[Bacterial flora of the nose and the maxillary sinuses during maxillary sinusitis and its sensitivity to antibiotics].
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Twelve patients with maxillary hyperplastic sinusitis or maxillary sinus empyema of oral/dental etiology have been treated according to a modified surgical technique. The treatment was initiated by several oro-nasal irrigations and drainage facilitated by an intact semilunar hiatus. This was followed by a surgical procedure including conservative curettage of inflamed sinus mucosa, adequate closure of the oro/antral communication, with establishment of a postoperative oral antrostomy. This antrostomy, through the canine fossa, was established by a vacuum drain, enabling continuous postoperative irrigation and aspiration. The rationale for this technique is discussed. A total of 12 patients operated according to this technique are described. Complete clinical and radiographic healing in all patients was observed over a postoperative period ranging from 6-12 months.
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Gallium-67 scans of 25 patients in whom the clinical symptoms and radiographic findings were suggestive of either maxillary sinus carcinoma or chronic sinusitis proved to be valuable in the differentiation between the two disease processes. Those patients with carcinoma had positive scans, while those with sinusitis had either negative or only weakly positive scans.
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Anemometry with the hot wire and hot film technique previously described, enables the rhinologist to record slow and rapidly changing air flow in the maxillary sinus. The advantages and disadvantages of this method are considered. Anemometry together with manometry may be designated sinumetry and used as a diagnostic procedure following sinuscopy in chronic maxillary sinus disease. The value of the function from velocity of time allows the estimation of flow-volume in the sinus. Furthermore, the method is useful to evaluate the optimal therapy to restore ventilation in the case of an obstructed ostium demonstrated before and after surgical opening in the inferior meatus.
The penetration of oral erythromycin stearate (Abboticin), administered in a dosage of 500 mg three times a day, into the maxillary sinus mucosa and secretion was studied in 15 patients (22 sinuses) operated on for chronic maxillary sinusitis. The average concentration in serum was 2.3 microgram/ml, 1.2 microgram/ml in secretion, and 1.8 microgram/ml in mucosa. These concentrations are highly effective against diplococci and most aerobic and anaerobic streptococci (MIC value 0.06 microgram/ml) but not against Haemophilus influenzae (MIC value for 80% of 2 microgram/ml).
The maxillary sinuses were studied roentgenographically and tomographically in 108 patients (with intact sinuses) and in 16 anatomical preparations of the cranium. It has been established that the main features of the laminar picture of the maxillary sinuses can be determined by two main properties of tomography as a method: the possibility to lead the portions of the sinus osseous walls of greater-length as compared with conventional roentgenography out to the edge-forming zone due to oblique course of the ray beam, and vise versa, disappearance of outlines of these walls in those sections where they are considerably inclined in relation to the roentgen film plane. A description of the laminar roentgen-anatomical picture of the maxillary sinuses in naso-frontal, nasomental and lateral projections is presented. It is stresses that in each of these projections several main types of the laminar picture of the maxillary sinuses can be detected, characterizing different depth of sections.
The effect of four frequently used antibiotics on the germs of the sinus maxillaris was studied. For this purpose germs of the sinus max. rinsing fluid, got from 127 patients, were cultured under nearly the same physical and chemical conditions which can be expected in the sinus itself. Each antibiotic substance was studied with three different comcentrations in the culture medium. By extrapolation of the linear regression between some characteristical parameters of the culture absorbancy development and the concentration, the inhibitory concentration can be estimated. The efficacy decreases in the following order: Doxycyclin greater than Gentamycin greater than Ampicillin greater than Lincomycin. An inhibitory concentration results, if the antibiotics are instilled in the sinus itself. The general side effects can be neglected but not at all the local ones. Investigations in this direction are still going on. As a preliminary report, 700 instillations of Lincomycin turned out with no incident.
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Occasionally the maxillary sinus is invaded by a cyst or tumor of odontogenic origin. Though usually benign, these lesions may be locally aggressive. A recent case involving bone destruction and sinus opacification is presented.
