Resection of Inverted Papilloma of the Maxillary Sinus via a Prelacrimal Recess Approach: A Multicenter Retrospective Analysis of Surgical Efficacy

Abstract

Background The intranasal endoscopic prelacrimal recess approach (PLRA) access to all aspects of the maxillary sinus while preserving the inferior turbinate and nasolacrimal duct and its use have been reported in the treatment of many maxillary sinus and lateral skull base diseases. Objective To retrospectively assess the effectiveness of a 10-year multicenter follow-up for the resection of inverted papilloma of the maxillary sinus (IPMS) via a PLRA. Methods A total of 71 patients were admitted and underwent IPMS excision via an intranasal endoscopic PLRA from 2003 to 2013. All patients underwent high-resolution computed tomography scanning of the nasal sinus, and some also underwent magnetic resonance imaging examination. Results Based on the Krouse staging system, all 71 patients belong to T3 staging. The PLRA was employed to remove IPMS in 71 patients. The postoperative pathological examination of the excised tissue revealed inverted papilloma, and cancerization was identified in 3 patients. The median follow-up time was 37.3 months (range: 13–134 months). Of the 71 patients, reoccurrence was seen in 5 patients (7.04%); 5 patients (7.04%) experienced numbness of the upper lid and the ala of the nose and 4 (5.63%) experienced mild collapse of the ala of the nose. Conclusions These multicenter follow-up results demonstrated that the PLRA is a safe and effective method for the excision of primary or recurrent IPMS with lower postoperative complications and recurrent rate.

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

“…In the surgical treatment of diseases originating from different sites of the maxillary sinus, the endoscopic pre-lacrimal approach makes possible the management of almost any aspect of internal linings. Especially the anterior and inferior aspect (e.g., alveolar recess and PLR), which are locations that traditional surgical corridors can hardly access (Nakamaru et al, 2010;Zhou et al, 2013Zhou et al, , 2016Lee et al, 2019;Zhou et al, 2018;Yu et al, 2018;Lin, Lin & Yeh, 2018). In select cases in which disease is located far laterally, surgeons can drill the pyriform aperture and/or part of anterior maxillary wall to extend surgical fulcrum (Turri-Zanoni et al, 2017;Nakamaru et al, 2010;Zhou et al, 2013).…”

“…However, before we try to implement this technique more widely, some of its disadvantages need to be understood. The first being that the inferior turbinate-nasal lacrimal duct mucosal flap is re-draped onto its original position, the anterior half of the maxillary sinus (especially the alveolar recess inferiorly and zygomatic recess laterally) is difficult to be evaluated even with the use of flexible endoscopy post-operatively (Zhou et al, 2018). Therefore, additional inferior meatotomy may be necessary for full-filled surveillance for patients with high risk of disease recurrence (Zhou et al, 2018).…”

“…The first being that the inferior turbinate-nasal lacrimal duct mucosal flap is re-draped onto its original position, the anterior half of the maxillary sinus (especially the alveolar recess inferiorly and zygomatic recess laterally) is difficult to be evaluated even with the use of flexible endoscopy post-operatively (Zhou et al, 2018). Therefore, additional inferior meatotomy may be necessary for full-filled surveillance for patients with high risk of disease recurrence (Zhou et al, 2018). Further, post-surgical debridement and saline delivery are less convenient in comparison with standard endoscopic medial maxillectomy (Turri-Zanoni et al, 2017).…”

“…Initially EPLA for neoplastic lesions were designed to provide a corridor to allow the management of lesions within infratemporal and pterygopalatine fossa tumors (Zhou et al, 2016). Recently, its use has been extended to the treatment of maxillary neoplasms, mostly sinonasal inverted papillomas (SNIPs) (Zhou et al, 2013;Lee et al, 2019;Zhou et al, 2018;Yu et al, 2018). The benefits of EPLAs over standard endoscopic maxillectomies when treating SNIPs include its ability to preserve as many normal structures as possible (Turri-Zanoni et al, 2017), which makes wound healing faster, and its ability to avoid alter turbulent nasal airflow due to preserve of inferior turbinate (Chen et al, 2010).…”

“…The use of the EPLA has been reported to provide results comparable to those of conventional external procedures (Lee et al, 2019). However, its application has mostly been focused on the removal of neoplasms and no studies have been performed to assess post-treatment life-quality following EPLA (Lee et al, 2019;Zhou et al, 2018;Yu et al, 2018;Lin, Lin & Yeh, 2018). Therefore, in this study, we retrospectively reviewed the clinical applications of endoscopic PLR approach in the surgical treatment of different maxillary pathologies.…”