YK Chew1*, MBBS, Y Noorizan1, MBBch, A Khir1, MS, S Brito-Mutunayagam 1,

1 Department of ENT, Hospital Pakar Sultanah Fatimah, 84000 Muar, Johor.


A thirty-nine-year-old lady presented with nasal blockage and rhinorhoea for a week and associated with occasional fever and persistent left-sided facial pain. She was previously diagnosed to have rhinosinusitis since ten years ago. She was treated repeatedly with steroid nasal sprays, oral antibiotics and decongestant. However the symptoms did not improve. On examination, there was left-sided facial asymmetry (Figure 1), bilateral inferior turbinates hypertrophy with left deviated nasal septum. The palate and teeth were normal. Rigid nasal endoscopy showed a deviated nasal septum to the left with gross inferior turbinates hypertrophy with no mucopus. Osteomeatal complex was not able to be assessed. She underwent computed tomography (CT) of the paranasal sinuses to assess the osteomeatal complex in view of endoscopic sinus surgery. The CT scan showed a small underaerated left maxillary sinus with mucosal thickening (Figure 2 & 3).
Maxillary sinus is present at birth presents as a shallow slit just beneath the medial side of the floor of the orbit. The sinus increases in size and after the second dentition. At about 8 years of age, the floor of the sinus is level with the floor of the nose. Rapid growth of the sinus occurs after puberty and reaches adult size at about 14 to 18 years old1. Hypoplasia of the maxillary antrum is a rarely encountered condition.Antral hypoplasia has been misdiagnosed as sinusitis, chronic sinus infection, and neoplasm. Antral hypoplasia can be associated with difficult and unnecessary surgical explorations2. Variations of the other paranasal structures, especially the uncinate process associated with maxillary sinus hypoplasia were defined. Maxillary sinus hypoplasia shows three distinct hypoplasia patterns. Type I maxillary sinus hypoplasia characteristics are mild hypoplasia of the maxillary sinus, normal uncinate process and a well-developed infundibular passage. Significant hypoplasia of the maxillary sinus, hypoplastic or absent uncinate process and absent or pathologic infundibular passage are seen in Type II maxillary sinus hypoplasia. Type III maxillary sinus hypoplasia is characterized by the absence of an uncinate process and cleft-like maxillary sinus hypoplasia3. The patient has a Type III maxillary sinus hypoplasia as the osteomeatal complex was not visualized and the uncinate process was absent. However, despite the hypoplastic left maxillary sinus, the facial pain persists and this indicates that the hypoplastic maxillary sinus is still subjected to risk of infection.

References
1. Khanobthamchai K, Shankar L, Hawke M, et al. Ethmomaxillary sinus and hypoplasia of maxillary sinus. J Otolaryngol. 1991; 20(6):425-7.
2. Radecki CA, Mintz SM. Maxillary antrum hypoplasia. Report of a case. Int J Oral Maxillofac Surg. 1990; 19(3):158-9.Erdem T, Aktas D, Erdem G, et al. Rhinology. 2002; 40(3):150-3.