Efficacy of Different Modalities of Treatment in Management of Different Types of Fungal Sinusits

Background Fungal sinusitis is generally classified into invasive and non invasive fungal sinusitis based on histological features, invasive fungal sinusitis divided into acute, chronic and chronic granulomatous invasive fungal sinusitis. While non invasive fungal sinusitis include saprophytic fungal infestation, fungal ball, and fungus-related eosinophilic. Distinguishing invasive disease from noninvasive disease is important because the treatment and prognosis are different for each. AIM A systemic review of effective and safe method in management of different types of fungal sinusitis either by medical or surgical approaches or even combined. Be up to date with the different upcoming new modalities. Methodology A meta-analysis study is done to evaluate the medical and surgical outcomes of patients with invasive and noninvasive Fungal Sinusits. Results Finally, forty-five studies were included in the present systematic review and metaanalysis. Fifteen included studies (No = 539 patients) assessed different modalities for management of fungal ball, via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach for FB of the maxillary sinus. The results showed that functional endoscopic sinus surgery has led to success rate of 98.1%. Twenty included studies (No = 806 patients) have assessed the efficacy and safety of different modalities for the management of allergic fungal sinusitis via,Endoscopic Sinus Surgery, Post-ESS Systemic steroids, Antifungals and immunotherapy. The results showed that ESS represents the firstline management strategy of AFRS, followed by aggressive medical therapies, the recurrence rate after postoperative steroids was 20.6%, postoperative antifungals was 40% and after immunotherapy was 9.1%. Ten studies (No = 327 patients) for Invasive Fungal Sinusitis.the results showed that combination of systematic antifungal therapy and aggressive surgical debridement are the treatment of choice. Conclusion FESS is the treatment of choice of fungal ball via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach. AFS treatment consists of surgical extirpation of the allergic mucin and polyps with maintenance of adequate sinus drainage followed by medical therapy consists of topical steroids, anti fungal therapy, Immunotherapy, and systemic corticosteroids. Treatment of invasive fungal sinusitis includes surgical resection of necrotic tissues, systemic antifungal therapy and reversal of immune dysfunction.

Bimodal intervention in cystic lesions of the maxillary antrum

<p class="abstract">Intrinsic or extrinsic cysts are common maxillary antral lesions as there is close proximity between the maxillary antrum and maxillary teeth. Main stay of treatment is complete surgical excision. Endoscopic trans nasal middle meatus corridor and the canine fossa approach facilitate 360-degree access, resection and removal of cystic lesions of the maxillary antrum. Bimodal technique to treat maxillary cysts that have expanded into the maxillary sinus is discussed here. </p>

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

Background While middle antrostomy (MA) is the most common approach to the maxillary sinus (MS), it is known for not allowing to fully inspect the whole MS, especially in its inferior and anterior portions. To overcome this limitation, alternative approaches have been proposed, such as inferior antrotomy (IA) and canine fossa accesses (CFA). Objective Given the lack of studies on the MS floor visualization with different accesses, our study aims, in a cadaver lab setting, to systematically compare three different approaches (MA, IA and CFA) in these regards. Methods Eight cadaver heads, previously submitted to CTscan, were prepared inserting fixtures corresponding to teeth 2, 4, 6, 11, 13 and 15 and into the canine fossae. Three approaches were prepared: a wide MA, an IM and a CFA. We endoscopically evaluated, for each specimen, side, access type and scope angle (0°, 30°, 45°, and 70°), which fixtures were visible on the maxillary sinus floor and whether the canine fossa fixture was visible (MA and IA only). Results IA allowed to visualize all fixtures in nearly all cases (14/16 with 70° endoscope), while MA showed poor visualization results (3/16 with 70° endoscope); CFA failed to gain full visualization in most specimens (7/16 with 70°endoscope). Such difference was statistically significant. MA proved unable to visualize the canine fossa fixture in most cases while IA showed excellent possibilities. All differences were statistically significant (p < .001, Mcnemar’s test). Conclusions Our data show that the IA grants a statistically significant superior surgical field vision when compared to MA and CFA, though in vivo validation of these results is still required.

Evaluation of Recurrent Maxillary Sinusitis due to Middle Meatal Antrostomy Site Stenosis

Objective: This study was performed to evaluate the incidence, timing, and factors contributing to recurrent maxillary sinusitis due to middle meatal antrostomy (MMA) site stenosis after endoscopic sinus surgery (ESS). Methods: The medical records and endoscopic photographs of 288 patients with chronic rhinosinusitis who underwent ESS were evaluated. Patients visited the clinic with similar schedule after ESS; recurrent maxillary sinusitis due to MMA site stenosis was investigated, including in terms of the incidence and timing. The preoperative computed tomography (CT) scans, intraoperative findings, and possible factors contributing to MMA site stenosis were examined. Results: Recurrent maxillary sinusitis due to MMA site stenosis occurred in 10 patients. Most had unilateral sinusitis and stenosis was observed within 6 months postoperatively. All patients had severe inflammation, pus retention, and thick mucosal hypertrophy in the maxillary sinus on preoperative CT; intraoperative findings confirmed these conditions. In most patients, extensive trimming of the hypertrophied mucosa was performed intraoperatively through canine fossa trephination. Conclusions: MMA site stenosis is a rare condition after ESS. We hypothesized that rapid shrinkage and fibrosis of the sinus mucosa after extensive trimming thereof may be the main causes of stenosis. Residual mucosal inflammation, granulation formation, and persistent sinus crust and debris may also be contributing factors. Therefore, conservative trimming, meticulous dressing, and removal of sinus crust and granulation tissue near the MMA site should be performed in patients with MMA site stenosis.

Polymethyl Methacrylate (PMMA) in the Treatment of a Case of Hemifacial Microsomia

Hemifacial microsomia (HMF) is a morphological alteration characterized by facial deformities. These alterations are a consequence of a congenital anomalous development of the first and second branchial arches. It may present a genetic or environmental origin or a mixture of both and is considered mostly multifactorial. The clinical presentation varies; however, some characteristics are predominant such as unilateral mandible hypoplasia, agenesis or malformation of the auricular pavilion, and agenesis or malformation of the eye globe. The aim of this paper was to report a clinical case of a patient with late diagnosis of HMF which presented multiple deformities and received treatment with polymethyl methacrylate (PMMA) implant in different concentrations. Aiming for facial harmony, the PMMA implant occurred in the following regions: canine fossa, nasolabial sulcus, mandible, Bichat Ball, chin outline, lip contour, nose base, columella, nose tip, and dorsum. The treatment resulted in significant improvement in the facial symmetry. Level of Evidence: 5