正常成人上颌窦锥形束CT的影像学研究

目的：本研究将锥形束CT应用于上颌窦影像学参数的测量,并比较不同性别、左右侧上颌窦间不同参数的差异性。方法选择200例正常成人的头颅锥形束CT影像,导入InVivo Dental软件进行三维重建,测量上颌窦前后径、左右径、上下径、容积和眶下壁骨质厚度,并使用SPSS 11.5统计软件进行分析。结果双侧上颌窦组间比较,上颌窦左右径、前后径、上下径、容积和眶下壁骨质厚度的差异均无统计学意义（P均＞0.05）;在不同性别组间比较,双侧上颌窦上下径、右侧上颌窦左右径和双侧上颌窦容积的差异均有统计学意义（P均＜0.05）。而左侧上颌窦的左右径、双侧上颌窦的前后径和双侧眶下壁骨质厚度的差异均无统计学意义（P均＞0.05）。结论锥形束CT可用来测量上颌窦的影像学参数,为临床提供影像学解剖数据。     

云南地区正常儿童与鼻窦炎患儿鼻窦发育情况比较

目的:研究我国儿童的鼻窦发育规律,探讨儿童鼻窦炎性疾病与鼻窦发育的相关性,为儿童鼻窦及其相关疾病的治疗提供依据.方法:随机选取无鼻窦相关病史儿童1705例及有鼻窦相关病史患儿1424例,均行螺旋CT检查,测量各鼻窦矢状径、冠状径及上下径,并进行统计分析.结果:有鼻窦病史者各鼻窦发育径线值均大于无病史者(P<0.01);经Pearson相关性分析,性别与鼻窦相关病史间差异无统计学意义(P>0.05),儿童年龄与鼻窦相关病史有低度相关(P<0.01),CT影像学诊断与临床鼻窦炎诊断有中高度一致性.结论:鼻窦炎患儿与正常儿童之间鼻窦发育存在差异,鼻窦炎患儿鼻窦总体发育好于正常儿童.     

计算机辅助婴儿鼻窦CT影像解剖学研究

目的:了解婴儿鼻窦解剖特点和发育规律,为婴儿鼻窦发育提供具体数据,为婴儿鼻窦炎的诊断治疗提供理论依据。方法:通过CT影像工作站研究36例婴儿鼻窦冠状位CT,观察各鼻窦是否发育正常,并对发育鼻窦测量左右径和上下径。结果:36例婴儿72侧(100%)额窦均未发育。72侧上颌窦均发育,左侧上颌窦左右径为(8.69±3.75)mm,上下径为(9.37±2.36)mm;右侧上颌窦左右径为(8.95±2.79)mm,上下径为(9.06±2.66)mm。72侧前组筛窦均发育,左侧前组筛窦左右径为(3.63±1.17)mm,上下径为(8.21±2.72)mm;右侧前组筛窦左右径为(3.48±1.32)mm,上下径为(8.28±2.62)mm。72侧后组筛窦均发育。左侧后组筛窦左右径为(4.09±1.13)mm,上下径为(6.61±1.36)mm;右侧后组筛窦左右径为(4.01±1.28)mm,上下径为(6.63±1.97)mm。72侧蝶窦中22侧(30.6%)可见气化腔,50侧(69.4%)未见气化腔。结论:婴儿期鼻窦开始发育,以上颌窦和前后筛窦为主,部分婴儿蝶窦开始发育,额窦未发育。     

单侧上颌窦真菌球患者上颌窦解剖参数的CT研究

目的 探讨单侧上颌窦真菌球（UMFB）与上颌窦解剖参数的关系。方法 回顾性分析55例UMFB患者的鼻窦CT资料,应用Mimics 21.0软件对双侧上颌窦进行三维重建,同时测量计算患侧与健侧上颌窦的容积、表面积、气化系数、骨壁厚度及密度等解剖参数,并对得到的数据进行统计学分析。结果 ①UMFB患者的双侧上颌窦中,患侧上颌窦容积、内表面积、气化系数、上下径均较健侧小,差异具有统计学意义（P<0.05）,而左右径、前后径的差异无统计学意义（P>0.05）;患侧上颌窦骨壁厚度及密度均较健侧大,差异具有统计学意义（P<0.05）;②UMFB患侧上颌窦解剖参数与Lund-Mackay评分均无相关性（P>0.05）。结论 UMFB更好发于上颌窦容积、表面积、气化系数以及上下径较小的一侧。上颌窦骨壁厚度及密度增大对于诊断UMFB具有一定价值。     

