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To evaluate the secretory element transformation of maxillary sinus mucosa after endoscopic sinus surgery (ESS), I enrolled 20 patients. Five normal antral mucosae were used as controls, and 15 antral mucosae were investigated according to pathologic and secretory patterns. The post-ESS mucosa was evaluated at the 16th week, when gross recovery appeared. Specimens from the rear wall of the antrum were observed under a scanning electron microscope (x2,000). A significant decrease of goblet cells and increase of glands was illustrated in the sinusitis cases, especially the polypoid and purulent groups. In post-ESS cases, the number of goblet cells is about the same as in controls, but the number of gland openings is higher. My conclusions were that 1) the repair of the antral mucosa requires more time than gross recovery and 2) post-ESS follow-up should be longer than 16 weeks to prevent recurrence.

To evaluate the outcome of surgery using objective methods in patients with sinusitis after endoscopic sinus surgery (ESS) and Caldwell-Luc operation, we randomly selected 37 Caldwell-Luc-operated and 40 ESS-applied cases. Selected patient groups were assessed and compared by endoscopic examination and computed tomography (CT). CT was found to be normal in 12% of Caldwell-Luc-operated sides in comparison to 75% of ESS-applied sides. Endoscopy revealed a patency rate of the windows as 48% in Caldwell-Luc-operated and 86.7% in ESS-applied sides. Fibrosis and abnormal bony changes of the maxillary sinus were encountered in more than half of Caldwell-Luc-operated cases. In conclusion, ESS has a much higher rate of cure compared to the Caldwell-Luc operation if subjective and objective evaluation methods (CT and endoscopy) are applied.

A healthy 13-year-old female was found to have no roots on the maxillary left second premolar and permanent first and second molars. Her history included chronic sinus infections treated with maxillary sinus curettage at approximately 4 years of age. The infection, or more likely the trauma associated with the surgery, may have caused agenesis of the roots. Other causes of rootless teeth such as odontodysplasia, dentin dysplasia, trauma, infection, radiation therapy, and neoplasia were excluded from her history and clinical and radiographic findings. This report suggests that damage to the developing dentition may be a serious complication of maxillary sinus surgery or chronic infection.

A method of repair of the maxillary sinus anterior wall after radical sinusotomy is presented. The defect is replaced by an osseomucosal autotransplant of an elongated shape cut out of the anterior sinus wall. After sinus revision the complex graft is placed transversely so that its edges overlap sinusal bone wound and fixed with sutures. Our results demonstrated the simplicity, reliability, and efficacy of the operation.

The association of headache and sinusitis was studied in 207 patients who underwent surgery for chronic sinusitis that failed to respond to medical management. Sixty-nine percent of the patients had headaches and 31% did not. In 9% headache was the only symptom and the diagnosis of sinusitis was made on clinical and/or CT grounds. The pain was usually pressure in character, moderate in intensity and lasted for hours. Its location usually, but not always, pointed to the sinuses involved. Discreet sphenoid or ethmoid disease discovered on imaging may be responsible for midline pains. Sinusitis may also trigger or aggravate vascular headaches.

Maxillary and frontal sinuses communicate with nasal cavity via very narrow and complicated clefts, which are the part of anterior ethmoid. Any disease changes in this area usually cause the obstruction of ventilation and drainage of these larger sinuses. Subsequently the inflammation can develop. Therefore these narrow clefts of anterior ethmoid hold the key position for normal function and the pathophysiology of larger paranasal sinuses. Accurate diagnosis of diseased areas and reestablishing sinus ventilation and drainage via natural ostia is the base of treatment of sinusitis.

