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© Borgis - New Medicine 4/2010, s. 118-121
*Lechosław P. Chmielik, Jolanta Jadczyszyn, Magdalena Frąckiewicz, Mieczysław Chmielik
Intra-operative evaluation of natural ostia of the maxillary sinuses in children with chronic rhinosinusitis
Department of Paediatric Otorhinolaryngology, Medical University of Warsaw, Poland
Head of Department: prof. Mieczysław Chmielik, MD, PhD
Summary
Introduction. Narrowing of the natural ostium of the sinuses is stated in the literature to be the main structural cause of chronic rhinosinusitis. Thanks to computed tomography (CT), we are able to confirm rhinosinusitis as well as to make a prognosis of its progression. CT also enables evaluation of the state of the natural ostia and any pathological lesions that may lead to chronic inflammation. The majority of authors make a diagnosis and evaluate the progression of the disease on the basis of computed tomography or magnetic resonance imaging. The need for endoscopy of the nasal cavities, with evaluation of natural ostia in the middle nasal duct, is also emphasised. Patients with chronic rhinosinusitis caused by narrowing of the natural ostia should be qualified for surgical treatment. Currently available paediatric endoscopic sinus surgery (PESS) is based on modifications of operations by Vigand or Stammberger.
Aim. The aim of this study was to analyse lesions that may influence the functioning of the paranasal sinuses, and the intra-operative image of the natural ostium, from both the nasal cavity and the lumen of the maxillary sinus, in a group of children operated on as a result of chronic rhinosinusitis.
Material and method. In the study, the intra-operative image of the natural ostia of the maxillary sinuses of children operated on for chronic rhinosinusitis in the Department of Paediatric Otolaryngology of the Medical University of Warsaw, during the period from July 2008 to December 2009, was assessed.
Results. Unilateral lesions of the natural ostia of the maxillary sinuses were found in 4 cases (3.84%) and bilateral lesions in 100 cases (96.15%). In total, 208 maxillary sinuses were evaluated. During evaluation of the ostia from the nasal cavity, normal ostia were found in 196 (94.23%) cases, inflammatory-oedematous lesions in 9 (4.32%) cases, and polyps in 3 (1.44%) cases. During evaluation of the ostia from the lumen of the maxillary sinuses, normal ostia were found in 4 (1.92%) cases, inflammatory-oedematous lesions in 191 (91.82%) cases, a diaphragm in the area of the ostium in 7 (3.36%) cases, and polyps in 6 (2.88%) cases.
Conclusions. 1. Inflammatory-oedematous lesions were found significantly more often in the ostium of the maxillary sinus from the lumen of the sinus than from the nasal cavity. 2. Defects in ventilation of the sinuses due to skeletal or mucosal deformations in the area of the ostia may cause a chronic inflammatory process in the upper respiratory tract. 3. Haller?s cells play an essential role in the pathogenesis of chronic rhinosinusitis in children.
INTRODUCTION
Chronic rhinosinusitis in children still remains a considerable diagnostic and therapeutic problem (1).
The result of treatment depends on precise determination of the factors that play a role in development of pathological changes in the patient (2). A doctor who carries out such treatment should evaluate, first, general conditions: the patient?s immunity, mobility of cilia, density of mucus, and susceptibility to allergies.
Second, local evaluation includes: nasal patency, condition of the osteomeatal complex, and co-existence of nasal polyps (3). Precise determination of the aforementioned factors allows preparation of the most efficient scheme of preservative or surgical treatment, and an estimate of the potential for complete recovery.
Particularly in patients with chronic rhinosinusitis with nasal polyps, complete recovery is very difficult (4). Early diagnosis and treatment to prevent the full development of the symptomatic departmental appearance of the disease is very important. The majority of authors state that the main structural cause of chronic rhinosinusitis is narrowing of the natural ostium of the sinuses (5). The basic examination in patients with chronic sino-nasal symptoms is currently, without doubt, based on computed tomography. Due to computed tomography we are able to confirm rhinosinusitis as well as predict its progress. CT also enables an evaluation of the state of the natural ostia and pathological lesions that may lead to chronic inflammation. The majority of authors make their diagnosis, and evaluate the progression of the disease, on the basis of computed tomography or magnetic resonance imaging (6). The necessity for endoscopy of the nasal cavities, with evaluation of the natural ostia in the middle nasal duct, is also emphasised. Patients with chronic rhinosinusitis caused by narrowing of the natural ostia should be qualified for surgical treatment. Currently available paediatric endoscopic sinus surgery (PESS) operations are modifications of Vigand?s or Stammberger?s operation (7, 8, 9, 10). In both surgical techniques, endoscopy of the nasal cavities is carried out as the first step, during which the osteomeatal complex and the natural ostia of the maxillary sinuses are examined. For an adequate prognosis, information about the condition of the osteomeatal complex from the maxillary sinus is necessary. This information is usually included in descriptions of the surgery, whereas in the available literature no research concerning such analysis has been found.
AIM
The aim of this study was to analyse lesions that may influence the functioning of the paranasal sinuses, and the intraoperative image of the natural ostium, from both the nasal cavity and the lumen of the maxillary sinus, in a group of children operated on as a result of chronic rhinosinusitis.
MATERIAL AND METHOD
In the study, the intra-operative image of the natural ostia of the maxillary sinuses of children operated on for chronic rhinosinusitis in the Department of Paediatric Otolaryngology of the Medical University of Warsaw, during the period from July 2008 to December 2009, was assessed.

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otrzymano: 2010-10-21
zaakceptowano do druku: 2010-11-17

Adres do korespondencji:
*Lechosław P. Chmielik
Klinika Otolaryngologii Dziecięcej WUM
ul. Marszałkowska 24, 00-576 Warszawa
tel./fax: +48 22 628 05 84
e-mail: laryngologia@litewska.edu.pl

New Medicine 4/2010
Strona internetowa czasopisma New Medicine