STIMA: Submucosal Temporary Inferior Maxillary Antrostomy: A Modification of Conventional Antrostomy, A Retrospective Review.

Introduction: Maxillary sinus pathology is commonly approached through endoscopic middle meatal antrostomy (MMA). However, MMA does not provide full exposure to certain aspects of the maxillary sinus, such as alveolar, zygomatic, and prelacrimal recesses. In these hidden maxillary sinus niches, a combination approach with MMA is required for better exposure and access. In this article, we present a modification of inferior maxillary antrostomy (IMA) to allow for a temporary intraoperative window with no significant postoperative consequences. Objectives: (1) To describe our modification of IMA. (2) To report the outcome of maxillary sinus disease, postoperative complications, and flap condition. Methods: This is a retrospective chart review study. It was performed on 20 patients where submucosal temporary inferior maxillary antrostomy (STIMA) was indicated in the period from January 1, 2020, and July 1, 2023. All patients were assessed for their demographics, diagnosis, indication for STIMA, maxillary disease outcome, presence of postoperative complications, and flap condition. Result: Total of 18 patients fulfilled our inclusion/exclusion criteria; of them, 13 were males while the remaining were females. Mean age of patients was 33 years; most common diagnosis was chronic sinusitis. Status of maxillary sinus mucosa was healthy in all except 4 patients having polypoidal mucosa while flap condition was intact in all patients except 2 patients with pinpoint defects. Postoperative complications assessment demonstrated no neural, orbital, lacrimal, or dental complications in all patients. Conclusion: This retrospective chart review showed promising technique to address challenging maxillary lesions in difficult-to-access locations where combined approaches are necessary.

Indications, Stability, and Surgical Outcomes of Using Osteochondral Nasal Septal Graft as a Septal Extension Graft in Rhinoplasty Patients: A Prospective Cohort Study.

Septal extension graft (SEG) is an adaptable tool that controls, supports, and stabilizes the nasal tip projection, rotation, length, and shape. Recent studies comparing SEGs to more conventional columellar strut grafts found that SEGs provided improved results. This prospective cohort study included 66 patients divided into 2 groups based on their indications. Group 1 was patients who underwent septorhinoplasty using osteochondral septal extension graft (OSEG), and group 2 underwent septorhinoplasty using cartilaginous SEG. The main reason for undergoing OSEG was insufficient septal cartilage (P<0.001). The outcomes were not significantly different between both groups, with the % of patients who experienced positive outcomes ranging from 78.8% to 97%. The OSEG is a safe, valid, and effective option in septorhinoplasty that can be used in patients with insufficient cartilaginous septum.

STIMA: Submucosal Temporary Inferior Maxillary Antrostomy: A Cadaveric Controlled Study of a Modification of the Conventional Antrostomy.

Introduction: Inferior meatal antrostomy (IMA) is a safe and easy approach to the maxillary sinus. However, studies have shown disadvantages of conventional IMA, such as disruption of mucociliary transport and injury of the nasolacrimal duct (NLD). Endoscopic middle meatal antrostomy (MMA) has become the standard of care for addressing various maxillary pathologies. It is more functional and physiological but offers limited exposure to certain areas of the maxillary sinus, such as the prelacrimal recess, alveolar recess, and zygomatic recess. We proposed submucosal temporary inferior maxillary antrostomy (STIMA) to improve visualization and accessibility to such difficult-to-access locations. Objectives: To describe our proposed modification, to compare the degree of visualization and ease of accessibility between MMA and STIMA. Methods: This is a descriptive cadaveric study. It was performed on 4 fresh frozen human cadavers, and 8 maxillary sinuses were used to achieve the study's objectives. Different angled rigid nasal endoscopes and suction tubes were used to score the degree of visualization and ease of accessibility between the MMA and STIMA. Result: We demonstrated the superiority of the STIMA over the MMA in the degree of visualization and ease of accessibility in these difficult-to-access locations (P-value was significant, <.05). We did not encounter orbital injury or injury to the NLD in our specimens. Conclusion: STIMA is a relatively easy and safe modification of conventional IMA. It improves the degree of visualization and ease of accessibility to difficult-to-access maxillary sinus locations without the potential complications of conventional IMA.