Ethmoidal cells that have developed into the floor of the orbit or into the roof of the maxillary sinus, respectively, are known as Haller's cells. 528 patients, in whom functional endoscopic sinus surgery was performed, were explored regarding the presence of Haller's cells. 43 patients presented with Haller's cells at least on one side (8.14%). CT scans of these patients were evaluated morphometrically measuring the dimensions of the Haller's cells as well as of the maxillary sinus. Further anatomical variations of the paranasal sinuses (concha bullosa, supraorbital cell, agger nasi cell) and the keros type of the ethmoid sinus roof were seen. A highly significant difference could be demonstrated between the incidence of Haller's cells in men (4.9%) and women (11.9%). For the first time it was possible to demonstrate a frequency distribution between Haller's cells deriving from the anterior ethmoidal cells (88%) and those originating from the posterior ethmoidal cells (12%). In 56% Haller's cells were opacified on CT-scan showing a mucosal swelling respectively a retention of secretion during endoscopic surgery.

An animal model was used to compare the surgical treatment of chronic sinusitis by opening the natural ostium vs. inferior antrostomy. Fifteen rabbits had surgical occlusion of the natural maxillary sinus ostia to induce sinusitis. At a second operation, the sinuses were entered and in each animal the natural ostia was reopened on one side and an inferior antrostomy was performed on the opposite sinus. Eight weeks after these operations the sinuses were evaluated. No differences were found in antrostomy patency rates, gross evidence of acute or chronic inflammation, or light or electron microscopic findings between sinuses with natural ostiotomy and those with lower antrostomy. The gross appearances and light and electron microscopic findings are discussed.

Recent studies on bacteriological findings in chronic maxillary sinusitis show a great variety of aerobic as well as anaerobic germs. For these reasons adequate chemotherapy has to support the necessary surgical procedure. In this study, the author reports about 60 adult patients suffering from chronic maxillary sinusitis. All of them had to undergo surgical treatment by the Caldwell-Luc procedure. Postoperatively, 30 of them were treated with brodimoprim, the others with doxycycline for 7 days. Bacteriological investigations have been performed during and at several days after surgery. At the same time, a number of laboratory data and the complications observed were registered. In this way, a comparative study of the two antibiotic drugs concerning the therapy of chronic maxillary sinusitis was established.

Obstruction of the natural ostium is known to be one of the major factors in the pathogenesis of maxillary sinusitis. To explore the therapeutic effect of ostial patency, sinusitis was induced in 32 rabbits by obstruction of the natural ostium and inocculation of Streptococcus pneumoniae. They were divided into two groups: the first ("open") group included 16 rabbits with experimentally induced sinusitis, from which bone chips for obstruction of the natural ostium were removed after a period of 5 days, and the second ("closed") group included 16 rabbits with continuous obstruction of the natural ostium. The induction of sinusitis was found to be successful in all cases, when examined after five days. The amount of nasal and sinus secretion as well as histopathological findings of the sinus mucosa were investigated with light microscopy, scanning and transmission electron microscopy, two and four weeks after induction of sinusitis. The findings were significantly improved in the "open" group.

Endoscopic sinus surgery is being applied increasingly for chronic or recurrent sinusitis and nasal polyps. We investigated the results, which we classified as subjective results (i.e. the opinion of the patient) and objective results (i.e. the result as seen with nasal endoscopy). The subjective result was 'good' in 85% of 92 patients with chronic or recurrent sinusitis, the objective result in 77% of the treated sides, with a median follow-up of 46 months. In 90 patients with nasal polyps the percentages were 90% and 65% respectively, with a follow-up of 24 months. In 63% of 30 patients with chronic obstructive lung disease and nasal polyps the pulmonary function increased postoperatively (FEV1). In 4.2% of 1235 operated sides in 593 patients local complications were seen. These were mainly minor complications. Only in 0.3% serious complications as a orbital hematoma or a CSF leak were seen. Endoscopic sinus surgery has good results and little morbidity.

During the last five years 10 patients received surgical treatment in our eye clinic for tumours of the eyelids and the orbit that had developed after endonasal sinus surgery. In most patients the first signs of lid or orbital involvement had occurred 4 weeks after ENT surgery and after a unilateral or bilateral postoperative haematoma had subsided. The histological examination of the surgical specimens showed chronic sclerosing lipogranuloma containing large vacuoles surrounded by epithelioid and giant cells, typical of a so-called paraffin granuloma. MR-spectroscopy detected high concentrations of paraffin in the specimens of 3 patients. Since paraffin is a constituent of many ointments, we assume that the granulomatous reaction was elicited by the ointment tampons routinely applied to the wound area following sinus surgery. The bleeding acted as a vehicle to distribute the paraffin into the surrounding tissues.

