Surgical outcomes between two endoscopic approaches for maxillary cysts

Abstract Objective: To compare recurrence rates and symptomatic relief in symptomatic maxillary sinus Retention Cysts (RCs) between Middle Meatus Antrostomy (MMA) alone and Inferior Meatus Antrostomy (IMA) with basal mucosa electrocoagulation. Methods: Patients with symptomatic unilateral maxillary RCs were randomly allocated to MMA (n = 54) and IMA combined with mucosa electrocoagulation (n = 53) groups. Symptomatic relief, cyst recurrence, and closure of the antrostomy opening were compared at 12-months postoperatively. Results: Symptomatic failure occurred in 13 (12.1%) patients, including 9 (16.7%) MMA and 4 (7.5%) IMA patients; this difference was not statistically significant (p = 0.251). Postoperative cyst recurrence occurred in 16 (29.7%) and 1 (1.9%) patient in the MMA and IMA groups, respectively (p<0.0001). Closure of the opening occurred in 7 (13.0%) and 17 (32.1%) patients in the MMA and IMA groups, respectively (p = 0.032). However, there were no significant pairwise correlations between closure of the opening and symptomatic failure or cyst recurrence. Conclusion: IMA combined with basal mucosa electrocoagulation and MMA alone provided similar symptomatic relief for symptomatic maxillary RCs, but IMA had shorter operation times and lower postoperative recurrence rates of RCs. Level of evidence: Level 1b.

Swing door technique for uncinectomy versus standard technique: a comparative study

INTRODUCTION@#Uncinectomy can be performed using various methods. The aim of the present study was to compare the results and complications of uncinectomy and middle meatus antrostomy using the standard and swing door techniques during functional endoscopic sinus surgery.@*METHODS@#In a prospective controlled study, 60 patients (aged 18-50 years) suffering from chronic maxillary sinusitis underwent functional endoscopic sinus surgery from January 2007 to December 2008 at a tertiary care centre. The patients were randomly divided into two groups of 30: Group A underwent uncinectomy using the standard technique, while Group B underwent uncinectomy using the swing door technique.@*RESULTS@#Group B showed more improvement in symptoms, with a mean visual analogue scale score of 80.58 ± 14.34 compared to 78.50 ± 16.63 in Group A. Both groups had no major complications. At the end of Week 2, minor complications were observed in 8 (26.7%) of the patients from Group A and 2 (6.7%) from Group B. By the sixth week, the minor complication rate was 1 (3.3%) and 0 (0%) in Group A and Group B, respectively. When compared statistically during the second week using chi-square test, the difference in the minor complication rate was found to be statistically significant (p < 0.05, χ@*CONCLUSION@#The swing door technique for uncinectomy produces good postoperative results, with fewer complications, as compared to the standard technique.

Study Of Frontal Air Sinus Opening In Hiatus Semilunaris Of Nasal Cavity

Background: Frontal air sinus opens in Hiatus semilunaris of middle meatus of Nasal cavity. Nowadays plentyof endoscopic surgeries are happening at Middle meatus; so there is need to explore more about detail anatomyof opening of sinuses. So Present study was undertaken to note the exact site of opening of Frontal air sinus inHiatus semilunaris of Nasal cavity.Context and Purpose of study: Study was conducted on 50 specimens. Out of that 27 were from Right side & 23were from Left side. The specimens were the sagittal sections of adult cadavers in the department ofAnatomy,Krishna Institute of Medical sciences University, Karad. The parameters measured were, Distance ofFrontal air sinus opening from Anterior end of Hiatus semilunaris (nasal bone). Distance of Frontal air sinusopening from Posterior end of Hiatus semilunaris(Inferior surface of Body of Spenoid bone). Diameter of Frontalair sinus opening. Shape of Frontal air sinus opening. All these measurements were taken by Sliding VernierCaliper of 30cm length & 0.001 accuracy.Results: The mean Distance of Frontal air sinus opening from Anterior end of Hiatus semilunaris (nasal bone)was- 1.63cms on Left side & 1.52cms on Right side. The mean Distance of Frontal air sinus opening fromPosterior end of Hiatus semilunaris(Inferior surface of Body of Spenoid bone) was- 4.26 cms on Left side &4.17cms on Right side. The mean Diameter of Frontal air sinus opening – 0.19cms on Left side & 0.18cms on Rightside. The shape of Frontal sinus opening is mainly Circular.Conclusion and Summary: Knowledge of the anatomy of the Frontal air sinus opening is basically helpful for theAnatomists, to know where exactly is the site of the opening of Frontal air sinus in the middle meatus of nasalcavity; And secondarily it might be helpful to ENT surgeons during the performance of endonasalcystorhinostomies.

