Healthy adults have maxillary fontanel perforations (accessory ostia) only in 0.5%. 20% of patients with chronic rhinitis et rhinosinusitis have maxillary sinus perforation.(Mladina R et al. The two holes syndrome. Am J Rhinol " Allergy 2009 23(6):602-4.) I think they resemble tympanic membrane perforations which are caused by otitis media and should be treated similarly.

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