Background Conventional minimally invasive surgery has a high recurrence rate, and nasal morbidity can occur if the scope of surgery is expanded to complete removal of maxillary sinus inverted papilloma. Objective To analyze the efficacy of the endoscopic prelacrimal recess approach (EPLRA) for maxillary sinus inverted papilloma removal. Methods Eighteen studies were included in this meta-analysis. Articles comparing the prelacrimal recess approach with conventional surgery (endoscopic surgery or the Caldwell–Luc operation) for inverted papilloma removal were included. Outcomes of interest included recurrence and postoperative morbidities. The methodological quality was assessed using the Newcastle–Ottawa scale. Results The recurrence rates of inverted papilloma, postoperative facial or gingival numbness, and alar collapse were 3.13% (95% confidence interval [CI]: 1.32, 7.27), 9.02% (95% CI: 3.70, 20.39), and 3.39% (95% CI: 1.28, 8.68), respectively. The recurrence rate of inverted papilloma was significantly lower after the EPLRA than after conventional surgery (odds ratio [OR] = 0.2290; 95% CI: 0.0808, 0.6489). However, there were no significant differences between the procedures in the rates of facial or gingival numbness (OR = 0.4567; 95% CI: 0.1497, 1.3933), epistaxis (OR = 0.3150; 95% CI: 0.0471, 2.1044), or periorbital swelling (OR = 1.2405; 95% CI: 0.1205, 12.7731). Conclusions The EPLRA can preserve the lacrimal system and is useful for maxillary sinus inverted papilloma removal due to a lower recurrence rate compared with conventional surgeries.
This study reports a case who presented with swallowing difficulty after orthognathic surgery. A female patient, who had undergone orthognathic surgery for esthetic purpose, presented with dysphagia. Administration of botulinum toxin injection to the cricopharyngeus muscle did not relieve or improve the severe dysphagia. The patient required nasogastric tube feeding for about three months. Swallowing ability was recovered after daily rehabilitation therapy and prescribing pyridostigmine. Injuries to the suprahyoid muscles (involved in laryngeal elevation during the pharyngeal phase of swallowing) during orthognathic surgery, and the inadvertent dissemination of inadequately injected botulinum toxin to adjacent muscles, are possible mechanisms of the severe dysphagia experienced by this patient. The authors also reviewed literature on the prevention and management of dysphagia following the orthognathic surgery.
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