Ciliary beating frequency, one component of mucociliary function, was measured outside of the sinus in vitro with a photoelectric method in 150 patients with chronic sinusitis and in 26 control subjects. In the mucosal samples of 35 patients (23%), no ciliary activity was seen. Ciliary beating frequency in maxillary sinus mucosa of the rest of the 115 patients (77%) was, as an average, 16.6 +/- 3.0 Hz (range, 10.9 to 23.3 Hz) and it was 15.9 +/- 2.6 Hz (range, 13.2 to 22.8 Hz) for the control patients. No differences in ciliary beating frequency were found according to quality of sinus secretion, prevalent respiratory allergy, or mucosal thickness. However, in sinuses with purulent secretion, ciliary beating frequency was slightly better (P < .05) than in "empty" sinuses. The study suggests that in many cases of chronic sinusitis, the sinus mucosa still has a capacity to recure.

Enophthalmos previously has been reported to be a rare complication of maxillary sinus mucoceles. We report three patients treated by the senior author (T.C.C.) over a 2-month period for enophthalmos or obvious deformity of the midface associated with complete opacification of the maxillary antrum. Most previous authors have stressed the role of chronic pressure necrosis or osteitis leading to bone destruction, with primary involvement of the orbital floor. No patients in this series had symptoms typical of maxillary sinus mucoceles. Two of our three patients presented with minimal symptoms of chronic infection. There was inward collapse of the anterior, superior, lateral, and medial walls of the maxillary sinus, with no radiographic or intraoperative confirmation of bone destruction. We speculate that this process may be the result of chronic maxillary hypoventilation with subsequent atelectasis of the antrum secondary to chronic negative pressure. All patients had obstruction at the osteomeatal complex and were treated by endoscopic enlargement of the natural maxillary ostium.

This prospective study included 51 patients with chronic maxillary sinusitis who had 90 middle meatal antrostomy procedures. The aim of the study was to examine the long-term patency of the antrostomy 18-30 months post-operatively (average 26 months) and the relationship between the degree of patency and the degree of improvement in each of the symptoms of chronic maxillary sinusitis. Our results showed patency as follows: 80% widely patent (more than 8 mm), 9% patent (5-8 mm), 4.5% stenosed (less than 5 mm), 6.5% blocked by mucosal disease and none were closed by bone. For all symptoms, there was a significant relationship between the degree of patency and the degree of improvement (P < 0.01 for headache, nasal obstruction and pain, P < 0.05 for post-nasal discharge). We conclude from this study that middle meatal antrostomy has a long-term high patency rate and there is a significant relationship between the degree of patency and the degree of improvement in each of the symptoms of chronic maxillary sinusitis.

Functional endoscopic sinus surgery (FESS) is being advocated to treat children with chronic sinusitis. The surgeon performing FESS needs an intimate understanding of the anatomy to adequately treat disease and avoid complications. One hundred thirty-six patients who had endoscopic sinus surgery were reviewed. Preoperative direct coronal computed tomography scans were available for review in 114 patients. Several nasal and paranasal sinus anomalies were uncovered during this evaluation. The most common was hypoplasia of the maxillary sinuses. All hypoplastic maxillary sinuses had diseased mucosa. Eleven patients were found to have a laterally deviated uncinate process and abnormal anatomy of the maxillary ostia. Other anomalies such as concha bullosa, Haller's cells, and paradoxic curvature of the middle turbinate were found, and their respective frequencies in this population were determined.

