Gender-specific differences in feasibility of pre-lacrimal window approach

Abstract

The feasibility and surgical effort of a pre-lacrimal window approach (PLWA) depends on the width of the bony window anterior to the nasolacrimal duct. This study aimed to investigate gender-specific differences in feasibility of PLWA. A consecutive series of paranasal computed tomography scans from 50 females (n = 100) and 50 males (n = 100) were retrospectively analyzed. The primary outcome measure was the antero-posterior length of the bony pre-lacrimal window (BPLWA). The secondary outcome measure was the distribution of Simmen’s PLWA feasibility types (major, moderate and minor surgical effort). On average, males had a 1.5 mm (95% CI 0.8–2.2) significantly higher BPLW length in comparison to females [t(198) = 4.4, p < 0.0001]. The requirement of major surgical effort occurred 29% more frequently in females [χ2(1) = 17.7, p < 0.0001], whereas the necessity of moderate surgical effort was 21% more prevalent in males [χ2(1) = 8.8, p = 0.003]. The need of only minor surgical effort was twice as high in males compared to females [χ2(1) = 3, p = 0.081]. Our data indicates that females require more significant surgical effort during a PLWA to gain access to the maxillary sinus. These results are highly informative as a high amount of bone removal and nasolacrimal duct dislocation are associated with a higher likelihood of complications.

Endoscopic-assisted approaches for enucleation of invaded sinonasal region by benign odontogenic cysts: a case series study

“…2). The mean CT scan score was Ragab and Abo El Naga The Egyptian Journal of Otolaryngology (2022) 38:141 11 with a range (of [3][4][5][6][7][8][9][10][11][12][13][14]. An endoscopic assisted minimal sublabial approach was used [4 patients (67%)] for central lesions (cysts originating from the medial incisors with expansion only into the nasal cavity floor) [1 patient (17%)], as well as for cysts originating from the canines (elevating the nasal and antral floors) [1 patient (17%)], extension below the level of the nasal floor and lateral expansions and extensions with or without scalloping of the anterior wall of the maxillary bones [2 patients (33%)].…”

“…Access to lesions at the anterior wall and alveolar recess of the maxillary sinus is challenging. Possible endoscopic options are the application of a 70° endoscope following a type III sinusotomy, endoscopic standard medial maxillectomy, endoscopic pre-lacrimal window approach (PLWA), Endoscopic endonasal minimal rhinotomy approach, modified Denker's and by way of a canine fossa trepanation [13]. During surgical planning for cyst enucleation, surgeons should consider choosing the appropriate endoscopic approach.…”

Prelacrimal window approach to the maxillary sinus: a systematic review and meta-analysis of the literature

“…Recent studies have reported gender-specific differences in the feasibility of a PLWA (42) . Andrianakis et al (42) reported a greater distance (1.5 mm (95% CI 0.8-2.2) between the lacrimal system and the anterior maxillary wall in males compared to females.…”

“…Consequently, females may potentially face an increased risk of intra-and post-operative morbidity due to problems caused by surgery during a PLWA (42) .…”

Prelacrimal Window Approach in the Management of Odontogenic Maxillary Sinusitis from Dental Foreign Body

“…Even with short distances, modifications to the technique involving the removal of the bony nasolacrimal canal and mobilisation of the NLD to create an adequate working channel have been described in the literature [ 20 , 21 , 31 ]. There is variability among the population in the length of this bony window, with gender differences reported in some studies, with females having shorter distances and greater surgical complexity in accessing the anterior maxillary sinus [ 32 ].…”