ON POSTOPERATIVE COURSES OF CHRONIC FRONTAL SINUSES OBSERVED FROM REOPERATED CASES: ITS CLINICAL AND HISTOPATHOLOGICAL STUDY

Abstract

The author made a clinical and histopathological study on 48 cases of recurrent frontal sinusitis developed from 10 days to 24 years after radical operation (Extransal procedure) of the frontal sinus. The materials used in the present study were 105 specimen including regenerated tissue and remained mucosa in the frontal sinus obtained at reoperation. The finding of the operation was also referred to note at the same time.
The main cause of postoperative recurrence of frontal sinusitis is considered attributable to the mucosal epithelium remained in the sinus at the former operation; 36 of 48 cases were found to show the presence of remained mucosa, but other 12 cases exhibited non-existence of the mucosa.
The frequency of the site of remained mucosa in the sinus is shown as follows; lateral fossa (Recessus lateralis)-14 cases, central part of the frontal sinus-9 cases, anterior ethmoid cells-6 cases, inner wall of the frontal sinus-4 cases, tegmen of the ethmoid cells, interosuperior wall and upper wall of the sinus-one case respectively. 8 cases were found to contain remained mucosa at more than two portions in the sinus.
In cases following usual course of recovery, regenerated tissue appeared in the frontal sinus after the operation required 30 days in its completion. In these cases, the frontal sinuses were found to be filled entirely with healthy tissue.
New formation of bony tissue in the sinus was observed in the specimen of the 15th day of operation. The process of ossification covered the entire stadiums of cases.
In cases with remained mucosa, cellular infilturation was most markedly observed within the period of 6 months or a year. In other words, it is well understood that at this stage of the postoperative course of frontal surgery, the sinus shows itself to be most likely affected by infection from clinical standpoint, displaying high re.-activity.
Regenerated tissue in co-existance with remained mucosa, becomes the most dense in texture during the period from 6 months to five years. 69% of cases with remained mucosa passed over the period of more than a year, showed abnormal thickening of basilar membrane of the mucosa.
The most prominent changes observed in the remained mucosa were those of glandular tissue; flattening and cystic enlargement of glandular cells with occasionally observed remarkable hyperplasia or my omatous degeneration shown in the specimens. Regenerated mucosal epithelium was observed in 6 of 48 cases.
As a conclusion, the only way to avoid previously development of recurrent frontal sinusitis is thought to consists in the total removal of mucosa of the sinus at the fist operation supplemented by ethmoid surgery which opens and cleans the cells radically.