COMPREHENSIVE DIAGNOSIS, TREATMENT AND PREVENTION OF CYSTIC MAXILLARY SINUSITIS
Keywords:
chronic cystic maxillary sinusitis, immunoregulatory index, immunohistochemistry, interleukins, cystsAbstract
Introduction: Chronic cystic sinusitis is accompanied by the depletion of local protective mechanisms. Cystic sinusitis represents one of the most common clinical variants of chronic sinusitis. Paranasal sinus cysts account for 3.9% of all otorhinolaryngological diseases and 12.6% of chronic sinusitis cases.
Objective: To substantiate and implement a comprehensive diagnostic and treatment protocol ensuring timely diagnosis, a personalized choice of surgical strategy, and the realization of a preventive measure system aimed at preventing disease recurrence.
Materials and Methods: The clinical study was conducted at the Otorhinolaryngology Department of the Samarkand Regional Medical Center between 2021 and 2024. The study included 230 patients with a verified diagnosis of maxillary sinus cyst. Along with standard management, patients in the main group (n=115) underwent comprehensive diagnosis, differentiated conservative and surgical treatment, and tertiary prevention based on the "staged postoperative rehabilitation protocol." Patients in the comparison (control) group (n=115) received standard diagnostic, treatment, and preventive care.
Results: Three infiltration morphotypes were identified: eosinophilic, lymphoc
ytic, and mixed leukocytic-lymphocytic with fibrosis. Immunohistochemical (IHC) analysis revealed an imbalance in the immunoregulatory index (IRI), which served as the basis for prescribing personalized therapy. A decrease in the functional activity of T-lymphocytes and the phagocytic system was observed in patients, indicating the suppression of local and systemic immunity. A comparative analysis of treatment outcomes demonstrated a significant advantage of the developed management strategy for patients in the main group compared to the control group. In the long-term period (12 months), the treatment efficiency in the main group reached 100% when using approaches via the inferior nasal meatus and the anterior wall, and 94% via the middle nasal meatus approach. These values significantly exceed the results of the control group, where good sinus pneumatization after a year was maintained in only 87–96% of cases, and the recurrence rate reached 9%. The complete absence of recurrences and surgical failures in the main group confirms the high reliability and radical nature of the chosen approaches.
Conclusions: The application of a differentiated surgical approach combined with an optimized postoperative rehabilitation protocol ensures full immunocorrection (normalization of CD3+, reduction of interleukins, and decrease of IgE to 63 IU/ml) and eliminates the risk of postoperative neuropathies (0%). This allows for personalized therapy based on IHC data and achieves full medical and social rehabilitation of patients, with the normalization of the quality of life according to the SNOT-22 questionnaire to 4.1 points (physiological norm) within a year.
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