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.

Author: Ketilar Samujar
Country: Saint Kitts and Nevis
Language: English (Spanish)
Genre: Art
Published (Last): 1 January 2007
Pages: 186
PDF File Size: 18.89 Mb
ePub File Size: 9.1 Mb
ISBN: 595-4-39201-222-2
Downloads: 59288
Price: Free* [*Free Regsitration Required]
Uploader: Mezishura

Endoscopic surgery without sufficient visibility and an extended tumor origin are considered to be risk factors of recurrence. The aim of the surgery is to provide maxilllectomy drainage of the maxillary sinus.

The average age was Recalcitrant, chronic maxillary sinusitis is an underreported entity. A year-old woman visited an otorhinolaryngologist with 5-year history of nasal congestion.

Normal Mddial of Dye A wide middle meatal antrostomy is usually sufficient in patients with normal movement of dye. Krouse suggested a staging system based on the range of IP and further suggested the procedures that should be selected for IP at different stages [ madillectomy ].

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. The mean SD V1 was The contrast CT shows bone defects in the anterior and medial walls of the maxillary sinus. Recirculation mechanism due to two windows in middle meatus and inferior meatus e. We have also performed MEMMs for patients with AFRS and fungal ball of the maxillary sinus in accordance with the sinus mucosal status intraoperatively after the methylene blue dye test.

When there was a large ostium, 0.

Case Reports in Otolaryngology

Once the condition has unquestionably been diagnosed as IP, the appropriate approach masillectomy be selected. Though many would be reluctant to advocate a radical surgery like a medial maxillectomy for persistent maxillary sinusitis, it is imperative to understand the physiology and its alteration following surgery and chronic infection, which leads to a radical change in the functioning capacity kedial the maxillary sinus.


Images with evidence of any sinonasal disease inflammatory or neoplastic were excluded from the study. Bringing the medial maxillary wall to the level of the nasal floor appears to alleviate symptoms in these patients.

These patients are still symptomatic due to recirculation phenomenon where there is circular movement of the mucous around the artificially created window. Top 10 reasons for endoscopic maxillary endoscopicc surgery failure.

Simmen D, Jones N S. Though the ciliary mechanism is lost, the goblet cells continue to secret mucus, which results in stasis, an additional factor. Alternatively, the dye could also be instilled into the sinus through a trocar in endoscoplc canine fossa.

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

This is performed for patients with delayed dye clearance. We advocate a surgery that would ensure gravity-dependent drainage of the sinus. Case Reports in Otolaryngology. Since IP was found at biopsy, she was referred to our hospital in order to undergo surgery. Delayed dye movement indicates that there is a certain degree of mucociliary clearance that, despite being present, is inadequate to prevent recurrent infection of the sinus.

An endoscopic and tomographic evaluation of patients with sinusitis after endoscopic sinus surgery and Caldwell-Luc operation: Sign in to customize your interests Sign in to your personal account. Purchase access Subscribe to the journal. The goals of surgery are threefold: Copyright American Medical Association. This was done in two ways. Iatrogenic factors involve inadvertent stripping of sinus mucosa, damage to the cilia bearing mucosa with the microdebrider or other instruments, exposure of bone, circumferential damage to the sinus ostium, improper widening of sinus ostium permitting recirculation of mucous, poor mucociliary clearance, among others.


Introduction Sinonasal inverted papillomas IPs are one of most commonly found benign tumors in the paranasal sinuses [ 1 ]. The anterior, inferior, and medial walls of the maxillary sinus could be observed endoscopically.

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. Management of chronic recalcitrant maxillary sinusitis. Early endoscopic techniques entailed an extended maxillary antrostomy with piecemeal resection of tumor of the lateral nasal wall.

No movement of dye indicates irreversible loss of ciliary function and hence a simple widening of the already widened ostium i. Distribution of maxillary sinus volume inferior to the attachment of the inferior turbinate for 38 maxillary sinuses. Drafting of the manuscript: All patients had good disease control in the postoperative visits with no clinical evidences of recurrences.

Type Indication Procedure I Recirculation mechanism due to two windows in middle meatus and inferior meatus e. National Center for Biotechnology InformationU. Resection anterior to this structure will foster visualization.

Recently, a new surgical approach named endoscopic modified medial maxillectomy EMMM was proposed. Discussion Medial maxillectomy through a lateral rhinotomy incision involves the removal of the lateral nasal wall, ethmoid labyrinth, and medial portion of the maxilla. These patients would require removal of secreting mucosa in addition to MEMM.

Preoperative observation of nasal cavity. Tanna, Edwards, Aghdam, and Sadeghi.