What is ostiomeatal disease with relation to the sinus?

Kathy

The ostiomeatal complex is THE sinus "hot spot," one of the most important anatomical regions with regard to sinus health and disease. We have talked a great deal about sinuses in the past: the anatomy of the facial sinuses, how sinuses work in the healthy individual, and how they become infected.
The ostiomeatal (sometimes spelled "osteomeatal") complex is located just to the side of each nasal cavity. Place your fingertip at the inside corner of one eye. Now drop your fingertip down about a half inch (one centimeter). Deep below your fingertip (well beneath the bone), there is an anatomical "bottleneck," a narrow passageway through which mucus produced in the maxillary sinus must drain. This bottleneck is the ostiomeatal complex. (The maxillary sinus is the sinus beneath your cheekbone and below your eye.)

One of the great advances in the last 30 years has been the recognition that the ostiomeatal complex is often the focal point for chronic infection of the sinuses. Because of its central location, inflammation of the ostiomeatal complex leads to obstructed outflow from the maxillary sinus, and also from the ethmoid sinuses. (Remember where you had your fingertip a moment ago? The ethmoids are a honeycomb of small sinuses located way behind your fingertip -- behind the ostiomeatal complex.) Once the maxillary and ethmoid sinuses are infected and inflamed, infection can readily spill over into the adjacent sinuses.

This concept has revolutionized our surgical approach to intractable sinus infection (i.e., infection that will not respond to aggressive medical intervention). We now know where to focus our attention and can avoid the overaggressive approach of "blowing everything wide open." By limiting the operation to one small (but critically important) area, we can (1) improve the beneficial results of the operation, (2) decrease postoperative pain and (3) reduce the risk of surgery.

You may still be wondering, "What is the DISEASE in the phrase, ostiomeatal disease?" The "disease" is merely swollen mucosa. The ostiomeatal complex consists of a channel formed by a small spike of bone (the uncinate process) and the paper-thin bone that forms the orbit in this region. (Orbit is the anatomically correct term that corresponds to the lay phrase, "eye socket.") This bony channel is lined with mucosa, the same tissue that lines the sinuses and nasal cavities. It is a narrow channel, so that even a minor degree of mucosal swelling can cause it to close altogether.

What causes mucosal swelling? Nasal allergies, inhaled irritants (smog, chemical fumes, cigarette smoke), viral infection (the common cold), drug side effects and bacterial or fungal infection are all potential causes of mucosal swelling. The key to successful medical treatment is accurate diagnosis, elimination of aggravating factors (e.g., cigarette smoke, or known allergens -- allergens are the things you're allergic to) and judicious use of medications to reduce inflammation, treat infection and control allergies.

If medical treatment fails, what then? The operation to relieve ostiomeatal complex obstruction is called, in general, endoscopic sinus surgery. The ear, nose and throat surgeon (ENT) uses slender fiberoptic telescopes and specially designed forceps to remove very small amounts of tissue from the wall that separates the nasal cavity from the sinus cavities. One of the most important bits of tissue that must be removed is the uncinate process; removing one of the walls of the ostiomeatal complex relieves the anatomical bottleneck.

One key principle of endoscopic sinus surgery is conservatism: The surgeon removes only diseased tissue, leaving healthy tissue behind. Unfortunately, today's healthy tissue can become tomorrow's diseased tissue. Thus, one of the possible outcomes following endoscopic sinus surgery is -- you guessed it -- recurrent disease, possibly requiring further endoscopic sinus surgery. Most ENT surgeons will warn their patients of this possibility well in advance of their first operation.