The Association Of Maxillary Accessory Ostia With Chronic Rhinosinusitis What is essential; ventilation or drainage.
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The study aimed to assess the role of the maxillary sinus accessory or secondary ostia in the pathophysiology of chronic maxillary sinusitis, and to solve the argument between surgeons as regards the close association between isolated maxillary sinusitis and the presence of accessory maxillary ostia and for a healthy sinus; drainage or ventilation is required. Patients &Methods: The study included 54 patients of both sexes with chronic or recurrent rhinological symptoms. All patients underwent examination by rigid nasal endoscopy (0&30 degree) for inspection of the inside of the nasal cavity and the lateral nasal wall. Computed tomography of the paranasal sinuses in the direct coronal plane without contrast was done for all patients pre-operatively after adequate medical treatment. Then, the patients had been classified into two groups; group A (with radiological finding of isolated maxillary sinusitis) which include 25 patients, group B (without radiological finding of maxillary sinusitis) either radiologically free or with anatomical variation as deviated septum, concha bullosa and/ or hypertrophied turbinates), which include 29 patients. The patients in each group had been classified into two subgroups according to the presence or absence of accessory ostium (AO); -Subgroups 1 (A-I and B-I with AO) -Subgroups 11 (A-II and Bll without A0).Twenty six patients (25 patients from group A with isolated maxillary sinusitis and one patient from group B with accessory ostium) underwent middle meatal antrostomies (MMA) under general anesthesia with hypotensive technique. The accessory ostium was connected to the natural ostium, the size of the created opening was around 8-10mm. Surgery was tailored according to the individual pathology as evidenced by the CT scan, the preoperative and operative findings. Post-operative evaluation was done for patients through systematic nasal endoscopy and sinuscopy over 2 years. Results: The patient's ages ranged from 13-47 years with a mean age of 26 years. Twenty six patients were males (48.1%) and the other twenty eight were females (51.9%).Twenty six patients underwent MMA (48.I%).A healthy middle meatus (MM) with no evidence of stenosis was noted in all cases operated upon. No adhesion or granulation tissue was present in the MM. There was no crust or discharge in the area. The surgical area had healed completely and lined with normal healthy mucosa. All widened ostia remained patent and healthy. The widened MO was patent in all cases. There was a statistically significant difference between presence and absence of AO in each group in the study, (P<0.05).There was no statistically significant difference between group A and group B as regard the main complaint (P>0.05). There was no statistically significant difference between group (A-I) and group (B-II) as regard the main complaint (P>0.05). The circulating mucous (circular flow) was found in two patients (22.22%) out of 9 patients exhibiting accessory ostium (AO). Conclusion: It could be concluded that there is a close association between isolated maxillary sinusitis and the presence of accessory maxillary ostia as the fontanelle defects could serve as maintainers of a chronic inflammation of the maxillary sinus. Also it appears that the sinus drainage via the natural ostium is more essential and mandatory than sinus aeration, in contrary with the condition in the middle ear cleft where the aeration is the most essentia