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Ostiumul accesor al sinusului maxilar

 Accessory ostium of the maxilar sinus

Cristian Ioniţă, I. Bulescu, Alexandra Schnaider, Bogdan Mocanu, Vlad Andrei Budu, Diana Cojocaru

First published: 10 martie 2016

Editorial Group: MEDICHUB MEDIA

DOI: 10.26416/Orl.30.1.2016.520

Abstract

Maxillary sinus ostium may be located anywhere along the ethmoid infundibulum (middle meatus). 
In rhinosinusal pathology we may find an accessory ostium of the maxillary sinus due to chronic inflam­mations or after previous endoscopic sinus surgery. Existence of the accessory ostium leads to a recirculation mechanism of sinus secretions and a very difficult to treat rhinosinusal simptomatology. For every patient with this pathology we performed an endoscopic exam of the nose and a rhinosinusal CT scan. Treatment is strictly surgical by creating a unique ostium (consisting of both primary and accessory ostium). Endoscopic anatomy of the ostiomeatal unit should be well understood by the surgeon in order to perform a correct endoscopic sinus surgery, obtaining a proper sinus ventilation and avoiding complications. The presence of an accessory maxillary sinus ostium has only an endoscopic surgical treatment for ensuring sinus drainage and increasing the quality 
of life of our patients.
Keywords:

Keywords
accessory ostium of the maxillary sinus, mucus recirculation, endoscopic sinus surgery

Rezumat

Ostiumul primar al sinusului maxilar este situat la nivelul infundibulului etmoidal (meatul mediu). Datorită unor cauze inflamatorii sau iatrogene, există riscul apariţiei unui ostium accesor al sinusului maxilar. Prezenţa acestuia determină apariţia mecanismului de recirculare a secreţiilor de la nivelul sinusului maxilar, cu simptomatologie cronică rezistentă la tratamentul medicamentos obişnuit. Algoritmul de diagnostic cuprinde examinarea endoscopică nazală cu vizualizarea ostiumului accesor şi examenul imagistic computer tomografic, cu punerea în evidenţă a patologiei rinosinuzale existente. Rezolvarea terapeutică este strict chirurgicală, cu crearea unui ostium unic (ce cuprinde ostiumul primar şi ostiumul accesor). Anatomia endoscopică rinosinuzală - şi în special a complexului ostiomeatal - trebuie bine înţeleasă de către chirurg, în vederea efectuării unei antrostomii medii corecte, obţinerii unei ventilaţii sinuzale corespunzătoare şi evitării apariţiei complicaţiilor. Prezenţa unui ostium accesor al sinusului maxilar impune un tratament chirurgical endoscopic pentru asigurarea drenajului sinuzal şi creşterea calităţii vieţii pacientului. 
 

Cuvinte cheie
ostium accesor sinus maxilar

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