Reversible Endoscopic Medial Maxillectomy: Endonasal Approach to Diseases of the Maxillary Sinus

Abstract Introduction The endoscopic access has reduced the morbidity associated with external approaches in diseases of the maxillary sinus. A reversible endoscopic medial maxillectomy (REMM) is presented as an alternative for treatment of benign maxillary diseases. Objective To describe the REMM technique and report four cases of patients with benign maxillary sinus conditions treated through this approach. Methods The present study was divided into two parts: anatomical and case series. Two cadaveric dissections confirmed the feasibility of the REMM approach. The same technique was performed on four consecutive patients with benign maxillary sinus disease. Results The cadaveric dissections confirmed wide exposure to the maxillary cavity, preserving the anatomy of the maxillary sinus. In the patient series, one patient presented with an antrochoanal polyp, one had a silent sinus syndrome, one had a chronic maxillary sinusitis secondary to a gunshot, and the last one had an inverted papilloma in the maxillary sinus. In all of the cases, the REMM approach provided excellent access and adequate resection, as well as preservation of the inferior turbinate, nasolacrimal duct, and lateral wall of the nose (including its osteomucosal component). Finally, all of the patients had an uneventful postoperative course. Conclusion The REMM technique is an excellent surgical approach to benign conditions of the maxillary sinus. It has few limitations and appears to be associated with less morbidity than conventional techniques.

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Endoscopic Trans-Turbinal Medial Maxillectomy: A Modified Endoscopic Medial Maxillectomy Technique to Preserve the Inferior Turbinate

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2021.00654 ◽

2021 ◽

Vol 64 (12) ◽

pp. 959-964

Author(s):

Ki Ju Cho ◽

Hyun-Jin Cho ◽

Yeon-Hee Joo ◽

Yung Jin Jeon ◽

Sea-Yuong Jeon ◽

...

Keyword(s):

Maxillary Antrum ◽

Maxillary Sinusitis ◽

Surgical Techniques ◽

Inferior Turbinate ◽

Complete Removal ◽

Nasolacrimal Duct ◽

Nasal Valve ◽

Mucosal Flap ◽

Medial Maxillectomy ◽

Valve Area

Endoscopic medial maxillectomy (EMM) and its modifications are surgical techniques are used to treat recalcitrant maxillary sinusitis as well as maxillary sinus tumors. In this report, we propose a simple and efficient modification of EMM, called endoscopic trans-turbinal medial maxillectomy (ETTMM), by which the inferior turbinate (IT), nasolacrimal duct, and anatomical integrity of the nasal valve area are preserved. A total of 10 patients (five tumorous and five nontumorous maxillary diseases) underwent ETTMM. Briefly, a turbinate mucosal flap on the superior aspect of the IT was elevated after middle meatal antrostomy. Then a trans-turbinal window was developed to expose the inferior meatus, after which an extended maxillary antrostomy was generated. Finally, the turbinate mucosal flap was repositioned after complete removal of the antral lesions. All lesions were successfully treated using ETTMM. Our modification was easy to perform, and we achieved good endoscopic visualization and accessibility throughout the whole antrum by creating a trans-turbinal window and extended maxillary antrostomy. We could perform postoperative surveillance easily through the wide antrostomy using rigid endoscopes of various angles. ETTMM is a simple and useful modification of EMM that provides clear visualization and great accessibility to most aspects of the maxillary antrum while preserving the nasal functional units, including the IT and nasal valve area.

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Results of Endoscopic Maxillary Mega-antrostomy in Recalcitrant Maxillary Sinusitis

American Journal of Rhinology ◽

10.2500/ajr.2008.22.3248 ◽

2008 ◽

Vol 22 (6) ◽

pp. 658-662 ◽

Cited By ~ 56

Author(s):

Do-Yeon Cho ◽

Peter H. Hwang

Keyword(s):

