Feasibility of Minimal Inferior Meatal Antrostomy and Fiber-Optic Sinus Exam for Fungal Sinusitis

Abstract

Background/objective The aim of this study was to evaluate the usefulness of simultaneous middle and inferior meatal antrostomies (SMIAs) as a treatment modality in patients with maxillary fungal sinusitis and to compare the efficacy of SMIA with that of conventional middle meatal antrostomy (MMA). Methods A retrospective study was performed on consecutive patients with noninvasive fungal maxillary sinusitis. Twenty-one patients underwent endoscopic sinus surgery with SMIA group and the remaining 24 patients were treated with the conventional MMA group. Medical records were reviewed for history, clinical presentation, radiographic findings, surgical intervention, complications, and outcomes. Outcomes consisted of the visual analog scale (VAS) for the main symptoms and maxillary sinus endoscopic scores. The stenosis or obstruction of the antrostomy site and postoperative mucociliary function was also evaluated. Results VAS scores for facial pain and nasal discharge/postnasal drip were significantly improved in the SMIA group. The maxillary endoscopic score was also significantly reduced in the SMIA group. There were no significant differences between 2 groups with respect to the preoperative Lund–Mackay score, VAS score of nasal obstruction, nasal bleeding, postoperative mucociliary function, and MMA patency. Conclusions The SMIA technique is useful for identifying and removing fungal debris that cannot be reached through the MMA and could bring better surgical outcomes.

Extended middle meatal antrostomy via antidromic extended medial wall for the treatment of fungal maxillary sinusitis

“…ESS with MMA was the gold standard surgical technique for FMS. Unfortunately, rhinologists subsequently found that endoscopic MMA alone is limited in terms of visualizing the whole MS cavity, and this incomplete access may lead to a recurrence of FMS [ 6 , 12 ]. Some studies have reported FMS recurrence rates of 3–14% after MMA alone [ 6 , 13 ].…”

Mini-Invasive Endoscopic Approaches to the Maxillary Sinus Floor: A Comparative Anatomical Study

“…Visualizing the MS floor and anterior wall has a pivotal role in several sinonasal conditions, among which it is worth mentioning antrochoanal polyps, especially in the pediatric population, recalcitrant MS infections, often of fungal origin, and complications of dental procedures such as fixture dislocation and maxillary sinus grafting failures. In all these settings some authors advocate the use of IA in selected cases, often coupled with traditional MA, 5,[20][21][22] with generally optimal, albeit nonsystematic, results, in small case series. Choi and al.…”

“…They searched for fungal debris with a flexible endoscope postoperatively and found 29.2% of residual in MA alone group, and 9.5% in SMIA group. 20 Pre-lacrimal recess approach 7 and medial maxillectomy 8 are aggressive approaches which achieves a full visualization of MS at the expense of functional complications such as, according to their extent, nervous lesions and paresthesia (anterior superior alveolar nerve injury), epiphora (nasolacrimal duct damage or transection), nasal fluid dynamics alterations (radical inferior turbinate resection). 23 Those procedures cannot be considered to be mini-invasive and are not generally indicated in the conditions cited above.…”

“…Straight, 45 and 90 nasal forceps, straight and curved probes and elevator and small-tipped mildly-curved suction tips can be inserted and rotated 360 (thus allowing reaching all the fixtures in the specimens), while extremely curved instruments can be easily inserted through the window but with limited rotation. Nevertheless, as it already happened for other in vivo proposals of IA, 5,[20][21][22] we still have to systematically assess which surgical and clinical results we might yield combining our modified IA with other endoscopic accesses. Last, at present we have only minimal in vivo data on the window size obtainable in the pediatric population.…”

Something for Everyone in Rhinology and Allergy

“…Choi et al describe the addition of an inferior meatal antrostomy to standard middle meatal antrostomy for the management of noninvasive fungal sinusitis. 9 They find improvements in endoscopic appearance and patient-reported symptom scores with the modified technique. Cheon et al describe a modification of the cutting and suture technique for performing caudal septoplasty.…”