Rajeshwari, S (2022) A Study of Various Endoscopic Surgical Approaches for Maxillary Sinus Pathology in Accordance to its Origin. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Maxillary sinus is a paired structure located on either side of nose below the orbit contained within bone of maxilla. It is the largest of all four paranasal sinuses and has a complex anatomy. It is pyramidal in shape and has body and four processes namely zygomatic, palatine, frontal and alveolar processes. Pathology within the maxillary sinus can have either one or more sites of attachment. It can range from simple to complex and from benign to malignant lesions. Endoscopic sinus surgeries are being widely used since it has the advantage of being less invasive, better magnification, minimal damage to adjacent structures thereby aim to restore the function. There are some areas within maxillary sinus which could not be accessed with basic procedures necessitating the need for alternative approaches. Also debulking and usage of powered instrumentation needs straight trajectory. This study describes various approaches to maxillary sinus like middle meatal antrostomy, inferior meatal antrostomy, mega antrostomy, endoscopic medial maxillectomy and modified endoscopic medial maxillectomy by prelacrimal approach and Denker approach. METHODOLOGY: STUDY PLACE : Upgraded Institute of Otorhinolaryngology Rajiv Gandhi Government General Hospital Chennai-600003 TYPE OF STUDY : Prospective observational study STUDY PERIOD : September 2019 to August 2021 SAMPLE SIZE : 28 ETHICAL CLEARANCE: Obtained clearance from Institutional Ethics Committee INCLUSION CRITERIA: 1. Age 15 to 60 years. 2. Both sexes- Male and Female. 3. Chronic rhinosinusitis with sinonasal polyposis refractory to medical management. 4. Benign and low grade pathology of maxillary sinus like Antrochoanal polyp, Mucocele, Inverted papilloma. 5. Patient with Mucormycosis or other pathologies who warranted improved exposure of pterygopalatine fossa and infratemporal fossa for disease clearance. 6. Understands the protocol and is able to give informed consent. EXCLUSION CRITERIA: 1. Age < 15 yrs and > 60 yrs. 2. Intracranial extension. 3. Malignancy. 4. Immunocompromised status. 5. Patient not willing for surgery or not fit for surgery. MATERIALS: Patients who attend UIORL OPD fulfilling inclusion criteria and exclusion criteria were subjected to detailed clinical ENT and Head and Neck Examination followed by diagnostic nasal endoscopy and radiological imaging and proceeded with surgical intervention for maxillary sinus. The findings are documented in proforma which includes other details like approach preferred, histopathological evaluation and follow up details. The patients were followed up periodically with clinical examination and diagnostic nasal endoscopy and if needed radiological imaging was done. CONCLUSION: ❖ Endoscopic sinus surgery is the preferred modality of treatment and it has replaced conventional surgeries for sinonasal pathologies since it aims to restore the physiology of nose and paranasal sinus. ❖ Preoperative radiological imaging helps to determine the attachment site of lesion based on focal hyperostosis. ❖ The approach preferred is predetermined based on the involvement of walls of maxillary sinus. ❖ Middle meatal antrostomy is the basic step in all surgeries as the mucociliary clearance is directed towards the natural ostium and for periodic follow up after surgery for suction clearance and also to look for recurrence. It permits visualization of posterior wall of maxillary sinus. It needs angled endoscopes and instrumentation for addressing the pathology. ❖ Benign and low grade pathology in anterior and lateral walls are addressed by modified endoscopic medial maxillectomy by prelacrimal approach and endoscopic anterior maxillotomy by modified Denker approach. These approaches facilitates the passage of straight endoscopes and instrumentation with access to all walls of maxillary sinus particularly improved access to anterolateral wall. ❖ Modified Denker approach provides additional access to antero inferior portion of maxillary sinus and also used in mucormycosis and other sinonasal pathologies as a second port to access structures behind maxillary sinus like pterygopalatine fossa and infratemporal fossa. ❖ Endoscopic medial maxillectomy is preferred for inverted papilloma as it helps in complete removal of tumour pedicle with removal of newly formed bone thereby preventing recurrence. ❖ Inferior meatal antrostomy is preferred where pathology in floor and medial wall of maxillary sinus need to be addressed. ❖ We faced difficulties in followup due to COVID pandemic. ❖ Nasal crusting was present in most of the cases but with periodic suction clearance the mucosa turned healthy. ❖ No major complications and recurrence were evident in our short follow up period.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221914019 |
| Uncontrolled Keywords: | Endoscopic Surgical Approaches, Maxillary Sinus Pathology, Accordance, Origin. |
| Subjects: | MEDICAL > Otolaryngology > MEDICAL > Otolaryngology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2022 14:44 |
| Last Modified: | 17 Dec 2023 07:18 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19375 |
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