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Medical Forum / Diseases and Disorders / Sinusitis / February 2007

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Post-Surgery Missed Ostium Recirc & Maxillary Bone Formation

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KLP49 - 04 Feb 2007 22:34 GMT
Perhaps someone can answer some questions for me.  I had sinus surgery in
April ’05 on one side.  These surgical errors were made:
1)  Oversized maxillary opening (antrostomy) – about 1.5+ cm.
2)  Missed the normal maxillary opening (ostium) causing mucous recirculation
between the normal and surgical (located slightly posterior) openings.  The
recirc can be readily seen.
3)  Removed the middle turbinate (without consent) – a small minority of ENTs
still do this – the majority believe it should be preserved.
4)  Somehow caused significant (1cm+) maxillary bone formation (neo-
osteogenesis) to occur at bottom and back wall of maxillary – possibly caused
by accidental tearing of mucosal lining.  
I still get continuous infection and pain.  Before surgery, my CT was fine -
after surgery it is a train-wreck.

Has anyone seen significant maxillary neo-osteogenesis?  What does it mean?
Does it stop?  What is the likelihood that it could harbor osteomyelitis?  If
it was caused by disturbed mucosa, can it restore its mucociliary clearance
capability?

Based on what I have read and per several ENTs, I assume that the recirc
problem is a must-fix (by combining the openings).  But, is there any
downside?  One doc told me it would cause frontal sinus problems, but how can
that be?  Will maxillary mucous find its way down and out without falling
back into the very large surgical opening?  How often does fixing recirc
typically resolve continual infection/inflammation?

Is a large antrostomy anything to be concerned about re drying, exposure to
allergens, loss of normally produced nitric oxide, etc.?  

If anyone can shed light on these – many thanks.
Steven L. - 05 Feb 2007 21:15 GMT
> Perhaps someone can answer some questions for me.  I had sinus surgery in
> April ’05 on one side.  These surgical errors were made:
> 1)  Oversized maxillary opening (antrostomy) – about 1.5+ cm.

That doesn't sound so bad.  In fact, my ENT told me that actually
*prefers* to create large antrostomies when he operates.  He's had to do
revision surgery to widen antrostomies that weren't large enough, so he
prefers to avoid that.

> 2)  Missed the normal maxillary opening (ostium) causing mucous recirculation
> between the normal and surgical (located slightly posterior) openings.  The
> recirc can be readily seen.

That needs to be fixed surgically, by connecting the openings together.
 Otherwise, the mucus can continue to recirculate, hosting more and
more bacteria each time through the loop, causing more infection.
Recirculation as a factor in chronic sinusitis is well documented.

> 3)  Removed the middle turbinate (without consent) – a small minority of ENTs
> still do this – the majority believe it should be preserved.
> 4)  Somehow caused significant (1cm+) maxillary bone formation (neo-
> osteogenesis) to occur at bottom and back wall of maxillary – possibly caused
> by accidental tearing of mucosal lining.  

It sounds like your surgeon stripped all the mucosa off the bone,
allowing infection to spread into it and/or bone scarring.

You're going to need revision surgery.  Revision surgery is a
specialized area, and not all ENTs who do usual sinus surgery are good
at it.  This time, shop around carefully.

And you may also want to contact a lawyer.  Enough went wrong with your
surgery that you might, just might, have grounds for a malpractice lawsuit.

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Steven D. Litvintchouk
Email:  sdlitvin@earthlinkNOSPAM.net
Remove the NOSPAM before replying to me.

 
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