therefore, the bacteriological findings in the middle meati may not reflect the real bacteriology in chronic sinusitis.

Adolescent↗
PubMed1990

[Carotid sinus syndrome and sick sinus syndrome: 2 frequent and distinct indications for pacemaker implantation].

UNLABELLED: At present, patients affected by carotid sinus syndrome and, more general by speaking, by vasovagal syncopes, are being considered more and more for pacemaker implant. However, neither the real incidence of the carotid sinus syndrome or its relation with the sick sinus syndrome with which it is often associated or even confused is precisely known. Of a total of 298 consecutive pacemaker implants, 36 (12%) were executed for carotid sinus syndrome, 33 (11%) for sick sinus syndrome and 24 (8%) for both. The annual incidence was respectively of 40, 37 and 26 implants per year/million of inhabitants. Patients affected by carotid sinus syndrome, when compared with those affected by sick sinus syndrome, showed: a higher prevalence of syncopes (97 vs 42%) more syncopal episodes per patient (2.9 +/- 2 vs 1.8 +/- 0.9), a lower prevalence of associated cardiac diseases (53 vs 100%), cardiac enlargement (36 vs 88%), heart failure (6 vs 36%) and paroxysmal atrial fibrillation (0 vs 97%), a more frequent indication to VVI pacing (75 vs 3%). Generally, when both syndromes were present, the patients showed intermediate characteristics. IN CONCLUSION: carotid sinus syndrome is a frequent indication of cardiac pacing as sick sinus syndrome; even if an association is present in about one third of patients, a distinction between carotid sinus syndrome and sick sinus syndrome is justified by theoretical and practical considerations.

Aged↗
PubMed1975

[Vagal effect on sino-atrial node frequency and A-V overdrive in hypersensitive carotid sinus reflex and sick sinus syndrome].

Two syndromes, hypersensitive carotid sinus reflex (HCSR) and "sick sinus syndrome" (SSS) were studied in 28 patients, 6 of whom served as controls. Carotid sinus pressure was performed during sinus rhythm (CSP 1) and atrial stimulation just above the sinus rate (CSP 2). Overdrive suppression was also tested. Vagal stimulation provoked different effects in HCSR and in SSS. The vagal reaction to CSP 1 was more manifest in HCSR than in both SSS and the controls. After CSP 2 A-V conduction was delayed longer in HCSR than in SSS and the controls. Following atropine, the vagal effect on HCSR was more pronounced than on SSS and the controls. With HCSR, the duration of vagal influence on R-R intervals (A-V conduction) was significantly shorter than on P-P intervals (sinus rate). After atropine, there was less vagal effect on A-V conduction than on the sinus rate in HCSR, meaning that A-V conduction was shorter and less affected than the sinus rate by carotid sinus pressure. Prolonged suppression following overdrive established the diagnosis of SSS. This suppression was found not to be affected by atropine. A dependency of suppression on the rate and duration of overdrive could not be ascertained for SSS. The newly formulated "postdrive P-P interval recovery time" subdivided SSS in such a way that two different degrees of severity could be illustrated. The conclusion was that HCSR was caused by an excessive reaction to vagal stimulation rather than by a dysfunction of the sinus node or A-V conduction system. SSS might be based on tissue damage in the sinus nodal region but it did not show increased sensitivity to vagal influence.

Adult↗
PubMed1980

Adams-Stokes attacks associated with carotid sinus syncope. Pathogenesis and therapy of the carotid sinus syncopes.

The pathophysiology and therapy of the carotid sinus syncope were studied by means of electrophysiological investigations and clinical observations in 84 patients suffering from carotid sinus syncope. The most important data and conclusions of the study are the following: 1. The most frequent cause of the carotid sinus syncope (Adams-Stokes) attack is the sinus arrest and a sinus block. 2 degrees-3 degrees av block can be observed less frequent in the course of syncope attack. 2. In a patient suffering from carotid sinus syncopes, disorders of impulse formation and impulse conduction of the heart are frequent. First of all, the association of the sick sinus syndrome and the carotid sinus syncope can be often detected. 3. It is not rare at all that the carotid sinus syncope occurs with extracranial obliterative disorders. Transitory cerebral ischaemic attack frequently develops on the stimulation of the carotid sinus area. 4. The drug -- atropine -- therapy of the carotid sinus syncope is usually insufficient. Generally, pacemaker implantation is the adequate treatment. Late results are very good after pacemaker implantation.

