Unilateral Paranasal Disease in 154 Operated Cases of Paranasal Diseases

抄録

Unilateral paranasal disease is often encountered at otorhinolaryngology outpatient clinics. CT is the most commonly used modality to differentiate malignant tumors from inflammatory diseases in cases with unilateral paranasal disease. Paranasal malignancies are characterized by bone destruction. In unilateral paranasal disease without any evidence bone destruction, it may be difficult to differentiate inflammatory diseases from malignancy. The purpose of this study was to examine the differences between the clinical and histopathological diagnoses in patients with unilateral and bilateral paranasal diseases diagnosed by radiological examinations. Preliminary diagnoses made on the basis of clinical observations and CT findings were compared with the final histopathological diagnoses made from the resected specimens and the reasons for inconsistencies are discussed. We focused on154 cases that were diagnosed as having paranasal disease by CT. The patients were treated by surgery and the resected specimens were processed for histopathological diagnosis. The 154 operated patients comprised 68 patients with unilateral disease and 86 patients with bilateral disease. In the unilateral paranasal disease group, we confirmed chronic sinusitis in 30 cases (44.1%), postoperative maxillary cyst (POMC) in 5 cases (7.4%), maxillary mycosis in 4 cases (5.9%), allergic sinusitis in 5 cases (7.4%), maxillary sinusitis of dental origin in 2 cases (2.9%), inverted papilloma in 11 cases (16.2%), hemangioma in 5 cases (7.4%), malignant lymphoma in 2 cases (2.9%), and maxillary cancer in 4 cases (5.9%). On the other hand, in the bilateral paranasal disease group, the diagnoses were chronic sinusitis in 72 cases (83.7%), allergic sinusitis in 12 cases (14%), inverted papilloma in 1 case (1.2%), and POMX in 1 case (1.2%). In 56% of cases with a preoperative diagnosis of chronic sinusitis in unilateral paranasal disease, the histopathological diagnosis differed; in particular, in 8.8% of these cases, the diagnosis was malignancy. Additional diagnostic examinations to get more information, such as MRI, cytological examinations, or even open biopsy, should be performed before surgery in patients with unilateral paranasal disease when malignancy is suspected. Early identification of paranasal disease avoids delay in surgical intervention.