[Operative treatment of paranasal sinus diseases in childhood].

An exact knowledge of the developing anatomy and physiology, and very conservative operative technique are the prerequisites for surgical therapy of the nose and the paranasal sinuses in children. These requirements are fulfilled by uncapping of the ethmoidal cells in chronic and especially acute ethmoid sinusitis. Intranasal antrostomy allows diagnosis to be made and limited local treatment to be given in acute and chronic maxillary sinusitis. More radical surgical procedures are not indicated in children, except in those cases, where severe orbital or endocranial complications have already developed. Uncapping of the ethmoidal cells and/or intranasal antrostomy combined with the elimination of mechanical obstruction of the upper respiratory tract are necessary, when conservative treatment of acute or chronic sinusitis is unsuccessful. Continuation of conservative therapy is then no longer indicated. The uncapping of the ethmoidal cells under antibiotic cover usually leads to a complete disappearance of the symptoms within a few days, even when orbital or periorbital complications of an acute ethmoiditis have already set in. Even after unsuccessful long-term treatment of a chronic maxillary sinusitis, intranasal antrostomy is successful in 75-90 per cent of cases. Complications did not occur in a personal series of 1,349 intranasal antrostomies in children in a period of 5 years.