Variaciones anatómicas del proceso uncinado en tomografía computada multidetector en pacientes con rinosinusitis crónica

Objetivo: Describir la anatomía del proceso uncinado y sus variaciones observadas a través de cortes coronales por tomografía computada multidetector (TCMD) en una población con rinosinusitis crónica. Introducción: Según la literatura científica revisada, no se encontraron estudios sobre las variaciones anatómicas del complejo osteomeatal (COM) en la población adulta colombiana. Los reportes coinciden en que las variaciones anatómicas de este complejo son parte de las causas de la sinusitis crónica refractaria a tratamiento médico, por lo que el presente trabajo se propone estudiar la anatomía de este complejo e identificar sus posibles variaciones anatómicas en pacientes adultos colombianos diagnosticados con sinusitis crónica. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal, observacional y retrospectivo. Para las variables continuas se estimaron medidas de tendencia central y de dispersión, con un intervalo de confianza del 95%, mientras que para las variables categóricas se determinaron las frecuencias y los porcentajes con que se presentaron en la muestra. Resultados: Se contó con 143 casos. De este total, el 53,8% fueron hombres y el 46,2% mujeres. Tanto en el lado derecho como en el izquierdo, el proceso uncinado del hueso etmoides se insertó en la lámina papirácea (el 49,7% y el 53,1% de los hombres y mujeres, respectivamente). La inserción del proceso uncinado en la lámina cribosa del hueso etmoides en el lado derecho fue el segundo en frecuencia (25,2%) y en el lado izquierdo este lugar lo ocupó la inserción en la concha nasal media (23,8%). También se encontró que, en la mayoría de los casos, el proceso uncinado tuvo una orientación lateral (el 51% en el lado derecho y el 56,6% en el lado izquierdo). Conclusión: El proceso uncinado es una estructura anatómica muy variable que se encuentra a cada lado de la cavidad nasal. Presenta diferentes puntos de inserción y tiene cambios en su angulación y distintas longitudes. Es importante tener en cuenta estas variaciones para el manejo quirúrgico de la rinosinusitis crónica.

Objective: To describe the uncinate process anatomy and its variations observed through coronal, multislice computed tomography (MSCT) in patients with chronic rhinosinusitis. Introduction: As reviewed in the literature, no studies of anatomical variations ostiomeatal complex in Colombian adults were found. The reports agree that the anatomical variations of this complex are part of the causes of chronic sinusitis refractory to medical treatment, which motivated the present work to study the anatomy of this complex and identify possible anatomic variations in adult patients from Colombia, diagnosed with chronic sinusitis. Materials and methods: A descriptive, cross-sectional, observational and retrospective study. Continuous variables were estimated with measures of central tendency and dispersion, with a confidence interval of 95%. Categorical variables were determined with frequencies and percentages. Results: The total sample was 143 cases. In the sample, 53.8% were men and 46.2% were women. Both of the right and left, the uncinate process of the ethmoid was inserted into the lamina papyracea in 49.7% and 53.1% of cases, respectively. The insertion of the uncinate process in the cribriform plate of the ethmoid (T6) had a frequency to the right side of 25.2%, but for the left side was the insertion into the middle nasal concha (T1) (23.8%). In most cases, the uncinate process had a lateral orientation and 51% on the right side and 56.6% on the left side. Conclusion: The uncinate process is a highly variable anatomical structure at each side of the nasal cavity, arranged indifferent insertion sites, changes in angle and different lengths which is important from the point of view of surgical management of chronic rinosinusitis.

What is the Relationship between the Localization of Maxillary Fungal Balls and Intranasal Anatomic Variations?

