J Rhinol.  2022 Mar;29(1):43-47. 10.18787/jr.2021.00368.

Modified Transseptal Approach: An Adjunct to Prelacrimal Recess Approach for Extensive Inverted Papilloma of Maxillary Sinus, How We Do It

• Varghese G
• Thomas RM

• KMID: 2528319
• DOI: http://doi.org/10.18787/jr.2021.00368

Abstract

The transseptal approach to the maxillary sinus has been described for resection of extensive tumours of the nose and paranasal sinuses. We describe a modification of this method in a patient diagnosed with inverted papilloma for which he had undergone two previous operations. This method provides complete access to the maxillary sinus, particularly the anterior wall, to provide adequate reach and ensure complete removal of tumours. We describe a technique modifying the existing transseptal approach used as an adjunct to prelacrimal recess approach, wherein a hemitransfixation incision placed in the contralateral nasal cavity along the septum provides access to the maxillary sinus with angled instruments. This modified transseptal approach provided better reach and access to the maxillary sinus. Postoperatively, there was no evidence of septal scarring or perforation and no evidence of lesion recurrence. Our technique is an easy modification to the transseptal approach that is a useful tool to access hidden areas of the maxillary sinus without associated morbidity.

Keyword

Nasal septum; Inverted papilloma; Maxillary sinus; Sinusitis

Figure

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  Fig. 1. Preoperative diagnostic nasal endoscopy.

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  Fig. 2. Contrast enhanced magnetic resonance imaging of paranasal sinuses. (A) Axial and (B) coronal cut.

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  Fig. 3. Incision made anterior to right inferior turbinate and extended along the floor of nose, posteriorly (star indicates inverted papilloma and arrow indicates remnant of inferior turbinate).

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  Fig. 4. Flap elevated exposing entire lateral wall of nose.

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  Fig. 5. Incision was extended posteriorly, horizontal along the superior part of nasal septum beneath the nasal roof (left side).

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  Fig. 6. A curved needle (Ethilon 3-0, Ethicon, Johnson and Johnson, Piscataway, NJ, USA) is introduced from the diseased side corresponding to the maxillary sinus opening.

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  Fig. 7. Cruciate incision made along contralateral part of septal cartilage, corresponding to the point of entry of the curved needle (Ethilon 3-0, Ethicon, Johnson and Johnson, Piscataway, NJ, USA).

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  Fig. 8. Curved instruments (Rad Blades 15, 40 and 60 degree, Medtronic Xomed Inc., Jacksonville, FL, USA) are introduced through this incision providing access to entire anterior wall of maxillary sinus on diseased side.

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  Fig. 9. Bone lying beneath tumour attachment is drilled.

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  Fig. 10. The 3-0 Vicryl RapideTM (Vicryl Rapide, Ethicon, Johnson and Johnson, Piscataway, NJ, USA) with a knot at one end was used for flap suturing.

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  Fig. 11. Septal suturing done.

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