Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Maxillary sinus hypoplasia masquerading as chronic sinusitis CPT Richard P. Vinson MC, USA & MA J Robert P. Collette MC, USA To cite this article: CPT Richard P. Vinson MC, USA & MA J Robert P. Collette MC, USA (1991) Maxillary sinus hypoplasia masquerading as chronic sinusitis, Postgraduate Medicine, 89:4, 189-190, DOI: 10.1080/00325481.1991.11700871 To link to this article: http://dx.doi.org/10.1080/00325481.1991.11700871
Published online: 17 May 2016.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [University of Technology Sydney]
Date: 23 July 2016, At: 00:44
Maxillary sinus hypoplasia masquerading as chronic sinusitis CPT Richard P. Vtnson, MC, USA MAJ Robert P. Collette, MC, USA
Downloaded by [University of Technology Sydney] at 00:44 23 July 2016
Preview Maxillary sinus hypoplasia is a common condition that may be misdiagnosed as chronic sinusitis. Although hypoplasia can usually be seen on conventional sinus films, computed tomography may be necessary, as in the cases described by the authors in this article.
Maxillary sinus hypoplasia and aplasia occur in more than 9% of patients with complaints related to the sinuses.1 Because hypoplasia may mimic chronic sinusitis, diagnosis may be difficult. Failure to recognize this condition may result in unnecessary treatment and persistent symptoms.
right maxillary sinus and had been treated with several antibiotics, antihistamines, and decongestants, but symptoms persisted. Sinus films showed opacification of the right maxillary sinus, and a cr scan revealed hypoplasia. A nasal cytogram revealed mastocytosis, and
Case I A 48-year-old woman was referred to the otolaryngology clinic after complaining of headaches. She had been treated unsuccessfully with antibiotics and decongestants for left maxillary sinusitis. Sinus films were unrevealing, but a computed tomographic (en scan showed hypoplasia of the left maxillary sinus with no evidence of infection or mucosal disease. The patient was referred to a neurologist, who diagnosed atypical migraine headaches. After treatment with isometheptene and propranolol hydrochloride, the patient recovered completely.
Discussion
• A PERPLEXING CASE
allergy skin tests were negative. A diagnosis of vasomotor rhinitis was made. After treatment with systemic decongestants, nasal saline irrigations, and a trial of nasal beclomethasone dipropionate, the patient's chronic nasal congestion improved.
Case2 A 41-year-old man was referred to the otolaryngology clinic for evaluation of chronic right maxillary sinusitis and nasal congestion. He had undergone nasoantrostomy (formation of a nasoantral window) of the
Case3 A 60-year-old man was referred to the otolaryngology clinic because of chronic left nasal obstruction and opacification of the left maxillary sinus as seen on sinus films. His past medical history included Wegener's granulomatosis. A Cf scan showed hypoplasia of the left maxillary sinus and a mass versus thickened mucosa in the sinus cavity. A Caldwell-Luc operation revealed chronic inflammation of the mucosa and no pathologic evidence ofWegener's granulomatosis. The patient's chronic nasal obstruction improved with saline irrigations, and progression ofWegener's granulomatosis to the nasal sinus tract was ruled out.
CPT Richard P. Vinson, MC, USA MAJ Robert P. Collette, MC, USA Dr Vinson is in staff family practice, 543rd General Dispensary, Taegu, South Korea. Dr Collette is chief, department of otolaryngology-head and neck surgery, Martin Army Community Hospital, Fort Benning, Georgia.
VOL 89/NO 4/MARCH 1991/POSTGRADUATE MEDICINE • MAXILLARY SINUS HYPOPLASIA
The maxillary sinus develops during the fourth month of gestation as a mucosal evagination of the middle meatus of the nose. Arrested development at this stage leads to aplasia. At birth, the maxillary cavity measures about 8 mm in length, 3 mm in height, and 2 mm in widffil and usually cannot be visualized easily on plain films. 3 At 15 years of age, the maxillary sinus is fully developed. 4 The incidence of maxillary sinus hypoplasia and aplasia was studied by Karmody and associates, 1who examined radiographs of the paranasal sinuses of750 patients with sinus symptoms or nonspecific headaches. Bilateral hypoplasia was seen in 54 (7.2%) and unilateral hypoplasia in 13 (I. 7%) of the patients. Aplasia, seen in 3 (0.4%) of the patients, was continued 189
Downloaded by [University of Technology Sydney] at 00:44 23 July 2016
PERPLEXING CASE CONTINUED
bilateral in 2 and unilateral in 1. Maxillary sinus hypoplasia and aplasia can usually be seen on conventional sinus films. Fearures include opacification, orbital enlargement on the ipsilateral side, and lateral displacement of the wall between the nasal fossa and hypoplastic sinuses, which may simulate the bone destruction caused by a maxillary sinus rumor. 3·5 The floor of the ipsilateral orbit appears rounded, in contrast to the flat floor that normally develops with enlargement of the maxillary sinus after birth.6 Depression of the orbital roof and floor causes the brain to be more caudally located. This abnormality has led to inadvenent entering of the central nervous system during sinus exploration.3 In some cases, Cf scans are necessary to establish the diagnosis of maxillary sinus hypoplasia. In the cases described, improper diagnosis had resulted in inappropriate treatment with antibiotics and decongestants (case 1), unnecessary surgical
References 1. Kannody CS, Carter B, Vmcent ME. Developmental anomalies of the maxillary sinus. Trans Am Acad Ophthalmol Orolaryngol 1977;84(4 Pr 1):0RL723-8 2. Davis WB. Anatomy of the nasal accessory sinuses in infancy and childhood. Ann Oro! Rhino! Laryngol1918;27:940-67 3. Modic MT, Weinstein MA, Berlin 1\J, et al. Maxillary sinus hypoplasia visualized with computed tomography. Radiology 1980;135(2):383-5
intervention (case 2), and failure to identifY diseased mucosa (case 3).
