Chronic rhinosinusitis is defined in a simplified manner as chronic inflammation of the rhinosinusal mucosa. AIM: In an attempt to understand the reason for treatment failure. STUDY DESIGN: Case-control. MATERIAL AND METHOD: We decided to study the ultrastructural inflammatory changes detected in the lamina propria of the maxillary sinus of 13 patients with chronic rhinosinusitis and nasosinusal polyposis submitted to surgical treatment. Biopsies of the superolateral wall of the maxillary sinus were obtained from these patients during the surgical act and, after preparation, were observed by transmission electron microscopy. RESULTS: Analysis of the data obtained showed five patterns of inflammatory response in the lamina propria studied. Acute inflammatory process - 1 case; non-acute and non-chronic inflammatory process - 5 cases; chronic inflammatory process - 2 cases; disorganized inflammatory process - 4 cases; indeterminate inflammatory process - 1 case. Analysis of the results showed that the lamina propria of the maxillary sinus of these patients was infiltrated with inflammatory cells without the predominance of any particular cell element. Glandular elements were not observed in the cases studied and fibrosis was noted in almost half of them, of varying intensity and preferentially localized immediately below the epithelium. CONCLUSION: In the situation observed the inflammatory process did not follow the normal stages of evolution and showed marked disorganization, with difficulty in progressing to resolution of the picture, thus explaining the difficulties of patients refractory to clinical and surgical treatment.
chronic rinossinusitis; histopatology; mucosa; surgery
