Comparison Between Endoscopic Prelacrimal Medial Maxillectomy and Caldwell-Luc Approach for Benign Maxillary Sinus Tumors

OBJECTIVES: Endoscopic prelacrimal medial maxillectomy (EPMM) was previously reported to treat maxillary inverted papilloma. This study aimed to compare prelacrimal recess approach with the conventional Caldwell-Luc approach (CLA) to remove benign maxillary sinus tumors and to evaluate the usefulness of this approach based on our experience. METHODS: Ten patients who underwent EPMM at our hospital from January 2013 to December 2017 were reviewed. We also reviewed 30 patients who underwent benign maxillary sinus tumor resection via CLA during the same period. From medical records, postoperative pathological results, complications due to surgery, and recurrence rate were evaluated. RESULTS: There were eight inverted papilloma, one ameloblastoma, and one ossifying fibroma in the EPMM group. In the CLA group, all 30 cases were inverted papilloma. There were no cases of failure at gross total removal during surgery, and no recurrences were observed during follow-up in either groups. Mean follow-up period was 13.0 months in CLA group and 10.8 months in EPMM group. Regarding postoperative complications, 11 patients of the CLA group (37%) and three patients of the EPMM group (30%) had numbness around the cheek and upper lip area after surgery (P=0.715). In the CLA group, there were eight patients who had numbness lasting more than 3 months after surgery, and two patients had numbness for more than 1 year. However, facial numbness disappeared within 3 months in all patients in the EPMM group, in which epiphora was not observed. CONCLUSION: EPMM is the effective surgical approach for resecting benign maxillary sinus tumor compared with CLA. Although facial numbness was reported in EPMM, the duration of numbness was shorter than CLA.

Mucocele del seno maxilar: Reporte de caso

Los mucoceles maxilares son lesiones que tienen un crecimiento gradual. Son de tipo quístico y contienen secreciones mucoides que causan erosiones a estructuras vecinas al aumentar su tamaño. Aunque la mayoría de las veces son completamente asintomáticas, pueden presentarse síntomas como dolor facial opaco, inflamación en la mejilla, y obstrucción nasal. Estos síntomas y cambios en la simetría facial se hacen presentes cuando hay erosión significativa de estructuras anatómicas circundantes. EL seno maxilar es el sitio menos frecuente donde se forman , y su diagnóstico se realiza con la ayuda de una tomografía computadorizada. La remoción quirúrgica completa es el mejor tratamiento indicado.

The maxillary sinus mucoceles are lesions which grow gradually. They are cyst like lesions which have mucoid secretions that cause erosion to neighboring structures as they increase in size. Although they are often asymptomatic, they can be present as dull orofacial pain, inflammation on the cheek and nasal obstruction. These symptoms and changes in facial symmetry are present when there is significant erosion to surrounding anatomic structures. The Maxillary Sinus is the less frequent site where these lesions will form, and the diagnosis is done with the assistance of Computerized Tomography. Complete surgical removal is the best treatment option.

Mucocele de seno maxilar: revisión a propósito de un caso / Maxillary Sinus Mucocele: Review of case report

El Mucocele del seno maxilar es una formación quística benigna originada en el interior del mismo, limitado por un epitelio (mucosa sinusal) con un contenido de moco. Es una patología poco frecuente que puede causar grandes dificultades a la hora de resolver su terapéutica, sobre todo en aquellos casos que invaden la órbita llevando a una exoftalmia. El presente estudio reporta el caso de un mucocele de seno maxilar derecho, en una paciente de sexo femenino de 68 años. Al examen clínico se visualizaba una deformación por vestibular desde el área de la pieza dentaria 12 a la 16. Al examen imagenológico se observaba el seno maxilar ocupado con límites cercanos a la órbita. Se realizó una biopsia exéresis, con resultado histopatológico de Mucocele de seno maxilar. Se discute su presentación y tratamiento clásico...

Maxillary sinus mucocele is a benign cyst formation that originates within the sinus and is lined by epithelium (sinus mucosa) containing mucus. It is a rare condition for which it might be very difficult to find a suitable therapeutic approach, especially when it involves the orbit, leading to exophthalmos.This study reports the case of a right maxillary sinus mucocele in a 68-year-old female patient. Through clinical examination, vestibular deformation from tooth 12 to tooth 16 was determined. Radiologic examination showed that the maxillary sinus was affected, with borders near the orbit. An excision biopsy was performed, which showed histopathological findings of maxillary sinus mucocele. Presentation and classic treatment are discussed...

