Abstract
In recent years, Dr. Takahashi has emphasized an increasing incidence of instable pathology of maxillary sinusitis. The number of patients with fixed chronic inflammation of paranasal sinusitis is on the decrease, while the number of patients having instable lesions is increasing. We have also observed and reported on this tendency but it is often difficult to establish a diagnosis of instable pathology of chronic sinusitis. The author performed the following clinical and histopathologic studies in patients with chronic sinusitis.
a) Radiographic examination (X-ray mucous membrane function test) using contrast media.
b) Endoscopic examination of the maxillary ostium.
c) Histopathologic observation of the mucosa of maxillary sinus.
d) Histologic observation of maxillary ostium including its wall and surrounding structure from specimens removed from cadavers.
Endoscopic findings of the maxillary orifice were classified into 5 types.
1) Normal type: Maxillary ostium opens well without abnormalities of the mucosa.
2) Slightly swollen type: Slight edema and hyperemia around the maxillary ostium.
3) Moderatery swollen type: Maxillary ostium is barely open and there is uneven mucosal surface due to edematous and polypous change.
4) Severely swollen type: Maxillary ostium is completery obstructed by polypous mucosa.
5) Overhung type: Maxillary ostium is completely obstructed by polypoid mucosa.
The interrelationship of radiographic, histopathologic and endoscopic findings was discussed. The type of maxillary ostium can be figured by routine rhinologic examinations. Radiographic findings suggestive of normal or instable pathology of maxillary sinusitis, slight swelling of mucosa and clear moljodol image of maxillary ostium are suggestive of normal type of maxillary ostium, while moderate or severe pathology of maxillary sinusitis, swelling of antral mucosa and obscure image are suggestive of abnormal type. Radiographic findings were compaired at different period during the course of the disease. History, physical examinations, course of condition and response to treatment are studied.
A significantly different course was noticed between the normal and abnormal types of maxillary ostium. The patients with normal type of maxillary ostium showed easy improvement and aggravation. It is presumed that normal maxillary ostium helps improvement of the sinus inflammation, however, inflammation in the nasal cavity easily invades the maxillary sinus. The abnormal type showed an unchanged (fixed sinusitis) or slightly changed course. In contrast, the abnormal type protect against invasion of inflammation into the maxillary sinus, but drainage of the contents and improvement of inflammation in maxillary sinus are disturbed.
The specimens from moderate and severe maxillary sinusitis revealed intence infiltration of lymphocytes, leucocytes, plasma cells and fibrosis. Edematous change of the mucosa was observed in the instable stage of maxillary sinusitis. The above observation suggests that severe pathology rather than instable changes would, proceed to fixed maxillary sinusitis.
The maxillary ostium was divided into 3 parts based on histologic findings; 1) Nasal cavity side, 2) Middle part, 3) Sinus side. Mucous and serous glands and cavernous blood spaces are abundant in the nasal cavity side as in the inferior nasal turbinate, less abundant in the sinus side and scarce in the middle part.
It is generally accepted that humidification, thermostatic control and filtering of air are the main functions of the nasal cavity and paranasal sinuses. On the basis of the above observation, it is probable that the inspired air which is insufficienty heated and humidified in the nasal cavity becomes adequate temperature and humidity between both orifices of maxillary ostium.
