resection of the medial and superomedial walls of the maxillary antrum. It is increasingly being done by transnasal endoscopic technique for suitable cases. the authors describe the endoscopic medial maxillectomy for neoplastic diseases involving the as operative technique for endoscopic medial maxillectomy. Conclusion Modified endoscopic medial maxillectomy appears to be an effective surgery for treatment of chronic, recalcitrant maxillary sinusitis.

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The patient gave her consent.

Granulation-like mucosal edema remained, but the maxillary sinus was meedial opened from the middle and inferior meatus sides. As shown in a cadaveric resection in Figure 3 and an endoscopic visualization of the maxillary sinus following TEMM in Figure 4TEMM allows for a wide view of the posterior, anterior, lateral, inferior, and superior borders of the maxillary sinus.

This allows for full access to the maxillary sinus, including the anterior and lateral walls, the ethmoid sinuses, and the anterior wall of the sphenoid sinus. No movement of dye indicates irreversible loss of ciliary function and hence a simple widening of the already widened ostium i.

Distribution of total maxillary sinus volume meial 38 maxillary sinuses. This approach can preserve the inferior turbinate and nasolacrimal duct.

EMMM produces access to the maxillary sinus identically to conventional EMM, despite preservation of the inferior turbinate and nasolacrimal duct. Our study is an attempt to define this subset of patients and a protocol for the treatment of these patients see Fig.

Role of Modified Endoscopic Medial Maxillectomy in Persistent Chronic Maxillary Sinusitis

The contrast CT shows bone defects in the anterior and medial walls of the maxillary sinus. Lacrimation and empty nose syndrome do not occur postoperatively as the nasolacrimal duct and inferior turbinate are preserved. We can deduce three conclusions from this test: We have attempted to evaluate the sinus physiology using a simple and easily reproducible methylene blue dye test, which can be performed in the office.


The inferior turbinate has a critical function in conditioning of the nasal airflow, and resection of the nasolacrimal ducts has a risk of epiphora. Top 10 reasons for endoscopic maxillary sinus surgery failure.

En bloc specimen after transnasal endoscopic medial maxillectomy. For treatment of a sinonasal inverted papilloma IPit is essential to have a definite diagnosis, to identify its origin by computed tomography CT and magnetic resonance imaging MRIand to select the appropriate surgical approach based on the staging system proposed by Krouse.

As familiarity and expertise with endoscopic techniques increase, these approaches are being used more frequently in the extirpation of sinonasal tumors.

Our website uses cookies to enhance your experience. We feel that merely taking down the medial wall of the maxillary antrum does not serve the purpose in patients with irreversible mucosal injury and necessitates a more radical procedure like a type IIb MEMM. We advocate a surgery that would ensure gravity-dependent drainage of the sinus as it will be the only means for drainage in the absence of viable mucosa.

Copyright American Medical Association. Details of the surgery are described in the Surgical Method section. Findings in the nasal cavity were similar to those after ESS Figure 5and the patient did not complain of either an empty nose or dryness in the nose. Case Presentation A year-old woman visited an otorhinolaryngologist with 5-year history of nasal congestion. We developed a newly derived surgical technique, endoscopic modified medial maxillectomy EMMMwhich enables preservation of the inferior turbinate and nasolacrimal duct.

The average age was Transnasal endoscopic medial maxillectomy in inverted papilloma. Transnasal endoscopic medial maxillectomy provides exposure for endoscopic resection of the orbital wall, pterygopalatine fossa, pterygoid plates, nasopharynx, and anterior skull base when indicated.

The anterior limit of dissection is the nasolacrimal duct. Adult patients with tumors of the head but outside the sinonasal region were selected for the study. Get free access to newly endkscopic articles. Analysis and interpretation of data: It is a true medial maxillectomy, involving resection of the entire lateral nasal wall.


maxillectomg This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A wide middle meatal antrostomy is usually sufficient in patients with normal movement of dye. EMM or TA is recommended for stage Endoscooic, in which lesions exist on the lateral side and the inferior, posterior, and anterior walls of the maxillary sinus.

Endoscopic medial maxillectomy with preservation of inferior turbinate and nasolacrimal duct.

The medial wall of the maxillary sinus is removed right down to the nasal floor inferiorly and up to the posterior wall posteriorly. The anterior end of the inferior turbinate and the medial wall anterior to the nasolacrimal duct is preserved.

Statistical analysis was performed, and mean, median, and standard deviation of these values were calculated using SPSS statistical software version We advocate a surgery that would ensure gravity-dependent drainage of the sinus. Table of Contents Alerts. Results of endoscopic maxillary mega-antrostomy in recalcitrant maxillary sinusitis.

Endoscopic medial maxillectomy with preservation of inferior turbinate and nasolacrimal duct.

Images with endosckpic of any sinonasal disease inflammatory or neoplastic were excluded from the study.

Type Indication Procedure I Recirculation mechanism due to two windows in middle meatus and inferior meatus e. Bringing the medial maxillary wall to the level of the nasal floor appears to alleviate symptoms in these patients.

Therefore, volumetric analysis of 38 maxillary sinuses was performed. We did remove the mucosa only without thinning of the bony wall of the maxillary sinus.