Adams-Stokes Syndrome↗
PubMed1999

Computed tomographic staging and the fate of the dependent sinuses in revision endoscopic sinus surgery.

OBJECTIVES: To determine the patterns of disease recurrence in chronic sinusitis and to examine the influence of surgical intervention on the presence or absence of disease among sinuses at the time of revision. DESIGN: Retrospective review of case series in a 56-month period. Preoperative computed tomography (CT) scans at the initial surgery and at revision were staged using the Lund and Mackay system. Patterns of disease and CT stage were analyzed with respect to operative intervention, and statistical analysis was conducted to determine the influence of the initial surgical intervention on the patterns of disease at revision. SETTING: An academic general otolaryngology practice. RESULTS: A total of 42 paired cases of primary and revision endoscopic sinus surgery were identified with complete data. The average interval between procedures was 11.8 months, with a mean follow-up of 31.7 months. The average total Lund scores for the CT scan before the primary procedure and at revision were not significantly different at 10.5 and 9.7, respectively (P = .38). Analysis of 84 sides revealed that performance of a sinusotomy on an initially undiseased sinus resulted in a higher percentage of disease in that sinus at revision, although this was not significant (P = .15). A sinusotomy performed on an initially diseased sinus was associated with a higher likelihood of disease in that sinus at revision (P = .02). Similar data were found for the subset analysis of the sphenoid and frontal sinuses. CONCLUSIONS: The Lund and Mackay system can be applied in the setting of revision endoscopic sinus surgery. Sinusotomies should be performed only in sinuses with radiographic disease, and not prophylactically to prevent disease. The standard functional approach may allow disease initially present in the sphenoid or frontal sinuses to normalize without formal sphenoidotomy or frontal sinusotomy.

Adolescent↗
PubMed2004

Endoscopic sinus surgery for paranasal sinus mucocoele with orbital involvement.

PURPOSE: To evaluate the results of endoscopic sinus surgery (ESS) for paranasal sinus mucocoele with orbital involvement and assess the frequency with which a direct orbital approach is required in these cases. METHODS: Retrospective, consecutive series of sinus mucocoeles with orbital involvement treated by ESS by a single surgeon over a 4-year period (1998-2002). RESULTS: A total of 24 mucocoeles of 15 patients, including 10 frontal, eight frontoethomoidal, two ethmoidal, and four maxillary. All cases demonstrated radiological orbital extension. Globe displacement was seen in 73%. At a median follow-up of 15.5 months, the mean cumulative clinical score improved from 4.2 +/- 1.5 (range 1-7) to 0.4+/-0.7 (range 0-2). Ophthalmic symptoms and signs resolved in all patients but one who had complex sinus anatomy following neurosurgery. Minor, self-limiting complications including epistaxis and intranasal adhesions occurred in three cases. Additional endoscopic sinus surgery was required in four patients for revision of narrowed frontal sinus ostium (two), mucocoele recurrence (two), and sinus toileting (one). No cases required external sinus surgery and the average hospital in-patient stay was 2.5 +/- 1.6 days. At final follow-up, sinus ostia were patent in all excluding one case that required a stent due to disrupted anatomy. CONCLUSION: ESS is effective in improving ophthalmic symptoms and signs due to paranasal sinus mucocoele. ESS may be a viable treatment for paranasal sinus mucocoele with orbital extension, and a direct orbital approach is rarely necessary.

Adolescent↗
PubMed1995

Signal-averaged electrocardiography of the sinus and paced P wave in sinus node disease.