Compressive Trigeminal Neuropathy after Caldwell-Luc Operation

Most postoperative maxillary cysts develop more than 10 years after a Caldwell-Luc operation. They can manifest with cheek pain, swelling and dental and visual symptoms. Brain imaging should be performed to distinguish trigeminal nerve compression from various other possible causes. It should be treated by surgical intervention to relieve the above-mentioned symptoms. We report a patient who presented with compressive trigeminal neuropathy caused by a postoperative maxillary cyst.

Compressive Trigeminal Neuropathy after Caldwell-Luc Operation

Most postoperative maxillary cysts develop more than 10 years after a Caldwell-Luc operation. They can manifest with cheek pain, swelling and dental and visual symptoms. Brain imaging should be performed to distinguish trigeminal nerve compression from various other possible causes. It should be treated by surgical intervention to relieve the above-mentioned symptoms. We report a patient who presented with compressive trigeminal neuropathy caused by a postoperative maxillary cyst.

Infraorbital nerve schwannoma: A rare cause of upper jaw swelling.

Introduction: Schwannoma of the infraorbital nerve is a rare entity, with lesser than a dozen cases reported in literature and only one from India. Report: This article reports a 23-year-old male presenting with a painless swelling in the cheek, which was eventually diagnosed as infraorbital nerve schwannoma. He underwent a complete excision of the tumor via a Caldwell Luc approach and continues to be disease free on 3 year follow-up. Conclusion: Despite its rarity, infraorbital nerve schwannomas should be considered in the differential diagnosis, of upper jaw swelling. We recommend the Caldwell Luc approach as safe, effective and cosmetically acceptable, for anteriorly based infraorbital schwannomas, and review literature on this unusual entity

Bilateral Cholesterol Granuloma of Maxillary Sinus: A Case Report

Cholesterol Granuloma [CG] is a rare pathology found in the paranasal sinuses and is usually associated with middle ear infections. The etiology of sinonasal CG is not yet known. The clinical manifestations are nonspecific. Most patient presents with nasal discharge, facial pain and nasal obstruction similar to current case. The additional feature observed in the present case was bilateral CG of the maxillary sinus which was extending into ostiomeatal complex and into the oral cavity, whose clinical, imaging and histological characteristics were unique.

Diagnosis and Treatment of Unilateral Maxillary Sinus Hypoplasia

A Case of Ameloblastoma in the Maxilla

Ameloblastoma is a benign tumor originating from residues of the dental lamina. Ameloblastoma constitute approximately 1% of all tumors of the jaw, and the occurrence in the mandible is four times higher than that in the maxilla, suggesting that maxillary ameloblastoma is a rare histopathological entity. Although these tumors grow slowly and demonstrate a histologically benign appearance, ameloblastomas are notorious for local invasiveness and a high incidence of local recurrence. We experienced a case of ameloblastoma arising from the left maxilla in a 70-year-old male who complained of left nasal obstruction. The ameloblastoma was completely removed via the endoscopic endonasal approach combined with the Caldwell-Luc approach. At a 29-month follow-up, there was no evidence of recurrence.

Fibrous dysplasia of the maxillary sinus: case report

Introduction and objective: Fibrous dysplasia is a non-neoplastic lesion of unknown origin with one-fourth involving head and neck. The aim of this paper is to report a case of fibrous dysplasia of the maxillary sinus, describing its clinical presentation, radiological features, histopathological appearance and surgical management. Case report: 38-year-old female patient who presented with a history of fullness of the right cheek and intraoral swelling was diagnosed to have fibrous dysplasia of the maxilla with involvement of the maxillary sinus based on the radiological features. The case was managed surgically via a conventional Caldwell-Luc approach. The histopathology of the excised tissue confirmed the diagnosis of fibrous dysplasia. Conclusion: Fibrous dysplasia is a benign non-neoplastic lesion of unknown origin that rarely involves the maxillary sinus. This case report highlights the clinical, radiological and pathological features of fibrous dysplasia and its surgical management. Conventional Caldwell-Luc approach allows more exposure and ensures complete removal of the lesion.