正常人鼓窦入口和鼓窦CT三维重建及解剖学研究

目的:对正常人鼓窦入口及鼓窦不同方向的直径进行CT测量及三维重建,检测其正常值范围。并对年龄、性别及侧别这3个因素分类后分别进行比较。方法:随机选取90例无耳部病变受试者,行矢状面、横断面及冠状面高分辨率CT扫描,后期对扫描图像进行鼓窦入口、鼓窦三维重建,左右径、上下径及前后径测量和分组对照分析。结果:不同年龄段鼓窦入口CT三维重建构像较为恒定,而鼓窦则较为多样;鼓窦入口左右径平均值为(5.19±1.39)mm,上下径为(5.74±1.16)mm。鼓窦左右径平均值为(8.27±1.41)mm(<6岁),(5.41±1.32)mm(≥6岁);上下径平均值为(11.78±1.65)mm(<6岁),(9.91±2.04)mm(≥6岁);前后径平均值为(12.25±1.23)mm(<6岁),(10.05±1.69)mm(≥6岁)。鼓窦入口左右径无年龄、性别和侧别差异(P>0.05),鼓窦入口上下径存在性别差异,即男性鼓窦入口上下径大于女性(P<0.05);鼓窦左右径、上下径及前后径均存在年龄间的差异(P<0.05),但无性别、侧别间的差异(P>0.05)。结论:正常人鼓窦入口影像学表现较为恒定,而鼓窦较为多样;不同性别鼓窦入口上下径存在显著性差异;不同年龄组间鼓窦左右径、上下径及前后径均存在显著性差异。     

儿童鼻窦正常气化规律初探

目的 利用磁共振成像探讨儿童鼻窦正常气化规律.方法 选取280例无鼻窦炎的年龄17 d(＜1岁患儿本研究中称为0岁)至14岁患儿的鼻窦MRI图像,观察各组鼻窦的气化规律,测量左侧上颌窦轴位与矢状位最大面积值.结果 0～1岁患儿上颌窦气化率为85%;至3岁时,气化率达95%,且男女患儿上颌窦气化率差异无统计学意义(x2=0.741,P=0.389);4岁以后全部气化.0～14岁患儿筛窦气化率达100%.＜1岁患儿蝶窦未见气化;至5岁时平均气化率为49%,且男女患儿气化率差异无统计学意义(x2=2.452,P=0.117);7岁以后气化率达100%.＜5岁患儿额窦未见气化;5～9岁额窦平均气化率为62%;10岁以后额窦气化率达到95%,男女患儿额窦气化率差异无统计学意义(x2=0.124,P=0.724).女性患儿上颌窦气化轴位、矢状位最大面积分别为(689.28±221.79)、(659.76±263.31)mm2,男性分别为(668.13±206.38)、(638.60±207.67)mmz,差异均有统计学意义(t=-19.78,P＜0.001;t=-19.89,P＜0.001).结论 了解儿童鼻窦正常气化规律有助于对不同年龄儿童鼻窦病变,特别是炎性病变的诊断提供参考.     

上颌窦三维立体形态与上颌窦炎关系的研究

目的:通过螺旋CT影像学研究,重建上颌窦的三维立体形态,探讨上颌窦炎症与上颌窦三维立体形态、容积和气化系数之间的关系。方法:对双侧上颌窦正常者、单侧上颌窦炎症及双侧上颌窦炎症者各50例(均为成年人)行鼻-鼻窦螺旋CT扫描,重建上颌窦的三维立体形态;测量并计算上颌窦的容积和气化系数,分析上颌窦三维立体形态、容积和气化系数与上颌窦炎的关系。结果:上颌窦炎组上颌窦形态不规则(凹陷、变形),容积为(14 971.86±360.93)mm3,气化系数为0.252±0.057;正常组上颌窦形态规则,容积为(15 018.64±473.36)mm3,气化系数为0.345±0.071;两组之间容积比较差异无统计学意义,气化系数比较差异有统计学意义。结论:上颌窦三维重建更加直观地描述了上颌窦的三维结构和立体形态;上颌窦炎症与上颌窦容积无相关性,而主要与上颌窦的三维立体形态及气化系数有关;上颌窦三维立体形态规则,气化系数>0.300,上颌窦发生炎症的概率较低;反之机会增大。成人炎症上颌窦可能来源于儿童及青少年期一个较大的上颌窦。     

