Department of Operating Theater, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Province, China.
Department of Science and Education, Qingdao Chengyang People's Hospital, No. 600 Changcheng Road, Chengyang District, Qingdao, Shandong Province, China.
BMC Surg. 2022 Jul 25;22(1):287. doi: 10.1186/s12893-022-01739-0.
The objective of this study was to compare the long-term results of extended middle meatal antrostomy (MMA) and MMA combined with inferior meatal antrostomy (IMA, combined approach) for the treatment of fungal maxillary sinusitis (FMS).
A retrospective analysis including 90 patients with non-invasive FMS was treated with endoscopic extended MMA via antidromic extended medial wall (extended MMA group), or with both MMA and IMA (combined approach group). The recurrence rate, operation time, and complications were evaluated at postoperative 12 and 36 months.
Of the 90 patients, 52 patients were in the extended MMA group and 38 patients in the combined approach group. CT revealed the thin medial wall or bone defect in 63.33% (57/90) patients. The mean operation time in the extended MMA group was significantly shorter than that of combined approach group (42.5 ± 6.5 vs 57.4 ± 4.9, P < 0.01). At postoperative 12 months postoperatively, the recurrence rate was 3.85% (2/52) in the extended MMA group and 0.0% (0/38) in the combined approach group, the difference wasn't significant (X = 0.618, P > 0.05). The recurrence rate wasn't increased during the follow-up period over time in both groups.13.5% (7/52) patients complained of cheek numbness in the extended MMA group, 60.5% (23/38) patients complained of cheek numbness and epiphora in 5.3% (2/38) patients in the combined approach group, the difference was significant (X test, P < 0.01). However, no major complications were observed in both groups. In addition, IMA closure was observed in 4 (10.5%) in the combined approach group at 12 months postoperatively and in 9 (23.6%) at 36 months postoperatively.
Extended MMA via antidromic extended medial wall may effectively prevent the recurrence and reduce the complications of FMS, IMA wasn't necessary for the treatment of FMS in most cases.
本研究旨在比较中鼻道扩大（MMA）和 MMA 联合下鼻道扩大（IMA，联合治疗）治疗真菌性上颌窦炎（FMS）的长期疗效。
回顾性分析 90 例非侵袭性 FMS 患者，采用内镜逆行扩大内侧壁（扩大 MMA 组）或 MMA 和 IMA 联合治疗（联合治疗组）。术后 12、36 个月评估复发率、手术时间和并发症。
90 例患者中，52 例患者行扩大 MMA 组，38 例患者行联合治疗组。CT 显示 63.33%（57/90）患者存在薄内侧壁或骨缺损。扩大 MMA 组的平均手术时间明显短于联合治疗组（42.5±6.5 vs 57.4±4.9，P<0.01）。术后 12 个月，扩大 MMA 组复发率为 3.85%（2/52），联合治疗组为 0.0%（0/38），差异无统计学意义（X=0.618，P>0.05）。两组随访期间复发率无随时间增加而增加。扩大 MMA 组 13.5%（7/52）患者诉面颊麻木，联合治疗组 60.5%（23/38）患者诉面颊麻木和溢泪，5.3%（2/38）患者诉面颊麻木和溢泪，差异有统计学意义（X 检验，P<0.01）。但两组均无严重并发症。此外，联合治疗组术后 12 个月有 4 例（10.5%）IMA 关闭，术后 36 个月有 9 例（23.6%）IMA 关闭。
逆行扩大内侧壁 MMA 可有效预防 FMS 复发，降低并发症发生率，大多数情况下，IMA 并非治疗 FMS 的必要手段。
