Restoration of the mucociliary clearance of the maxillary sinus after endoscopic sinus surgery.

BACKGROUND

Whether endoscopic sinus surgery (ESS) restores the mucociliary clearance of the maxillary sinus needs further evaluation.

METHODS

We evaluated the mucociliary clearance of the maxillary sinus by using a radionuclide technique in 12 patients with chronic sinusitis (sinusitis group) and in six patients who had undergone ESS 6 to 14 months after the surgery (post-ESS group). The mucosal cilia taken from the maxillary sinus in 12 patients with sinusitis before and after ESS (paired experiments) were examined by light and electron microscopy.

RESULTS

The radionuclide placed endoscopically in the maxillary sinus in eight patients immediately after ESS maintained 81.2 +/- 16.3% of its radioactivity after 30 minutes. This result was consistent with results in four patients with untreated chronic sinusitis in whom the radionuclide had been instilled by antral puncture (86.9% +/- 3.5%). On the other hand, in six patients in the post-ESS group the radionucleotide maintained only 25.9% +/- 11.6% of its radioactivity, demonstrating statistically significant differences from those of both the sinusitis group without ESS (p < 0.005) and the group 4 days after ESS (p < 0.005). The absence of the cilia in the sinusitis condition was recognized in 35.5% +/- 12.1% (n = 12) of the epithelial cells. On the other hand, the absence of cilia was significantly (p < 0.01) reduced to 5.3% +/- 3.7% of the epithelial cells in the post-ESS condition. Electron microscopic observation also revealed abnormal cilia in the sinusitis condition, whereas the mucosal cilia were regularly arranged in the post-ESS condition.

CONCLUSIONS

The mucociliary clearance of the maxillary sinus disturbed by chronic inflammation was restored by ESS, indicating the clinical effectiveness of ESS for the treatment of chronic sinusitis.