不同的评估指标在鼻咽癌放疗后慢性鼻-鼻窦炎治疗方案选择和疗效评估中的价值

目的 探讨不同病情评估方法在鼻咽癌放疗后慢性鼻窦炎(CRS) 选择个性化治疗方案及疗效评估中的价值。方法 将98例鼻咽癌放疗后CRS分成3组：经保守治疗(组1)、经上颌窦自然口扩大(组2)及联合下鼻道开窗(组3)为特征的鼻内镜手术治疗,分析治疗前后视觉模拟量表(VAS)评分、鼻窦CT Lund-Mackay评分、鼻内镜检查Lund-Kennedy评分等完整的主观、客观评价指标的特点。结果 在症状的VAS评估中,保守治疗仅黏脓性鼻涕评分有统计学意义,手术治疗另有面部胀痛评分治疗前后差异有统计学意义,联合下鼻道开窗组优于单纯上颌窦自然口扩大组。保守治疗对上颌窦炎及蝶窦炎控制较差,手术对各鼻窦炎控制率较好,联合下鼻道开窗对上颌窦炎的控制优于单纯上颌窦自然口扩大。Lund-Mackay与Lund-Kennedy评分在保守治疗前后差异无统计学意义(P>0.05); Lund-Mackay评分在每组手术治疗前后、治疗后两组间及保守组与手术组治疗后的差异均有统计学意义(P<0.05),而Lund-Kennedy评分差异无统计学意义(P>0.05)。结论 ①黏脓性鼻涕、面部胀痛这两项VAS评分较高的患者宜选择以上颌窦自然口扩大联合下鼻道开窗术为主的综合治疗方案;②在对治疗前病变范围的评估和手术疗效的判断上,Lund-Mackay评分更能真实反映放疗后CRS的控制情况。     

分泌性中耳炎鼓窦入口、鼓窦解剖学研究

目的通过测量成人分泌性中耳炎(单侧病变)患侧耳鼓窦入口、鼓窦CT三维成像及解剖径线数值,并与健侧耳进行对照,观察有无显著性差异。拟从解剖学角度分析、探讨鼓窦入口、鼓窦在成人分泌性中耳炎发病中的作用及影响。方法回顾性分析南方医科大学附属珠江医院耳鼻咽喉-头颈外科,于2003年1月～2011年10月收治成人分泌性中耳炎(单侧病变)患者43例。行矢状面、横断面及冠状面高分辨率CT(HRCT)扫描,后期对扫描图像进行患侧和健侧耳鼓窦入口、鼓窦三维重建及左右径、上下径及前后径测量并分组对照分析。结果两组鼓窦入口CT三维重建构像较为恒定,鼓窦则较为多样。患侧耳鼓窦入口左右径平均值为5.17±1.30mm,上下径为5.65±1.13mm;鼓窦左右径平均值为5.47±1.35mm,上下径平均值为9.22±3.13mm,前后经平均值为9.51±2.24mm。健侧耳鼓窦入口左右径平均值为5.42±1.07mm,上下径为5.96±1.17mm;鼓窦左右径平均值为5.54±1.26mm,上下径平均值为9.92±2.67mm,前后径平均值为9.74±1.98mm。结论成人分泌性中耳炎患者患侧耳和健侧耳两组鼓窦入口左右径及上下径;鼓窦左右径、上下径及前后径均无侧别和性别显著性差异(P>0.05)。提示成人分泌性中耳炎致病病因中,鼓窦入口、鼓窦解剖结构大小可能为非重要和关键因素。     

上颌窦发育过程的CT研究

本研究对 4 8例儿童鼻窦用层距为 5mm的连续冠状 CT扫描进行上颌窦容积的测量并与既往成人鼻窦CT资料相比较。 4 8例儿童 94侧 CT分两组 ,正常组4 0侧 ,双侧鼻窦炎组 58侧 ,后者又分为手术治疗亚组16侧和药物治疗亚组 38侧。应用数学积分原理按鼻窦由前至后的冠状 CT资料计算上颌窦容积。其结果如下 :按 4～ 9岁以至 70～ 79各年龄段平均上颌窦容积的分布作成曲线呈单峰状 ,正常人组或手术治疗亚组的峰值均位于 2 0岁左右处。在 4～ 9岁年龄段 ,正常组女孩较男孩上颌窦容积大 ,这可能因为在日本该年龄段女孩发育较男孩早的缘故。从上颌…     

Acquired Maxillary Sinus Hypoplasia: A Consequence of Endoscopic Sinus Surgery?