Conclusion
Maxillary sinus hypoplasia and aplasia can simulate sinusitis and other conditions. Misdiagnosis leads to use of unnecessary medications or surgical procedures. Accurate diagnosis of maxillary sinus hypoplasia and aplasia may be difficult with plain radiographs. Therefore, the physician needs to consider computed tomography befure recommending a surgical procedure or when empirical therapy is ineffective. RN The views expressed herein are those of the authors and do not necessarily reflect the views of the US Army or the Department of Defense. Address for correspondence: MAJ Robert P. Collette, MC, USA, Martin Army Community Hospital, Otolaryngology Service, Fort Benning, GA 31905.
4. Jonas I, Mann W. [Misleading x-ray di~nosis due ro maxillary sinus asymmetries.) Authors trans!. Laryngol Rhino! Oro! (Stung) 1976; 55(11):905-13 5. ~ LF, ed. Disorders of the head and neck sylfabus. Series 2. Set 12. Chicago: American College of Radiology, 1977:128-37 6. Biemy JP, Dryden R. Orbital enlargement secondary to paranasal sinus hypoplasia. AJR 1977; 128(5):850-2
Readers are invited to submit brief reports of perplexing cases related to primary medi-
cal care. Address submissions to: Manuscript Administrator, POSTGRADUATE MEDICINE, 4530 W 77th St, Minneapolis, MN 55435. 190
MAXILLARY SINUS HYPOPLASIA • VOL 89/NO 4/MARCH 1991/POSTGRADUATE MEDICINE
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Maxillary sinus hypoplasia masquerading as chronic sinusitis CPT Richard P. Vinson MC, USA & MA J Robert P. Collette MC, USA To cite this article: CPT Richard P. Vinson MC, USA & MA J Robert P. Collette MC, USA (1991) Maxillary sinus hypoplasia masquerading as chronic sinusitis, Postgraduate Medicine, 89:4, 189-190, DOI: 10.1080/00325481.1991.11700871 To link to this article: http://dx.doi.org/10.1080/00325481.1991.11700871
Published online: 17 May 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [University of Technology Sydney]
Date: 23 July 2016, At: 00:44
Maxillary sinus hypoplasia masquerading as chronic sinusitis CPT Richard P. Vtnson, MC, USA MAJ Robert P. Collette, MC, USA
Downloaded by [University of Technology Sydney] at 00:44 23 July 2016
Preview Maxillary sinus hypoplasia is a common condition that may be misdiagnosed as chronic sinusitis. Although hypoplasia can usually be seen on conventional sinus films, computed tomography may be necessary, as in the cases described by the authors in this article.
Maxillary sinus hypoplasia and aplasia occur in more than 9% of patients with complaints related to the sinuses.1 Because hypoplasia may mimic chronic sinusitis, diagnosis may be difficult. Failure to recognize this condition may result in unnecessary treatment and persistent symptoms.
right maxillary sinus and had been treated with several antibiotics, antihistamines, and decongestants, but symptoms persisted. Sinus films showed opacification of the right maxillary sinus, and a cr scan revealed hypoplasia. A nasal cytogram revealed mastocytosis, and
Case I A 48-year-old woman was referred to the otolaryngology clinic after complaining of headaches. She had been treated unsuccessfully with antibiotics and decongestants for left maxillary sinusitis. Sinus films were unrevealing, but a computed tomographic (en scan showed hypoplasia of the left maxillary sinus with no evidence of infection or mucosal disease. The patient was referred to a neurologist, who diagnosed atypical migraine headaches. After treatment with isometheptene and propranolol hydrochloride, the patient recovered completely.
Discussion
• A PERPLEXING CASE
allergy skin tests were negative. A diagnosis of vasomotor rhinitis was made. After treatment with systemic decongestants, nasal saline irrigations, and a trial of nasal beclomethasone dipropionate, the patient's chronic nasal congestion improved.
