Anatomical Variations of Accessory Maxillary Sinus Ostium: an Endoscopic Study

Address for Correspondence: Dr Anupama Mahajan, Professor & Head, Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences & Research, Amritsar (Punjab), India. Mobile no. 9815733321 E-Mail: [email protected] Introduction: There has been a significant shift from external and headlight sinus surgery to functional endoscopic sinus surgery (FESS) in the past quarter century. Therefore understanding of anatomical variations of Accessory Maxillary Ostium(AMO) becomes essential for an endoscopic sinus surgeon to differentiate it from the natural ostium for safe and efficacious surgery in this region. AIM: To note the presence and anatomical variations of AMO that predisposes to recurrent sinusitis and headache. Materials and Methods: Material for the present study consisted of 100 adult patients(58 males&42 females) in the age group of 22 to 72 years old, selected from OPD of Chikitsa ENT hospital, Amritsar. Systematic nasal endoscopy was done and the shape, size, location, number and laterality of AMO was noted. Results: Among 100 subjects(200 half sides) AMO was found in 42(21%) halves, 33(78.57%) were found in anterior nasal fontanelle(ANF), 7(16.66%) in posterior nasal fontanelle (PNF)and 2(4.76%) in hiatus semilunaris(HS). These ostia were circular in 34(80.95%) halves and oval in 8(19.04%) halves. Regarding position, those situated in ANF and HS were placed in horizontally while those lying in PNF were vertically. Out of 42(21%) halves, unilateral AMO was present in 36(85.71%) halves, bilateral in 6(14.28%) halves and double in 14(33.33%). whereas single in 28(66.66%) halves. Conclusions: Each sinus cavity has a specific drainage point/ostium through which normal mucociliary clearance is channeled. The endoscopic sinus surgeons must have a detailed knowledge of anatomical variations of AMO in any interventional maxillary sinus surgery to gain maximum result(restoring normal function) with minimal trauma and morbidity.