OBJECTIVES: Although the mechanisms underlying the initiation and maintenance of inflammation in unilateral maxillary fungal balls (FBs) are poorly understood, the relationship between intranasal anatomy and maxillary FB is thought to play an important role. The aim of this study was to investigate the relationship between anatomic variations and FB. METHODS: We enrolled 140 patients who were composed of 56 patients with FB, 56 patients with unilateral chronic rhinosinusitis (CRS), and 28 patients with no sinus disease. Computed tomography scans were retrospectively analyzed to identify and compare the associated nasal anatomic abnormalities. To measure the volume of the nasal cavity and middle meatus, computed tomography scans were reconstructed into three-dimensional images. RESULTS: The relatively larger volume of the middle meatus was associated with the localization of the FB in contrast with the CRS. However, the nasal-cavity volume, nasal valve area, and nasal septal deviation were not significantly associated with localization of FB. The mean volumetric and areal measurements such as nasal cavity, middle meatus, and nasal valve in FB-ipsilateral sides were not significantly different from those in contralateral sides as well as other groups. CONCLUSION: The middle meatus bears the major part of the inspiratory nasal airflow, and its volume may influence the occurrence of FB.

Microbiologia do meato médio em indivíduos sadios / Microbiology of middle meatus in healthy individuals

Introdução: A microbiologia nasossinusal de indivíduos sadios é pouco documentada. Seu conhecimento permite a determinação dos agentes colonizantes nasossinusais e a monitoração dos padrões de resistência bacteriana. Objetivos: Determinar a microbiologia do meato médio em indivíduos sadios e compará-la com a de pacientes com rinossinusite crônica. Método: Foram incluídos 61 indivíduos sadios. As amostras foram coletadas sob visão endoscópica e submetidas a exame de Gram com contagem leucocitária e cultura para aeróbios, anaeróbios e fungos. 114 pacientes com rinossinusite crônica constituíram o grupo controle. Resultados: Nos indivíduos sadios foram isolados 58 microorganismos, sendo os mais prevalentes Staphylococcus coagulase-negativos, Staphylococcus e Corynebacterium. Fungos foram cultivados em 10%.Todas as amostras apresentaram leucócitos raros ou ausentes. Identificou-se resistência à penicilina em 75% dos Staphylococcus aureus e 69% dos Staphylococcus coagulase-negativos. Quanto à oxacilina, 100% dos Staphylococcus aureus e 92% dos Staphylococcus coagulase-negativos foram sensíveis. No grupo controle foram cultivados 158 microorganismos. Os mais freqüentes foram Staphylococcus aureus e coagulase-negativos. Os Gram-negativos representaram 26% dos aeróbios. Entre as amostras com cultura positiva, 73% apresentavam alguns ou numerosos leucócitos. Conclusão: Ausência ou raridade de leucócitos, Staphylococcus coagulase-negativos e Corynebacterium foram mais freqüentes em sadios, e Streptococcus pneumoniae, anaeróbios, Staphylococcus coagulase-negativos oxacilino-resistentes e Gram-negativos mais freqüentes no grupo controle.

Introduction: The nasosinusal microbiology of healthy individuals is not much documented. Its knowledge allows to determine the nasosinusal colonizing agents and to monitor the patterns of bacterial resistance. Objective: To evaluate the microbiology of the middle meatus in healthy individuals and to compare it with that of patients with chronic rhinosinusitis. Method: 61 healthy individuals were included. The samples were collected under endoscopic view and Gram stained with leucocytes count and aerobic, anaerobic and fungus cultures. 114 patients with chronic rhinosinusitis formed the control group. Results: In healthy individuals 58 microorganisms were isolated. The most frequent ones were coagulase-negative Staphylococcus, Staphylococcus and Corynebacterium. Fungi were cultivated in 10%. There were rare or no white blood cells in all samples. There was penicillin resistance in 75% of the Staphylococcus aureus and 69% of the coagulase-negative Staphylococcus. As for oxacillin, 100% of Staphylococcus aureus and 92% of coagulase-negative Staphylococcus were sensitive. In the control group 158 microorganisms were cultivated. The most common ones were Staphylococcus aureus and coagulase-negative Staphylococcus. Gram-negatives represented 26% of the aerobics. 73% of the samples with positive cultures presented a few or many white blood cells. Conclusion: Rare or no white blood cell, coagulase-negative Staphylococcus and Corynebacterium were more frequent in healthy individuals and Streptococcus pneumoniae, anaerobics and oxacillin resistant coagulase-negative Staphylococcus and Gram-negative were more frequent in the control group.