Maxillary Sinus ◽

Revision Rate ◽

Maxillary Sinusitis ◽

Maxillofacial Surgery ◽

Inferior Turbinate ◽

Symptomatic Improvement ◽

Sinus Surgery ◽

Sinus Disease ◽

Mucus Clearance ◽

Maxillary Sinuses

Background In patients with chronically diseased maxillary sinuses, poor mucociliary clearance may result from long-standing inflammation or scarring from previous surgery. This subset of patients often has persistent sinus disease despite medical therapy and adequate antrostomy. Endoscopic maxillary mega-antrostomy (EMMA) is a mucosal sparing technique that facilitates mucus clearance and sinus irrigation in terminally dysfunctional maxillary sinuses. EMMA involves extending the antrostomy through the posterior half of the inferior turbinate down to the floor of the nose, creating a significantly enlarged antrostomy. This study describes our results of EMMA in recalcitrant maxillary sinusitis. Methods A retrospective review was performed of patients who underwent EMMA for recalcitrant maxillary sinusitis between July 2005 and September 2007. We studied diagnoses, comorbid factors, clinical efficacy, revision rate, and complications. Results Twenty-eight patients (average age, 48 years) underwent 42 EMMAs for recalcitrant maxillary sinusitis. Average follow-up was 11 months. All patients had previous maxillary sinus surgery (mean = 2.3). Relevant comorbid factors included prior Caldwell-Luc or maxillofacial surgery (16/42), cystic fibrosis (11/42), asthma (11/42), and IgG deficiency (3/42). The most common symptoms reported were facial pain/pressure and purulent rhinorrhea. At the time of the most recent postoperative examination, 74% of patients reported complete resolution of symptoms while 26% reported partial symptomatic improvement. There were no complications and the revision rate was 0%. Conclusion Maxillary sinuses that appear to be terminally diseased may be rehabilitated surgically without the need for surgical stripping. EMMA is an effective and safe treatment option for the management of recalcitrant maxillary sinus disease.

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Endoscopic Modified Medial Maxillectomy for Resection of an Inverted Papilloma Originating from the Entire Circumference of the Maxillary Sinus

Case Reports in Otolaryngology ◽

10.1155/2015/952923 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6

Author(s):

Kota Wada ◽

Takashi Ishigaki ◽

Yutaro Ida ◽

Yuki Yamada ◽

Sachiko Hosono ◽

...

Keyword(s):

Maxillary Sinus ◽

Surgical Approach ◽

Staging System ◽

Inferior Turbinate ◽

Nasolacrimal Duct ◽

Inverted Papilloma ◽

Sinonasal Inverted Papilloma ◽

Medial Maxillectomy ◽

Magnetic Resonance Imaging Mri ◽

Modified Medial Maxillectomy

For treatment of a sinonasal inverted papilloma (IP), it is essential to have a definite diagnosis, to identify its origin by computed tomography (CT) and magnetic resonance imaging (MRI), and to select the appropriate surgical approach based on the staging system proposed by Krouse. Recently, a new surgical approach named endoscopic modified medial maxillectomy (EMMM) was proposed. This approach can preserve the inferior turbinate and nasolacrimal duct. We successfully treated sinonasal IP with EMMM in a 71-year-old female patient. In this patient, the sinonasal IP originated from the entire circumference of the maxillary sinus. EMMM is not a difficult procedure and provides good visibility of the operative field. Lacrimation and empty nose syndrome do not occur postoperatively as the nasolacrimal duct and inferior turbinate are preserved. EMMM is considered to be a very favorable approach for treatment of sinonasal IP.

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Indications for the Caldwell-Luc approach in the endoscopic era

Otolaryngology ◽

10.1016/j.otohns.2004.09.014 ◽

2005 ◽

Vol 132 (2) ◽

pp. 219-220 ◽

Cited By ~ 38

Author(s):

Geva Barzilai ◽

Elhanan Greenberg ◽

Nechama Uri

Keyword(s):

Surgical Treatment ◽

Maxillary Sinus ◽

Surgical Approach ◽

Nasal Polyposis ◽

Chronic Sinusitis ◽

Maxillary Sinusitis ◽

Dentigerous Cyst ◽

Inverted Papilloma ◽

Sinus Disease ◽

Medial Maxillectomy

OBJECTIVE: Caldwell and Luc described the Caldwell-Luc operation more than 100 years ago as the surgical treatment for maxillary sinus disease. During the last decades less radical interventions using endoscopic approach have mainly replaced the classical procedures done for chronic and recurrent maxillary sinusitis. STUDY DESIGN AND SETTING: Between 1991 and 2002, 62 patients had the Caldwell-Luc approach for different indications. RESULTS: Twenty (32%) patients had chronic sinusitis, 16 (26%) patients had inverted papilloma, 9 (15%) patients had suffered from nasal polyposis, 4 patients (6%) had dentigerous cyst, 4 (6%) patients had fungal ball, and 9 (15%) patients were operated for other indications. CONCLUSIONS: The use of this surgical approach is rational in cases of fungal disease and in endoscopic medial maxillectomy for treating inverted papilloma. In all other cases, the preferred approach should now be endoscopic.

