Maxillary Recirculation Problem.
This post is for patients who have:
Recurrent sinus infections
Heavy post-nasal drainage
Constant cheek pressure
The above symptoms are the most common complaints of patients with a maxillary recirculation problem.
There should only be one drainage hole in each maxillary sinus. This hole is called the natural ostia. An extra drainage hole or holes in the maxillary sinus can cause recirculation problems. The causes of the extra hole/s are:
Congenital - some patients are just born with them
Others acquire them from recurrent infections that cause an extra hole to form.
Some patients have had previous surgery that left an extra hole in the maxillary sinus.
From birth, all of the mucus in the maxillary sinus is programmed to drain toward the natural ostia, which is the hole that drains the mucus out of the sinus. It doesn’t matter if you have an extra hole/s in the sinus; the mucus won’t naturally drain through these holes because all the mucus in the sinus is pushed toward the natural ostia.
The problem with a recirculation situation is that mucus will try and leave the natural ostia and run down the throat like it is supposed to, but will frequently fall back into one of the accessory ostia, and then it goes round and round. Hence, the term recirculation problem.
The natural ostia
In the picture noted below, the label NO refers to natural ostia. You can’t see the natural ostia here because it is hidden behind some tissue, but the symbol NO notes where it is. The other 2 symbols, AO-1 and AO-2, refer to accessory ostia 1 and accessory ostia 2. You can see a large amount of mucus collecting over accessory ostia 1.
In the image below, I have started suctioning out the excess mucus, and you can clearly see the two pathways of the excess mucus. Some coming from AO-1, and the other coming from the NO.
The two pathways of the excess mucus
In this image, you can see that almost all of the excess mucus has been removed.
The excess mucus has been removed
In this image, you get your first view of the natural ostia because I have removed some tissue to reveal its location.
The first view of the natural ostia
The only way to fix the recirculation problem is to connect all holes. There's no way to plug or block accessory ostia. You just have to make sure that all of the holes connect into one common hole. In this image, I have removed all of the tissue between the natural and two accessory ostia to make one large hole. This will solve the recirculation problem.
Removed all of the tissue between the natural and two accessory ostia
If you think you may have a recirculation problem? It can be easily diagnosed with a nasal endoscopy and/or CT scan of your sinuses.
Till next week,
Jim Atkins, MD, Follow me on Twitter.
Lori Atkins, PA-C
P.S.
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