Endoscopy of the maxillary sinus

The use of modern fiber-optic endoscopes allows for in vivo examination of the maxillary sinus and detection of signs of inflammation (hyperemia of the mucous membrane, its polypous changes, etc.). Modern fiber-optic endoscopes are complex devices equipped with ultra-short-focus optics with a wide viewing angle, a digital video signal converter, and a television monitor, which allows for image analysis. In addition, the monitor screen can be used to view not only the overall picture of pathological changes, but also to detail individual elements of the image, determining their pathological anatomical essence.

Ultrasound examination is performed using a device called "Sinuscan". The method is based on the following properties of ultrasound:

1. do not penetrate through the air (ultrasound in gases spreads with great attenuation);
2. penetrate well through liquid and solid media;
3. reflected from the boundary of two contacting media of different density, for example liquid/bone, bone/air, bone/cyst, etc.; therefore, when ultrasound passes through dissimilar layers of tissue, it is partially reflected from each interface and returns to the receiver, combined with an acoustic probe; the mini-computer reads the time difference in the arrival of the reflected ultrasound to the receiver and forms spatially separated indicator strips on the display screen, the distance of which is from the “zero mark”.

X-ray diagnostics allows to establish the nature of the pathological process almost completely, since the structures that fill the paranasal sinus cavities are revealed on X-ray images. If there are inflammatory changes in the paranasal sinuses, their transparency is impaired.

When X-rayed in a standing position (upright head position), the fluid contained in the sinus flows down, and then its level is visualized on the X-ray as an arc. Sometimes, pillow-shaped limited swelling of the mucous membrane is detected on the X-ray, which is visualized as gentle rounded shadows.

A very promising and inexpensive method of X-ray examination of the paranasal sinuses is the method of using water-soluble contrast agents of low concentration, which has a number of advantages over conventional contrasting of the sinuses using iodolipol: reduced consumption of the contrast agent, improved quality of diagnostics, reduced degree of masking of volumetric formations located in the lumen of the sinus. For this, the authors used a 60% solution of verografin or iodamide-300 of low concentration. Standard preparations were diluted with distilled water in a 1:1 ratio, which achieved the maximum contrast effect.

Computer and magnetic resonance imaging of the maxillary sinus are used when there is a suspicion of the presence of gross organic lesions of the facial skeleton caused by a highly virulent infection in immunodeficient states of the body, as well as in severe clinical course of the inflammatory process, accompanied by signs of purulent complications (phlegmon of the face, orbit and retromandibular region, abscesses of the frontal lobe and lesions of the venous sinuses of the brain, etc.). As for CT of the maxillary sinus in their acute inflammation, such works are few. S.V. Kuznetsov et al. (1990) examined 84 patients with acute rhinosinusitis using CT. In the maxillary sinus with influenza etiology, an increase in the volume of the mucous membrane of the inner lining is revealed due to its edema and infiltration, while thickened internal structures of the nose are visualized, the density of which is reduced and fluctuates within (10.6 ± 4.8) X units (normally, soft tissues in the paranasal sinuses are not visualized at all on CT). With bacterial rhinosinusitis, the soft tissue membrane in the affected sinuses also increases, but to a lesser extent than with influenza sinusitis. Its density is 28-32 X units. In the lumen of the maxillary sinus, a certain amount of exudate with a density of 22 to 31 X units is almost always observed. As noted by the authors, in bacterial inflammation, the information content of CT does not exceed that of traditional X-ray techniques, and for differential diagnostics of the nature of pathological changes, it is also necessary to resort to traditional X-ray. Therefore, as the authors note, with sufficiently clear radiological signs confirming the clinical picture of acute inflammation, it is inappropriate to resort to CT.

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