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Transnasal Endoscopic Medial Maxillary Sinus Wall Transposition with Preservation of the Inferior Turbinate and Nasolacrimal Duct

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0035-1546658 ◽

2015 ◽

Vol 76 (S 01) ◽

Author(s):

Alice Zhao ◽

Kristina Piastro ◽

Anna Butrymowicz ◽

Tiffany Chen ◽

Tyler Kenning ◽

...

Keyword(s):

Maxillary Sinus ◽

Inferior Turbinate ◽

Nasolacrimal Duct ◽

Sinus Wall

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A Comparison of Near-Infrared Imaging and Computerized Tomography Scan for Detecting Maxillary Sinusitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211060623 ◽

2021 ◽

pp. 000348942110606

Author(s):

Mehdi Abouzari ◽

Brooke Sarna ◽

Joon You ◽

Adwight Risbud ◽

Kotaro Tsutsumi ◽

...

Keyword(s):

Maxillary Sinus ◽

Computerized Tomography ◽

Sensitivity And Specificity ◽

Near Infrared ◽

Maxillary Sinusitis ◽

Tertiary Care ◽

Pixel Intensity ◽

Sinus Disease ◽

Nir Imaging ◽

Average Pixel Intensity

Objective: To investigate the use of near-infrared (NIR) imaging as a tool for outpatient clinicians to quickly and accurately assess for maxillary sinusitis and to characterize its accuracy compared to computerized tomography (CT) scan. Methods: In a prospective investigational study, NIR and CT images from 65 patients who presented to a tertiary care rhinology clinic were compared to determine the sensitivity and specificity of NIR as an imaging modality. Results: The sensitivity and specificity of NIR imaging in distinguishing normal versus maxillary sinus disease was found to be 90% and 84%, normal versus mild maxillary sinus disease to be 76% and 91%, and mild versus severe maxillary sinus disease to be 96% and 81%, respectively. The average pixel intensity was also calculated and compared to the modified Lund-Mackay scores from CT scans to assess the ability of NIR imaging to stratify the severity of maxillary sinus disease. Average pixel intensity over a region of interest was significantly different ( P < .001) between normal, mild, and severe disease, as well as when comparing normal versus mild ( P < .001, 95% CI 42.22-105.39), normal versus severe ( P < .001, 95% CI 119.43-174.14), and mild versus severe ( P < .001, 95% CI 41.39-104.56) maxillary sinus disease. Conclusion: Based on this data, NIR shows promise as a tool for identifying patients with potential maxillary sinus disease as well as providing information on severity of disease that may guide administration of appropriate treatments.

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Endoscopic modified medial maxillectomy for odontogenic cysts and tumours

Rhinology Journal ◽

10.4193/rhino13.134 ◽

2014 ◽

Vol 52 (4) ◽

pp. 376-380

Author(s):

Tsugihama Nakayama ◽

Nobuyoshi Otori ◽

Daiya Asaka ◽

Tetsushi Okushi ◽

Shin-ichi Haruna

Keyword(s):

Dentigerous Cyst ◽

Inferior Turbinate ◽

Nasolacrimal Duct ◽

Odontogenic Cysts ◽

Odontogenic Tumour ◽

Intraoral Approach ◽

Safe Technique ◽

Medial Maxillectomy ◽

Keratocystic Odontogenic Tumour ◽

Modified Medial Maxillectomy

Background: Odontogenic maxillary cysts and tumours originate from the tooth root and have traditionally been treated through an intraoral approach. Here, we report the efficacy and utility of endoscopic modified medial maxillectomy (EMMM) for the treatment of odontogenic maxillary cysts and a tumour. Methodology: We undertook EMMM under general anaesthesia in six patients: four had radicular cysts, one had a dentigerous cyst, and one had a keratocystic odontogenic tumour. Results: The cysts and tumours were completely excised and the inferior turbinate and nasolacrimal duct were preserved in all patients. There were no peri- or postoperative complications, and no incidences of recurrence. Conclusion: Endoscopic modified medial maxillectomy appears to be an effective and safe technique for treating odontogenic cysts and tumours.

