Introduction: The role of the accessory maxillary ostium, a common anatomical variant, in the development of chronic sinusitis remains unclear. This study aimed to examine the association between chronic sinusitis and presence of an accessory maxillary ostium using computed tomography (CT) of the paranasal sinuses. Methods: We conducted a retrospective study of 1188 paranasal sinus CT scans performed in a major tertiary medical center between January 1, 2016 and December 31, 2016. Axial and coronal and views were reviewed to evaluate the presence of accessory maxillary ostia and maxillary and ethmoid sinusitis. Results: Nine hundred twenty-eight patients were included for analysis. A 52.8% were male. Mean patient age was 33.8 years. A right accessory maxillary ostium was detected in 274 patients (29.5%), which was the same number of patients with a left accessory maxillary ostium. Bilateral accessory maxillary ostia were found in 172. The presence of right maxillary sinusitis was significantly associated with male gender and the presence of a right accessory maxillary ostium. Male gender was the only factor significantly associated with the presence of left sinusitis. Left or right ethmoidal sinusitis was significantly associated with male gender and the presence of left or right maxillary sinusitis, respectively. Conclusion: The presence of an accessory maxillary ostium may contribute to the development of maxillary and ethmoidal sinusitis. Further studies are needed to elucidate this association and determine indications for incorporating the natural and accessory ostia when performing middle meatus antrostomy during endoscopic sinus surgery.

Background: Dacryocystorhinostomy (DCR) is a procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct obstructed. This study aimed to compare the success rates of two different techniques in endonasal endoscopic DCR; namely single and double mucosal flap techniques. Material and methods: A nonequivalent quasi-experiment design was used in this study. Retrospectively, patients underwent endoscopic DCR for primary nasolacrimal duct (NLD) obstruction were included. Patients were divided into the single-flap technique and the double-flap technique groups. Success was defined as the achievement of patency of the NLD throughout the period of follow-up with significant improvement in epiphora. Results: Overall, 77 cases were included in the final analysis. Mean age was 41 years and 60% were female. Forty-six cases underwent the single-flap technique and 31 cases underwent the double-flap technique. Recurrence of NLD obstruction occurred in 11 (23.9%) cases in the single-flap group and in only one case (3.2%) in the double-flap group. Conclusion: The modified double-flap technique for primary NLD obstruction resulted in less recurrence compared to the single-flap technique. Creating double flaps to cover any exposed lacrimal bone may reduce the rate of postoperative adhesions over the nasolacrimal duct ostium.

Background: Tonsillectomy is one of the most commonly performed procedures among children and it is the gold standard management to reduce episodes of tonsillitis and obstructive symptoms. Many studies showed a significantly higher incidence of previous tonsillectomy in the parents and siblings. This study investigated the influence of familial and environmental trends in tonsillectomy. Methods: Retrospectively, we identified those patients who underwent tonsillectomy (the case group). Also, a control group of participants attending the hospital as visitors who had not undergone tonsillectomy was collected. Both groups are compared using the proper statistical tests. Results: This study included 1,232 participants; 615 underwent tonsillectomy (cases) and 617 did not (controls). It was found that paternal and maternal history of tonsillectomy, childhood asthma, and daycare attendance are independent factors influencing tonsillectomy in the offspring. Of about 85.4% of fathers who underwent tonsillectomy their children will also have tonsillectomy. Also, regarding the maternal history, 72.5% of offspring will have tonsillectomy if the mothers underwent the procedure. Conclusion: This study reveals that genetic predisposition factors may have a role for tonsillectomy and its underlying causative indications. Also, it highlights the importance of asthma control in children. Moreover, the role of ethnicity may be minimal due to the similar trend of this study with other studies. Further studies and prospective research are recommended.