The effects of functional endoscopic sinus surgery (FESS) on sinus and midfacial development remain unclear. The authors report five children who, at a median age of 30 months, underwent FESS for refractory sinusitis. Three of the children had cystic fibrosis, and two had asthma. Preoperative computed tomographic (CT) scanning showed symmetric maxillary sinus development with varying degrees of mucosal disease. At a mean of 42 months after surgery, CT scans were obtained to evaluate recurrent symptoms in the five children. The scans showed unilateral maxillary hypoplasia in four children and bilateral maxillary sinus hypoplasia in one child. No child had clinically apparent facial asymmetry or midfacial hypoplasia. The authors also discuss the factors involved in maxillary sinus pneumatization, the possible effects of sinus surgery on sinus development, and the clinical implications of “acquired” maxillary sinus hypoplasia. Laryngoscope, 106:1210-1213, 1996     

Comparison of maxillary sinus puncture with endoscopic middle meatal culture in pediatric rhinosinusitis

BACKGROUND: Although maxillary sinus puncture is considered the gold standard for obtaining bacterial cultures, there is an increasing field of evidence indicating that results of endoscopic middle meatal culture correlate well with those of maxillary sinus punctures. However, the subjects of these studies were adults and there was no prior study comparing endoscopic middle meatal culture with maxillary sinus punctures in children with rhinosinusitis. The aims of this study were to compare the results obtained by endoscopic middle meatal culture and maxillary sinus punctures in children with rhinosinusitis. METHODS: A prospective study of children with community-acquired rhinosinusitis was conducted. Results obtained by endoscopic culture were compared with those of maxillary sinus puncture, and the correlation of these 2 techniques was investigated. RESULTS: There were 41 specimen sets sent for aerobic cultivation. Correlation obtained from the middle meatus with those from the maxillary sinus puncture was demonstrated in 32 of 41 specimens (78.0%). When looking at the diagnostic usefulness of endoscopic middle meatus sampling versus maxillary sinus puncture, endoscopic sampling provided a sensitivity of 75.0%, a specificity of 88.9%, a predictive value of a positive result of 96.0%, a predictive value of a negative result of 50.0%, and an accuracy of 78.0%. CONCLUSION: We demonstrated that, when performed in pediatric patients, the correlation between endoscopic middle meatal culture and maxillary sinus puncture was not as favorable as in the case of adult patients.     

Outcome of adenoidectomy versus adenoidectomy with maxillary sinus wash for chronic rhinosinusitis in children

OBJECTIVES: To compare postoperative outcomes of adenoidectomy versus adenoidectomy with maxillary sinus wash as surgical treatment of chronic rhinosinusitis (CRS) in children. STUDY DESIGN: A retrospective review of prospectively collected data. METHODS: Children who failed to respond to medical therapy for CRS and had an adenoidectomy alone (A) or an adenoidectomy with a maxillary sinus wash (wash/A) were reviewed. Outcome was assessed at least 12 months postoperatively. RESULTS: Sixty children who satisfied the inclusion criteria were reviewed. Thirty-two of the children had a sinus wash at the time of adenoidectomy. The age range was 3 to 13 years (mean, 6.3 years) and the mean computed tomography (CT) score was 6.1. The two surgical groups were comparable with regard to age, sex, presence of allergies, asthma, and smoking in the household. Twenty-eight (87.5%) of the 32 patients who underwent wash/A showed improvement of their symptoms after 12 months follow-up compared with 17 (60.7%) of 28 patients who underwent A (P = .017). Multivariable analysis using logistic regression analysis with age, sex, asthma, allergy, and CT score as covariables showed that the success of wash/A compared with adenoidectomy was higher (93% to 60%) for children with a high CT score compared to those with a lower CT score (P = .011). None of the other variables showed statistical significance. CONCLUSIONS: Children with more severe sinus disease as evidenced by a high CT score had a higher success rate if a maxillary sinus wash was performed at the time of adenoidectomy. Children with a low CT score did not have that benefit.     

