Canine fossa puncture in endoscopic sinus surgery: report of two cases / Punção da fossa canina em cirurgia endoscópica sinusal: relato de dois casos

Abstract Introduction: Chronic rhinosinusitis with nasal polyposis is a common chronic disease that often affects maxillary sinus. Endoscopic sinus surgery is the most common procedure for treating the majority of maxillary sinus lesions. Objective: To demonstrate the role of canine fossa puncture during endoscopic sinus surgery procedure in patients with severe maxillary sinus disease. Methods: We present 2 cases where canine fossa puncture has been performed as method to obtain a complete access to the maxillary antrum. Results: According our experience, 2 cases on 296 endoscopic sinus surgery (0.6%) where antrostomy and used of angled microdebrider were not sufficient, canine fossa puncture has been performed as an alternative method to obtain a complete access to the maxillary antrum. Conclusion: Although the advent of endoscopic sinus surgery, our cases support the fact that actually canine fossa puncture is a minimally invasive technique useful in selected cases.

Resumo Introdução: A rinossinusite crônica com polipose nasal é uma doença crônica comum que frequentemente afeta o seio maxilar. A cirurgia endoscópica sinusal é o procedimento mais comum para tratar a maioria das lesões do seio maxilar. Objetivo: Demonstrar o papel da punção da fossa canina durante o procedimento de cirurgia endoscópica sinusal em pacientes com doença grave do seio maxilar. Método: Apresentamos dois casos em que a punção da fossa canina foi feita como método para obter acesso completo ao antro maxilar. Resultados: De acordo com nossa experiência, dois casos em 296 cirurgias endoscópicas sinusais (0,6%) nos quais a antrostomia e o uso de microdebridador angular não foram suficientes, a punção da fossa canina foi feita como um método opcional para obter acesso completo ao antro maxilar. Conclusão: Apesar do advento da cirurgia endoscópica sinusal, os nossos casos apoiam o fato de que a punção da fossa canina é uma técnica minimamente invasiva útil em casos selecionados.

The Role of Powered Instrumentation in the Removal of Antrochoanal Polyps: A 10-Year Review

Antrochoanal polyps are rare lesions. We report a series of 40 consecutive cases of antrochoanal polyps treated in our tertiary centre over a period of ten years between May 1998 and April 2008. The median age of the patients was 37 years. The most common clinical symptom was nasal obstruction (92.5%) followed by rhinorrhoea (45%), postnasal drip (35%) and snoring (22.5 %). The median period of follow-up of these patients was 30 months. Various surgical approaches were used; the commonest was powered endoscopic polypectomy and middle meatal antrostomy in 28 patients (70%), followed by endoscopic polypectomy and middle meatal antrostomy in seven patients (17.5%). Five patients (12.5%) underwent powered endoscopic polypectomy without middle meatal antrostomy. In addition, two patients had septoplasty and one had a frontal sinustomy. There were six patients (15%) who had combined sublabial antrostomy. No major complications occurred; four patients relapsed; three patients had initial operation performed elsewhere and one patient developed recurrence after the first surgery. The median hospitalization period was three days. We conclude that, the use of powered instrumentation in the removal of antrochoanal polyps is safe, effective and associated with minimal morbidity.

Advantage of Middle Meatal Antrostomy in Transnasal Endoscopic Reconstruction of Medial Orbital Blow-out Fracture

PURPOSE: Blowout fracture is an outward fracture of the orbital wall. That usually occurs at inferior or medial wall of the orbit. The main pathophysiology is high intraocular pressure derived from impact of trauma. Among the four orbital wall, the medial wall is thinnest and most vulnerable to trauma. Many kinds of methods were introduced for correction of medial orbital wall fracture. Recently, transnasal endoscopic reconstruction methods were widely used. Endoscopic methods had many advantages. However, we experienced some cases of postoperative maxillary sinusitis. This study was planned to find out the effectiveness of middle meatal antrostomy after endoscopic reconstruction of medial orbital wall fracture. METHODS: This study was retrospective analysis of 28 patients who underwent transnasal endoscopic repair of medial orbital wall fracture. The 18 male and 10 female patients were ranged from 17 to 57 years of age(mean, 30.9 years). Among 28 patients, randomly selected 17 patients underwent middle meatal antrostomy as additional procedure by the same surgeon. After at least 12 months of follow-up period, we examined the nasal symptom, endoscopic and CT findings. RESULTS: One patient complained of nasal obstruction in middle meatal antrostomy group and four patients complained nasal symptoms in non middle meatal antrostomy group. On the endoscopic findings, three patients of non middle meatal antrostomy group had continuous nasal discharge. But middle meatal antrostomy group had no abnormal endoscopic findings. The abnormal CT finding(abnormal mucosal hypertrophy) were detected in four patient of non middle meatal antrostomy group. There were no abnormal CT findings in middle meatal antrostomy group. The data were statistically significant at comparative study. CONCLUSION: Authors think that the middle meatal antrostomy has some advantages as a additional procedure of endoscopic reconstruction of medial orbital wall fracture. Especially, it is good at preventing post- operative maxillary sinusitis. But, more larger group and strict application of disease entity are need for correct evaluation of middle meatal antrostomy effect.

Effects of Middle Meatal Antrostomy on Ciliary Beat Frequency and Histopathology of the Nasal Mucosa in Experimentally Induced Maxillary Sinusitis in Rabbits / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to observe the effects of middle meatal antrostomy (MMA) on ciliary beat frequency (CBF) and histopathology of the nasal mucosa in experimentally induced maxillary sinusitis in rabbits. MATERIALS AND METHOD: Maxillary sinusitis was induced in both maxillary sinuses (MSs) of 30 Pasturella-free New Zealand white rabbits by partially occluding the natural ostium and inoculating with P. aeruginosa. After 4 weeks, the MS and inferior turbinate mucosae were obtained in 5 rabbits. In the remaining 25 rabbits, the ostia were reopened. Five rabbits were sacrificed 2, 4, 6, 8, and 12 weeks after MMA, respectively and the MS and inferior turbinate mucosae were obtained. Another 5 normal rabbits were used as a control group. CBF was measured by video-computerized analysis. Degree of inflammation in histopathology was graded using a 100-point scale of inflammation score. CBF and inflammation score were compared among the 6 experimental and control groups. RESULTS: CBF of the MS mucosa significantly improved after MMA in a time-dependent pattern, but did not reach a normal level even after 12 weeks. CBF of the inferior turbinate mucosa significantly improved after MMA in a time-dependent pattern, and reached a normal level after 12 weeks. Inflammation scores of the MS and inferior turbinate mucosae were significantly decreased after MMA in a time-dependent pattern. However, they did not reach a normal level of the control group even after 12 weeks. CONCLUSION: MMA can improve not only the primary inflammation of the MS mucosa but also functionally and morphologically improve the secondarily developed inflammation of the nasal mucosa in experimentally induced maxillary sinusitis in rabbits.

Caldwell-Luc's Operation with Middle Meatal Antrostomy / 第二军医大学学报

Fifty-nine patients (62 cases ) with chronic antritis were operated by Caldwell-Luc's operation with middle meatal antrostomy and followed up for 0.5 ~5 years. It was found that curative effect of the oper ation was quite well. Eghty patients treated with Caldwell-Lucs operation were followed up as control at the same time. Caldwell-Luc's operation with middle meatal antrostomy was found safe, easy to operate and not injurious to agger nasi, as well as partially recoverable to sinus function.