Les Sinusites Chroniques Maxillaires Aspergillaires Traitées par Biméatotomie : Une Étude de 19 Cas Opérés à Pontoise (France)

RESUME Introduction. Les indications de la chirurgie endoscopique endonasale, n’ont cesse de croitre en remplacement des voies externes plus invasives. La meatotomie moyenne isolee est souvent pratiquee ; on peut associer des abords complementaires afin de mieux controler l’ensemble de la cavite sinusienne maxillaire. Quand cet abord complementaire interesse l’ouverture du meat inferieur, on parle de bimeatotomie. Cet abord complementaire assure un meilleur controle visuel de la cavite sinusienne, l’exerese peut donc etre la plus totale possible, afin de reduire la survenue de recidives. But. Le but de cette etude etait de presenter cette technique chirurgicale dans le traitement des sinusites maxillaires chroniques aspergillaires. Patients et methodes. Il s’agissait d’une etude transversale prospective, etalee sur 36 mois ; realisee dans le service ORL de l’Hopital Rene Dubos de Pontoise (France). Resultats. Le nombre de patients retenu etait de 19 cas. Le profil epidemiologique et clinique de l’echantillon a revele : une moyenne d’âge de 49 ans, une predominance feminine (sex ratio 8,5), les soins dentaires et mauvais etat dentaire comme principale facteurs de risque (63,15%), les patients presentaient pour la majorite une association de signes clinique, l’imagerie retrouvait majoritairement un aspect de corps etrangers intra sinusiens (10 patients). Le profil evolutif montrait : une evolution favorable avec une disparition des plaintes des patients dans 96% des patients apres 90 jours. Conclusion. La bimeatotomie est une technique chirurgicale endonasale, qui dans le traitement des sinusites maxillaires chroniques aspergillaires donne de bons resultats. Des travaux complementaires sont necessaires afin de confirmer nos resultats. ABSTRACT Introduction. The indications for endoscopic sinus surgery are gradually increasing and becoming more and more common in regular ENT practice. Some of these indications have already replaced usual external approaches. The middle meatus approach is often performed alone but it can be associated with other approaches in other to get access to the whole maxillary sinus cavity during the surgical procedure. When the middle meatus approach is associated with the inferior meatus approach, it is called the double meatus approach procedure. This procedure helps to control the whole maxillary cavity and is very useful when a full resection of a tumour is needed to prevent further reoccurrences. Objectives. The aim of this study was to present the endoscopic double meatus approach in the management of chronic fungal maxillary sinusitis. Patients and methods. We conducted a case series study over a period of 36 months at the ENT department of the RENE DUBOS Hospital (Pontoise, France). Results. 19 patients were recruited for this study. The mean age was 49 years old and the sex ratio 8.5 for female patients. Dental cares and poor dental status were the most common risk factors (63.1%). Most patients presented with a variety of clinical signs involving the nasal cavity. The most common picture observed on the CT scan was the presence of a foreign body in the maxillary sinus cavity. 96% of the patients were happy with the treatment and did not present any complaint after 3 months follow up. Conclusion. The double meatus approach seems to be very effective in case of chronic maxillary fungal maxillary sinusitis. More research needs to be carry out in order to confirm the effectiveness of this technique for that particular indication.