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Maxillary sinusitis of odontogenic origin in relation to ectopic 2.8 associated with follicular dentigerous cyst: Combined transnasal and oral endoscopic approach, a case report

Global Dentistry ◽

10.36879/god.20.000131 ◽

2020 ◽

pp. 1-3

Keyword(s):

Oral Cavity ◽

Maxillary Sinus ◽

Maxillary Sinusitis ◽

Dentigerous Cyst ◽

Amorphous Material ◽

Fungal Spores ◽

Lateral Wall ◽

Healing Time ◽

Vestibular Cortex ◽

Follicular Cyst

Purpose of the study: To describe the management of orosinusal pathology by combined transnasal endoscopy and oral combined. Methods: The 54-year-old patient underwent a dental and otolaryngological evaluation for left odontogenic maxillary sinusitis in relation to plausible dental follicular cyst of ectopic element 2.8. The symptoms reported at the time of access to the hospital were nasal obstruction and nocturnal rhonchopathy. To the ENT evaluation in videorinoscopy with rigid optics, complex deviation of the nasal septum was relevated with not any evident formations or pathological secretions. While on inspection of the oral cavity the mucous membranes appeared unscathed. Alveolus of 1.6 previosuly extracted was evident. The radiological examination, facial CT, revealed the left maxillary sinus almost completely occupied by a cystic appearance, with thin calcified walls and homogeneous content that has a dental element, probably the 2.8, which fenestrates the vestibular cortex of the lateral wall of the maxillary sinus. This lesion erodes the medial wall of the sinus, obliterating the ostio-meatal complex and imprinting the ipsilateral ethmoidal cells. Biohumoral tests showed normal coagulation parameters, indices of renal function, liver and ionemia. The patient under general anesthesia and oral intubation with a combined intervention of the left anterior FESS, intrasulcular flap from dental elements 2.7 to 2.3 with mesial releasing incision, moderate osteotomy, ectopic 2.8 extraction and enucleation of the cystic lesion with simultaneous closure of the orosinusal communication with advancement of the Bichat adipose bolla and closure by first intention. In the same session, the ENT moment is carried out trans nasally for total left uncinectomy, medium antrostomy with the union of the natural ostium and the accessory ostium. Bilateral lower turbinoplasty with bipolar forceps. The patient was then controlled after 15 days and six months, showing good healing and no signs of recurrence at the rhinoscopic check on the physical examination of the oral cavity. Results: based on the clinical and radiological aspect, the diagnosis of a follicular dentigerous cyst (WHO 2017) covered by a multi-layered non-keratinized paving epithelium, with moderate chronic inflammation, including gigantocellular and cholesteric crystals, is reached from the microbiological and histological examination. Necrotic amorphous material coexists including rare hyphae and fungal spores, with therefore mycotic and actinomycotic super infection. Conclusions: The combined oral and nasal intervention, allowed by the collaboration between the oral surgeon and ENT, has made it possible to shorten the healing time and to resolve the pathology without any sign of recurrence.

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Antroscopy in maxillary sinus disease associated with nasal polyposis

The Journal of Laryngology & Otology ◽

10.1017/s002221510011031x ◽

1989 ◽

Vol 103 (9) ◽

pp. 861-863 ◽

Cited By ~ 3

Author(s):

J. G. Gilbert

Keyword(s):

Maxillary Sinus ◽

Nasal Polyps ◽

Nasal Polyposis ◽

Maxillary Sinusitis ◽

X Rays ◽

Sinus Disease ◽

High Incidence ◽

Satisfactory Method ◽

Careful Assessment

AbstractAlthough the association of maxillary sinusitis with nasal polyps is widely recognized little has been written on its precise incidence and degree. Antroscopy of 70 antra with ipsilateral polyps showed a high incidence of mucosal abnormalities, retained secretions and ostial narrowing. Comparison of these findings with pre-operative X-rays showed the latter were unreliable in detecting retained antral fluid. It is concluded that in nasal polyposis the antra warrant careful assessment and that antroscopy is a highly satisfactory method for this purpose.

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