Is inferior meatal antrostomy still relevant? A 12-year analysis of 93 oroantral fistulae closure with concomitant Caldwell-Luc operations

Rosenfeld, Eli; Ben-Zvi, Yehonatan; Gillman, Leon; Avishai, Gal; Sella, Adi; Chaushu, Gavriel

doi:10.1016/j.oooo.2020.08.025

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…Al-Belasy et al also emphasized the lack of necessity to perform an IMA in patients with an open osteomeatal complex without anatomical deformities [36]. In addition, some rare but possible complications, such as iatrogenic injury to the sphenopalatine artery, which occurred in one of our cases, injury of the nasolacrimal duct with duct obstruction and epiphora, and disruption of physiology with unchanged ostially-directed mucociliary beat, have been related to IMA [36][37][38][39]. According to the literature, IMA is nowadays no longer standard in the treatment of odontogenic maxillary sinusitis and is reserved only for a few specific indications with additional middle meatotomy, for example, to gain additional access to the anterior-inferior part of the maxillary sinus in cases of extended fungus balls [40][41][42].…”

Section: Discussionmentioning

confidence: 69%

Factors Influencing Recurrence after Surgical Treatment of Odontogenic Maxillary Sinusitis: An Analysis from the Oral and Maxillofacial Surgery Point of View

Sakkas

Weiß

Ebeling

et al. 2023

JCM

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The aim of the study was to determine the factors influencing the development of recurrence after the surgical treatment of odontogenic maxillary sinusitis in an oral and maxillofacial surgery clinic over a 7-year period. Demographic and anamnesis data, clinical and radiological findings, treatment and outcome were analyzed. A multivariable analysis was performed to find associations between patient age, causative focus, surgical access for sinus revision, multilayer closure with a buccal fat pad, inferior meatal antrostomy (IMA) for temporary sinus drainage and sinusitis recurrence. A total of 164 patients with a mean age of 51.7 years were included. Sinusitis recurrence was observed in nine patients (5.48%) within 6 months after primary surgery. No significant correlation was detected between patient age, causative focus, surgical access for sinus revision, multilayer closure with a buccal fat pad, IMA for sinus drainage and the development of recurrence (p > 0.05). Patients with a history of antiresorptive-related osteonecrosis of the jaw showed a significant tendency toward disease recurrence (p = 0.0375). In conclusion, except for antiresorptive administration, none of the investigated variables were related to a higher risk of sinusitis recurrence. We encourage a combined approach of intraoral removal of the infective focus and sinus drainage via FESS, as well as an individual treatment decision in a multidisciplinary setting with collaboration between dentistry, maxillofacial surgery and otorhinolaryngology to avoid sinusitis recurrence.

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Section: Discussionmentioning

confidence: 69%

Factors Influencing Recurrence after Surgical Treatment of Odontogenic Maxillary Sinusitis: An Analysis from the Oral and Maxillofacial Surgery Point of View

Sakkas

Weiß

Ebeling

et al. 2023

JCM

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“…The conventional inferior meatal antrostomy was abandoned in the modified Caldwell-Luc procedure due to increased morbidity without added benefits [ 5 , 6 ]. In some cases, the Cald-well-Luc procedure is not indicated, but a broad exposure is needed for full visualization and clearance of the sinus pathology such as maxillary fungal sinusitis to expose all sinus walls; EIMA would be the optimal option for such cases [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Temporary Submucosal Inferior Maxillary Antrostomy: A Modification of the Inferior Antrostomy

Alromaih¹,

Aloraini²,

Al-Rasheed³

et al. 2023

Cureus

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Complete removal of maxillary sinus pathology can be challenging in specific locations. In the past, the Caldwell-Luc procedure was used for maxillary sinus disease. Currently, the endoscopic middle meatal antrostomy (EMMA) approach is used. However, it can often be difficult to reach certain locations of lesions by EMMA alone, requiring an endoscopic inferior meatal antrostomy (EIMA), which has been reported in the literature to have numerous complications. Furthermore, multiple techniques have been suggested for a combined bi-meatal approach to remove such lesions. We present a case of a 17-year-old with a challenging antrochoanal polyp (ACP) location requiring EIMA. The patient underwent our modified technique of submucosal inferior antrostomy with mucosal flap with no observed intra-operative and post-operative complications. Maxillary sinus pathology can be challenging due to limited access to specific regions. In this case report, we present a novel technique to achieve a temporary inferior antrostomy through a minimally invasive approach with a promising post-operative course.

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“…Nevertheless, very few reports have evaluated the results of a combination of MMA with an IMA for FMS, and it has not been established whether IMA is necessary for successful ESS. Furthermore, IMA might harm long-term MS mucociliary clearance [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Extended middle meatal antrostomy via antidromic extended medial wall for the treatment of fungal maxillary sinusitis

Ding

Na-guo²,

Lou³

2022

BMC Surg

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Objective The objective of this study was to compare the long-term results of extended middle meatal antrostomy (MMA) and MMA combined with inferior meatal antrostomy (IMA, combined approach) for the treatment of fungal maxillary sinusitis (FMS). Methods and materials A retrospective analysis including 90 patients with non-invasive FMS was treated with endoscopic extended MMA via antidromic extended medial wall (extended MMA group), or with both MMA and IMA (combined approach group). The recurrence rate, operation time, and complications were evaluated at postoperative 12 and 36 months. Results Of the 90 patients, 52 patients were in the extended MMA group and 38 patients in the combined approach group. CT revealed the thin medial wall or bone defect in 63.33% (57/90) patients. The mean operation time in the extended MMA group was significantly shorter than that of combined approach group (42.5 ± 6.5 vs 57.4 ± 4.9, P < 0.01). At postoperative 12 months postoperatively, the recurrence rate was 3.85% (2/52) in the extended MMA group and 0.0% (0/38) in the combined approach group, the difference wasn’t significant (X2 = 0.618, P > 0.05). The recurrence rate wasn’t increased during the follow-up period over time in both groups.13.5% (7/52) patients complained of cheek numbness in the extended MMA group, 60.5% (23/38) patients complained of cheek numbness and epiphora in 5.3% (2/38) patients in the combined approach group, the difference was significant (X2 test, P < 0.01). However, no major complications were observed in both groups. In addition, IMA closure was observed in 4 (10.5%) in the combined approach group at 12 months postoperatively and in 9 (23.6%) at 36 months postoperatively. Conclusions Extended MMA via antidromic extended medial wall may effectively prevent the recurrence and reduce the complications of FMS, IMA wasn’t necessary for the treatment of FMS in most cases.

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Is inferior meatal antrostomy still relevant? A 12-year analysis of 93 oroantral fistulae closure with concomitant Caldwell-Luc operations

Cited by 4 publications

References 20 publications

Factors Influencing Recurrence after Surgical Treatment of Odontogenic Maxillary Sinusitis: An Analysis from the Oral and Maxillofacial Surgery Point of View

Factors Influencing Recurrence after Surgical Treatment of Odontogenic Maxillary Sinusitis: An Analysis from the Oral and Maxillofacial Surgery Point of View

Temporary Submucosal Inferior Maxillary Antrostomy: A Modification of the Inferior Antrostomy

Extended middle meatal antrostomy via antidromic extended medial wall for the treatment of fungal maxillary sinusitis

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