Evaluation of Telescopes and Forceps for Endoscopic Transnasal Surgery on the Maxillary Sinus

Abstract

Routine surgery on the maxillary sinus in case of chronic hyperplastic pansinusitis via middle meatal antrostomy does not cover all hidden niches of the sinus. The most important area that is out of sight and control is the prelacrimal recess.

Assessing Current Technical Limitations in the Small-Hole Endoscopic Approach to the Maxillary Sinus

“…His study notes that "not even an additional inferior antrostomy offers help in all cases." 12 Our results suggest that access through the natural ostium can, within a few percentage points, effectively reach areas in the maxillary sinus as well as inferior antrostomy approaches. Regardless of the antrostomy or the instrument selected, ϳ 1 ⁄3 of the maxillary sinus volume was reached.…”

Prelacrimal approach to the maxillary sinus

“…2,3 Historically the sinus was approached via the Caldwell-Luc approach popularized over 100 years ago. 4,5 In recent times the importance of the natural ostium of the sinus, coupled with enhancements in equipment and visualization, has led to approaches including uncinectomy, maxillary antrostomy, and endoscopic medial maxillectomy, which all incorporate the natural ostium into the new opening.…”

“…The removal of soft tissue attachments to the piriform aperture has been (1). To the right of the nasolacrimal duct is the mucosa of the medial wall of the maxillary sinus (2), and further to the right side of the image the anterior wall of the maxillary sinus (3) can be identified.…”

Application of the endoscopic prelacrimal recess approach to the maxillary sinus in unilateral maxillary diseases

“…The mucus and purulent discharge is aspirated, and in some cases, gauze could be inserted to replace the fungus. However, the prelacrimal recess and anterior inferiorly located alveolar recess are difficult to approach . Most frustratingly, although we can visualize problems, such as a fungal infection, polyps, or tumors, it is difficult to remove lesions from the prelacrimal recess and/or alveolar recess using instruments through the natural ostium.…”