Histological and ultrastructural findings on mucocele of maxillary sinus

The authors describe a rare case of mucocele of maxillary sinus and, on the basis of the histological and namely of the ultrastructural findings, they maintain that the mucocele has in all probability a multiple pathogenesis being dependent not only on the inflammatory processes, but also on other local predisposing factors and namely the active participation of the mucosa in the formation of the cavity of mucocele.     

Specific features of the development of chronic inflammation in the maxillary sinus

The present morphological study was based on the analysis of materials obtained during the surgical treatment of 64 patients aged from 15 to 68 years presenting with long-term chronic purulent maxillary sinusitis. All the patients had been inadequately treated with antibacterial preparations during the pre-hospitalization period. It was shown that the patients developed well-apparent pathomorphological changes in maxillary sinus mucosa that promoted chronization of the inflammatory process.     

Computed tomogram findings of mucous recirculation between the natural and accessory ostia of the maxillary sinus

BACKGROUND: The phenomenon of recirculation involves the circulation of mucous secretion between the natural ostium and other openings and is observed mainly after surgery when the surgical opening is not connected. METHODS: Seven patients with a mucous stream transporting into an accessory ostium, as found during endoscopic examination, were entered into study. The coronal computed tomogram findings of the mucous recirculation were analyzed at three levels: anterior, middle, and posterior portion of it. RESULTS: The anterior portion was visualized at the level of the natural ostium in five patients. The middle portion inside the maxillary sinus was visible in six cases. The posterior portion was visualized at the level of the accessory ostium in five patients. Among the axial scans, mucous rings were visible in two patients. CONCLUSIONS: The primary mucous recirculation between the natural and accessory openings is shown as a ring structure in coronal computed tomogram scans.     

Cellular and tissue reactions of the mucous membrane of the maxillary sinus in the patients presenting with odontogenic aspergillous maxillary sinusitis

The results of this morphological study of the mucous membrane of the maxillary sinuses in the patients presenting with the non-invasive fungal form of odontogenic sinusitis revealed the signs of granulematous inflammation. Epithelium underwent metaplasia into the single-row cubic or prismatic layer. The invasive form of fungal odontogenic sinusitis was characterized by allergic inflammation with intensive infiltration of maxillary sinus mucosa by antigen-representing and effector cells.     

Histological evaluation of maxillary sinus mucosa after functional endoscopic sinus surgery

BACKGROUND: This study was performed to evaluate the histological changes of the maxillary sinus mucosa of patients with chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS). METHODS: In a cohort study, biopsy specimens were collected from the maxillary sinus of patients submitted for FESS. One year after surgery, patients were clinically reassessed. Patients showing recurrence of disease (group 1) required a revision surgery, through which a second biopsy specimen was collected. Patients showing a favorable clinical response (group 2) were submitted to an outpatient maxillary biopsy through the previous opened middle meatus antrostomy. Biopsy material from four cadavers was used as control. The histological and electron microscope findings were analyzed. RESULTS: At the initial surgery, patients presented many histopathological alterations, such as an inflammatory process infiltrating the submucosa, atypical respiratory epithelium with an important increase in goblet cells, metaplasia, or mixed epithelium. Group 1 patients persisted with the same alterations 1 year later, but ciliary dysmorphy was more accentuated. Group 2 patients presented a predominantly pseudostratified epithelium, but some areas contained an increased number of goblet cells and a reduction in the number of ciliated cells. CONCLUSION: Recovery of the maxillary sinus mucosa of patients with CRS, observed by electron and light microscopy, was incomplete 1 year after endoscopic surgery, even in nonsymptomatic patients; nevertheless, these alterations were more important in symptomatic patients than in asymptomatic patients.     

慢性鼻-鼻窦炎炎症状态的内镜评价和临床相关因素分析

目的探讨内镜评价系统对慢性鼻-鼻窦炎（chronic rhinosinusitis，CRS）的炎症状态进行定量评价的可行性。方法以大体结构、黏膜形态、分泌物质量为主线制定标准，前瞻性地对CRS的鼻腔和鼻窦黏膜炎症状态进行评分；并将这一评分与可能影响CRS的因素（包括：年龄、病程、术后是否复发、复发时间、变应性、血清总IgE、血清嗜酸细胞阳离子蛋白、分泌物细菌培养、血嗜酸粒细胞计数、局部炎症细胞等级、放射学疾病范围、吸烟、伴发的呼吸道疾病）进行单因素和多因素相关性分析；探讨通过内镜评分对CRS进行定量评价的可行性，并确定本评分系统对炎症状态的体现程度。结果在单因素分析中，与内镜评分有相关性的因素有8个：①年龄（x1，r=-0．310，P=0.016）；②疾病范围（x2，r=0.810，P〈0．0005）；③术后是否复发（x3，r=0．408，P=0.001）；④组织嗜酸粒细胞数（x4，r=0.279，P=0.031）；⑤病程（x5，r=0．536，P〈0．0005）；⑥是否伴发息肉（r=0．549，P〈0．0005）；⑦浆细胞数（r=0．317，P=0．014）；⑧复发时间（r=0．385，P=0．002）。在多元线性回归分析中，对内镜评分有独立影响的因素为：疾病范围、手术是否复发、年龄、组织嗜酸粒细胞数和病程。多元回归方程为：y=10.148—0．152（x1）＋2．250（x2）＋3．348（x3）＋1．233（x4）＋0．270（x5）。结论通过适当的内镜评价体系，对CRS的炎症状态进行定量评分是可行的，据此有望对疾病程度和预后进行一致性评估。