Shielded Swab: A New Swab Technique Avoiding Contamination in Endoscopically Guided Middle Meatal Culture / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopically guided middle meatal culture is recommended to determine organ-specific antibiotic therapy in sinusitis. This study was designed to decrease the chance of contamination in endoscopically guided middle meatal swab through a shielded pathway using a sterile straw to bypass the contaminated area in the nose from the vestibule to the middle meatus. SUBJECTS AND METHOD: Seventeen healthy volunteers underwent endoscopically guided middle meatal culture. With or without the sterilization of the nasal vestibule, endoscopically guided middle meatal culture was performed by using a sterile cotton swab (routine swab) and using a sterile cotton swab through a sterile straw (shielded swab). We compared the contamination rates between the routine swab versus shielded swab. RESULTS: With and without the sterilization of the nasal vestibule, the contamination rates of the routine swab was 11.7% and 64.7%, respectively and the contamination rates of the shielded swab was 5.8% in both. CONCLUSION: In endoscopically guided middle meatal culture, the contamination rates was significantly decreased by using the shielded swab without sterilization of the nasal vestibule. This study suggests that the shielded swab is a new and reliable swab method that can be used easily and simply at the office.

Bacteriologia do aspirado do meato médio em pacientes com fibrose cística / Bacteriology of the middle meatus aspirate in patients with cystic fibrosis

A combinação de fatores como viscosidade das secreções dos seios paranasais, diminuição da drenagem sinusal e comprometimento do transporte mucociliar podem ser responsáveis pela criação de um ambiente propício e adequado para a colonização de bactérias nos seios paranasais de pacientes com fibrose cística. OBJETIVO: Analisar a bacteriologia do aspirado do meato médio de pacientes portadores de fibrose cística. MATERIAL E MÉTODO: Através de um estudo prospectivo de delineamento transversal, avaliou-se uma amostra composta de 23 pacientes, avaliados durante 2 anos. Realizaram-se relações entre a cultura do meato médio e a avaliação radiológica do seio maxilar e a avaliação clínica. Secundariamente, estudou-se a relação da bacteriologia do aspirado do meato médio e a do escarro. RESULTADOS: No total foram realizadas 42 aspirações do meato médio. Em 17 (73,91 por cento) dos 23 pacientes, as culturas foram negativas e, em 6 (26,08 por cento), positivas. Das 42 aspirações, 31 (73,8 por cento) foram negativas e 11 (26,2 por cento), positivas. A presença de Pseudomonas aeruginosa foi observada em 18,18 por cento das culturas positivas e o Staphylococcus aerus em 27,28 por cento. CONCLUSÃO: A maioria das culturas do aspirado do meato médio de pacientes com fibrose cística foi negativa.

The combination of factors, such as abnormal viscosity of the paranasal sinus secretions, decreased sinus drainage, and impaired mucociliary clearance may account for the establishment of a suitable and opportune environment for the colonization of bacteria in the paranasal sinuses of patients with cystic fibrosis. AIM: The goal of the present study was to assess the bacteriology of the middle meatus aspirate in patients diagnosed whit cystic fibrosis. MATERIAL AND METHODS: Through a cross-sectional prospective study, a sample consisting of 23 patients evaluated for 2 years, was assessed. Firstly, we established the relationship between the middle meatus culture and the maxillary sinus x-ray. In second, we studied the relationship between the middle meatus aspirate bacteriology and the sputum bacteriology. RESULTS: In total, 42 aspirates of the middle meatus were carried out. In 17 (73.91 percent) of the 23 patients, the aspirates were negative; and in 6 (26.08 percent) they were positive. Out of the 42 aspirates,31 (78.8 percent) were negative, and 11 (26.2 percent) were positive. The presence of Pseudomonas aeruginosa was observed in 18.18 percent of the positive cultures, and Staphylococcus aureus was observed in 27.28 percent. CONCLUSION: The great majority of the middle meatus aspirates of the patients with cystic fibrosis were negative.