Repair in the Paranasal Sinuses of Man Following Removal of the Mucous Membrane Lining

Abstract

Sufficient clinical evidence has accumulated in recent years to show that certain persistent infections in degenerated mucous membranes lining the paranasal sinuses require surgical removal. In the usual operative procedure in the antrum the diseased tissue is scraped out with a curette; or the entire membrane is removed in one piece by sub-periosteal dissection through an opening in the canine fossa (Dr. Kistner). Clinically it is observed that repair occurs with variable results. In some cases the new lining is thick and in others thin. The exact nature of the new tissue has never been determined.

In our investigations human material is employed, inasmuch as there is no available experimental animal with the surgical and pathological characteristics of sinusitis in man. At the reoperation the specimens are immediately mounted on thick paper supports and immersed in Zenker's fluid. The tissues are dehydrated in alcohol, cleared in cedar oil, imbedded in paraffin and stained with hematoxylin-eosin.

Repair After Part of the Mucous Membrane is Removed:

1. Repair in a Small Area—Approximately one square centimeter was cut from the nasal wall of the antrum in the usual gland-bearing portion of the mucous membrane. Four months later the healed area with some adjacent membrane was removed. Microscopic sections show a layer of ciliated columnar pseudo-stratified epithelium resting on white fibrous scar tissue. No submucous glands are found.

2. Repair of a Large Area—About one-third of the mucous membrane was removed from 2 cases. Two years later the sinuses were reoperated and the entire antrum lining removed. Microscopic sections show the original portion of the membrane containing the normal histologic structures as follows: (1) A layer of pseudo-stratified ciliated columnar epithelium; (2) a superficial spongy layer of areolar connective tissue with large tissue spaces; (3) tubo-alveolar mucous and serous glands in the layer of loose connective tissue; (4) an orderly arrangement of branching arteries and arterioles in definite layers; (5) a definite periosteal layer of compact connective tissue.