Case2 A 41-year-old man was referred to the otolaryngology clinic for evaluation of chronic right maxillary sinusitis and nasal congestion. He had undergone nasoantrostomy (formation of a nasoantral window) of the
Case3 A 60-year-old man was referred to the otolaryngology clinic because of chronic left nasal obstruction and opacification of the left maxillary sinus as seen on sinus films. His past medical history included Wegener's granulomatosis. A Cf scan showed hypoplasia of the left maxillary sinus and a mass versus thickened mucosa in the sinus cavity. A Caldwell-Luc operation revealed chronic inflammation of the mucosa and no pathologic evidence ofWegener's granulomatosis. The patient's chronic nasal obstruction improved with saline irrigations, and progression ofWegener's granulomatosis to the nasal sinus tract was ruled out.
CPT Richard P. Vinson, MC, USA MAJ Robert P. Collette, MC, USA Dr Vinson is in staff family practice, 543rd General Dispensary, Taegu, South Korea. Dr Collette is chief, department of otolaryngology-head and neck surgery, Martin Army Community Hospital, Fort Benning, Georgia.
VOL 89/NO 4/MARCH 1991/POSTGRADUATE MEDICINE • MAXILLARY SINUS HYPOPLASIA
The maxillary sinus develops during the fourth month of gestation as a mucosal evagination of the middle meatus of the nose. Arrested development at this stage leads to aplasia. At birth, the maxillary cavity measures about 8 mm in length, 3 mm in height, and 2 mm in widffil and usually cannot be visualized easily on plain films. 3 At 15 years of age, the maxillary sinus is fully developed. 4 The incidence of maxillary sinus hypoplasia and aplasia was studied by Karmody and associates, 1who examined radiographs of the paranasal sinuses of750 patients with sinus symptoms or nonspecific headaches. Bilateral hypoplasia was seen in 54 (7.2%) and unilateral hypoplasia in 13 (I. 7%) of the patients. Aplasia, seen in 3 (0.4%) of the patients, was continued 189
Downloaded by [University of Technology Sydney] at 00:44 23 July 2016
PERPLEXING CASE CONTINUED
bilateral in 2 and unilateral in 1. Maxillary sinus hypoplasia and aplasia can usually be seen on conventional sinus films. Fearures include opacification, orbital enlargement on the ipsilateral side, and lateral displacement of the wall between the nasal fossa and hypoplastic sinuses, which may simulate the bone destruction caused by a maxillary sinus rumor. 3·5 The floor of the ipsilateral orbit appears rounded, in contrast to the flat floor that normally develops with enlargement of the maxillary sinus after birth.6 Depression of the orbital roof and floor causes the brain to be more caudally located. This abnormality has led to inadvenent entering of the central nervous system during sinus exploration.3 In some cases, Cf scans are necessary to establish the diagnosis of maxillary sinus hypoplasia. In the cases described, improper diagnosis had resulted in inappropriate treatment with antibiotics and decongestants (case 1), unnecessary surgical
References 1. Kannody CS, Carter B, Vmcent ME. Developmental anomalies of the maxillary sinus. Trans Am Acad Ophthalmol Orolaryngol 1977;84(4 Pr 1):0RL723-8 2. Davis WB. Anatomy of the nasal accessory sinuses in infancy and childhood. Ann Oro! Rhino! Laryngol1918;27:940-67 3. Modic MT, Weinstein MA, Berlin 1\J, et al. Maxillary sinus hypoplasia visualized with computed tomography. Radiology 1980;135(2):383-5
intervention (case 2), and failure to identifY diseased mucosa (case 3).
Conclusion
Maxillary sinus hypoplasia and aplasia can simulate sinusitis and other conditions. Misdiagnosis leads to use of unnecessary medications or surgical procedures. Accurate diagnosis of maxillary sinus hypoplasia and aplasia may be difficult with plain radiographs. Therefore, the physician needs to consider computed tomography befure recommending a surgical procedure or when empirical therapy is ineffective. RN The views expressed herein are those of the authors and do not necessarily reflect the views of the US Army or the Department of Defense. Address for correspondence: MAJ Robert P. Collette, MC, USA, Martin Army Community Hospital, Otolaryngology Service, Fort Benning, GA 31905.
4. Jonas I, Mann W. [Misleading x-ray di~nosis due ro maxillary sinus asymmetries.) Authors trans!. Laryngol Rhino! Oro! (Stung) 1976; 55(11):905-13 5. ~ LF, ed. Disorders of the head and neck sylfabus. Series 2. Set 12. Chicago: American College of Radiology, 1977:128-37 6. Biemy JP, Dryden R. Orbital enlargement secondary to paranasal sinus hypoplasia. AJR 1977; 128(5):850-2
Readers are invited to submit brief reports of perplexing cases related to primary medi-
cal care. Address submissions to: Manuscript Administrator, POSTGRADUATE MEDICINE, 4530 W 77th St, Minneapolis, MN 55435. 190
MAXILLARY SINUS HYPOPLASIA • VOL 89/NO 4/MARCH 1991/POSTGRADUATE MEDICINE