The detection of paroxysmal atrial fibrillation (AF) in patients requiring a permanent pacemaker for sinus node disease may influence the choice of both pacemaker and programmed mode. While signal-averaged ECG of the P wave (SAEP) during sinus rhythm may detect patients with paroxysmal AF, the value of SAEP in the presence of sinus node disease is unknown. We therefore evaluated SAEP in patients with sinus node disease during sinus rhythm and atrial pacing. We investigated 10 patients with sinus node disease alone (SND), 10 with sinus node disease and paroxysmal AF (SND-PAF), and 20 normal controls (NC) using a P wave specific, signal-averaging system. In sinus rhythm, duration and energy were greater in SND-PAF than in SND and NC (mean [SEM] duration: 153 [4] msec, 140 [4] msec, and 134 [2] msec, P < 0.001; energy from 20-150 Hz: 76 [18] muV2.sec, 48 [7] muV2.sec, and 36 [3] muV2.sec, P = 0.006). Atrial pacing in SND-PAF produced an 11% prolongation of atrial activation but little further abnormality in P wave characteristics. In SND, atrial pacing caused a 20% prolongation of the P wave and increased P wave energy to a greater extent than in SND-PAF. We conclude that in patients with SND, atrial activation appears similar to normal controls during sinus rhythm but changes significantly on pacing. In patients with SND-PAF, atrial activation is abnormal during sinus rhythm with little further change when the atrium is paced. SAEP may be useful in detecting a predisposition to paroxysmal AF in the presence of sinus node disease and might help optimize pacemaker prescription.

Adult↗
PubMedDate not supplied

Efficacy of endoscopic sinus surgery in the management of patients with asthma and chronic sinusitis.

An association between chronic sinusitis and asthma has been noted for many years, although the precise nature of the relationship is poorly understood. Earlier studies, using traditional surgical techniques, have demonstrated subjective improvement in asthmatic complaints. Reports demonstrating improvement following endoscopic sinus surgery for chronic sinusitis are rare. To report our experience with endoscopic sinus surgery and asthmatics, we reviewed the charts of 75 consecutive patients with asthma and chronic sinusitis who underwent endoscopic sinus surgery between 1994 and 1996. Study criteria included the following: chronic sinusitis, one year preoperative and one year postoperative follow-up from endoscopic sinus surgery, and asthma requiring inhaled steroids and oral prednisone for control. Many patients required prednisone bursts for control of asthma. Number of days and total dose of oral prednisone were used as objective measures of asthma control. Number of weeks of antibiotics was used as a relative measure of sinusitis. Fourteen of the 15 patients meeting study criteria decreased their postoperative prednisone requirement by total number of days (preoperative 84 versus postoperative 63 days [p < 0.0001]). Postoperatively, patients required an average of 1300 mg less oral prednisone (p < 0.033). Antibiotic use also decreased, with an average use of antibiotic nine weeks preoperatively versus seven weeks postoperatively (p < 0.045). This study provides corroborative objective evidence that, at least in the short term, endoscopic sinus surgery is efficacious in the management of patients with chronic sinusitis and asthma.

Adolescent↗
PubMed1992

Occlusion of the pig superior sagittal sinus, bridging and cortical veins: multistep evolution of sinus-vein thrombosis.

Cerebral sinus-vein thrombosis may lead to severe hemodynamic changes, elevated intracranial pressure (ICP), and brain edema. It is supposed that progression of the thrombus from the sinus into bridging and cortical veins plays a key role in the development of these pathophysiological changes, but this hypothesis lacks experimental proof. The aim of this study, using a novel animal model of sinus-vein thrombosis, was to evaluate the effects of a standardized occlusion of the superior sagittal sinus and its bridging and cortical veins on hemodynamic alterations, on brain water content, and on ICP in domestic pigs. In 10 animals, the middle third of the superior sagittal sinus was occluded with a catheter-guided balloon. Five of these pigs received an additional injection of 1 ml fibrin glue into the superior sagittal sinus anterior to the inflated balloon, leading to an obstruction of bridging and cortical veins. In five control animals the balloon was inserted but not inflated. Five pigs underwent cerebral angiography. Four hours after occlusion, the brains were frozen in liquid nitrogen, and coronal slices were examined for Evans blue dye extravasation, regional water content, and histological changes. Occlusion of the superior sagittal sinus alone did not affect ICP or cerebral perfusion pressure (CPP). The additional injection of fibrin glue caused an obstruction of cortical and bridging veins as well as severe increases in mean (+/- standard deviation) ICP to 49.4 +/- 14.3 mm Hg, compared with 8.3 +/- 4.5 mm Hg in sham-treated controls and 7.1 +/- 3.9 mm Hg in animals with occlusion of the superior sagittal sinus alone. There was also a steep fall in the mean CPP to 34.2 +/- 19.6 mm Hg compared with 96.4 +/- 13.8 mm Hg in the control group. White-matter water content anterior to the occlusion site was elevated to 81.9 +/- 3.7 gm/100 gm frozen weight in the fibrin group as compared to 70.7 +/- 2.2 gm/100 gm in controls. Posterior to the occlusion site, water content did not differ among the three groups. Angiography demonstrated collateral flow via cortical and bridging veins in animals with occlusion of the superior sagittal sinus alone. Additional fibrin glue obstructed these collateral vessels. The data suggest a multistep process of pathophysiological alterations in patients with sinus-vein thrombosis and may explain why these patients present with a wide variety of symptoms: minor neurological deficits or headache might indicate thrombosis of the superior sagittal sinus and/or its bridging veins.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2001

[Deciding about pacing mode in sinus node dysfunction: should carotid sinus massage be performed and in which circumstances?].

OBJECTIVE: To state the incidence of carotid sinus syndrome (CSS) with atrioventricular node manifestation in patients with sinus node dysfunction (SND) and indication for a definitive pacemaker (PM), we propose a new protocol between atrial pacing AAI and double chamber DDD. POPULATION AND METHODS: 69 patients (PTS) (male 71%), median age 65 +/- 10 years, with SND (normal PQ and no intraventricular conduction defect), that had a PM implant following the protocol that included carotid sinus massage for the pacing decision, were followed prospectively between December 1995 and November 1999. During the protocol we implanted DDD PM in PTS with Wenckebach less than 130 or Wenckebach equal/over 130 and CSS. At least, in PTS with Wenckebach equal/over 130 and no CSS we implanted AAI PM. The follow-up was between 4 months and 4 years, with clinical evaluation in the first and fourth months and then half yearly, with carotid sinus massage in the first evaluation. RESULTS: About 1/4 of the 69 patients followed had SND without carotid sinus syndrome, or atrioventricular node repercussion; the SND involved the atrioventricular node in 56% of the patients, and there was a relation between the SND and carotid sinus syndrome in 18.8%. The follow-up revealed, in all patients, a complete remission of the symptoms, and when we repeated the carotid sinus massage in the first evaluation, there was a response like in the surgery room, in all patients. CONCLUSIONS: There is a significant number of patients with SND and carotid sinus syndrome. The carotid sinus massage performed in the surgery room does not influence the test sensitivity and specificity in the diagnosis of carotid sinus syndrome. The authors think that carotid sinus massage should be considered in the protocol that defines the pacing mode, in patients with SND, and that influence the choice of pacemaker in 18.8% of patients.

Aged↗
PubMed2005

Dural sinus compartment in dural arteriovenous shunts: a new angioarchitectural feature allowing superselective transvenous dural sinus occlusion treatment.

BACKGROUND AND PURPOSE: The dural sinus occlusion has been shown to be effective in the treatment of some dural arteriovenous shunts (DAVS). No long-term results are available, however, regarding the significance of occlusion of a dural sinus. If the disease will stop or if other events will occur later in the remaining sinuses are not well known yet. Careful analyses of our cases led us to discover that, in some instances, the shunt involves only a single portion or compartment of a sinus. In this report, we describe our results in the treatment of these lesions: occluding only the involved compartment while preserving patency of the remainder of the sinus and the angiographic signals, thus allowing diagnosis of the presence of a compartment. METHODS AND RESULTS: From 1996 to October 2002, we found 12 cases of DAVS (among 40 news cases of DAVS) with two types of compartments--one inside the sinus, which we call "septation" (nine cases), and the other outside the sinus, which we call "accessory sinus" (three cases). It was possible to occlude completely the lesion superselectively in nine cases. In two cases, it was necessary to occlude the entire sinus secondarily, and in one case the sinus was occluded because was impossible to catheterize the septation. Two cases with recanalization on the control were treated by additional arterial and arterial and venous approach. CONCLUSION: It is very important to diagnose the presence of a compartment in dural arteriovenous shunts during the diagnostic angiography. In most cases, it allows curative treatment of the lesion by occluding only the compartment while preserving patency of the remainder of the sinus.

