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.

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

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.

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.

Treatment of Blow-out Fracture Located in the Posterior Portion of the Orbital Floor

Until now, there has been many papers about orbital blow-out fracture, but reports regarding the treatment and the prognosis of fractures located in the posterior portion of the orbital floor have been limited. The most common fracture site of the orbital floor is the medial portion of the infraorbital groove and repairing of the floor fracture located in the anterior portion of the floor is relative easy and has minimal complications. But when the fracture is located in the posterior portion of the floor, the possibility of the optic nerve injury is anticipated by surgical manipulation itself and the implanted silastic sheet Authors reconstructed posterior portion of the orbital floor fracture through conjunctival approach combined with Caldwell-Luc procedure in 5 patients, confirmed posterior orbital floor fracture on CT scan from July 1993 to November 1994. The results were satisfactory with no residual diplopia. Complications including prolonged maxillary sinusitis and lateral canthal deformity were encountered in each patient, but cured with ENT treatment and lateral canthoplasty. In reconstruction of orbital floor fracture, Caldwell-Luc approach was seldom used because of several reasons including the poor predictability, bleeding problrm, and the high incidence of sinus infection. But recently, Caldwell-Luc approach is reanimated by some endoscopic surgeons because of good visualization and less traumatic. In case of posterior floor fracture, our surgical method can reduce the possibility of injury to optic nerve and vital tissues around the orbital apex in spite of enlarging surgical field.