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 |
