From the Guidelines
The management of chronic maxillary sinusitis should prioritize medical therapy, including consideration of systemic corticosteroids for noninfectious forms, before proceeding to surgical options like functional endoscopic sinus surgery. The approach to chronic maxillary sinusitis involves a thorough evaluation to determine the underlying cause of the condition, which could include chronic hyperplastic eosinophilic rhinosinusitis that does not respond to antibiotics 1. This condition is marked by a preponderance of eosinophils and mixed mononuclear cells, with a relative paucity of neutrophils, and might require a course of systemic corticosteroids.
Key considerations in the management of chronic maxillary sinusitis include:
- Evaluating for and addressing any anatomical obstructions, such as significant nasal septal deviation or the presence of obstructing nasal polyps, which may require consultation with an otolaryngologist 1.
- Utilizing coronal sinus CT with extra cuts through the ostiomeatal complex to clarify the extent of disease and specific location or locations 1.
- Considering nasal-sinus biopsy in suspected cases of neoplasia, fungal disease, granulomatous disease, or evaluating ciliary structures and function 1.
- Maximizing medical treatment for underlying rhinitis before proceeding with surgical intervention, which is typically functional endoscopic sinus surgery 1.
Medical therapy should be individualized and may include allergy management, saline nasal irrigation, intranasal corticosteroids, and, when indicated, a course of antibiotics targeting common sinus pathogens. The goal of treatment is to reduce inflammation, clear infection, improve mucociliary clearance, and address underlying factors such as allergies or anatomical obstructions. Following any intervention, whether medical or surgical, continued management is often necessary to prevent recurrence, as chronic sinusitis is typically a long-term inflammatory condition requiring ongoing management 1.
From the Research
Management of Chronic Maxillary Sinusitis
- The management of chronic maxillary sinusitis involves understanding the basic concepts and classifications of rhinosinusitis, as well as the most up-to-date management strategies 2.
- A comprehensive review of the physiology, development, and imaging anatomy of the maxillary sinus is essential for otolaryngologists, rhinologists, oral and maxillofacial surgeons, head and neck and dental and maxillofacial radiologists 3.
- The fundamental physiological concept of mucociliary clearance and its role in sinus health is crucial in managing chronic maxillary sinusitis 3.
- Anatomical variants that predispose to sinusitis of rhinogenic origin, such as nasal inflammation followed by anterior ethmoid disease and secondary obstruction of the ostiomeatal unit, should be considered in the management of chronic maxillary sinusitis 3.
- Understanding the anatomy of the alveolar process, morphology of the alveolar recess of the maxillary sinus, and neurovascular supply is essential for deliberate surgical intervention of the sinus and complications related to oral surgical procedures 3, 4.
Considerations for Treatment
- The role of imaging in the diagnosis and management of chronic maxillary sinusitis should not be overlooked, with multi-modality imaging providing essential information for radiologists reporting imaging involving the paranasal sinuses and midface 3, 4.
- Patients with chronic rhinosinusitis, including those with chronic maxillary sinusitis, may experience sleep disruption and are at a higher risk for obstructive sleep apnea (OSA) 5.
- The presence of comorbid conditions, such as asthma and eczema, should be considered in the management of chronic maxillary sinusitis, as they may impact treatment outcomes 5.