Missed Maxillary Sinus Ostium Syndrome and its Management

Area of Science:

• Otolaryngology
• Rhinology
• Surgical Anatomy

Background:

• Functional obstruction of the maxillary sinus ostium, often due to a displaced uncinate process, impedes sinus ventilation and drainage.
• Inflammation leading to nasal edema can compromise the ostium-infundibulum interface, causing inadequate maxillary sinus drainage.
• Incomplete surgical removal of the uncinate process, failing to include the natural ostium, can lead to missed ostium syndrome and persistent sinus disease.

Purpose of the Study:

• To present a case of missed maxillary sinus ostium syndrome and its successful management.
• To highlight the importance of recognizing and addressing missed maxillary sinus ostium syndrome.

Main Methods:

• A 28-year-old male patient with chronic post-nasal drip and facial pain following prior functional endoscopic sinus surgery (FESS) was evaluated.
• Diagnostic nasal endoscopy and CT scan revealed mucopurulent discharge and maxillary sinus opacity with a wide antrostomy.
• Revision FESS involved converting dual ostia into a single, wide middle meatal antrostomy using specialized surgical instruments.

Main Results:

• The revision surgery successfully created a single wide middle meatal antrostomy, preventing maxillary sinus mucus recirculation.
• One year post-operatively, the patient remained asymptomatic with no recurrence of sinusitis.
• The management strategy effectively resolved the patient's chronic symptoms.

Conclusions:

• Missed maxillary sinus ostium syndrome is a significant cause of recurrent sinusitis after FESS.
• Recognizing and surgically correcting this condition by creating a unified wide middle meatal antrostomy is crucial for successful patient outcomes.
• This approach ensures adequate sinus ventilation and drainage, preventing disease recurrence.