Access to the Maxillary Sinus via Canine Fossa Trephination

Abstract

Objective: 1) To assess how much of the maxilary sinus could be accessed through a 5-mm endoscopic canine fossa trephination (eCFT) in a cadaveric model. 2) Review the clinical benefits as well as co-morbidities associated with this procedure. Method: A cadaveric study involving 6 fresh-frozen heads that underwent endoscopic sinus surgery giving 12 sides. eCFT was performed and heads were registered with an image guidance system (IGS). Access to predetermined points in the sinus was assessed by whether the registration probes could reach corners of sinus as demonstrated on the IGS. Results: Instrumentation access through an eCFT allowed for 89.6% (range, 75%-100%) of corners within the maxillary sinus to be reached as demonstrated on the IGS. The 0° probe was capable of accessing 97.9% of the posterior face. The anterior face was more difficult to access with only 81.3% of points being reached. Conclusion: eCFT is a simple procedure that should be added to the repertoire of the modern endoscopic sinus surgeon. It allows for excellent surgical access to the maxillary sinus, far above what is accessible through the natural ostium alone. Refinements in technique report significantly decreased complication rates when compared to Caldwell-Luc.