Endoscopic nasal lateral wall dissection approach to maxillary sinus / 中华耳鼻咽喉头颈外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To report a new approach to maxillary sinus without ablation of nasolacrimal duct and inferior turbinate by endoscopic nasal lateral wall dissection (ENLWD). The preliminary clinical application results, the operative technique and indications were discussed.</p><p><b>METHODS</b>Twelve hospitalized patients, aged from 42 years to 68 years, were enrolled in this paper, 9 patients were male and 3 were female. Among the 12 patients, 8 were inverted papilloma (IP), 2 were nasal polyps, 1 was Kubo's postoperative cyst of maxillary sinus (MS) and 1 was recurrent bone cyst of maxilla. Two IP patients were excluded from this group for the follow-up time was less than 12 months. Preoperative nasal endoscopy and CT scan were done in all patients, 6 patients with tumor also received MRI examination. The operation began with a mucosal incision in front of inferior turbinate (IT) and then the lacrimal duct (LD) was dissected, thus a IT-LD flap was formed. The MS lesion was removed under endoscope when the flap was replaced medially. The inferior antrostomy was performed when the flap was repositioned.</p><p><b>RESULTS</b>All 10 patients were unilateral lesion. Six MS IP patients were T3 Krouse stage. The tumor was found originating from the every part of the MS wall in the operation, especially from the anterior and medial wall. The same situation was seen in 2 patients with nasal polyps. The follow-up ranged from 7 months to 60 months (average 22 months). The shape of IT was good, and well-epithelized operative cavities were observed. Only 1 patients of IP had a local recurrence in its inferior antrostomy 6 months after operation and no recurrence was seen after local debridement. All of them had no epiphora and other complications.</p><p><b>CONCLUSIONS</b>ENLWD is a new and minimally invasive approach not only to MS, in which the lesion can be thoroughly removed, but also to orbital floor and pterygopalatine fossa without ablation of lacrimal duct and IT.</p>