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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EMM is an endonasal surgical procedure but does not appear to be a desirable approach because it necessitates the resection of the inferior turbinate and the cutting of the nasolacrimal duct, which impairs the function of the nose and may induce postoperative lacrimation [ 11 ]. We performed MEMMs in 37 maxillary sinuses of 24 patients. 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.

Critical revision of the manuscript for important intellectual content: Postoperative observation of nasal cavity. The surgery was performed under general anesthesia.

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

Our study is an attempt mmaxillectomy define this subset of patients and a protocol for the treatment of these patients see Fig. The inferior turbinate bone was observed endoscopically and the conchal crest was cut with a chisel, allowing for the inferior portion of the nasolacrimal duct to be observed and for the inferior turbinate bone to be freely moved medially. 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.


EMMM is not a difficult procedure and provides good visibility of the operative field.

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

However, EMM usually removes the inferior turbinate and nasolacrimal duct. At present, there are no definitive guidelines for the treatment of this subset of patients. As the nasolacrimal duct could be clearly observed by endoscope, the tumor deviating to the inferior meatus and the lateral mucosa and the bony wall of the inferior meatus could be sufficiently resected.

Others 16 have supported this notion that an endoscopic medial maxillectomy is completed only with resection of the medial wall of the maxilla including the inferior turbinate up to its anterior wall.

All patients underwent a diagnostic nasal endoscopy. All procedures were done under general anesthesia. Decision to surgically intervene and to determine the type of surgery was inferred by results of the dye test. One patient had postoperative bleeding from the sphenopalatine artery, which was controlled in the operation theater by cauterization. Modified endoscopic medial maxillectomy for chronic maxillary sinusitis.

The areas that may offer difficulty include the sinus recesses and the anteromedial wall. Ponnaiah Thulasidas 1 and Venkatraman Vaidyanathan 2. Maxillary sinus was widely opened from the inferior meatus side so that endoscope could be inserted from inferior meatus towards maxillary sinus.

Surgical Method The aim of the surgery is to provide gravity-dependent drainage of the maxillary sinus. It was considered that there were all IP-involved mucosae without normal mucosa inside the maxillary sinus.

Case Reports in Otolaryngology

Many of these lesions, including inverted papillomas, have shown favorable outcomes with transnasal endoscopic resections. One patient with mucocele was referred for dacryocystorhinostomy because of epiphora. 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.


The patient gave her consent.

Role of Modified Endoscopic Medial Maxillectomy in Persistent Chronic Maxillary Sinusitis

Medial maxillectomy through a lateral rhinotomy incision involves the removal of the lateral nasal wall, ethmoid labyrinth, and medial portion of the maxilla. When there was a large ostium, 0. The frontal and maxillary sinuses were opened wide, while the posterior ethmoidal sinus was not opened. MRI T1 Gd-DTPA shows secondary maxillary sinusitis and a serpentine cerebriform filamentous structure, but there is no mass to otherwise indicate a possible origin.

The details of the patients are listed in Table 2.

Introduction The central dogma of functional endoscopic sinus surgery is restoration of the natural sinus physiology, namely mucociliary clearance and ventilation. A computed tomography CT scan of the paranasal sinus may reveal localized thickening of maxiloectomy bone [ 67 ], indicating the site of origin of IP. We have attempted to highlight this point through this article.

This was done in two ways. Preoperative observation of nasal cavity.

Purchase access Subscribe to JN Learning for one year. This is done in patients with a prior inferior meatal antrostomy and maxiklectomy middle meatal antrostomy Caldwell-Luc. Recalcitrant, chronic maxillary sinusitis is an underreported entity.

Details of the surgery are described in the Surgical Method section. Note that the middle turbinate, nasolacrimal duct, and anterior portion of the inferior turbinate are preserved Fig. Sign in to download free article PDFs Sign in to access your subscriptions Sign in to your personal account.

The aim of the surgery is to provide gravity-dependent drainage of the maxillary sinus.