Maxillary sinusitis caused by nasoseptal obstruction

Ear, Nose & Throat Journal, March, 2006 by Dewey A. Christmas, Joseph P. Mirante, Eiji Yanagisawa

A 27-year-old woman presented with a history of recurrent fight sinus infections that usually caused a significant degree of right facial and cheek discomfort. She said that noticeable right nasal airway congestion had been present since childhood. Her right facial discomfort would resolve with the use of antibiotics only to return with recurrent upper respiratory infections. She reported no symptoms on the left side.

On clinical examination, the patient was found to have a marked septal bulging that obstructed the right nasal airway (figure, A). Examination of the left nasal airway revealed a marked concavity of the nasal septum to the fight; the airway itself was widely patent. Computed tomography (CT) of the nose and sinuses confirmed the marked septal deformity to the right and revealed an opacified right maxillary sinus (figure, B).

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Because of the recurrent nature of her symptoms, the patient elected to undergo powered endoscopic sinus surgery and nasal septal reconstruction. During surgery, a marked edema was noted in the right middle meatus (figure, C). When suction was applied to the middle meatus, mucopus drained from the area of the right ethmoid infundibulum (figure, D). Powered endoscopic sinus surgery on the right provided good ventilation and drainage, and nasoseptal reconstruction relieved the obstruction and markedly improved the function of the right nasal airway.

Nasal septal deformity is a common cause of nasal obstruction. Obstruction of the nasal airway can cause inflammation of the middle meatus and result in sinus infections. (1) Surgical correction of nasoseptal deformities has been discussed for many years. (2) Newer techniques involving an endoscopic approach (3,4) and powered instrumentation (5) have been described.

References

(1.) Yanagisawa E. Endoscopic view of the septal spur and ridge. In: Yanagisawa E, ed. Atlas of Rhinoscopy. San Diego: Singular Thomson Learning, 2000:58-9.

(2.) Cottle MH, Loring RM. Corrective surgery of the external nasal pyramid and the nasal septum for restoration of normal physiology. Illinois Med J 1946;90:119-31.

(3.) Lanza DC, Rosin DF, Kennedy DW. Endoscopic septal spur resection. Am J Rhinol 1993;7:213-16.

(4.) Yanagisawa E, Joe JK. Endoscopic septoplasty. In: Yanagisawa E, ed. Atlas of Rhinoscopy. San Diego: Singular Thomson Learning, 2000:191-2.

(5.) Mirante JP, Christmas DA Jr. Powered endoscopic septoplasty. In: Yanagisawa E, Christmas DA Jr., Mirante JP, eds. Powered Instrumentation in Otolaryngology-Head and Neck Surgery. San Diego: Singular Thomson Learning, 2001:183-7.

Dewey A. Christmas, MD; Joseph P. Mirante, MD; Eiji Yanagisawa, MD

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante); and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group; the Section of Otolaryngology, Hospital of St. Raphael; and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa).