Canine fossa puncture for severe maxillary disease in unilateral chronic sinusitis with nasal polyp.

OBJECTIVES/HYPOTHESIS: To evaluate the efficacy of canine fossa puncture (CFP) by comparing patients with unilateral chronic rhinosinusitis (CRS) accompanying nasal polyposis (NP) who underwent CFP with those who underwent maxillary sinus clearance through a middle meatal antrostomy (MMA).

STUDY DESIGN: Prospective randomized study.

METHODS: Twenty-nine patients were randomly assigned to the CFP and MMA groups. Preoperative computed tomography (CT) established that all patients had severely diseased maxillary sinuses. Subjective outcomes were evaluated preoperatively and at 3, 6, and 12 months postoperatively using the Sino-Nasal Outcome Test 20 (SNOT-20) and a visual analogue scale (VAS). Additionally, mucosal thickening was measured as a percentage of total maxillary sinus volume on CT images taken 12 months postoperatively.

RESULTS: Twenty-five patients who completed the follow-up, questionnaires, and postoperative CT evaluation were included in the analysis. SNOT-20 and VAS scores improved significantly at 3, 6, and 12 months postprocedure in both groups. However, significant improvement of SNOT-20 at 12 months and VAS scores for purulent discharge, foul odor, and postnasal drip at 6 and 12 months were observed in the CFP group compared with the MMA group. In addition, the volume of mucosal thickening was significantly greater in the MMA group than in the CFP group on postoperative CT images.

CONCLUSIONS: CFP is a useful method for the removal of severe maxillary mucosal disease that cannot be reached through MMA, and is superior to conventional MMA for improving subjective and objective outcomes in patients with unilateral CRS accompanying NP.