ELECTRON-MICROSCOPIC CHANGES IN THE ETHMOID SINUS MUCOSA IN PATIENTS WITH CHRONIC SINUSITIS INTRAOPERATIVELY AND SIX MONTHS AFTER ENDOSCOPIC SINUS SURGERY
Mohamed A. Autifi, Medhat M. Tiba*, Waleed A. Ezzat*
*Anatomy Department, Faculty of Medicine, Al-Azhar University, **Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Egypt
This study was designed to compare the intraoperative and six months postoperative Electron-Microscopic (EM) changes of Paranasal Sinus (PNS) mucosa in patients with chronic sinusitis treated with Functional Endoscopic Sinus Surgery (FESS) for chronic sinusitis. Seventeen patients undergoing FESS for the treatment of chronic sinusitis with or without sinonasal polyposis were involved. The ethmoid sinus mucosa was sampled during operation and six months after surgery. The ciliated epithelium of the sinus mucosa was evaluated with transmission electron microscopy (EM). Intraoperative specimens of the ciliated epithelium of the sinus mucosa of the patients showed abnormal architecture and degenerated ultrastructures. Postoperatively, normal architecture and ultrastructure of the ciliated epithelium was restored in most of the patients (n = 13), few patients (n = 4) showed persistent ulrastructural changes in their ethmoid sinus mucosa after FESS; those patients also showed mucosal changes and persistent radiological abnormalities in CT scan studies. These observations showed that unlike other conventional surgical procedures involving the sinonasal tract, paranasal sinus mucosa can regenerate and the ciliated epithelium can restore its normal structures after proper FESS and proper postoperative follow up. Persistent degenerative changes were found mostly as a result of incomplete procedures and/or inadequate postoperative follow up. A precise understanding anatomy of the paranasal sinuses ensures optimum patient care and outcome.