Abnormal "hair-like" filaments in chronic maxillary sinusitis . A scanning electron microscopic investigation

Endoscopic endonasal surgery--concepts in treatment of recurring rhinosinusitis. Part II. Surgical technique

Our endoscopic endonasal surgery, under the guidance of rigid endoscopes, aims at the primary focuses in the anterior ethmoid, clearing stenotic clefts and infected ethmoidal cells of diseased mucosa. The maxillary ostium is enlarged into the anterior nasal fontanelle to provide drainage and ventilation. There is no need for any fenestration into the inferior nasal meatus. Once the ethmoidal focus is cleared, the dependent larger sinuses usually heal without having been touched--even if their mucosal pathologies seemed almost irreversible. The endoscopic procedure, which except in children is carried out under local and surface anesthesia, is described in detail. Excellent results with this method, developed by Messerklinger, indicate that there is seldom need for a Caldwell-Luc operation as the state-of-the-art procedure in chronic recurring sinusitis.

Endoscopic endonasal surgery--concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and pathophysiologic considerations

Many years of endoscopic investigation and observation proved that most infections of the paranasal sinus are rhinogenic, spreading from the nose into the sinuses. The common focus of infection in cases of recurring sinusitis is the stenotic areas of the anterior ethmoid, with infection recurring in the larger sinuses. The anterior ethmoid, especially its infundibulum, is thus a key location for infection or cure, and maxillary as well as frontal sinuses are fully dependent on the pathophysiologic conditions there. Histologic examination demonstrates that massive changes of the nasal glands are the reason for permanent mucosal thickening. Retention cysts, highly viscous mucus, mucus extravasations, and metaplastic epithelial changes add to the vicious cycle of blockage of the ostium-meatus unit.

A study of experimental sinusitis in rabbits

Sinusitis was experimentally induced in rabbits by injecting one ml of casitone semi-liquid agar containing Staphylococcus aureus 209P in the order of 10(7) per ml into rabbit's bilateral paranasal sinuses (which had been sensitized with a 2.5% concentration of a purified egg white albumin solution) through a percutaneous route with a sterilized syringe. Two weeks after the last injection the rabbits were sacrificed and dissected. Light microscopic (LM) and scanning electron microscopic (SEM) examination of pathomorphological changes in this experimental model revealed that chronic inflammation developed in the mucous membranes of the paranasal sinuses at a high incidence.