Minimally invasive transnasal medial maxillectomy for treatment of maxillary sinus and orbital pathologies

Abstract

Conclusion: Minimally invasive transnasal medial maxillectomy with preservation of the nasolacrimal duct may provide an alternative method for surgical treatment of selected maxillary sinus and inferior orbit pathology if more extensive endonasal or external approach procedures are to be avoided. Objectives: To present a modification of the transnasal endoscopic approach to the maxillary sinus leading through its medial wall, anteriorly to the nasolacrimal duct that considerably improves access to the antero-inferior part of the maxillary sinus and entire orbital floor. To discuss indications for the procedure along with surgical outcome after at least 12 months of follow-up. Methods: A total of 22 selected patients with extensive/refractory inflammatory maxillary sinus disease that could not be cleared completely through middle meatal antrostomy or pathologies of the inferior orbit that required uncompromised access to the orbital floor were operated with this method. The effectiveness of the treatment was evaluated through clinical symptomatology and endoscopic examination to confirm eradication of the disease. Results: The presented method allowed for good overall symptom control and eradication of disease confirmed endoscopically in about 90% of cases with an inflammatory type of disease. The visualized reach within the maxillary sinus with commercially available endoscopic instruments was conspicuously improved as compared with middle meatal antrostomy.

Keywords::

• Endoscopic medial maxillectomy
• lacrimal recess
• nasolacrimal duct
• middle meatal antrostomy
• endoscopic Denker operation

Acknowledgments

The authors would like to thank Dr Daniel B. Simmen and Dr Hans R. Briner from the Clinic Hirslanden Center for Rhinology and Facial Plastic Surgery in Zurich for surgical instructions regarding principles of the presented approach to the maxillary sinus. This study was supported by grant no. 113-59780 L from the Medical University of Bialystok, Poland.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.