Background To reduce the risk of cerebrospinal fluid leak, clinicians utilize a filling material placed in the sella followed by floor reconstruction with various materials, including glue sealing. Cyano-acrylic glue Glubran (R) 2 glue is commercially available and is generally used as embolizing agent and for the prevention of cerebrospinal fluid leakage. Case Description A 25-year-old woman underwent endoscopic endonasal transsphenoidal surgery for pituitary adenoma. After tumor resection, sellar floor reconstruction was performed by mucosal graft and Glubran (R) 2 glue. The early post-operative period was uneventful. However, 2 months after surgery, the patient complained of headache, facial pain and greenish foul-smelling nasal discharge with solid particles dripping from the nose. Medical treatment was unsuccessful. Brain MRI showed inflammation and thickening of the sphenoidal and para-sphenoidal mucosa. The patient underwent endoscopic endonasal surgery and a solid glass-like mass surrounded by inflamed infected mucosa was seen in the inferior and lateral aspects of the sphenoid sinus. Efforts were made to erupt and de-crust the solid mass until total resection was achieved. Early post-operative period was uneventful, and a course of antibiotics was continued until total disappearance of the discharge. Conclusion To the best of our knowledge, this is the first case reporting of acrylic glue (Glubran (R) 2)-related sinusitis. Surgeon should be aware about similar side effects for the glue material that would complicate the surgery.

Allergic fungal rhinosinusitis (AFRS) is a highly recurrent form of chronic allergic rhinosinusitis in immunocompetent patients. This study aims to compare the recurrence rates of AFRS between patients who received nasal steroid spray alone and patients who received a combination of nasal and oral steroids after endoscopic sinus surgery. This was a retrospective chart review of patients who underwent endoscopic sinus surgery for AFRS. The selection of the 39 participants has followed the 5 aspects of Bent and Kuhn criteria. Patients were divided into 2 groups: those discharged on both nasal and oral steroids (combination group) and those discharged on nasal steroids alone (local therapy group). All patients were followed for 3 years post operatively, and multiple assessments done for disease recurrence. One patient from 13 patients in the combination therapy group (7.7 %) and 9 patients from the 26 patients in the local therapy group (34.6 %) had recurrence of the condition and underwent functional endoscopic sinus surgery revision surgery (Fisher Exact Test = 3.30, P = .069). AFRS has recurred more frequently among patients who had bilateral disease (33.3%) compared to those who had unilateral disease (0%) (Fisher Exact Test = 4.03, P value = .045). In the postoperative medical management in ARFS, the combination of a short course of oral prednisolone and nasal steroid spray maybe effective to lower the recurrence rate of the disease when compared to nasal steroid spray alone.

Background: The accessory maxillary ostium (AMO) is a common anatomical variant of the lateral nasal wall and has been implicated in impaired maxillary sinus drainage, mucus recirculation, and chronic sinus pathology. Although AMO can be identified using both radiologic and endoscopic techniques, the endoscopic visualization rate of CT-documented AMO has not been well characterized. This study aimed to evaluate the endoscopic visualization rate of AMO using FFE in patients with CT-documented AMO. Method: This retrospective cohort study was conducted at a tertiary referral center between January 2023 and December 2024. Patients with CT-confirmed AMO who subsequently underwent FFE were included. Patients with a history of prior sinus surgery were excluded. Demographic data, CT findings, and endoscopic visualization of AMO were collected from electronic medical records. Descriptive statistics were used to summarize the data, and categorical variables were analyzed using Chi-square or Fisher's exact tests as appropriate. Results: A total of 274 patients were included, with a mean age of 34.4 ± 14.1 years; 51.8% were male. While AMO was confirmed on CT imaging in all participants by inclusion criteria, FFE visualized AMO in only 26% of cases (71/274), indicating a low endoscopic visualization rate among patients with CT-confirmed AMO. Maxillary sinus opacification was detected on CT in 49.6% of patients, while nasal polyps were present in 34.3%. No significant gender differences were observed in the prevalence of maxillary opacification or nasal polyps. Conclusion: Flexible fiberoptic endoscopy demonstrated limited ability to visualize accessory maxillary ostium in patients with CT-documented AMO. While FFE remains useful for functional and mucosal assessment, CT imaging appeared to useful for anatomical identification of AMO and may be considered for comprehensive evaluation and surgical planning.