Adult↗
PubMed2003

Ethmomaxillary sinus: a particular anatomic variation of the paranasal sinuses.

We assessed the morphological and radiological characteristics of ethmomaxillary sinus (EMS), which is an enlarged posterior ethmoidal air cell occupying the superior portion of the maxillary sinus while draining into superior meatus. This study is based on 1450 patients submitted to CT examination of the paranasal sinuses between 1998 and 2002. Sequential CT scans were obtained in the coronal plane in all the patients with 2.5- to 5-mm section thickness and were evaluated for EMS. The diagnosis of EMS was made when there was a posterior ethmoidal cell occupying the superior part of the maxillary sinus while draining to the superior meatus. When EMS was diagnosed, the morphology of the septum between the and maxillary sinus, and width of the superior meatus, were noted. The EMS was found in 10 of 1450 (0.7%) patients. The coexisting anatomic variations were concha bullosa (50%), upper concha pneumatization (20%), maxillary sinus hypoplasia (20%), uncinate bulla (10%), hypertrophied inferior concha (10%), paradoxic middle concha (10%), and septate maxillary sinus (10%). There was no relation between EMS and sinus disease. The EMS is a rare anatomic variation and does not appear to be associated with sinusitis. The EMS is not a well-studied anatomic variation, and the literature is lacking adequate information about this anatomic variation. This study performed in a large series of patients will possibly contribute to better understanding of this particular anomaly.

Adolescent↗
PubMed1995

Unroofed coronary sinus and coronary sinus orifice atresia. Implications for management of complex congenital heart disease.

OBJECTIVES: The aim of this study was to assess the morphology of the coronary sinus, its drainage and associated cardiac malformations when there is either complete unroofing of the coronary sinus or atresia of its connection to the right atrium. BACKGROUND: As more children with complex cardiac anomalies are accepted for primary surgical repair or palliation with cavopulmonary anastomoses, a knowledge of coronary sinus and systemic venous anomalies is important if coronary venous return is to be preserved and residual shunts avoided. METHODS: Twenty-six heart-lung specimens without a coronary sinus draining to the right atrium were identified from the Leiden collection of congenital heart malformations. These were classified into specimens with an unroofed coronary sinus and those with atresia of the coronary sinus orifice. Attention was paid to the associated cardiac malformations. RESULTS: In 14 (54%; confidence limits [CL] 35%, 73%) of 26 specimens, there was an unroofed coronary sinus, associated with persistence of the left superior caval vein. An inferoposterior location of an atrial septal defect was detected in 2 (14%; CL -4%, 33%) of 14. Atrial appendage anomalies were seen in 13 (93%; CL 79%, 106%) of 14 specimens, exemplified by both right and left isomerism. These were frequently associated with an atrioventricular septal defect (12 [86%; CL 67%, 104%] of 14). An atretic coronary sinus orifice was seen in 12 (46%; CL 27%, 65%) of 26. Atrial appendage anomalies (2 [17%; CL -4%, 38%] of 12) were rare in these cases. The drainage was then by way of a left superior caval vein or, in its absence, a coronary sinus to left atrial window. Ventricular hypoplasia was seen in both categories of coronary sinus abnormalities. Important ventricular hypoplasia was seen in 12 cases (46%; CL 27%, 65%). CONCLUSIONS: These findings emphasize the need to study coronary sinus drainage before procedures such as ligation or transcatheter coil embolization of a left superior caval vein, venous redirection or closure of a dorsal atrial septal defect are contemplated. These procedures might inadvertently lead to impairment of coronary venous return or persistence of an intracardiac shunt.

Coronary Vessel Anomalies↗
PubMed2004

Remodeling of sinus node function in patients with congestive heart failure: reduction in sinus node reserve.

BACKGROUND: Experimental and clinical studies have demonstrated diffuse atrial remodeling in congestive heart failure (CHF). We hypothesized that patients with CHF would demonstrate derangement of sinus node function. METHODS AND RESULTS: Eighteen patients with symptomatic CHF (left ventricular ejection fraction, 26+/-5%) and 18 age-matched control subjects were studied. Under autonomic blockade, the following were evaluated: intrinsic sinus cycle length, corrected sinus node recovery time (CSNRT), sinoatrial conduction time, number and duration of fractionated electograms or double potentials along the crista terminalis, and location of the earliest sinus activity. Electroanatomic mapping was performed to evaluate the location and nature of the sinus node complex, to characterize sinoatrial propagation, and to evaluate conduction abnormalities and voltage amplitude along the crista terminalis. Patients with CHF demonstrated the following findings compared with age-matched control subjects: prolongation of the intrinsic sinus cycle length (P=0.005), prolongation of CSNRT (P<0.0001), caudal localization of sinus activity both during sinus rhythm (P=0.03) and after pacing (P=0.002), prolongation of sinoatrial conduction time (P=0.02), greater number (P<0.0001) and duration (P<0.0001) of fractionated electrograms or double potentials along the crista terminalis, loss of voltage amplitude along the crista terminalis (P=0.02), and abnormal and circuitous propagation of the sinus impulse. CONCLUSIONS: This study demonstrates that patients with CHF have significant sinus node remodeling characterized by anatomic and structural changes along the crista terminalis with a reduction in functional sinus node reserve. This finding may have implications for the development of clinical bradycardia in CHF and for the use of negatively chronotropic agents and pacing in this condition.

Adult↗
PubMed1994

Results of endoscopic sinus surgery in pediatric patients with chronic sinusitis and asthma.

OBJECTIVE: To determine the efficacy of endoscopic sinus surgery in pediatric patients with chronic sinusitis and asthma. SETTING: Patients were selected from the tertiary care practice of a pediatric pulmonologist (R.S.) and immunologist (R.L.W.); all underwent sinus surgery at Children's Medical Center at Dallas (Tex). PATIENTS: Fourteen pediatric patients aged 3.5 to 13 years with severe asthma requiring at least intermittent systemic steroid therapy. All patients had a history of sinusitis aggravating asthma and all had computed tomographic evidence of chronic sinus disease. INTERVENTION: All patients underwent endoscopic sinus surgery consisting of bilateral total ethmoidectomies and middle meatus antrostomies at a minimum. MAIN OUTCOME MEASURES: The period 12 months prior to surgery was compared with 12 months postoperatively with regard to total hospitalization days for asthma treatment, number of school days missed, pulmonary function test results, and systemic glucocorticoid medication requirements. Symptom scores for asthma and sinusitis were assessed via parental questionnaire both preoperatively and postoperatively. RESULTS: No significant difference was found for pulmonary function test results. Eleven of 14 patients demonstrated a significant reduction in hospitalization and school days missed. Twelve of 14 patients experienced a reduction in glucocorticoid requirements. Eleven of 14 and 13 of 14 patients experienced a significant improvement in asthma and sinusitis symptom scores. CONCLUSION: Endoscopic sinus surgery was effective in reducing sinusitis and improving the overall management of asthma in a majority of study patients.

Absenteeism↗
PubMed2002

Anatomic variations of the paranasal sinus area in pediatric patients with chronic sinusitis.

Endoscopic endonasal surgery has been performed in children. Therefore, we need to know the precise anatomy and anatomic variations of the lateral nasal wall. This is important in order to achieve better surgical results and avoid complications. We also need to know the relationship between the anatomic variations and sinonasal disease. For the purpose of this study we assessed the anatomic variations of the lateral nasal wall and the association of these variations with chronic sinusitis in children. Forty-seven children with chronic sinus disease were included in the study. There were 25 female and 22 male patients with ages ranging from 2 to 16 years (mean 10.5+/-3.8 years). On coronal and axial computed tomographic (CT) scans, the anatomic variations of the lateral nasal wall and sinusitis were assessed. A pneumatized middle concha (MC) was the most common anatomic variation, followed by pneumatization of the superior concha (SC), Haller cell and agger nasi cell. Secondary MC, large ethmoidal bulla, maxillary sinus hypoplasia, Onodi cell, and uncinate process pneumatization were relatively rare. Maxillary sinusitis was the most common sinus infection, followed by ethmoidal, sphenoidal and frontal sinusitis in that order. There was no significant relationship between the sinusitis and anatomic variations except for some minor associations. In conclusion, anatomic variations in the lateral nasal wall are common in children. Local, systemic or environmental factors appear to be more important in pediatric sinusitis than the anatomic variations. Due to the absence of a definitive relationship between the anatomic variations and sinus disease, aggressive surgical interventions should be avoided while performing endonasal endoscopic surgery in the children.