Chronic rhinosinusitis and adenoid hypertrophy in children

PURPOSE: The purpose of this study was to investigate the relationship between adenoid microbiology, adenoid size, and maxillary sinus microbiology in children with both chronic rhinosinusitis and adenoid hypertrophy. METHODS: The children with both chronic rhinosinusitis and adenoid hypertrophy were admitted to this prospective study. The study included 30 children. The diagnosis of chronic rhinosinusitis was based on clinical and radiologic examinations. Adenoid hypertrophy was classified as medium and large based on the preoperative flexible fiberoptic endoscopy and nasal endoscopy during surgery. Maxillary sinus aspiration and adenoidectomy was performed in all patients. Sinus aspirate and adenoid tissue specimens were cultured. The correlation of culture results was investigated. The relationship between adenoid size and maxillary sinus culture results was analyzed by using chi-square test. RESULTS: Adenoid sizes were medium in 12 (40%) and large in 18 (60%) cases. Bacterial growth was found on 14 of 30 (47%) sinus aspirate, and all adenoid specimen cultures showed bacterial growth (100%). There was no statistical correlation between cultures obtained from the adenoid tissue with those from the maxillary sinus. The relationship between adenoid size and maxillary sinus culture results was not found statistically significant (chi(2) = 0.96, P = 1.0). CONCLUSION: The reason that there was no correlation between cultures obtained from the adenoid tissue with those from the maxillary sinus is that it seems possible that the adenoids act as a barrier causing mechanical obstruction rather than a nidus for chronic sinus infection. However, there is no relationship between adenoid size and maxillary sinus culture positivity. Medium adenoids causing partial obstruction may lead to changes in the microenvironment and may start bacterial growth in children with positive maxillary culture. Further investigation is needed to explain the association between adenoid hypertrophy and rhinosinusitis. Adenoidectomy helps to resolve the symptoms of chronic rhinosinusitis in the children with both chronic rhinosinusitis and adenoid hypertrophy.     

The diagnostic value of transillumination for maxillary sinusitis in children

In 52 children between 3 and 9 years of age drainage of the maxillary sinus was performed because of chronic purulent rhinitis and opacity of the maxillary sinuses on the radiographs. The results of preoperative transillumination were compared with the drainage findings. In this selected group of children the sensitivity of transillumination for the demonstration of congestion in the maxillary sinuses was found to be limited. The authors consider transillumination to be an obsolete method for this purpose in children.     

Development of the maxillary sinus in infants and children

ObjectiveTo examine the age related volume change of the maxillary sinus in children by measuring the change of the height, weight, and depth using computed tomography (CT).MethodsChildren <18 years of age who underwent a CT Scan of the sinuses for reasons other than sinus related issues were included in the study.Results139 patients were included (68 females and 71 Males) and the mean age of the patients was 9.6 ± 5.4 years. The cohort was divided into three groups based on their ages – Age <6 years (n = 45), age between 6 and 12 years (n = 44) and age > 12 years (n = 50). Patients in each age group demonstrated an increase in their Maxillary sinus height (p<0.001). Patients < 6years of age and between 6 and 12 years of age had a significant increase in their maxillary sinus width and depth (p < 0.001). The maxillary sinus width, depth and volume did not increase significantly after the age of 12 years in these patients.ConclusionWe demonstrated periods of significant size increase of the maxillary sinuses as determined by different dimensions in children at various ages. The height of the maxillary sinus has steady growth from birth to at least the age of 18 years. The width and depth increase up to 12 years of age.     

The role of Chlamydia pneumoniae infection in children with chronic sinusitis

BACKGROUND: Chlamydia pneumoniae infection is a frequent cause of lower respiratory disease in both adults and children. However, its role in upper respiratory disease, including sinusitis, is less clear. OBJECTIVE: To determine the role of infection with C. pneumoniae in chronic sinusitis in children. DESIGN: Prospective collection of specimens. SETTING: Tertiary care academic medical center. PARTICIPANTS: Children with clinical and radiologic evidence of chronic sinusitis unresponsive to medical management undergoing adenoidectomy, maxillary sinus lavage, or endoscopic sinus surgery for treatment.Intervention Nasopharyngeal and middle meatal swabs and portions of surgical specimens were obtained and cultured for C. pneumoniae. RESULTS: Specimens were obtained from 20 children (14 boys and 6 girls) aged 3 through 16 years. Thirteen bilateral endoscopic ethmoidectomies with maxillary antrostomies, 10 adenoidectomies, and 3 bilateral maxillary sinus lavages were performed. Chlamydia pneumoniae was isolated from the nasopharyngeal swab and adenoid tissue of 1 child (aged 6 years); however, his middle meatal swabs and maxillary sinus aspirates were negative. After 10 days of treatment with clarithromycin, repeat nasopharyngeal cultures were negative for C. pneumoniae. CONCLUSIONS: With the use of sensitive culture methods, C. pneumoniae was not isolated from sinus specimens of children enrolled in this study. This preliminary study suggests that C. pneumoniae does not play a significant role in chronic sinusitis in children.     

