Masaya Fukami

Experimentally induced polyps in the sinus mucosa : a structural analysis of the initial stages

To document polyp formation in the sinus mucosa, the authors of this study subjected New Zealand white rabbits to different modes of manipulation intended to induce inflammation of the maxillary sinus. These manipulations included a combination of bacterial infection and mechanical trauma, the deposition of agarose into the sinus cavity, and the deposition of N‐formyl‐methionyl‐leucyl‐phenylalanine, a chemotactic peptide, into the sinus cavity. A majority of animals developed polyps, which were examined by light and electron microscopy.

Healing Process of Sinus Mucosa after Endoscopic Sinus Surgery

In the treatment of chronic sinusitis, the mucosa should be preserved, or, when severely damaged, only the mucosal surface removed with cutting forceps. It is especially important not to expose the surface of the bone by complete removal of the mucosa. When the mucosa is conserved, or excision is limited to only the mucosal surface, ciliated cells regenerate within 6 months. However, where the mucosa was completely removed during surgery and the bone was exposed, the area was covered with nonciliated cells, and only scattered cilia were present.

Saccharin test of maxillary sinus mucociliary function after endoscopic sinus surgery.

Objectives: To determine the usefulness of the saccharin time (ST) test for evaluating the mucociliary function of the maxillary sinus after endoscopic sinus surgery (ESS) for chronic sinusitis.

Mucosal Pathology of the Nose and Sinuses: A Study in Experimental Maxillary Sinusitis in Rabbits Induced by Streptococcus Pneumoniae, Bacteroides Fragilis, and Staphylococcus Aureus

Unilateral maxillary sinusitis was experimentally induced in New Zealand White rabbits with Streptococcus pneumoniae serotype 3, Bacteroides fragilis NCTC 9343, and Staphylococcus aureus V8 in order to study possible differences in the inflammatory response of the sinus and nasal mucosa at different time-intervals during a 12-week period of infection. The initial sinus mucosal response, most pronounced in pneumococcal sinusitis, was characterized by leukocytosis, epithelial desquamation, and squamous cell metaplasia. Tissue reactions at later intervals included fibrosis of lamina propria, gland involution, polyp formation, and bone remodelling, and were most pronounced in S. aureus and B. fragilis sinusitis. The nasal mucosa was altered with a redistribution of goblet cells, development of polyps in the ethmoidal region, involution of Bowmans glands and locally, areas of degenerated olfactory sensory epithelium. These findings endorse that the degree of local pathology depends on the infecting microorganisms specific pathogenetic factors. However, local tissue factors guiding the cellular inflammatory proliferative and regenerative processes are also of fundamental importance for the type of pathological changes occurring in an infected nasal or sinus mucosa.

Effects of Surgery on Mucosal Pathologic Changes following Experimental Sinusitis in Rabbit

In the present investigation, the regenerative capacity of the infected maxillary sinus mucosa following surgical procedures was studied in a rabbit model. Sinusitis was induced by occluding the ostium with and without the addition of Staphylococcus aureus or Bacteroides fragilis, or by provoking a prolonged bacterial infection with both pathogens. The surgical procedures performed were 1) widening of the natural sinus ostium (middle meatal antrostomy; MMA) and 2) removal of sinus mucosa without ostial interference (modified radical operation; MRO). The histologic features of the entire nose-sinus complex were studied, graded semiquantitatively, and compared with findings in untreated sinusitis, or after surgery only. Whereas MMA and MRO both led to a decrease of the inflammatory features of the sinus mucosa in induced sinusitis, persistent local histopathology was observed in the ostial region following MMA surgery. This indicates the importance of local pathologic changes resulting from interactions of bacterial colonization, inflammation, and surgery in chronic sinusitis.

Endoscopic Endonasal Treatment of Ostium of the Frontal Sinus and the Results of Endoscopic Surgery

We discuss a procedure for opening the nasofrontal duct and the postoperative findings in endoscopic endonasal surgery. The route of the anterior ethmoidal artery was also studied. The subjects of this study were 57 patients (105 sides) who had frontal sinus disease. The patients all underwent surgery for chronic sinusitis between 1990 and 1992. Patients undergoing revision surgery were excluded. All patients were operated on by the same surgeon. In each patient, following anterior and posterior ethmoidectomy, the frontal sinus ostial region was opened using a 70 endoscope, while carefully monitoring the anterior ethmoidal artery. The agger nasi was left intact. The cells around the ostium were opened using a curved suction tip and upward bent forceps, and the lamellae were removed to achieve the greatest possible communication with the frontal sinus. In 77 sides (73.4%), the communication between the frontal and ethmoidal sinuses was well maintained. The ostium was patent with edematous mucosa in 18 sides (17.1%). The opened ostium could not be confirmed due to presence of polyp, etc., in 10 sides (9.5%). During surgery, the route of the anterior ethmoidal artery was confirmed in 70.8%; and of these cases, it was located anterior to the third ground lamella in about 50%.