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Misdiagnosis of maxillary sinus hypophasia usually as sinus infection, sometimes as neoplasm, can lead to unnecessary and difficult surgical explorations. Associated anatomical abnormalities, e.g., caudal displacement of the ipsilateral frontal lobe of the brain or central position in the maxilla of the infraorbital nerve may create unexpected surgical hazards. Associated orbital enlargement can lead to diagnostic confusion in the investigation of headache, especially if the superior orbital fissures show marked asymmetry suggesting erosion. Projection of the fissure into the antrum in Waters view can simulate trabeculation of the sinus or fracture of the inferior orbital rim. Radiologic examination of 500 patients without intracranial or intraorbital lesions revealed maxillary sinus hypoplasia in 36 cases (7.2%) and in half the hypoplasia was unilateral (sinus asymmetry); aplasia was not encountered. Fissure asymmetry was present in 30 cases (6%), being present in 3.66% of patients with normally developed sinuses and in 36.1% of the hypoplasia patients. The appearances and measurements of the fissure are presented and examples of marked normal fissure asymmetry are demonstrated. Maxillary sinus hypoplasia is classified in this series as grade I-mild hypoplasia with limited inferolateral expansion (4 cases) and grade II in which there is also a curved orbital floor and lateral displacement of the adjacent nasal wall (32 cases).

This was a study of the effect of functional endoscopic sinus surgery (FESS) on the ciliary regeneration of maxillary sinus mucosa in patients with chronic maxillary sinusitis, using objective quantitative methods. Twenty specimens from the mucosa of both the superolateral wall and the ostium of the maxillary sinus were sampled during FESS and then six to 12 months later. They were light examined first by light microscopy and then by scanning electron microscopy in combination with image analysis software in order to study the cilia under higher magnification and to calculate proportion of the field that was ciliated. Samples were taken and studied at Cairo University hospital. This study showed that the maxillary sinus mucosa in chronic sinusitis is capable of regeneration and could return towards normal with the improvement of ventilation and drainage of the maxillary sinus following FESS. There were no significant changes in the degree of glandular hyperplasia, goblet cells or pathological glands after surgery.

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Background Enteral feeding intolerance (EFI) is a frequent problem in the Intensive care unit (ICU) and is associated with poor clinical outcomes leading to worse prognosis in terms of mortality and ICU stay. Nowadays, prokinetic drugs are the mainstay of therapy in EFI. However, available prokinetics have uncertain efficacy and safety profiles. Itopride, is a prokinetic agent which is different and unique from the available prokinetics because of its dual mode of action as well as its tolerability and safety. The current study compared the efficacy and safety of Itopride against metoclopramide for EFI in critically ill patients. Moreover, it tested the utility and applicability of ultrasonography to measure gastric residual volume (GRV) in this population. Methods This randomized, double-blind study included 76 EFI patients who were randomly assigned to either Itopride or metoclopramide group. The primary outcome was to measure GRV by ultrasonography. Secondary outcomes included the percentage ratio of enteral feed volume, energy and protein received by patients over 7 days of treatment, ICU length of stay, safety parameters and occurrence of infectious complications or vomiting. Results Thirty-five patients of each group completed the study. At day 7, itopride significantly decreased GRV compared with metoclopramide group (p = 0.001). Moreover, there was a significant increase in the ratios of received enteral nutrition feed volume, calories, and protein after the one-week therapy in the itopride group more than the metoclopramide group (p = 0.001), (p = 0.002), (p = 0.01), respectively and there were no differences in any secondary outcomes or adverse events between the two groups. Conclusion In critically ill patients with EFI, itopride was well tolerated with superior efficacy to metoclopramide. In addition, we demonstrated that ultrasonography is a simple, non-invasive, inexpensive, and undemanding method for GRV measurements and can offer reliable assessments in the gastric emptying modality. Trial registration The trial was registered in ClinicalTrials.gov (NCT03698292). Date: October 5, 2018