The use of intranasal glucocorticosteroids in patients with chronic rhinosinusitis in the preoperative period

Introduction. Chronic rhinosinusitis is a disease that occurs everywhere, characterized by inflammation of the mucous membrane of the paranasal sinuses and nasal cavity. If it is impossible to eliminate the causes of the recurrent disease with medical therapy, the use of surgical treatment help to recover the normal functioning of the ostium, including the ostiomeatal complex to improve ventilation and drainage of the paranasal sinuses and recover nasal breathing to relieve chronic inflammation.Purpose of the study. Assessment of the degree of intraoperative bleeding in patients with chronic rhinosinusitis.Materials and methods. On the basis of the FGBU SPB Research Institute of ENT of the Ministry of Health of the Russian Federation in the period from 2020 to 2021. the study of the effect of local intranasal glucocorticosteroids (INGKS) in the intraoperative period in patients with chronic polypous rhinosinusitis was carried out. The total amount of blood loss during surgery for chronic polypous rhinosinusitis in patients who used mometasone furoate preoperatively and in patients not taking topical hormonal drugs was analyzed.Results. In the study group, the average blood loss per operation was 257 ml, in the control group – 401 ml. In patients who took intranasal glucocorticosteroids during surgery, the intensity of bleeding is less pronounced. Undoubtedly, there are many reasons that affect the intensity of bleeding in general, however, a decrease in the inflammatory response in the nasal cavity and a decrease in inflammatory metabolites have a beneficial effect on the state of the nasal mucosa.Conclusion. The use of intranasal glucocorticosteroids in the preoperative period has a positive effect on reducing the inflammatory process in the nasal cavity, which helps to reduce the intensity of intraoperative bleeding.

Endoscopic Inferior Meatal Antrostomy for Antrochoanal Polyps: A Long-Term Follow-Up

<b><i>Background:</i></b> Endoscopic middle meatal antrostomy (EMMA) is considered the standard approach for surgical management of antrochoanal polyps (ACPs). Recently, an endoscopic inferior meatal antrostomy (EIMA) approach for clearing lesions in the maxillary sinus was described. In this study, we compared the long-term outcome of patients with ACP following surgical treatment using one of these 2 approaches (EIMA or EMMA). <b><i>Methods:</i></b> The medical charts of all patients treated for ACPs in our institution between January 1, 2009, and July 1, 2020, were reviewed retrospectively. Patients were invited to complete a long-term follow-up assessment. <b><i>Results:</i></b> Thirty-eight patients were included in the study: EIMA was the only procedure performed in 25 patients (66%) and EMMA was the only procedure performed in 7 patients (18%). Both procedures were performed in 6 patients (16%): 2 patients (5%) underwent simultaneous EMMA and EIMA for better access and visualization and 4 patients (10.5%) underwent surgical revision consisting of EIMA secondary to failed EMMA at other institutions. Median follow-up was 44 months (range, 6 months–11 years). No evidence of recurrent ACPs, recirculation, synechiae, nasolacrimal duct injury, or bleeding was observed in any of our patients. Small nonobstructing cysts were observed in 2 patients (8%) following EIMA. <b><i>Conclusions:</i></b> EIMA prevents violation of the ostiomeatal complex. It provides access to the anteroinferior aspect of the maxillary sinus and should be considered as an alternative to EMMA in patients with ACPs.

Pathomorphological Features of the Mucoperiostasis of the Processus Uncinatus in Discrete Diseases of the Maxillary Sinus

