Clinical outcome of endonasal endoscopic prelacrimal approach in managing different maxillary pathologies

Abstract

Background The aim of the study was to evaluate the treatment outcomes of endoscopic prelacrimal recess approaches (EPLAs) in managing different sinus pathologies, analyzing associated adverse events and post-treatment quality-of-life. Methods We enrolled 21 consecutive patients (22 lesions) who received endoscopic sinus surgical procedures with EPLAs in two tertiary medical institutes between 2015 and 2018. Quality-of-life and self-rated symptom severity data were collected using the 22-item Sino-Nasal Outcomes Test (SNOT-22) and 10-point visual analog scales (VAS), respectively. Results A total of 21 patients (mean age (standard deviation) 51.7 (14.5) years; 16(76.2%) male) were followed up for 12.7 months. The most common symptoms were nasal discharge and nasal airway obstructions. Nine lesions (40.9%) were sinonasal papilloma’s, seven lesions were other types of neoplasms (31.8%; five benign and two malignant), two were trauma-related (9.1%), and four inflammatory diseases (18.2%). Patients with non-papilloma lesions had higher presurgical SNOT-22 than those with papillomas (P-value = 0.021). After EPLAs, non-papilloma patients had significant improvements in SNOT-22 and VAS (P-values = 0.012 and 0.012, respectively), while those with papillomas had only marginally significant improvements in VAS (P-value = 0.061). The most common adverse events was temporary cheek/tooth numbness (n = 11), and patients with sinonasal papillomas were more likely to have post-treatment complications than those with other disease entities. Conclusions EPLAs were found to effectively manage various sinus diseases. Short-term life-quality improvements were promising. Future large-scale studies with longer follow-up periods are recommended.

Third window approach assisted middle meatal antrostomy: prospective cohort study of the two ports technique in management of hard to reach maxillary sinus pathology

“…Lin et al . 19 evaluated the treatment outcomes of the prelacrimal recess approach utilising the visual analogue and SNOT-22 scales in the management of different maxillary sinus pathologies: 9 lesions were sinonasal papilloma, 7 were other types of neoplasms (5 benign and 2 malignant), 2 were trauma-related and 4 were inflammatory diseases, with a total of 22 lesions (21 patients). They found that the prelacrimal recess approach could be used safely and efficaciously to manage various maxillary sinus lesions and could replace the other invasive procedures.…”

Abordaje prelagrimal del seno maxilar: experiencia del Hospital Clínico de la Universidad de Chile

“…Si bien la mayor utilidad de este abordaje estaría dada en casos de patología del seno maxilar en sus aspectos anterior e inferior, de difícil acceso para el abordaje endoscópico tradicional, también existe experiencia satisfactoria en lesiones que ocupan el resto de las paredes, la fosa pterigopalatina e infratemporal e incluso algunos autores plantean su uso en patología inflamatoria del seno maxilar como la rinosinusitis crónica. Sin embargo, no existen estudios que comparen el abordaje prelagrimal con otros abordajes tradicionales del seno maxilar con esta última indicación 13 .…”

“…En la mayor serie publicada hasta la fecha con 71 casos, se evidenció que hasta un 7% podría presentar hipoestesia del labio superior y del ala nasal, y un 5,63% un colapso nasal leve 3 . Los déficits sensoriales serían transitorios en la mayoría de los casos, cediendo antes de los 6 meses desde la cirugía, como se observa en nuestra casuística y que es consistente con otras series recientes 7,13 . Otras complicaciones incluyen la aparición de vesículas quísticas y granulomas en la cavidad.…”

“…En forma diferida, cuatro pacientes presentaron complicaciones menores que cedieron en forma espontánea, mencionadas previamente, por lo que en nuestra serie de casos el abordaje prelagrimal mostró ser una técnica segura y sin morbilidad importante. Sin embargo, se desconoce si este abordaje tiene un impacto en la resistencia del flujo respiratorio y aclaramiento mucociliar a largo plazo, por lo que se requieren estudios de mayor seguimiento a futuro 13 .…”

“…Algunos autores han realizado el seguimiento únicamente con endoscopía rígida de 0º, 45º y/o 70º, limitando el uso de imágenes como TC o RM en caso de sospecha clínica para evaluar eventuales mucoceles o recurrencia 4,8,13 . Otros autores realizan el seguimiento principalmente con endoscopía flexible 14 , mientras que otros añaden incluso un control tomográfico cada 6 meses en el primer año y anual luego de este periodo 3 .…”