Hypoplasia of the Maxillary Antrum: Anatomic Abnormalities, Diagnostic Difficulties and Surgical Implications

Abstract

ABSTRACfUsing conventional radiography, maxillary sinus hypoplasia (MSH) may be misdiagnosed as chronic infective sinusitis in patients with chronic nasal symptoms. Commonly associated anatomical abnormalities of the lateral nasal wall and orbit may also be missed. Failure to recognize these abnormalities is fraught with hazards should sinus surgery be contemplated on such patients. With the use ofhigh resolution computed tomography scans and rigid nasal endoscopy, MSH and associated subtle anatomic abnormalities of related structures are diagnosed with higher precision and surgical complications minimized. The incidence, pathogenesis, and classification of MSH is reviewed. The clinical and surgical implications of associated anomalies of the lateral nasal wall are discussed. Two illustrative cases are presented. (Am J Rhinology 7: [105][106][107][108][109][110] 1993) H ypoplasia of the maxillary sinus has been described as early as 1912. 1 Early descriptions were confined to the maxillary antrum with little attention given Am J Rhinology to adjacent anatomic structures, namely the lateral nasal wall and the orbit. This was, at least partly, due to the suboptimal visualization of these structures using traditional methods of clinical examination and plain roentgenography.Since the embryology and development of the nose, sinuses, and orbit are closely related, anomalies of the maxillary antrum are often associated with abnormal anatomy of the lateral nasal and orbital walls.2,3Using conventional roentgenography, maxillary sinus hypoplasia (MSH) could be misdiagnosed as an opacified maxillary sinus suggesting chronic infective sinusitis in patients with chronic nasal symptoms. More importantly, associated anatomical abnormalities of the lateral nasal wall and orbit may be missed. Failure to recognize these abnormalities is fraught with hazards should sinus surgery be contemplated on such patients.The use of computed tomography (CT) scans and the advent of nasal endoscopy have revolutionized the diagnosis and management of nasal-sinus disorders. With the improved visualization offered, subtle anatomic abnormalities are diagnosed with greater accuracy and surgical hazards are minimized.This present report describes MSH in two patients and emphasizes the advantages of using high resolution coronal CT scans and nasal endoscopy in evaluating such patients. A literature review describing the incidence, pathogenesis, classification, as well as the clinical and surgical implication of MSH is presented. CASE REPORTS Case 1A 7-y.ear-old male presented to his family physician WIth a 4-month history of intermittent bilateral 105

Maxillary Sinus Atelectasis with Enophthalmos

“…This finding should be readily differentiated from those of maxillary hypoplasia with anomalous uncinate formation. 18 Surgical treatment of patients with maxillary sinus atelectasis and enophthalmos is based on two main objectives. The first goal is to obtain adequate clearing of the maxillary sinus and restore a normal drainage pathway.…”

Functional endoscopic sinus surgery outcome in chronic rhinosinusitis patients with hypoplastic maxillary sinus

“…The majority were case reports, with a small number of case series. 7,9,10 In this retrospective study describing a single surgeon's experience, FESS was found to be a safe and effective approach in the management of hypoplastic maxillary sinus related sinusitis.…”

Prenatal Development of the Maxillary Sinus

“…The reduction in the volume of the maxillary sinus is known as maxillary sinus hypoplasia. Although its origin is unknown, failure of prenatal development has been a major theory; another theory is a poor pneumatization caused by a sinus infection or sinus trauma in childhood 8,9 . This study would provide an excellent opportunity to determine the existence of MSH since prenatal life.…”

“…This location is not different from the early reports and corroborates the great relation that both structures maintain during fetal life; in fact, at this stage, the maxillary sinus is an extension of the infundibulum ( Figure 1 ). A poorly developed infundibular passage is associated with MSH, 8,9 evidencing the importance of considering the maxillary sinus and the ethmoid infundibulum as an anatomic and development unit.…”

“…Although its origin is unknown, failure of prenatal development has been a major theory; another theory is a poor pneumatization caused by a sinus infection or sinus trauma in childhood. 8,9 This study would provide an excellent opportunity to determine the existence of MSH since prenatal life. However, we are faced with the challenge of establishing diagnostic criteria for MSH in fetuses because there is no precedent.…”