11 patients with radio-opaque concrements in the sinus maxillaris underwent a preoperative computerized tomographic examination of the sinus maxillaris and the sinus concrements. 8 patients (72.7%) with the occurrence of radio-opaque concrements presented postoperative a histological and microbiological infection with aspergillus fumigatus. The CT-numbers of radio-opaque concrements in patients with aspergillus were 2802 +/- 302.4 HU (Hounsfield Unit). Concrements of patients without aspergillus infection (n = 3) had lower density (368.6 +/- 149.1 HU; p < 0.001). The root filling materials showed nearly the same CT-numbers in patients with aspergillus infection (2537 +/- 398.5 HU) and in patients without aspergillus infections (2544.3 +/- 460.6 HU). Density of root filling material was at the same level as density of radiopaque concrements in patients with aspergillus infections. According to CT-examinations a direct connection between root filling materials and aspergillus infection was noted. Therefore in patients with radio-opaque concrements computerized tomographic examination helps to determine the kind of sinus infection.

The anterior skull base can be approached intranasally, and the development of endoscopes and accompanying endoscopic instruments in recent years makes possible extremely precise and defined work along the ethmoid and sphenoid sinus roof. Since these areas are the most frequent locations of anterior skull base CSF rhinorrhea, it follows that the localization and subsequent closure of these defects theoretically can be accomplished in this manner. Our report and others show that closure of CSF leaks can be accomplished successfully using this procedure, with minimal morbidity and at a fraction of the cost of frontal craniotomy. In our opinion, this should become the initial procedure of choice for closure of anterior fossa CSF leaks in amenable cases.

Inferior and middle meatal antrostomy have been used for over a century in the treatment of chronic rhinosinusitis. The historical, pathophysiological and clinical aspects of the two approaches are discussed to compare the advantages and disadvantages of each. Whilst surgery in the inferior meatus is relatively safe, it does not address the underlying pathophysiology of the condition in contrast to achieving maxillary ostial function which consequently offers better surgical results.

The authors report on 16 new cases of non-invasive nasosinusal aspergillar sinusitis over a period of 4 years. They stress the importance of the local inducive factors in such apparently healthy patients. The value of treatment by endonasal microsurgery is underlined, enabling the positive diagnosis and cure of these chronic sinusites that do not respond to medical treatment.

The authors report an uncommon case of maxillary sinusitis due to Microsporum canis. To their knowledge this is the first observation in which a zoophilic dermatophytic fungus which grows usually on keratin has been isolated in a dental maxillary sinusitis in human. This observation makes it possible to discuss nosologic and diagnostic features of dental caseous sinusitis and fungal sinusitis which are often or too often called aspergillosis sinusitis.

Functional Endoscopic Sinus Surgery (FESS) is now undoubtedly the choice procedure for the surgical treatment of chronic sinusitis and nasal polyposis after failure of medical treatment. Between January 1990 and December 1992, 51 patients with chronic sinusitis and 44 with nasal polyposis who underwent FESS were evaluated (170 ethmoidectomies). Preoperative evaluation is obtained through personal scaling combined with a CT of the sinuses, whereas postoperative assessment is based on the same scoring together with an endoscopic evaluation. Good functional results and no significant differences between the two types of pathology are obtained after a 1 year follow-up.

Between 1985 and 1992, 40 patients with mycosis of the maxillary sinus were treated in the department at Hôpital Saint Michel and of otolaryngology, head-neck surgery at Hôpital Saint Michel and their charts retrospectively analysed. The clinical signs, radiological findings and etiopathological hypothesis are described. The authors report their experience of functional endoscopic sinus surgery for treatment of mycosis of maxillary sinus. A high rate of postoperative successes, a low rate of complications, the recovery of a normal intrasinusal aerial flow and the easy endoscopic follow-up lead them to adverate the use FESS in primary treatment for mycosis of the maxillary sinus.

Enophthalmos is usually a consequence of orbital trauma resulting in a blowout fracture of the orbital floor. We report here the case of a 35-year-old male who had a radical operation of the maxillary sinus and the ethmoidal sinus, and 2 months after the operation, developed spontaneous enophthalmos and ocular pain. The left orbit was enophthalmic by 5mm according to Hertel enophthalmometry. Surgical correction was performed under general anesthesia. The left orbit was explored through a transcutaneous incision of the left lower lid which revealed marked periosteal adhesions and absence of the bony floor of the orbit. A rib cartilage graft was used to reconstruct the floor of the orbit, and the globe was brought forward by means of retrobulbar placement. Enophthalmos and ocular pain disappeared postoperatively.

