Bilateral Chronic Maxillary Atelectasis with a Unilateral Accessory Ostium

Year 2020, Volume: 3 Issue: 1, 23 - 25, 01.04.2020

Joyce Pui Kiu Ho Eugene Wong Narinder Pal Singh

Abstract

Chronic maxillary atelectasis (CMA) is an underdiagnosed condition that can occur bilaterally and may lead to significant complications. An accessory maxillary ostium (AMO) is a defect in the posterior fontanelle that is associated with maxillary sinus pathology. We present a case of a 47-year-old man with sinonasal symptoms. Nasendoscopy demonstrated bilateral lateralized uncinate processes. Radiological findings were consistent with a diagnosis of bilateral stage II CMA, with the left side less atelectatic than the right and only partially opacified. The patient was treated surgically with bilateral uncinectomy and maxillary antrostomy. Intraoperatively, an AMO was visualized on the left. The main theory regarding the etiology of CMA is sustained obstruction of the ostiomeatal complex resulting in negative intra-sinus pressures and subsequent atelectatic remodeling of the antral walls. Our patient had an AMO on the left side,
which was also the side of reduced severity of both symptoms and radiographic findings. We propose that the patient initially had bilateral CMA, with subsequent development of a left AMO, which halted further progression of the disease on this side. This case suggests that an AMO can develop or enlarge and supports the notion that CMA is caused by negative intra-sinus pressures. Further research is required to establish the detailed etiology of CMA.

Keywords

Maxillary sinus , maxillary sinusitis , paranasal sinuses , sinusitis

References

• Montgomery WW. Mucocele of the maxillary sinus causing enophthalmos. Eye Ear Nose Throat Mon 1964; 43: 41-4.
• Kass ES, Salman S, Rubin PA, Weber AL, Montgomery WW. Chronic maxillary atelectasis. Ann Otol Rhinol Laryngol 1997; 106: 109-16.
• Yenigun A, Fazliogullari Z, Gun C, Uysal II, Nayman A, Karabulut AK. The effect of the presence of the accessory maxillary ostium on the maxillary sinus. Eur Arch Otorhinolaryngol 2016; 273: 4315-9.
• Ho JPK, Wong E, Gunaratne DA, Singh N. Chronic maxillary atelectasis (including silent sinus syndrome) can present bilaterally. J Laryngol Otol 2019; 133: 251-5.
• Numa WA, Desai U, Gold DR, Heher KL, Annino DJ. Silent sinus syndrome: A case presentation and comprehensive review of all 84 reported cases. Ann Otol Rhinol Laryngol 2005; 114: 688-94.
• Kass ES, Salman S, Montgomery WW. Manometric study of complete ostial occlusion in chronic maxillary atelectasis. Laryngoscope 1996; 106: 1255-8.
• Jog M, McGarry GW. How frequent are accessory sinus ostia? J Laryngol Otol 2003; 117: 270-2.
• Ali IK, Sansare K, Karjodkar FR, Vanga K, Salve P, Pawar AM. Cone-beam computed tomography analysis of accessory maxillary ostium and Haller cells: Prevalence and clinical significance. Imaging Sci Dent 2017; 47: 33-7.
• Genc S, Ozcan M, Titiz A, Unal A. Development of maxillary accessory ostium following sinusitis in rabbits. Rhinology 2008; 46: 121-4.
• Parsons DS, Wald ER. Otitis media and sinusitis: Similar diseases. Otolaryngol Clin North Am 1996; 29: 11-25.