Document Type

Poster

Publication Date

9-20-2014

Comments

Presented at: 60th Annual American Rhinologic Society Meeting in Orlando, Florida.

Abstract

Background: A small subset of patients have dysfunctional maxillary sinus mucosa. These patients require more aggressive surgical treatment to allow for gravity dependent mucous drainage, intra-operative and office debridements, and the delivery of irrigations and topical treatments. The aim of this study is to examine the use of inferior meatus maxillary antrostomy (IMMA) in combination with traditional maxillary antrostomy, in this challenging patient population.

Methods: We performed a retrospective study from February, 2008 until April, 2014 with a 118 patients undergoing a total of 128 IMMA procedures. Data was gathered regarding patient demographic, prior therapy, post-operative medical therapy, IMMA patency, SNOT-22 scores, Lund Mackay score, and the presence of disease recurrence.

Results: 118 patients (mean age 53) underwent 128 IMMA procedures. The mean length of follow-up was 1.6 years, and 66 % of patients had previous sinus surgery. 62 operations were for recalcitrant maxillary sinus disease, 36 for recalcitrant polyp disease, 6 for maxillary fungal disease, 4 for mucosal disease and 20 for odontogenic infections. 49 patients completed both pre and post-operative SNOT-22 scores, and the mean scores were 39 and 21, respectively. At 3 months post-operatively, we found that patients undergoing revision surgery and patients with nasal polyposis had the greatest SNOT-22 improvement. Males had 64% less SNOT-22 improvement compared to women at 3 months post operatively. In addition, 18% of patients did not experience any symptomatic improvement at 3 months post-operatively. With regards to post-operative medical therapy, men were more likely to have been prescribed steroid irrigations and antibiotics. Patients with fungal sinusitis had the greatest need for post-operative steroids. In addition, increased age correlated to fewer post-operative steroid courses. Out of 202 total inferior windows, 197 were patent post-operatively. There were 9 patients requiring revision surgery for maxillary sinus disease following IMMA, and patients requiring revision had the poorest outcomes.

Conclusion: Inferior meatal windows prove to be efficacious in patients with mucocillaray dysfunction without disrupting the normal mucociliary flow pattern. The inferior turbinate is also preserved, which may be a less destructive alternative to a mega antrostomies. We have determined that IMMA is a safe and successful procedure for chronic maxillary sinus pathology.

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