Introduction
The natural ostium of the maxillary sinus is an anterior part of the
posterior fontanelle and extends transversely with an oval shape toward
the inferior part of the ethmoid infundibulum. In routine nasal
endoscopic examinations, the ostium of the maxillary sinus is not
typically visible.1 An accessory maxillary ostium is
an anatomical variant commonly observed in the middle meatus that
potentially contributes to the development of chronic
rhinosinusitis.2,3 However, there is a lack of clarity
about the causal relationship between accessory ostia and chronic
rhinosinusitis.
Research has systematically evaluated the pathophysiology of chronic
rhinosinusitis and has attributed it to aberrant interactions between
environmental factors and the host immune system. Accessory or secondary
ostia are defined as defects in the fontanelle region of the lateral
nasal wall.4 It has not yet been determined if
accessory ostia are a congenital anatomical variant or if they are
acquired. It has been postulated that accessory ostia are often found in
the posterior nasal fontanelle of the middle meatus, and they may be
unilateral or bilateral.5,6
Our evaluation of accessory maxillary sinus ostia highlighted some
accessory ostia in the superior meatus. Previous studies conducting
cadaver evaluations, computed tomography examinations, and endoscopies
have reported various incidences of accessory maxillary sinus ostia in
the middle meatus.7-9 Accessory ostia in the maxillary
sinus have been associated with chronic maxillary sinusitis, and these
ostia can cause recirculation of mucus, leading to the recurrence of
sinusitis.10,11 Studies based on computed tomography
have also indicated that accessory maxillary sinus ostia are
significantly associated with chronic maxillary
sinusitis.8,12 Therefore, any interventional maxillary
sinus surgery must be supported by an in-depth knowledge of anatomical
variations in the accessory maxillary sinus ostia of the patient to
ensure maximum results and to prevent recurrence.7However, there are few reports on accessory maxillary sinus ostia in the
superior meatus and the association with chronic rhinosinusitis. Thus,
this study investigated the incidence of accessory maxillary sinus ostia
in the superior meatus of patients exhibiting clinical and radiological
signs of maxillary sinusitis and associations with the severity of
chronic rhinosinusitis.