Endoscopic view of an obstructing polyp of the maxillary sinus ostium viewed through an accessory ostium.

A 44-year-old man presented with a history of recurring left facial and cheek pain associated with recurrent sinus infections. Despite intermittent antibiotic treatment over a 2-year period, he continued to experience recurrent problems. Computed tomography (CT) of the sinuses showed some obstruction of the ostiomeatal complex and some soft tissue near the natural ostium of the left maxillary sinus (figure, A). Clinical examination revealed the presence of an accessory ostium of the left maxillary sinus in the left lateral nasal wall (figure, B). A polypoid mass located posterolaterally in the maxillary sinus could be seen through the accessory ostium.

[FIGURES A-B OMITTED]

The patient elected to undergo functional endoscopic sinus surgery. During surgery, closer examination of the left accessory maxillary sinus ostium revealed a definite polypoid mass in the maxillary sinus (figure, C). This appeared to be arising posterior and lateral to the accessory ostium. Once the uncinate fold was identified, an uncinectomy was performed (figure, D). Careful examination revealed that a polypoid mass was present just lateral to the large natural ostium (figure, E). A maxillary antrostomy was carried out, and the polypoid mass was removed with a microdebrider (figure, F). The patient experienced no further facial discomfort postoperatively.

[FIGURES C-F OMITTED]

Obstruction of the natural ostium of the maxillary sinus can be caused by medial blockage on the nasal side or lateral blockage from the sinus. (1-4) Common causes of medial blockage are nasal polyposis and mucosal swelling. Blockage from the sinus laterally can be caused by sinus mucosal swelling and sinus polyposis. (1-4) Rarely does obstruction result from a tumor or an inverting papilloma. Although sinus polyposis is a common cause of maxillary sinus ostial obstruction, it is not usually caused by an isolated polyp. This case illustrates the unusual finding of an isolated sinus polyp obstructing the maxillary sinus ostium and causing intermittent infections and facial pain.

References

(1.) Stammberger H. Functional Endoscopic Sinus Surgery: The Messerklinger Technique. Philadelphia: B.C. Decker, 1991.

(2.) Yanagisawa E, Christmas DA, Yanagisawa R. Endoscopic view of the sites of origin of nasal polyps. Ear Nose Throat J 2000;79: 490-2.

(3.) Yanagisawa E. Maxillary sinoscopic view of polyps obstructing the natural ostium of the maxillary sinus. Ear Nose Throat J 2000;79: 424-6.

(4.) Yanagisawa E. Atlas of Rhinoscopy: Endoscopic Sinonasal Anatomy and Pathology. San Diego: Singular Publishing, 2000.

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Mirante and Dr. Christmas); and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group, the Section of Otolaryngology, Hospital of St. Raphael, and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa).