Department of Otorhinolaryngology - Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sci Rep. 2024 May 4;14(1):10257. doi: 10.1038/s41598-024-58726-z.
Endoscopic middle meatal antrostomy (MMA) is commonly used for maxillary sinus (MS) fungal ball removal. For challenging cases involving anterior or inferior recess, an additional inferior meatal approach (IMA) might be needed. We analyzed the differences in MS dimensions on CT scans according to the surgical approach to suggest preoperative variables that could facilitate an additional IMA. CT scans of 281 adult patients who underwent ESS for the MS fungal ball (139 MMA, 62 MMA & IMA) were evaluated for comparative analysis of 8 MS measurements based on the surgical approach. Complete removal was achieved in all cases. Age and sex didn't differ significantly (p > 0.05). The maximum distances between the anterior-posterior walls, the inferior ostium border to the lateral recess, and the ostium to the inferior wall of the MS were statistically greater in the MMA & IMA group compared to the MMA group (p = 0.003, p = 0.005, and p = 0.010, respectively), especially among females. This study underscores the clinical importance of specific measurements-anterior to posterior wall, medial wall to lateral recess, and ostium to inferior wall of the maxillary sinus-for guiding optimal surgical approaches in MS lesions.
内窥镜中鼻道上颌窦造口术（MMA）常用于上颌窦（MS）真菌球切除。对于涉及前或下隐窝的复杂病例，可能需要额外的下鼻道入路（IMA）。我们分析了根据手术入路的 MS 尺寸在 CT 扫描上的差异，以提示术前变量，这些变量可能有助于额外的 IMA。对 281 例因 MS 真菌球接受 ESS 的成年患者的 CT 扫描进行评估，根据手术入路对 8 项 MS 测量进行了比较分析。所有病例均达到完全清除。年龄和性别无显著差异（p>0.05）。MMA 和 IMA 组的前-后壁之间、下窦口边界到外侧隐窝以及窦口到 MS 下壁之间的最大距离与 MMA 组相比具有统计学意义（p=0.003、p=0.005 和 p=0.010，分别），尤其是在女性中。这项研究强调了特定测量值的临床重要性，即上颌窦的前-后壁、内侧壁到外侧隐窝和窦口到下壁，以指导 MS 病变的最佳手术入路。