Endoscopic-assisted Enucleation of Radicular Cysts — A Case Report

The standard management for the majority of benign jaw cysts is enucleation, marsupialisation, curettage and decompression. Enucleation has the advantage that the whole specimen is sent for microscopic evaluation so that more sinister pathological processes (i.e. squamous cell carcinoma) may not be missed. In a large cystic lesion, enucleation is still possible, but technical difficulties might be encountered. In such instances, inevitable damage can occur to the surrounding structures. We report a case of a large radicular cyst of the maxilla that was enucleated via endoscopic assistance through the Caldwell Luc approach.

Role of the "Mini" Caldwell-Luc Operation for Treatment of Chronic Maxillary Sinusitis

BACKGROUND AND OBJECTIVES: The aims of the study were to reintroduce a surgical technique for a "mini" Caldwell-Luc operation and to determine its efficacy. MATERIALS AND METHODS: A prospective study was performed in 23 patients undergoing the "mini" Caldwell-Luc operation. Improvements in clinical symptoms and endoscopic and computed tomographic (CT) findings were evaluated postoperatively over a follow-up period ranging from 6 to 21 months. All patients were surveyed for nasal symptoms (nasal obstruction, rhinorrhea, posterior nasal drip, headache, and anosmia), complications (tooth or gum pain, numbness, persistent facial pain, and facial hypo-paresthesia), and recurrence. Preoperative nasal polyps were classified by the Gaskins method, and preoperative paranasal sinusitis was graded according to the Kennedy CT staging system. RESULTS: Symptom scores were all significantly reduced postoperatively (paired t-test, p<0.05). There were no major complications specific to this technique. Among 29 maxillary sinuses that received the "mini" Caldwell-Luc operation, seven showed recurrence (24%). CONCLUSION: The "mini" Caldwell-Luc operation provides an alternative method of obtaining access to the maxillary antrum and is associated with minimal morbidity.

Treatment Results of 111 Cases of Antrochoanal Polyp

BACKGROUND AND OBJECTIVES: Antrochoanal polyp (ACP) is a benign maxillary sinus polyp that originates from the mucosa of the maxillary sinus, passes through the sinus ostium, and extends into the choana. Surgical methods employed in the treatment of antrochoanal polyp are simple avulsion, Caldwell-Luc operation, osteoplastic maxillary sinus operation, and endonasal endoscopic removal. In this study, we evaluated the clinical presentation of ACP and compared its surgical outcomes. MATERIALS AND METHODS: We retrospectively reviewed 111 patients who were treated for ACP between January 1995 and May 2008, and analyzed clinical features, radiologic findings, and surgical results. RESULTS: The study group consisted of 111 patients (65 males, 46 females) with a mean age of 20.0 years (range, 4 to 70). Sixty-one cases were accompanied by sinusitis (20 with unilateral sinusitis, 41 with bilateral sinusitis). Endoscopic sinus surgery (ESS) was used to treat 95 cases, and the external approaches of Caldwell-Luc operation or osteoplastic maxillary sinus operation were applied in 12 and four cases, respectively. Among those who received ESS, ACP recurred in 16 cases, whereas none of the patients who received the external approach showed recurrence. CONCLUSION: Endoscopic sinus surgery is a good alternative method for the treatment of ACP. If the antral part of ACP cannot be removed completely, an external approach such as Caldwell-Luc operation or osteoplastic maxillary sinus operation for pediatric patients may be considered to prevent recurrence.

Glucocorticoid Receptor-beta Overexpression According to Nasal Polyp Severity: Immunohistochemical Study

BACKGROUND AND OBJECTIVES: The aims of the study were to reintroduce a surgical technique for a "mini" Caldwell-Luc operation and to determine its efficacy. MATERIALS AND METHODS: A prospective study was performed in 23 patients undergoing the "mini" Caldwell-Luc operation. Improvements in clinical symptoms and endoscopic and computed tomographic (CT) findings were evaluated postoperatively over a follow-up period ranging from 6 to 21 months. All patients were surveyed for nasal symptoms (nasal obstruction, rhinorrhea, posterior nasal drip, headache, and anosmia), complications (tooth or gum pain, numbness, persistent facial pain, and facial hypo-paresthesia), and recurrence. Preoperative nasal polyps were classified by the Gaskins method, and preoperative paranasal sinusitis was graded according to the Kennedy CT staging system. RESULTS: Symptom scores were all significantly reduced postoperatively (paired t-test, p<0.05). There were no major complications specific to this technique. Among 29 maxillary sinuses that received the "mini" Caldwell-Luc operation, seven showed recurrence (24%). CONCLUSION: The "mini" Caldwell-Luc operation provides an alternative method of obtaining access to the maxillary antrum and is associated with minimal morbidity.

