| Sinusitis is a common health problem in both children and adults. It can be defined as inflammation of the paranasal sinuses, the etiology of which includes both infectious agents and also allergic mechanisms. While sinusitis can be categorized in many ways, the most common description is by duration of symptoms. Chronic sinusitis refers to symptoms lasting more than 3 months. The pathogenesis of sinusitis is multifactorial and involves a complex interaction between host defense mechanisms and the infecting organisms. The treatment of chronic sinusitis has four objectives: to control infection, to reduce tissue edema, to facilitate the drainage of sinus secretions and to maintain ostial permeability. Medical treatment includes antibiotics, decongestants, mucolytics, steroids and analgesics. Surgical treatment may be conservative, functional or radical. At present, "FESS" is the "Golden Standard". It is focused on the middle ostiomeatal complex and the ethmoid cells .So the blockade of sinonasal drainage by anatomical abnormalities (like paradoxicity of middle turbinate, e.g. convexity facing laterally; concha bullosa, e.g. aircells in the head of middle turbinate, variation in the uncinate process and large ethmoid bulla) and zuxtaposition of mucosalabutting surfaces in chronic inflammation will predispose to different sinus conditions like inflammatory and polyp pathology due to stenosis in middle meatus. So endoscopic endonasal surgery of diseased ethmoid is important in treatment of chronic sinusitis. Endoscopic sinus surgery has enjoyed impressive success curing chronic disease in sinuses and has virtually replaced the Caldwell-Luc procedure for correction of problems with sinuses. With the introduction of nasal endoscopy, functional endoscopic sinus surgery(FESS) has become an important means in treating chronic sinusitis and polyps. To investigate the regulation of the morphological and functional mucosal recovering after FESS and the epithelial type indicating epithelization, light microscopic examination, saccharin test and immunohistochemical streptavidinbitin peroxidae complex (SABC) method were taken at 4m and 10m after operation in 20 cases with chronic sinusitis and 10 normal subjects as control. The mucosa specimens were taken from the anterior ethmoid, that is the posterior removing edge of uncinate process. The tests showed that (1) Squamous cells and squamous continuing peseudostratified ciliated columnar epithelium were observed in 15% patients at 4m postoperatively. And peseudostratified ciliated columnar epithelium at 10m after operation. (2) Mucociliary transport rate (MTR) in patients at 4m postoperatively was significantly longer than that in the patients at 10m and the controls, and there was no significantly difference between the controls and the patients at 10m postoperatively. (3) The numbers of inflammatory cell, that is the immunocompetent cells in patients at 4m postoperatively was significantly more than those in the healthy control (p<0.01) and patients at 10m.There was no significantly difference between the healthy control and patients at 10m. In conclusion, the study showed a benign process of the morphological and histological transitionary of sinus mucosa in patients with chronic sinusitis and polyps after FESS at two periods:4 months and 10 months. And the physiological function, the clearance function of mucociliary system of the operative cavity in nasal middle meatus and protective role of the immumocompetent cells were also improved. These results also provided theoretical foundation for the proper local care postoperatively. It is of great importance to reduce the recurrence rate of chronic sinusitis and nasal polyps and improve the curable rate.
|
PDF Full Text Request