Clinical Study Of Maxillary Sinus Cystectomy Through Its Anterior Wall With Nasal Endoscope

Objective: The purpose of this study was to evaluate the important function of nasal mucosa which is nearby the maxillary sinus meatus, and to appraise the treatcment of maxillary sinus cyst through its anterior wall with nasal endoscope. We meant to afford some certain view points for consequent improvements in maxillary sinus cystectomy through its anterior wall with nasal endoscope.Study design and setting: 1,The tissue of maxillary sinus mucosa was taken through it's anterior wall with nasal endoscope in cadaver.Specimens were taken with clamps from two different sites in each individual--1/2 of them were nearby maxillary ostium (the distance was not exceed 0.5cm); the other 1/2 specimens were 2.0cm away. Then all of them were stained with HE, and observed under light micro-scope. We counted out submucosal gland and blood vessel in each eyeshot under microscope(×100), and observed the thickness of submucosa with every specimen. 2,Cystectomy were performed to 16 cases suffered with maxillary sinus cyst. All of them were simple maxillary sinus cyst. According to different methods of operation, the patients were classified into two groups:Group A, 10 cases, who through maxillary sinus anterior wall with nasal endoscope; Group B, another 6 cases, who through the windowing of the inferior nasal meatus. All patients were respectively followed up by endoscopy and CT 3 months after surgery. According to the recrudescence of cyst the outcome of surgery was evaluated as cured or ineffective. Effects of endoscopic sinus surgery with different paths were analyzed.Result: 1,Specimens of nasal mucasa from nearby maxillary ostium (the distance was not exceed 0.5cm): the quantity of submucosal glands was 20.28±2.75each eyeshot, and the quantity of blood vessels was10.32±2.00; specimens of nasal mucasa which were 2.0cm away from maxillary ostium: the quantity of submucosal glands was 4.13±2.03 each eyeshot, and the quantity of blood vessels was 3.20±2.21each eyeshot.In addition we can see that the tissue of submucosa was more thick in tissue of around ostium than that far away from ostium. 2,All patients were available for postsurgical controls and showd a patent antrostomy. Being followed-up for 3months, all 16 cases were cured and no one was recured. The cure rate was 100%(16 in 16).In Group A,none of 10 cases who were performed maxillary sinus cystectomy through its anterior wall with nasal endoscope recurred by 3 months follow-up,and no surgical complication was noted.In Group B, all 6 cases were cured and none recurred, but 2 of them were suffered from complication of surgery,such as chronic sinusitis of maxillary. Conclusion: Maxillary sisus mucosa with submucosal gland may have relations with mucociliary transport systerm, especially the mucosa around the natural ostium of maxillary sinus.So it is important to protect mucosa around the natural ostium in surgery.Maxillary sinus cystectomy through its anterior wall with nasal endoscope has the characteristics of safe,easy operating,good effect,few adverse reactions, few complicatons.With this path, we also found that the maxillary sisus mucosa and its important functions such as cleansing can be protected well.In addition, outbord wall of the nasal cavity can retain integrity after this kind of operation.