Results of 90-degree endoscope application in removing foreign bodies and fungal balls from hard-to-reach areas of the maxillary sinus

Endoscopic antrostomy through the middle nasal meatus (MNM) is a commonly accepted surgical treatment method for chronic inflammatory diseases of the maxillary sinus (MS). Due to the anatomical features of this area, the anteromedial areas often remain out of visual control even with a 70° endoscope and are hard-to-reach for manipulation by standard endoscopic instruments. However, it is essential to remove all pathological substrate in order to minimize the risk of revision intervention in the surgical treatment of foreign bodies and fungal balls of MS. Objective. To assess the effectiveness of the author’s method of applying the 90° endoscope in the surgical treatment of foreign bodies and/or fungal balls in hard-to-reach areas of MS through MNM. Patients and methods. The results of surgical treatment of chronic maxillary sinusitis, caused by fungal ball and/or migration of foreign body into MS, using irrigation method, «gauze turunda» method and 90° endoscope were analyzed. The degree of MS visualization with the 90° endoscope, the frequency of cases when the 90° endoscope use affected the operation course, the frequency of the need for additional access, the surgery time and the quality of life of patients before and after the intervention were assessed. Results. The study included 39 patients (15 men and 24 women) with a mean age of 49.41±12.07 years. Fungal ball has been found in 20 (51.3%) patients, foreign body — in 11 (28.2%), combination of them — in 8 (20.5%). In 24 (61.5%) cases, the application of 90° endoscope allowed to reveal a pathological substrate that was not visualized using 70° endoscope. Additional prelacrimal access was applied in 2 (5.14%) cases and in 1 (2.7%) case a modified maxillectomy was performed. The use of 90° endoscope did not affect the operation time. There were no «large» or «small» perioperative and postoperative complications in patients, and the quality of life in the postoperative period, according to the SNOT-22 questionnaire, has improved significantly. Conclusion. Application of endoscopic antrostomy through MNM using the 90° endoscope allows to detect pathological substrate and to completely remove the content of the MS in 92.2% of cases without formation of additional access.