The Choice Of Fenestration In Endoscopic Sinus Surgery And Clinical Observation Of Chronic Maxillary Sinusitis

Objective:To observe the therapeutic effect of different fenestration of chronic maxillary sinusitis under nasal endoscopy.Methods:We observed 56 patients(56sides)who were diagnosed chronic ethmomaxillary sinusitis with or without polyps and were in hospital.Preoperative sinus CT and electronic rhinoscopy were made.Acording to Lund-Mackay CT score,Ⅰ:maxillary CT score=1,patients were devided into A and B group,Ⅱ: maxillary CT score=2,patients were devided into C and D group.A:12 cases and the maxillary sinus ostium were enlarged within 1cm.B:13 cases and the maxillary sinus ostium were enlarged 1.5～2.0cm.C:16 cases and the maxillary sinus ostium were enlarged within 1cm.D:15 cases and simultaneous inferior and middle meatus antrostomies were made,the maxillary sinus ostium were enlarged within 1cm and the inferior meatus antrostomies were made 1.5～2.0cm.All patients selected the general anesthesia and we adopted Messerklinger procedure.Postoperative therapies were given routinely,such as cephalosporin antibiotics, local corticosteroid, myrtol standardized enteric capsules and nasal irrigation.We told patients the time for first review,according to lesions extent and local situations under endoscopy. During the follow-up,we clip vesicles broken and clean blood scabs at the right time.Result:1. use the SNOT-20 to assess symptomThe SNOT-20 scores before and 6 months after operation were all statistically significant in each group,it meant that symptoms were improved than voroperativ.The postoperative SNOT-20 scores of A and B were not statistically significant,it meant that for lightly diseased maxillary(CT score=1),there was no distinct difference about symptom between enlargement of maxillary sinus ostia within 1cm and 1.5～2.0cm. The postoperative SNOT-20 scores of C and D were statistically significant,it meant that for severely diseased maxillary(CT score=2), simultaneous inferior and middle meatus antrostomies had a better improvement of symptom.2. use the Lund-Kennedy standard to establish endoscopic scoresThe Lund-Kennedy scores 6 months after operation were statistically significant between group A and B,it meant that for lightly diseased maxillary(CT score=1),enlargement of maxillary sinus ostium within 1.0cm had a better operation area improvement. The Lund-Kennedy scores were statistically significant between group C and D,it meant that for severely diseased maxillary(CT score=2), simultaneous inferior and middle meatus antrostomies had a better operation area improvement.3. the observation of mucociliary transport functionThe MTT of group A and B 6 months after operation were statistically significant,it meant that for lightly diseased maxillary(CT score=1),enlargement of maxillary sinus ostium within 1.0cm had a better improvement of mucociliary transport function. The MTT were statistically significant between C and D group,it meant that for severely diseased maxillary(CT score=2), simultaneous inferior and middle meatus antrostomies had a better improvement of mucociliary transport function.4. the observation of mucociliary transmission pathTransmission path of methylene blue : methylene blue were drained out by inferior edge to middle meatus in 50cases,methylene blue were drained out by front edge and then move to the superior and inferior edge in the other 5 cases.In group D,even the inferior antrostomies were open, methylene blue still drained out from the maxillary sinus ositium.5. complicationsNo systemic complications and intracranial,orbital complications happened No uncontrollable bleeding happened during and after the operation,we encountered a lateral posterior-nasal arteries bleeding when enlarged the ostia posteriorly and use electricity coagulation to stop it.All 56 cases had no nasal septem perforation.The complications happended are as follows:scab,nasal adhesion, periorbital ecchymosis,maxillary sinus ostium atresia ,inferior antrostomy atresia and cheek pain.Conclusion:1.For lightly diseased maxillary(CT score=1),there is no need to enlarge the ostia excessively,within 1cm is appropriate.2.For severely diseased maxillary(CT score=2), simultaneous inferior and middle meatus antrostomies can gain a better effect.3.The inferior edge of maxillary ostium is an important path for mucociliary transmission,it is extremely important for the drainage of maxillary sinus.