Optimizing Visualization and Access to the Maxillary Sinus through the Prelacrimal Approach

Authors: Ruggeri CS*, Herranz F, Acosta L, Serrano C and Marinelli S

DOI: 10.23880/ooaj-16000290

Volume 9, Issue 1

Abstract

Objectives: To determine if endoscopic endonasal prelacrimal approach to the maxillary sinus would be feasible based on the space available between the posterior limit of the frontal process of the maxilla (FPM) at the level of its junction with the anterior wall of the sinus and the anterior wall of the lacrimal duct (NLD) and the rate of complications caused by this approach according to the access space. Material and Methods: Patients who underwent endonasal prelacrimal approach to the maxillary sinus from September 2021 to March 2023 were prospectively evaluated. The distance between the posterior limit of the FPM, at the level of its junction with the anterior wall of the sinus, and the NLD was established on axial cuts of preoperative computed tomography. Three grades were established based on the space between the FPM and the LND: 1) distance less than 3 mm, II) distance between 3 to 7 mm, and III) Distance greater than 7 mm. Results: A total of 30 patients were treated using either a standalone prelacrimal maxillary approach or combined with a medial maxillary antrostomy. There were 5 patients with grade I, 15 with grade II, and 10 with grade III. Only one patient experienced a complication of the approach, transient epiphora for 2 months. In all patients, the prelacrimal approach could be performed without difficulties. Conclusions: The space between the posterior limit of the FPM at the level of its junction with the anterior wall of the sinus and the NLD was not relevant for performing a prelacrimal approach to the maxillary sinus. In cases of reduced prelacrimal windows, the LND was dissected and medialized to perform osteotomy and expose the maxillary sinus. The frequency of complications was 0,3% and was not related to a reduced space (grade 1).

Keywords: Prelacrimal Approach; Maxillary Sinus; Lacrimal Duct; Frontal Process of the Maxilla; Inferior Meatus; Endoscopic Surgery; Endonasal; Medial Maxillary Antrostomy; Epiphora; Inverted Papilloma

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