The state of the mucoperiostasis of the maxillary sinus is one of the important factors that affect the effectiveness of dental implantation, especially in case of need for augmentation of the maxillary bone. Chronic rhinosinusitis with nasal polyps, chronic rhinosinusitis with fungal bodies, and sinus cysts are among the most common pathological processes in the maxillary sinus that are encountered when performing subantral augmentation. In addition, a separate category of patients is made up of those with a history of sinus surgery in their anamnesis. The condition of sinus mucoperiosteum can be estimated based on results of processus uncinatus research, because it has a similar histological structure, directly contacts with all maxillary sinus excretion and, as usual, gets removed while endoscopic sinusotomy. The purpose of the work was to study the histological features of mucoperiostasis and adjacent bone in the ostiomeatal complex in discrete diseases of paranasal sinuses: chronic rhinosinusitis with nasal polyps, maxillary sinus cysts, fungal balls and postoperative scar changes in the ostium. Materials and methods. Histological features of processus uncinatus fragments removed during endoscopic interventions in 45 patients were investigated: with sinus cysts – 12 patients (group 1), chronic rhinosinusitis with nasal polyps – 13 patients (group 2), sinus fungal body – 13 patients (group 3) and postoperative scarring changes in the ostiomeatal complex – 7 patients. The condition of the epithelial layer of the mucoperiosteum, the structure of its own plate, the periosteal layer and the bone to be treated were evaluated. Results and discussion. In 91.67 ± 0.08% of patients with maxillary sinus cysts, there were no changes in the mucoperiostasis and the bone of processus uncinatus. Most patients in groups 2 and 3 showed mucoperiostal edema with a predominant reaction of the mucosal layer and lamina propria. Fibrous changes of the processus uncinatus were most often detected after the intervention was performed at 71.43 ± 0.13% and in chronic rhinosinusitis with nasal polyps – 53.85 ± 0.14%. This confirms the significance of the mucoperiostasis injury factor with the underlying bone for the development of gross adhesive changes between the periosteum and bone tissue. Osteitis of the processus uncinatus was detected in 38.46 ± 0.13% of patients in group 2, 15.38 ± 0.1% in group 3, and 28.57 ± 0.17% in group 4. Conclusion. Signs of periostitis and processus uncinatus osteitis were most often detected in patients with neutrophilic mucoperiosteum infiltration in chronic rhinosinusitis with nasal polyps and in fungal balls sinus. History of surgery with periosteal and bone trauma promotes scarring and results in a tight connection between bone and periosteum, which can be regarded as a risk factor in relation to the rupture of the later in its peeling off during sinus lifting procedure. Therefore, when performing surgery on the maxillary sinus, in order to maintain conditions for possible dental implantation, excessive trauma of the periosteal layer of mucoperiosteum should be avoided

Maxillary sinus cyst as a risk factor for osteomeatal complex block

Introduction: Cysts of the maxillary sinuses are found in about 10% of the population. There is a necessity to clarify indications for cyst removal taking into account its size. The purpose of the study to clarify the indications for surgical treatment of maxillary sinus cysts as a risk factor for sinus drainage disorders in the development of maxillary sinusitis. Methods and materials: 57 people (92 sinuses) were examined. There were 20 patients (40 sinuses) with acute rhinosinusitis, 22 patients (22 sinuses) with post-augmentation sinusitis, and 15 (30 sinuses) almost healthy individuals among them. Prediction of the cyst size, which can lead to blockage of the maxillary sinus ostium, was performed by direct measurement on coronary sections at the ostiomeatal complex level distance from the surface of the mucoperiosteum in the area of the alveolar recessus to the lower surface of the mucosal surface in the area of the ostium. The obtained data were verified by calculation method taking into account the height of the sinus at the level of the osteomeatal complex, the magnitude of possible mucoperiosteum edema in the alveolar recessus and ostium in acute rhinosinusitis and post-augmentation sinusitis, as well as the magnitude of mucoperiosteum elevation due to sinus lift. Results: It was found that the vertical size of the cyst, which can potentially lead to blockage of the maxillary sinus ostium in acute rhinosinusitis is 21.2±0.8 mm, 14.7±1.1 mm in sinusitis after augmentation of the maxilla, and 28.5±0.7 mm in practically healthy individuals. The calculated values are 18.5 mm, 14.0 mm and 24.5 mm, respectively. In case of acute rhinosinusitis, the distance from the apex of the cyst to the surface of the mucous membrane of the ostiomeatal complex area may decrease by 12.8 mm, and in sinusitis after sinus lift it may decrease by 20.4 mm. Conclusions: To assess the potential of the ostiomeatal complex block by a cyst located in the alveolar recessus in acute rhinosinusitis, its vertical size is really important according to coronary sections of at the ostiomeatal complex level corresponding to the location of 5-6 teeth of the upper jaw. The indication for removal of the cyst of the alveolar recessus of the maxillary sinus, as a factor that may worsen the course of acute rhinosinusitis due to the anastomosis block, is its size exceeding 20 mm, and 15 mm for patients who plan to sinus lift.