Temporary Submucosal Inferior Maxillary Antrostomy: A Modification of the Inferior Antrostomy.

Complete removal of maxillary sinus pathology can be challenging in specific locations. In the past, the Caldwell-Luc procedure was used for maxillary sinus disease. Currently, the endoscopic middle meatal antrostomy (EMMA) approach is used. However, it can often be difficult to reach certain locations of lesions by EMMA alone, requiring an endoscopic inferior meatal antrostomy (EIMA), which has been reported in the literature to have numerous complications. Furthermore, multiple techniques have been suggested for a combined bi-meatal approach to remove such lesions. We present a case of a 17-year-old with a challenging antrochoanal polyp (ACP) location requiring EIMA. The patient underwent our modified technique of submucosal inferior antrostomy with mucosal flap with no observed intra-operative and post-operative complications. Maxillary sinus pathology can be challenging due to limited access to specific regions. In this case report, we present a novel technique to achieve a temporary inferior antrostomy through a minimally invasive approach with a promising post-operative course.

Drug-Induced Rhinitis: Narrative Review.

OBJECTIVES: Rhinitis, one of the most common inflammatory conditions of the nasal mucosa, is known to affect a large proportion of people worldwide. It is generally classified into allergic and non-allergic types and both are associated with several unpleasant symptoms. Several medications prescribed for different medical conditions can cause unpleasant rhinitis as an adverse effect, which is known as drug-induced non-allergic rhinitis. The aims of this article were to review the literature to identify drugs that could induce rhinitis, prevalence of drug-induced rhinitis, and the associated pathogenic mechanisms if known. METHODS: Literature search screening for eligible papers published up to December 31st, 2021, in Medline (via PubMed) and Embase was conducted. The search included the following combination of keywords and terms: rhinitis, sneezing, congestion, allergic, non-allergic, rhinorrhea, vasomotor, medication, drug-induced. RESULTS: The review findings suggest that 12 subtypes of drugs potentially could induce rhinitis. Based on their mechanisms of action, the pathogenic causes for the induction of rhinitis have been recognized for some drugs, while others remain unknown. CONCLUSION: Awareness of the list of drugs that reportedly induce non-allergic nasal symptoms, along with taking the patient's medication history, is important in the diagnosis of rhinitis.

Huge Concha Bullosa Involved With Allergic Fungal Sinusitis and Mimicking a Bony Tumor.

Concha bullosa (CB) is a pneumatized air cell within the nasal turbinates, often in the middle turbinate. CB is one of the most common anatomical variations found in the middle turbinate. It generally tends to be asymptomatic but can cause symptoms such as nasal obstruction, facial pain, and a decrease in the sense of smell. Moreover, CB can be involved in chronic rhinosinusitis, which can lead to its confusion with other lesions, as the radiographic picture might mimic other nasal pathologies. Here, we report a case of massive CB involved with allergic fungal sinusitis (AFS) and mimicking a bony tumor in order to highlight the diagnostic challenge of this clinical entity.

Isolated intramaxillary sinus cell causing long-standing facial pain: A case report.

INTRODUCTION: Sinus pneumatization by definition is a cystic enlargement within the paranasal sinuses, and that expansion causes clinical symptoms. IMPORTANCE: This case highlights the importance of identifying clinically significant sinus pneumatization and the significant role of surgical treatment. CASE PRESENTATION: This case report describes a clinical presentation of intramaxillary sinus cell affecting the patient's quality of life. Despite the rare location of the cyst, it was diagnosed by computed tomography and managed by Functional Endoscopic Sinus surgery (FESS). CLINICAL DISCUSSION: This case discussion describes the nomenclature, classifications, location and the treatment of sinus pneumatic dilatations. CONCLUSION: Our case demonstrates the importance of managing the underlying cause of the patient symptoms by a thorough history and physical examination and it can be confirmed by imaging. Symptomatic maxillary air cysts, albeit controversial in its nomenclature and mechanism, should be addressed surgically as it carries high levels of success.