Two patients are presented with maxillary bone loss and atelectasis of the sinus walls in association with chronic subclinical maxillary sinusitis. Maxillary sinus atelectasis results in a mild cosmetic deformity, but may also cause diplopia by involving the orbital floor. Ostial obstruction and inflammation-mediated osteopenia are postulated to be the responsible mechanisms. Surgical treatment of the sinusitis may prevent progression of the bone loss.

Acute infection the paranasal sinus is a rather frequent pathology in children. On the contrary, local orbital complications are rare. The employment of antibiotics reduces the incidence of complications but can sometimes conceal their appearance so that diagnosis is delayed. Orbital as well as intracranial complications of ethmoidal and maxillary sinusitis are most often encountered in childhood. Within a brief time span, 8 patients with complicated frontal and ethmoid-maxillary sinusitis were diagnosed and treated: 4 cases of periorbital cellulitis, 2 of subperiorbital abscess and 2 of orbital abscess (one of which with cavernous sinus thrombosis). Particularly relevant from the diagnostic point of view was the employment of C.T. scan which furnished an accurate definition of the orbit and its surrounding structures which influenced treatment choice. Under antibiotic cover all patients but one (who had been treated very early and had responded immediately to intensive antibiotic therapy) were treated surgically and the clinical course of the disease showed significant improvement very shortly after surgical drainage.

Surgical modalities such as tonsillectomy and/or adenoidectomy, antral irrigations, and inferior meatal windows have not been effective in treating most cases of chronic sinusitis. Recent advances in technology have allowed a more direct approach to the obstruction and diseased tissue. The ethmoid sinus can now be approached directly and safely. The natural ostium to the maxillary sinus can be enlarged endoscopically with a high degree of patency. Techniques have been developed that limit the amount of scarring, and the procedure can be performed safely. The endoscopic ethmoidectomy and maxillary antrostomy has provided our best surgical modality for the treatment of chronic sinusitis in children to date.

It was previously believed that sinusitis lasting longer than 3 months might lead to irreversible disease. Experience with functional endoscopic sinus surgery indicates that this is rarely the case. Functional endoscopic sinus surgery describes an approach whereby target areas of obstruction are cleared of disease, which allows for ventilation of secondarily involved sinuses and return of mucociliary function. Although endoscopic sinus surgery is one of the techniques most frequently used to manage chronic sinus disease, it is not a suitable surgical approach for every otolaryngologist or all patient settings. Success with this endoscopic approach for chronic sinus disease is based primarily on rigorous perioperative medical care and postoperative surgical debridement. The greatest advancement that the nasal endoscope has brought to patient care is the ability to diagnose disease and follow objectively the effects of different treatment modalities. This advantage is recognized by allergists and used at several centers.

An ectopic third molar within the maxillary antrum was found to be the etiology of recurring sinusitis. The fully erupted tooth was extracted endoscopically.

The primary or secondary reconstruction of the facial access after Caldwell-Luc and the more selective resection of sinusal mucous membranes can be important in the therapy and prevention of postoperative complications such as neuralgic facial pain, formation of cysts and chronic sinusitis. The different osteoplastic sinus operations are described and the use of a pedicled bonelid is illustrated. The most common accepted ethiology of post-operative pain is based on the formation of scar-tissue. Postoperative pain is first being treated conservatively, while in case of persisting pain an exploration with dissection of the infra-orbital nerve and reconstruction of the facial defect can be indicated. In a retrospective study of 36 patients the results of our surgical therapy are illustrated.

The paper specifies x-ray picture of surgically treated frontal and maxillary sinuses in uneventful healing without inflammation relapses (30 cases), in relapse of purulent (21 sinuses), purulent-polypous (15 sinuses), polypous (4 sinuses) sinusitis, in pain syndrome in the region of the operated on maxillary sinus projection (7 patients). X-ray symptoms of postoperative changes in the sinuses, varying in clinical course, are characterized.