Irrigation of the maxillary sinus is a common procedure in clinical practice for removing the contents of the antrum for either diagnosis or therapy. For many years, it has been accomplished by inserting a trocar in either the natural ostium or the medial wall of the sinus under the inferior turbinate. Recently, the anterior wall of the maxillary sinus has been re-introduced as a better route. It is more direct and is the only one suited for use in a child whose sinus is underdeveloped. The anterior route has been termed the canine fossa technique and is the preferred route since it has a high degree of patient acceptance and safety and can be done easily and quickly by the clinician through a familiar anatomical pathway.
Pneumocele of the maxillary sinus is a recently described disease, first noted in 1974. Three subsequent cases have been encountered. Pneumocele refers to an expansile cystic air-containing mass, occupying the entire maxillary sinus, and lined by the original attenuated mucous membrane. It is analogous to mucocele, but containing air rather than fluid content. Radiologic signs are diagnostic, and it is the purpose of this presentation to enumerate these radiologic findings.
The antibacterial effect of antibiotic treatment in maxillary sinusitis has been assessed by studying the elimination of bacteria from the maxillary sinus during treatment with penicillin and tetracycline. As adequate antibiotic concentrations are the prerequisite for maximal antibacterial effect, the antibiotic concentrations were controlled. The antibiotic concentrations were determined in maxillary sinus secretions and/or mucosas of 113 patients with maxillary sinusitis, treated with single or repeated doses of penicillin or tetracycline, or the two antibiotics in combination. In 30 patients treated with either penicillin or tetracycline, the bacterial growth in sinus secretion was controlled before and after treatment. It was established that ordinary clinical doses of penicillin and tetracycline may, although not invariably, result in antibiotic concentrations in sinus secretion and sinus mucosa than can be regarded as adequate for treatment, i.e. for penicillin greater than or equal to 0.25 mug/ml and for tetracycline greater than or equal to 1.0 mug/ml. The necessity of achieving adequate antibiotic concentrations in sinus secretion and sinus mucosa to ensure therapeutic success was demonstrated. Thus, bacterial growth remained in the secretions of most maxillary sinuses when the concentrations of penicillin or tetracycline in the secretions were not regarded as adequate for treatment. In contrast, the bacteria were exterminated in most cases where concentrations were regarded as adequate.
Apparently, the incidence of postoperative maxillary sinus mucoceles is greater in Japan than in the Western world. Between 1967 and 1976 at the Tokyo Medical and Dental University Hospital, Department of Otorhinolaryngology, 132 patients had the diagnosis of mucoceles of the maxillary sinus. Of these patients, 131 (99%) had histories of previous maxillary sinus surgery. A number of etiologic mechanisms are probably involved in producing these mucoceles.
Asymmetries of the maxillary sinus with partial or total radiographic opacity mislead to the diagnosis of chronic sinusitis. Using three radiographic standard projections, computerised planimetric analysis and cephalometric studies helped to explain radiological opacity in 26 patients. So called "mucosal thickening" may be due to varying development of the zygomatic recess. Total opacity was caused not only by unilateral volume difference exceeding 30%, but also by straightning of the first lateral line in basal views of small and moderate sized sinuses. Cephalometric analysis in maxillary sinus asymmetry revealed ipsilateral transversal underdevelopment of facial- and skullbone. Reduced pneumatisation of the ethmoid, spenoid, mastoid and frontal sinus in diminishing order was also ipsilateral. Using photostat analysis there was nevertheless no correlation between facial- and coexisting maxillary sinus asymmetry.
A case of a large compound odontoma in the right maxillary sinus causing acute maxillary sinusitis is reported. Seven large antral odontomas have been previously reported, none with the typical findings of acute sinusitis. Radiographs should always be considered in cases of recurrent maxillary sinusitis or pain, and the general practitioner should familiarize himself with lesions of the maxillary sinus that might be revealed in radiographic examination. Surgical excision is the preferred treatment for all odontomas, with no expectancy of recurrence. The odontoma described here was associated with an unusual bonelike capsule or cyst covering its superior surface, which necessitated careful exploration and dissection.
Panoramic tomography (orthopantomography) is useful in exploration of maxillary sinuses, specially of its floor and its connection with teeth alveoles. Interest of this examination in the diagnosis of sinusian cyst of polypus, apical teeth cyst growing in the sinus, fistula from mouth to sinus, repeating sinusitis by dental infectious focus, sinusian stranger corps and finally, in the schedule or surveillance of the extension of sinus maxillary cancer to the posterior wall, particularly to the pterygomaxillary fossae.