A rare cause of nasolacrimal duct obstruction: Dentigerous cyst in the maxillary sinus.

The most common abnormality of the lacrimal drainage system is congenital or acquired nasolacrimal duct obstruction. The causes of acquired nasolacrimal duct obstruction may be primary or secondary. The secondary acquired obstructions may result from infection, inflammation, neoplasm, trauma or mechanical causes. The maxillary sinus cysts usually obstruct the nasolacrimal duct mechanically. Dentigerous cysts are one of the main types of maxillary cysts. These cysts are benign odontogenic cysts which are associated with the crowns of unerupted teeth. The clinical documentations of mechanical nasolacrimal duct obstructions due to a dentigerous cyst in the maxillary sinus are very rare in literature. In this case report, we describe a dentigerous cyst with a supernumerary tooth in the maxillary sinus in an 11-year-old male child causing an obstruction to the nasolacrimal duct. The case was successfully managed surgically by Caldwell Luc approach.

Two Cases of Pneumocele of Maxillary Sinus / 대한이비인후과학회지

Pneumocele is a rare disease involving one or more paranasal sinuses. It is defined as abnormal dilatation of paranasal sinus, which is air-filled with either focal or generalized thinning of bony sinus walls. The aim of pneumocele treatment is two-fold: to re-establish permanent pressure equilibrium in the involved sinus and to correct the possible facial deformities. The first goal can be achieved by middle meatal antrostomy. When alterations of the maxillary or orbital contour are present, corrections can be obtained by osteotomies through Caldwell-Luc or an infraorbital approach. We report two cases of pneumocele of maxillary sinus. The first case was treated with osteotomy via Caldwell-Luc approach and the second case was treated simultaneously with osteotomy and rhinoplasty. No recurrence was observed after surgical treatment in both cases.

Removal of extensive maxillary dentigerous cyst via a Caldwell-Luc procedure

A case of a large dentigerous cyst associated with canine tooth in the maxillary antrum is presented. This case is of interest because of its extensiveness and the presence of an ectopic tooth in the roof of the maxillary sinus. Theoretical aspects of canine impaction and cyst formation are reviewed. The management of a jaw cyst, in particular, the still popular Caldwell-Luc procedure is discussed.

Case report: Maxillary sinus aspergillosis

The incidence of aspergillosis infections in the maxillary sinus has increased recently, because of overuse of antibiotics, steroids, anticancer agents, immunosuppressant, antimetabollites, and uncontrolled diabetes mellitus. The clinical features of maxillary sinus aspergillosis include pain, swelling and foul odor nasal excretion. This needs to be differentiated from bacterial maxillary sinusitis, and surgical treatment with antifungal agents are suggested. Recently, we treated two patients with maxillary sinus aspergillosis surgically (Caldwell Luc operation) and with antifungal agents(itraconazole). The results were satisfactory so we report these cases with literature review.

Acute pulmonary edema caused by impaired switching from nasal to oral breathing during the caldwell-luc operation resulting from anesthesia: a case report

Nasotracheal intubation is performed routinely in maxillofacial surgery to optimize visualization of the surgical field. The CaldwellLuc operation is an approach to the maxillary sinus through the labiogingival sulcus and canine fossa. The operation is used to treat chronic maxillary sinusitis, and involves curettage of the mucosa of the maxillary sinus and the creation of an inferior meatal antrostomy. After the operation, a nasal Foley catheter is inserted into the inferior nasal meatus for the discharge of blood and tissue fluid. Then, the nostril is packed with vaseline gauze. Before the patients awaken, they experience impaired switching from nasal to oral breathing. Pulmonary edema can result from excessive negative intrathoracic pressure caused by acute airway obstruction in patients breathing spontaneously. During anesthesia and sedation, airway obstruction can occur at the levels of the pharynx and larynx. Even in patients who are awake, alteration in the ability to change the breathing route from nasal to oral may affect breathing in the presence of an airway obstruction, causing this catastrophic event. We experienced a case in which acute pulmonary edema resulted from acute airway obstruction triggered by the patient's inability to switch the breathing route from nasal to oral during emergence from anesthesia.