Recurring disease in the maxillary sinus, despite inferior meatal antrostomies, has led to the widespread use of middle meatal antrostomy or simple decompression of the natural ostium of the middle meatus in attempts to restore function to the maxillary sinus. We have reported recurrent disease in the maxillary sinus in patients with stage III or stage IV hyperplastic rhinosinusitis in whom attempts at functional surgery of the middle meatus were unsuccessful in reversal of retrograde changes. One hundred patients who had previously undergone intranasal sphenoethmoidectomy with removal of the middle turbinate, decompression of the maxillary ostium, and removal of overt hyperplastic disease of the middle meatus underwent revision transantral ethmoidectomy. All recurrent or residual diseased mucosa was removed, including polyps, occasional mucoceles, and hyperplastic changes that occurred despite patency of a middle meatal maxillary ostium. In many of these patients the maxillary sinus was widely marsupialized secondarily into the posterior nasal vault. While the initial overall polyp recurrence rate after intranasal sphenoethmoidectomy in these patients was as high as 19.2%, the rate of polyp recurrence after transantral revision was less than 5% in from 18 to 48 months postoperatively. The experience in this series suggests that mucosal changes have played a primary role in unsuccessful treatment, independent of whether or not adequate functional egress for maxillary secretion, drainage, or ventilation has been created or restored.(ABSTRACT TRUNCATED AT 250 WORDS)

In search for high-efficacy therapy for childhood sinusitis, the author developed a unit providing a long-term perfusion followed by local oxygenation the maxillary sinuses. Intrasinus administration of 10% dimexide solution did not produce a negative effect on the ciliated epithelium. Out of 52 patients treated, cure within 2-year follow-up was achieved in 49 subjects. All the sufferers with maxillary sinusitis recovered. The disease relapsed in 5 cases. In control group treated by long-term drainage with local antibiotics recurrent inflammation was registered in 12 out of 52 cases.

An experimental study was designed to compare the effects of enlargement of the maxillary ostium to inferior meatal antrostomy. In 10 rabbits, the sinus ostium was enlarged (osteoplasty group), and in 10 other animals, a window of the same size was created far from the ostium (antrostomy group). The control groups were 7 rabbits in which no surgery was performed and 6 rabbits in which only the surgical approach was performed. At reexploration 14 and 84 days after surgery, it was observed that rabbits in the osteoplasty group had significantly more infections of the sinuses than the antrostomy group and both control groups (P less than .05). Possible reasons for the difference in infection rate are discussed. These data indicate that, in normal maxillary sinuses of rabbits, disruption of the ostium results in an increased incidence of infection.

Aseptic samples of sinus mucosa or aspirates from maxillary sinuses were taken from 197 patients who underwent sinus surgery and were cultured for aerobic bacteria. Anaerobic cultures were also obtained from 143 of these patients. A total of 236 bacterial isolates from 174 patients were analyzed. No anaerobic organisms were isolated. The most commonly isolated organisms were Staphylococcus species (coagulase-negative), Staphylococcus aureus, gram-negative bacilli, and Streptococcus species. Penicillin G, erythromycin, tetracycline hydrochloride and, to a lesser degree, first-generation cephalosporins were found to be inferior to ciprofloxin, trimethoprim/sulfamethoxazole, and cefuroxime axetil when the susceptibilities of all the bacterial isolates to oral antibiotics used commonly in the empiric therapy of chronic sinusitis were compared.

Recent research on inflammatory sinus disease has implicated a central role for the ethmoid labyrinth, which may influence changes in the maxillary and frontal sinuses. CT can provide excellent definition of the paranasal sinuses and particularly the ethmoids, which is a prerequisite for endoscopic surgery. We describe a prospective series of 110 coronal CT scans performed on patients with a clinical diagnosis of sinusitis who had undergone diagnostic nasal endoscopies and medical treatment prior to surgery. 86% of the scans showed abnormal mucosal thickening. The ethmoids were affected in 73% and the maxillary sinus in 64%. Pneumatization of the middle turbinate was a common variant and when present was associated with anterior ethmoid disease in 60% of patients. Anterior ethmoid inflammatory changes were demonstrable in 95% of patients with maxillary sinus disease. Direct coronal CT can readily demonstrate disease in the infundibulum, frontal recess and posterior ethmoids in the same orientation confronting the endoscopist, and helps in the planning of ethmoidal surgery. Following surgery the sinuses can be directly inspected in outpatients which reduces the need for any further plain radiographs. It is important that the diagnosis of sinusitis is not based on CT findings alone as isolated areas of mucosal thickening are common in the normal population.

