Abstract
Objective: After sinus surgery, disease sometimes persists despite appropriate medical therapy and postoperative debridement until the underlying bone is removed. The aims of this study were to explore the pathogenic role of bone in chronic sinusitis and to determine whether mucosal disease may be induced by underlying disease within the bone.
Method: Ten patients with chronic sinusitis were studied at the Virgen de la Arrixaca University Hospital (Murcia, Spain). Nasal endoscopy and computed tomography of the paranasal sinuses were performed. Bone and nasal mucosa specimens were collected during endoscopic sinus surgery and were studied with light and electronic microscopy.
Results: In 45.3% of the specimens, the ethmoid cells and maxillary sinus mucosa were normal but the bone displayed inflammatory changes. These changes included alterations in bone architecture with coordinated osteoclasis and appositional bone formation adjacent to the infected sinuses, as well as intramembranous bone remodeling. In addition, fibrosis within the haversian system and increased vascularity were observed. The bony ethmoid septae showed demineralization and irregular bony thickening. The osseous changes in histopathology were significantly increased with higher mucosal grades in nasal endoscopy. The findings in CT scans and histopathology were well correlated with nasal endoscopy.
Conclusion: Bone plays an active role in the process of chronic sinusitis. This may in part explain the recalcitrance of late-stage disease. If the potential for inflammation to spread through the bone exists, it may well explain some of the clinical findings seen in chronic sinusitis.
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