Cho Do-Yeon, Hwang Peter H
Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California 94305-5739, USA.
Am J Rhinol. 2008 Nov-Dec;22(6):658-62. doi: 10.2500/ajr.2008.22.3248.
In patients with chronically diseased maxillary sinuses, poor mucociliary clearance may result from long-standing inflammation or scarring from previous surgery. This subset of patients often has persistent sinus disease despite medical therapy and adequate antrostomy. Endoscopic maxillary mega-antrostomy (EMMA) is a mucosal sparing technique that facilitates mucus clearance and sinus irrigation in terminally dysfunctional maxillary sinuses. EMMA involves extending the antrostomy through the posterior half of the inferior turbinate down to the floor of the nose, creating a significantly enlarged antrostomy. This study describes our results of EMMA in recalcitrant maxillary sinusitis.
A retrospective review was performed of patients who underwent EMMA for recalcitrant maxillary sinusitis between July 2005 and September 2007. We studied diagnoses, comorbid factors, clinical efficacy, revision rate, and complications.
Twenty-eight patients (average age, 48 years) underwent 42 EMMAs for recalcitrant maxillary sinusitis. Average follow-up was 11 months. All patients had previous maxillary sinus surgery (mean = 2.3). Relevant comorbid factors included prior Caldwell-Luc or maxillofacial surgery (16/42), cystic fibrosis (11/42), asthma (11/42), and IgG deficiency (3/42). The most common symptoms reported were facial pain/pressure and purulent rhinorrhea. At the time of the most recent postoperative examination, 74% of patients reported complete resolution of symptoms while 26% reported partial symptomatic improvement. There were no complications and the revision rate was 0%.
Maxillary sinuses that appear to be terminally diseased may be rehabilitated surgically without the need for surgical stripping. EMMA is an effective and safe treatment option for the management of recalcitrant maxillary sinus disease.
在患有慢性上颌窦疾病的患者中，黏液纤毛清除功能不佳可能是由于长期炎症或既往手术留下的瘢痕所致。尽管进行了药物治疗和充分的鼻窦开窗术，但这部分患者的鼻窦疾病往往持续存在。内镜下上颌窦大开窗术（EMMA）是一种保留黏膜的技术，可促进终末期功能障碍的上颌窦内的黏液清除和鼻窦冲洗。EMMA包括将鼻窦开窗术延伸至下鼻甲后半部直至鼻底，从而形成一个显著扩大的鼻窦开口。本研究描述了我们应用EMMA治疗难治性上颌窦炎的结果。
对2005年7月至2007年9月期间因难治性上颌窦炎接受EMMA治疗的患者进行回顾性研究。我们研究了诊断、合并因素、临床疗效、翻修率和并发症。
28例患者（平均年龄48岁）因难治性上颌窦炎接受了42次EMMA手术。平均随访时间为11个月。所有患者既往均接受过上颌窦手术（平均2.3次）。相关合并因素包括既往行考德威尔-卢氏手术或颌面手术（16/42）、囊性纤维化（11/42）、哮喘（11/42）和IgG缺乏（3/42）。报告的最常见症状是面部疼痛/压迫感和脓性鼻漏。在最近一次术后检查时，74%的患者报告症状完全缓解，26%的患者报告症状部分改善。无并发症发生，翻修率为0%。
看似终末期病变的上颌窦可通过手术修复，无需手术剥离。EMMA是治疗难治性上颌窦疾病的一种有效且安全的治疗选择。