Evaluation of patient experience for a computationally-guided intranasal spray protocol to augment therapeutic penetration

The global respiratory outbreak in the form of COVID-19 has underlined the necessity to devise more effective and reproducible intranasal drug delivery modalities, that would also be user-friendly for adoption compliance. In this study, we have collected evaluation feedback from a cohort of 13 healthy volunteers, who assessed two different nasal spray administration techniques, namely the vertical placement protocol (or, VP), wherein the nozzle is held vertically upright at a shallow insertion depth of 0.5 cm inside the nasal vestibule; and the shallow angle protocol (or, SA), wherein the spray axis is angled at 45 degrees to the vertical, with a vestibular insertion depth of 1.5 cm. The SA protocol is derived from published findings on alternate spray orientations that have been shown to enhance targeted delivery at posterior infection sites, e.g., the ostiomeatal complex and the nasopharynx. All study participants reported that the SA protocol offered a more gentle and soothing delivery experience, with less impact pressure. Additionally, 60% participants opined that the VP technique caused painful irritation. We also tracked the drug transport processes for the two spray techniques in a computed tomography-based nasal reconstruction; the SA protocol marked a distinct improvement in therapeutic penetration when compared to the VP protocol.

Post-implantation maxillary sinusitis: prevention and diagnosis

According to the data of domestic and foreign authors, the incidence of maxillary sinusitis has doubled over the past 10 years, and the proportion of patients hospitalized in ENT hospitals is increasing annually by 1.5–2.0%, moreover, rhinology and rhinosurgery are the main areas of work of the ENT hospital currently. An important role in the occurrence of chronic maxillary sinusitis is played by the condition of the nasal cavity, especially the area of the ostiomeatal complex. For more than 30 years, rehabilitation of patients with complete or partial absence of teeth using subantral grafting and dental implantation has been widespread in Russian dental practice. Odontogenic maxillary sinusitis is increasingly found as a complication of dental implant treatment in the upper jaw. Patients usually get consultations with an otorhinolaryngologist already with the appearance of complications, and this reduces the effectiveness of dental operations. The question of diagnosis of maxillary sinusitis and insufficient preoperative preparation before implant treatment at the dentist remains open. When preparing a patient for implant treatment at the dentist, important components are the otorhinolaryngological examination and computed tomography of the paranasal sinuses, which can reveal a violation of the architectonics of the nasal cavity, the ostiomeatal complex and the pathology of the maxillary sinuses.

The Use of Computed Tomography for the Study of Chronic Maxillary Sinusitis: Based on Crania from the Pucará De Tilcara Fortress, Argentina

We discuss the methodological advantages of using X-ray computed tomography (CT) for diagnosing chronic maxillary sinusitis (CMS) of various etiologies on skeletal samples. A CT examination of 20 crania from the Pucará de Tilcara fortress, Argentina (late 8th to 16th centuries AD), was carried out. Criteria for identifying CMS included osteitic lesions in the form of focal destruction, and thickened and sclerotized walls of maxillary sinuses. To determine the etiology of the disease, a tomographic and macroscopic examination of the dentition and bones of the ostiomeatal complex were performed, the presence or absence of facial injuries was assessed, and the co-occurrence of various pathologies was statistically evaluated. Five cases of CMS were identified. Four of these may be of odontogenic origin; in two cases, a secondary infection of the maxillary sinuses is possible. In one instance, the etiology was not determined. No indications of traumatic infection were found. Statistical analysis revealed a relationship of CMS with apical periodontitis and the ante-mortem loss of upper molars and premolars. An indirect symptom of CMS may be the remodeled bone tissue and porosity of the posterior surface of the maxilla.