Preservation or removal of the lateral nasal wall in endoscopic management of maxillary sinus neoplasia: A comparison of approach related morbidity

Mickey Kondo; Kachorn Seresirikachorn; Joao P M C Gomes; Eugene Wong; Lu Hui Png; Larry Kalish; Raymond Sacks; Richard J Harvey

doi:10.1016/j.amjoto.2024.104314

Preservation or removal of the lateral nasal wall in endoscopic management of maxillary sinus neoplasia: A comparison of approach related morbidity

Am J Otolaryngol. 2024 Apr 22;45(4):104314. doi: 10.1016/j.amjoto.2024.104314. Online ahead of print.

Authors

Mickey Kondo¹, Kachorn Seresirikachorn², Joao P M C Gomes³, Eugene Wong³, Lu Hui Png⁴, Larry Kalish⁵, Raymond Sacks⁵, Richard J Harvey⁶

Affiliations

¹ Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia. Electronic address: kimiyasu.kondo@health.nsw.gov.au.
² Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
³ Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.
⁴ Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; Department of Otorhinolaryngology - Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore.
⁵ Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia.
⁶ Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW, Sydney, Australia.

PMID: 38663327
DOI: 10.1016/j.amjoto.2024.104314

Abstract

Background: The endoscopic modified medial maxillectomy (MMM) and prelacrimal approach (PLA) are two routinely performed endoscopic approaches to the maxillary sinus when access via a middle meatal antrostomy is insufficient. However, there is no data in the literature that has compared outcomes and complication profile between the two procedures to determine which approach is superior.

Objective: To compare the approach related morbidity of PLA and MMM.

Methods: A retrospective cohort study of all consecutive adult patients undergoing either MMM or PLA from 2009 to 2023 were identified. The primary outcome was development of epistaxis, paraesthesia, lacrimal injury, iatrogenic sinus dysfunction within a minimum of 3 months post-operative follow up.

Results: 39 patients (44 sides) underwent PLA and 96 (96 sides) underwent MMM. There were no statistically significant differences between the rates of paraesthesia (9.1 % vs 14.6 %, p = 0.367) or prolonged paraesthesia (2.3 % vs 5.2 %, p = 0.426), iatrogenic maxillary sinus dysfunction (2.3 % vs 5.2 %, p = 0.426) or adhesions requiring removal (4.5 % vs 4.2 %, p = 0.918). No cases of epiphora or nasal cavity stenosis occurred in either arm in our study.

Conclusions: According to our data, the endoscopic modified medial maxillectomy and prelacrimal approach are both equally safe approaches with their own benefits to access.

Keywords: Approach-related morbidity; Endoscopic endonasal surgery; Endoscopic nasal and sinus surgery; Maxillary sinus; Minimally invasive surgery; Modified medial Maxillectomy; Paraesthesia; Prelacrimal approach; Sinonasal neoplasia; Sinonasal tumour.