Endoscopic Medial Maxillectomy with Preservation of Inferior Turbinate and Nasolacrimal Duct

Nakayama, Tsuguhisa; Asaka, Daiya; Okushi, Tetsushi; Yoshikawa, Mamoru; Moriyama, Hiroshi; Otori, Nobuyoshi

doi:10.2500/ajra.2012.26.3791

Cited by 103 publications

(70 citation statements)

References 16 publications

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“…The EMMM approach was then utilized. An perpendicular incision was made in the lateral nasal wall at the level of anterior tip of the inferior turbinate (Nakayama et al 2012). The complex of the nasolacrimal duct, mucosal flap, and inferior turbinate was pushed medially and preserved.…”

Section: Case Presentationmentioning

confidence: 99%

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Minimally Invasive Treatment for Hard Palate-Invading Maxillary Keratocystic Odontogenic Tumor

Nomura

Arakawa

Fujishima

et al. 2015

Tohoku J. Exp. Med.

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Keratocystic odontogenic tumor (KCOT) is one of the benign developmental odontogenic cystic lesions arising from impacted teeth. In comparison to other odontogenic cysts, such as radicular cysts and dentigerous cysts, KCOT is known to be more aggressive and is associated with a relatively high recurrence rate. Traditionally, KCOT has been treated with total resection through sublabial incision. Marsupialization is advocated to reduce surgical invasion. However in all the cases, marsupialization was performed in the oral cavity. With the recent development of appropriate instruments and the endoscopic modified medial maxillectomy (EMMM) technique, which allows preservation of the inferior turbinate and nasolacrimal duct, an exclusive endoscopic approach to KCOT becomes possible. However, when the KCOT invades the hard palate, total resection of the tumor requires subtotal maxillectomy including hard palate. Consequently, as the maxillary sinus connects to the oral cavity, life-long use of a prosthesis becomes mandatory. Here we report a case of a seventeen-year-old female with a hard palate-invading KCOT who was successfully treated with the EMMM approach. The KCOT was fenestrated to the nasal cavity, leading to preservation of the hard palate. The lesion invading the hard palate was found to remain unchanged over one year upon follow-up. The trans-nasal approach with EMMM is a direct, minimally invasive method providing a direct field of view for the treatment of maxillary odontogenic cysts. Marsupialization of the KCOT with the EMMM technique might be a viable treatment option if the maxillary KCOT invades surrounding structures.

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Section: Case Presentationmentioning

confidence: 99%

“…Recently, other surgical strategies have been advocated. Endoscopic modified medial maxillectomy (EMMM) with preservation of the inferior turbinate and nasolacrimal duct was proposed for the treatment of inverted papilloma of the anterior wall of the maxillary sinus (Nakayama et al 2012). …”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Treatment for Hard Palate-Invading Maxillary Keratocystic Odontogenic Tumor

Nomura

Arakawa

Fujishima

et al. 2015

Tohoku J. Exp. Med.

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“…In our experience, odontogenic tumours and cysts were relatively easy to resect using this technique, as it was possible to peel them away from the maxillary wall, which contrasts with our experience of inverted papillomas (12) .…”

mentioning

confidence: 46%

“…We performed EMMM under general anaesthesia as previously described (12) . First, we created a mucosal incision just behind the pyriform aperture ( Figure 1A) and elevated the nasal mucosa from the lateral nasal wall ( Figure 1B).…”

Section: Surgerymentioning

confidence: 99%

“…We previously reported the use of endoscopic modified medial maxillectomy (EMMM) for the treatment of inverted papillomas and mucocoeles (12) . This technique completely preserves the inferior turbinate mucosa and nasolacrimal duct, and preserves as large a portion of the inferior turbinate as possible, while facilita-ting equally good access to the maxillary sinus as conventional EMM.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic modified medial maxillectomy for odontogenic cysts and tumours

Nakayama¹,

Otori²,

Asaka³

et al. 2014

Rhin

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Background: Odontogenic maxillary cysts and tumours originate from the tooth root and have traditionally been treated through an intraoral approach. Here, we report the efficacy and utility of endoscopic modified medial maxillectomy (EMMM) for the treatment of odontogenic maxillary cysts and a tumour. Methodology:We undertook EMMM under general anaesthesia in six patients: four had radicular cysts, one had a dentigerous cyst, and one had a keratocystic odontogenic tumour. Results:The cysts and tumours were completely excised and the inferior turbinate and nasolacrimal duct were preserved in all patients. There were no peri-or postoperative complications, and no incidences of recurrence. Conclusion:Endoscopic modified medial maxillectomy appears to be an effective and safe technique for treating odontogenic cysts and tumours.

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Outcomes of sinonasal inverted papilloma resection by surgical approach: an updated systematic review and meta‐analysis

Peng

Thamboo

Choby

et al. 2019

Int Forum Allergy Rhinol

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BackgroundSelecting the optimal surgical approach for resection of sinonasal inverted papilloma (SIP) remains a challenge, with endoscopic, external, and combined approaches being utilized. This systematic review was conducted as an update to a 2006 systematic review to determine the preferred surgical approach for tumor control.MethodsThe study protocol was developed a priori following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) process. Data were collected and outcomes were analyzed according to surgical approach and sites of tumor involvement.ResultsA total of 96 papers and 4134 SIP patients were included. The overall recurrence rate was 12.80% (322/2515) for the endoscopic approach group, 16.58% (182/1098) for the external approach group, and 12.60% (65/516) for the combined approach group. Meta‐analysis by random effects model showed that the summarized risk ratio (RR) of recurrence was 0.61 (95% confidence interval [CI], 0.44 to 0.85, p = 0.003), I2 = 37.95% for the endoscopic vs external approach; 0.98 (95% CI, 0.69 to 1.39, p = 0.901), I2 = 9.06% for the endoscopic vs combined approach; 1.61 (95% CI, 1.06 to 2.43, p = 0.025), I2 = 0.00% for the external vs combined approach. After adjusting for publication bias, the adjusted RRs were 0.66 (p = 0.014) for endoscopic vs external; 0.99 (p = 0.955) for endoscopic vs combined; and 1.33 (p = 0.224) for external vs combined.ConclusionAn enlarging and maturing body of literature continues to indicate that endoscopic approaches result in significantly lower recurrence rates than open approaches for surgical resection of SIP.

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Endoscopic Medial Maxillectomy with Preservation of Inferior Turbinate and Nasolacrimal Duct

Abstract: EMMM produces access to the maxillary sinus identically to conventional EMM, despite preservation of the inferior turbinate and nasolacrimal duct.

Cited by 103 publications

References 16 publications

Minimally Invasive Treatment for Hard Palate-Invading Maxillary Keratocystic Odontogenic Tumor

Minimally Invasive Treatment for Hard Palate-Invading Maxillary Keratocystic Odontogenic Tumor

Endoscopic modified medial maxillectomy for odontogenic cysts and tumours

Outcomes of sinonasal inverted papilloma resection by surgical approach: an updated systematic review and meta‐analysis

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