Endoscopic View of Maxillary Sinus Cysts Viewed Through an Accessory Maxillary Ostium,

Eiji Yanagisawa, MD, FACS, Joseph P. Mirante, MD, MBA, FACS, Dewey A. Christmas, MD

First Published October 30, 2019 Other

https://doi.org/10.1177/0145561319882580


A 31-year-old male presented because of nasal congestion which had progressed following blunt trauma to his nose. The patient had no nasal evaluation at the time of the nasal trauma but sought evaluation approximately 2 years after the traumatic episode.

Nasal examination revealed a marked shift of the nasal septum into the right nasal airway. Sinus computed tomography scan revealed bilateral cystic masses in both maxillary sinuses and confirmed the marked right nasal septum deviation (Figure 1A). Endoscopic examination of the nose revealed a large accessory maxillary ostium posterior to the left uncinate process (Figure 1B). A similar finding was seen on the right side. Using a 30° telescope in the left airway, a large cystic mass could be visualized in the inferior left maxillary sinus (Figure 1C). A similar view could be seen through the right accessory maxillary ostium.

Figure 1. A, Computed tomography scan shows bilateral maxillary cysts and right nasal septal deviation. B, A large accessory maxillary sinus ostium is seen in the medial wall of the left maxillary sinus posterior to the uncinate process. C, Using a 30° telescope, an inferior maxillary sinus cyst is seen through the left accessory maxillary sinus ostium.

The high medial wall of the maxillary sinus is made of thin bone and partly membranous. In this area, an accessory ostium of the maxillary sinus may be found, reported in 30% to 40% of cases.¹ In functional endoscopic sinus surgery of the maxillary sinus, it is important for the surgeon to recognize an accessory ostium, from the natural ostium. Opening an accessory ostium risks the phenomenon of recirculation and the possible need for revision surgery due to the missed natural ostium.²

Acknowledgment

The authors thank Grayson Bertaina for his assistance in preparing this article.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

1.	Hollingshead, WH . Anatomy for Surgeons. Philadelphia, PA: Harper and Row; 1988:2261. Google Scholar
2.	Parsons, DS, Stivers, FE, Talbot, AR. The missed ostium sequence and the surgical approach to revision functional endoscopic sinus surgery. Otolaryngol Clin North Am. 1996;29(1):169–183. Google Scholar | Medline

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