Eighty-two cases of functional endoscopic sinus surgery were analyzed. It include 62 males and 20 females; the oldest was 72 years of age and the youngest eight years of age. A hard endoscope with a diameter of 4mm and the CCD micro-videorecorder produced by Circon and Olympus Company were used. Operations were done under general anesthesia in all cases. Twenty-three cases (28.1%) recovered in one stage and recovery was delayed in 28 cases (34.2%); late inflammation occurred in 23 cases (28.1%); 8 cases failed (9.8%). The cure rate was 62.2%. Two cases (2.4%) had operative complications namely injury to the lamina papyracea and anterior ethmoidal artery, all recovered uneventfully.

Surgery was performed in the maxillary sinus with restoration of the surgical defect in the anterior wall with a resutured bone-lid, in 12 patients with an average age of 45 years, the technique is described and evaluated clinically and radiographically (computed tomography). During the followup time of 1-4 years, the condition of the maxillary sinus was normalized. It is our opinion that the bone-lid technique for maxillary sinus surgery is useful, especially when good overview and access is necessary.

With the exclusion of posterior or diffuse disease, anterior sinusitis is an inflammatory process affecting one or more cells draining through the middle meatus. When medical treatment fails, functional endoscopic surgery is indicated. Two hundred and three surgical cases are reviewed. Anterior sinusitis forms 44% of the surgical indications. Twenty months later, 80% obtain good or very good subjective and objective results. In 20% the quality is poor with suppuration. When suppuration persists, further endoscopic or radical surgery is indicated. In this series, complication rate is low. Endoscopic surgery advantages are discussed.

A 59-year-old woman suffered from occipital headache and bilateral cranial nerve VII, VIII, IX, X, XI and right XII deficit after developing otitis media. Magnetic resonance imaging (MRI) showed a thickening of the dura mater which was enhanced by gadolinium-DTPA (Gd). Aspergillus flavus was identified from the culture of otorrhea. She was treated with miconazole, flucytosin and fluconazole, which resulted in an improvement of the clinical symptoms and a thinning of the Gd-enhanced lesions on MRI. This is the first case of hypertrophic cranial pachymeningitis caused by Asp. flavus infection.

Every maxillary sinusitis suspected of chronicity has to be fully investigated by CT-scan. Failure of medical treatment will confirm chronic disease and will lead to surgery. According to the authors, endoscopic middle meatotomy is the treatment of choice, possibly associated with anterior ethmoidectomy and/or inferior meatotomy.

About a series of 20 aspergillus maxillary sinusitis, the correlation between this pathology and previous dental treatments is emphasized. In some cases such as sinusitis can occur without any dental pathology and/or in absence of foreign body on the X-rays. C.T. findings are the basis of the diagnosis. Surgical treatment, using endonasal micro surgery, has been performed in all cases.

Nine maxillary sinuses of 8 patients who had undergone Caldwell-Luc surgery (CWL) were injected with 100-125 microCi 99mTc-DTPA in 0.2 ml from the gingivo-buccal sulcus, passing through the canine fossa window. Sinus half-emptying times and percent contribution of the natural ostium (NO) and the naso-antral window (NA) to the clearance from the sinus were calculated, using time-activity curves as well as the activity of cotton wool plugs placed into the middle and lower conchae. Mean half-emptying times in patients in whom the mucosa had been removed were shorter than those in patients in whom it had been left in place. In the former group percent drainage through the NO was higher than that through the NA whereas in the latter group the opposite was the case. These findings are consistent with the thesis that if the mucosa is retained, the cilia continue their sweeping action towards the NO but if it is removed the NA gains importance in the drainage. This method is promising for the evaluation of maxillary sinus drainage following CWL.