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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Received Sep 27; Accepted Dec Back to top Article Information. The patient refused to undergo lateral rhinotomy and was therefore informed that ESS and EMMM procedures would be used concomitantly and that a transantral approach TAColdwell-Luc surgery, would be used if necessary.

Our study is an attempt to define this subset of patients and a protocol for the treatment of these patients see Fig. LR requires a skin incision.

A year-old woman visited an otorhinolaryngologist with 5-year history of nasal congestion. Distribution of total maxillary sinus volume for 38 maxillary sinuses. Arch Otolaryngol Head Neck Surg. Values measured included the volume of the maxillary sinus inferior to a transverse line through the most superior insertion of the inferior turbinate to the lateral nasal wall hereinafter, V1the volume of the maxillary sinus superior to this line hereinafter, V2the volume of the maxillary sinus anterior to the most posterior portion of the nasolacrimal canal hereinafter, V3and the total volume of the maxillary sinus hereinafter, V4.

In addition, it should provide wide access for extended resections when indicated.

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

Careful follow-up is essential to prevent recurrence or malignancy following surgery. This subset of patients often has persistent sinus disease despite medical therapy and adequate antrostomy.

The levels of SCC antigen had decreased to 2. Medkal modifications of the medial maxillectomy. Open in a separate window. It was the gold standard for the removal of inverted papilloma. 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.


The surgery was performed under general anesthesia. Our experience indicates that EMMM is an effective and relatively easy approach for treating IP that originated in the anterior, inferior, and medial walls of the maxillary sinus. The tumor on the inferior wall could be observed as the lateral wall of the inferior meatus was resected down to the floor of the nasal cavity.

However, the inferior turbinate is resected to provide complete exposure of the maxillary sinus for drainage. Distribution of maxillary maxillectmoy volume inferior to the attachment of the inferior turbinate for 38 maxillary sinuses. Four patients had fungal balls, and one patient had chronic indolent fungal sinusitis. The drainage of the sinus is by gravity.

A computed tomography CT scan of the paranasal sinus may reveal localized thickening of the bone [ 67 ], indicating the site of origin of IP. Type II involves widening it posteriorly and inferiorly to a maximum of 2 cm.

Role of Modified Endoscopic Medial Maxillectomy in Persistent Chronic Maxillary Sinusitis

Alternatively, the dye could also be instilled into the sinus through a trocar in the canine fossa. The posterior portion could be observed with a 0-degree endoscope and the anterior portion could be observed by degree endoscope.

Recalcitrant, chronic maxillary sinusitis is an underreported entity. Preoperative CT scan is mandatory in all patients undergoing revision sinus surgery as it defines the bony anatomy or rather the loss of it due to previous surgery well. Resection of the lateral nasal wall to the level of the inferior meatus and anteriorly beyond the nasolacrimal canal is required to gain full access to the maxillary sinus during endoscopic medial maxillectomy.


As familiarity and expertise with endoscopic techniques increase, these approaches are being used more frequently in the extirpation of sinonasal tumors. Published endosxopic Feb Endoscopic medial maxillectomy is a radical procedure that includes removal of uncinate process, bulla, inferior turbinate, middle turbinate, and medial maxillary wall with the nasolacrimal duct. Revision functional endoscopic sinus surgery aims to overcome these shortcomings but can fall short due to irreversible damage to the mucous membrane by prior surgery.

Case Reports in Otolaryngology

In EMMM, a 0-degree endoscopy can provide adequate visibility of the lesion, and a degree side-viewing endoscopy allows the entire circumference of the maxillary sinus to maxillecto,y visible. Extended surgery, such as surgery for a malignant tumor, is recommended for T4 in which the tumor extends outside of maxillary sinus.

We have attempted to classify the severity of mucosal disease and advocate appropriate surgical treatment. Statistical analysis was performed, and mean, median, and standard deviation of these values were calculated using SPSS macillectomy software version Woodworth et al reported in a retrospective review comprising 19 patients that MEMMs are both safe and an effective treatment for chronic maxillary sinusitis refractory to standard medical and endoscopic surgical management.

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

En block resection is desirable, but this is difficult with an endoscope owing to the limited visibility of the operative field. In patients with a normally functioning sinus, this movement can be observed within minutes of instilling the dye. This approach can preserve the inferior turbinate and nasolacrimal duct.