Naslov
Why do the antrochoanal polyps recur?

Autori
Mladina, Ranko ; Poje, Gorazd ; Vuković, Katarina ; Skitarelić, Neven

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
First Croatian Rhinologic Congress / Baudoin, Tomislav - Zagreb : Rinološka sekcija Hrvatskog društva za otorinolaringologiju i kirurgiju glave i vrata, 2010, 57-57

Skup
First Croatian Rhinologic Congress

Mjesto i datum
Zagreb, Hrvatska, 25.02.2010. - 27.02.2010

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
sinus surgery ; antrochoanal polyps

Sažetak
The use of endoscopes made possible to finally understand that so called accessory ostia of the max¬illary sinus do not exist at all, i.e. that only one natural ostium of the maxillary sinus exists in reality. Therefore all other "holes" that can be seen at the lateral nasal wall during endoscopy mean the same: the defect, i.e. chronic inflammation of the maxillary sinus itself. It seems, furthermore, that the cyst at the posterior wall of the maxillary sinus in cases of antrochoanal polyps (ACP) is not just a simple retention cyst as other cysts in this sinus are. It rather goes for a circumscript inflammation of the regional mucosa of grade 2 to 3 after Terrier's classification. So, when operating ACP it is not enough to remove the „polypous" part from the nasal cavity and then get into maxillary sinus and pull out the cyst. What one has to perform is to precisely identify the natural ostium first, and then to make „unification" of the natural ostium and the defect of the posterior fontanellae as to make a widely open approach to the posterior sinus wall. As to the recurrences of ACP, it must be pointed out that the wall of the sinus cyst histologically shows very loose, edematous stroma full of inflam¬matory cells and dilated vessels, suggesting chronic inflammation. According to Kern and Zinreich, chronic osteomyelitis can be found in almost all cases of chronic sinusitis. Inflammation of the bone produces the sequestration. A new, avascular bone replaces sequestered parts forming so called involcrum (meaning an envelope), containing exudates and debris, therefore supporting the main¬tenance of the chronic inflammation. In addition, recent molecular studies of the ACP showed up- regulation of bFGF (basic fibroblast growth factor), up-regulation of TGF (transforming growth factor) and up-regulation of MUC genes (MUC 5AC, MUC 5B, MUC 8), thus suggesting the importance of the local inflammatory reaction. Thus, the surgery for antrochoanal polyps performed in this way di¬minishes the chances for recurrences, which at the moment, even in cases operated endoscopically, seems to range between 3 up to 16%. Some aspects of the possible role of the biofilm in recurrences of the ACP will be discussed too.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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