Treatment of intractable diseased tissue in the maxillary sinus after endoscopic sinus surgery with high-pressure water jet and preservation of the periosteum

OBJECTIVE: To describe a new high-pressure water jet (HPWJ) treatment to remove intractable diseased mucosa persisting in the maxillary sinus several months after endoscopic sinus surgery (ESS) while preserving the periosteum. DESIGN: A retrospective review of HPWJ treatment in 45 consecutive patients with at least 12 months follow-up. SETTING: A private surgicenter in Japan. PATIENTS: Patients (25 male and 20 female) ranged in age from 8 to 59 years. All patients had diffuse intractable lesions in the opened maxillary sinus after the initial ESS, with or without disease of the ethmoid and other major sinuses. MAIN OUTCOME MEASURES: Resolution of diffuse intractable disease in the maxillary sinus and postoperative change in the size of the cavity were evaluated using nasal endoscopy and computed tomographic scan. RESULTS: Twenty-six (81%) of 32 sides in 25 patients with isolated persistent maxillary sinus disease were restored after HPWJ procedures; 25 (93%) of 27 sides in 20 patients who also had ethmoiditis also were restored. In the latter group, ethmoiditis recurred in 5 sides, which also included 2 sides of unrestored maxillary sinuses. Of the 51 restored sides, 33 (65%) were restored within 3 months after HPWJ treatment under endoscopic observation. No complications were seen during the surgery. Except for 1 side in 1 patient from which all diseased mucosa was removed almost completely, along with the periosteum, no reduction of the cavity by scar tissue formation was observed. This method did not affect the development of the maxillary bone in children. CONCLUSION: Removing diffuse intractable diseased mucosa in the maxillary sinus while preserving the periosteum with HPWJ treatment is an effective surgical therapy that fulfills the ultimate purpose of ESS.     

儿童上颌窦异位脑膜瘤4例报告并文献复习

目的：探讨儿童上颌窦异位脑膜瘤的临床表现及诊治方法。方法：对4例儿童上颌窦异位脑膜瘤的临床资料进行回顾性分析并复习文献。结果：4例患儿表现为进行性鼻塞,其中1例伴有眼球突出,临床检查4例于鼻腔外侧壁可见类球状新生物,黏膜光滑,质硬。CT检查显示,上颌窦鼻腔新生物高密度影,边界清楚,周围可见骨质吸收。治疗均于全身麻醉下手术切除,3例采用面中翻揭术,1例采用鼻侧切开术,随访4～6年无复发。结论：CT对上颌窦异位脑膜瘤的诊断有重要意义,完整切除肿瘤是治疗儿童上颌窦异位脑膜瘤的最佳方法。     

Organized hematoma of the maxillary sinus

OBJECTIVE: Organized hematoma of the maxillary sinus can develop by means of organization of hematoma in the unaerated maxillary sinus. To our knowledge, this is only the second article describing organized hematoma in the maxillary sinus. MATERIAL AND METHODS: We have observed eight cases of organized hematoma of the maxillary sinus recently and here we describe the clinical features (using CT scans and medical records), radiologic characteristics and pathologic findings. RESULTS: The patients comprised five males and three females (mean age 58 years), all of whom had a history of frequent epistaxis. They also complained of nasal obstruction, hyposmia, headache and swollen cheeks. Rhinoscopy revealed obliterated nasal cavities due to bulging lateral walls. CT scans showed soft-tissue densities expanding the maxillary sinus into the nasal cavity. The treatment modalities used (applied either alone or in combination) were Denker's operation, Caldwell-Luc's operation and endonasal endoscopic surgery, and the outcomes were successful. CONCLUSION: Organized hematoma should be included in the differential diagnosis when patients have frequent epistaxis and an expansile mass in the maxillary sinus.