Clin Exp Otorhinolaryngol.  2019 Aug;12(3):287-293. 10.21053/ceo.2018.01165.

Comparison Between Endoscopic Prelacrimal Medial Maxillectomy and Caldwell-Luc Approach for Benign Maxillary Sinus Tumors

• Lee JJ
• Ahmad Z AM
• Kim D
• Ryu G
• Kim HY
• Dhong HJ
• Chung SK
• Hong SD

• KMID: 2455370
• DOI: http://doi.org/10.21053/ceo.2018.01165

Abstract

OBJECTIVES
Endoscopic prelacrimal medial maxillectomy (EPMM) was previously reported to treat maxillary inverted papilloma. This study aimed to compare prelacrimal recess approach with the conventional Caldwell-Luc approach (CLA) to remove benign maxillary sinus tumors and to evaluate the usefulness of this approach based on our experience.
METHODS
Ten patients who underwent EPMM at our hospital from January 2013 to December 2017 were reviewed. We also reviewed 30 patients who underwent benign maxillary sinus tumor resection via CLA during the same period. From medical records, postoperative pathological results, complications due to surgery, and recurrence rate were evaluated.
RESULTS
There were eight inverted papilloma, one ameloblastoma, and one ossifying fibroma in the EPMM group. In the CLA group, all 30 cases were inverted papilloma. There were no cases of failure at gross total removal during surgery, and no recurrences were observed during follow-up in either groups. Mean follow-up period was 13.0 months in CLA group and 10.8 months in EPMM group. Regarding postoperative complications, 11 patients of the CLA group (37%) and three patients of the EPMM group (30%) had numbness around the cheek and upper lip area after surgery (P=0.715). In the CLA group, there were eight patients who had numbness lasting more than 3 months after surgery, and two patients had numbness for more than 1 year. However, facial numbness disappeared within 3 months in all patients in the EPMM group, in which epiphora was not observed.
CONCLUSION
EPMM is the effective surgical approach for resecting benign maxillary sinus tumor compared with CLA. Although facial numbness was reported in EPMM, the duration of numbness was shorter than CLA.

Keyword

Prelacrimal Recess Approach; Maxillary Sinus Neoplasms; Caldwell-Luc Approach; Inverted Papilloma; Endoscopy

MeSH Terms

Ameloblastoma
Cheek
Endoscopy
Fibroma, Ossifying
Follow-Up Studies
Humans
Hypesthesia
Lacrimal Apparatus Diseases
Lip
Maxillary Sinus Neoplasms
Maxillary Sinus*
Medical Records
Papilloma, Inverted
Postoperative Complications
Recurrence

Figure

• 

  Fig. 1. Surgical procedures for prelacrimal recess approach medial maxillectomy. (A) Mucosal incision of the lateral nasal wall at the inferior turbinate anterior margin. (B) Elevation of the lateral nasal wall mucosa posteriorly. (C) Identification of the lacrimal bone by navigation (asterisk). (D) Identification of the lacrimal duct (arrow) after removing the lacrimal bone. (E) Drilling the medial wall of the prelacrimal recess. (F) Full exposure of the maxillary sinus. (G) Reposition of mucosal flap and suture an incision site after tumor removal. (H) Endoscopic finding at postoperative 1 month.

• 

  Fig. 2. Three cases using the prelacrimal recess approach for maxillary sinus inverted papilloma. Left shows preoperative radiological finding, and right is postoperative follow-up image. (A) Medial wall-attached inverted papilloma. (B) Anterior wall-attached inverted papilloma. (C) Inverted papilloma of diffuse attachment to the maxillary sinus.

• 

  Fig. 3. Ossifying fibroma excision case using endoscopic prelacrimal medial maxillectomy. (A) Fibro-osseous lesion in the anterior wall of the left maxillary sinus shown on preoperative computed tomography (CT) scan (arrow: infraorbital nerve). (B) Bony tumor in the maxillary sinus anterior wall encasing the infraorbital nerve (asterisk). (C) Decompressed infraorbital nerve was defined. (D) Postoperative 6-month CT scan showed removal of bony tumor and only a small amount of soft-tissue lesion remaining (arrow: infraorbital nerve).

• 

  Fig. 4. Ameloblastoma excision case using endoscopic prelacrimal medial maxillectomy. (A) Computed tomography (CT) scan showed a large expansile mass in the left maxillary sinus. (B) A well-capsulated round mass was successfully removed. (C) Postoperative 18-month CT scan showed absence of tumorous lesion and well pneumatized maxillary sinus.

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