Adolescent↗
PubMed2002

[Maxillary sinus examination after sinus floor elevation combined with autologous onlay osteoplasty].

BACKGROUND: Complication rates after sinus floor augmentation of up to 10% are mentioned in literature, often when heterologous bone implants are used. The aim of our retrospective study was to determine the complication rate involving the maxillary sinus of patients treated with autologous spongiosa. PATIENTS AND METHODS: In 46 patients with an absolute maxillary atrophy (61% female, 39% male, mean age 49 years), a sinus floor augmentation, if necessary combined with an onlay bone graft of the iliac crest, was performed. Implants (Brånemark) were placed in a two-stage procedure after 3-6 months. Prior to surgery, a panoramic film was made for diagnosis and treatment planning; in addition, a sinus X-ray was taken when disease of the maxillary sinus was suspected. panoramic radiography was routinely taken after surgery. A clinical and radiological follow-up examination was performed after 6-12 months, and the patients answered a questionnaire. This study also included evaluation of operation reports and case histories. Ultrasound as well as magnetic resonance imaging to prevent radiation exposure were performed additionally. RESULTS: In spite of perforation of the maxillary sinus mucosa in about 25%, removal of the bone graft due to inflammation was not necessary. A transient sinusitis developed in 2%. The implant loss rate (3 out of 154) may be called small. DISCUSSION: Even though alternative heterologous graft materials exist, maxillary sinus floor elevation with autologous bone graft is still a safe option. Changes of the maxillary sinus are detectable in a small percentage, relatively often due to preexisting unrecognized or subclinical diseases of the maxillary sinus. Magnetic resonance imaging is, in spite of the high financial and technical effort required, a serious alternative to computed tomography. The combination of autologous bone graft with calcium phosphate ceramics, platelet-rich plasma, or synthetic bone growth factors should be tested as an alternative treatment method.

Adult↗
PubMed2000

Immunohistochemical localization of cytokines and cell adhesion molecules in maxillary sinus mucosa in chronic sinusitis.

OBJECTIVE: Chronic sinusitis is a common disease characterized by persistent inflammation of the nasal and paranasal sinus mucosa. Accumulating evidence supports the importance of proinflammatory cytokines and endothelial cell adhesion molecule (CAM) expression as an initiating process in tissue inflammation. This study was conducted to investigate the localization of major cytokines and CAMs in the maxillary sinus mucosa from patients with chronic sinusitis and from normal subjects. METHODS: Maxillary sinus mucosal specimens from patients with chronic sinusitis (n = 10) and from normal subjects (n = 6) were immunostained with specific antibodies directed against the cytokines (IL-1alpha, IL-1beta, IL-6, IL-8 and TNF-alpha) and the CAMs (intercellular adhesion molecule-1, ICAM-1 and vascular CAM-1, VCAM-1). RESULTS: The number of immunoreactive cells for IL-1alpha, IL-1beta, IL-6, IL-8, and TNF-alpha was increased significantly in patients with chronic sinusitis compared with normal controls. Immunoreactivity for ICAM-1 was also increased significantly in patients with chronic sinusitis compared with normal controls, whereas VCAM-1 is only minimally expressed or is absent in both groups. CONCLUSION: These findings indicate that bacterial and/or viral infection may induce functional and morphologic changes in the maxillary sinus mucosa in chronic sinusitis through enhanced generation of specific cytokines in conjunction with CAMs.

Adult↗