Modified endoscopic medial maxillectomy for recalcitrant chronic maxillary sinusitis

Abstract

Modified endoscopic medial maxillectomy (MEMM) is an accepted alternative treatment for benign sinonasal neoplasms. Its use as definitive treatment for inflammatory disease of the maxillary sinus has yet to be adequately explored. We evaluate the efficacy of MEMM for chronic maxillary sinusitis and attempt to identify factors that predispose patients for failure. A retrospective chart review of 46 patients who underwent a total of 61 medial maxillectomies for recurrent chronic maxillary sinusitis from 2003 to 2010 was performed. Data was collected regarding patient demographics, prior therapies, and exudative cultures. Complete resolution of disease was achieved in 37 of 46 patients (80%). Four patients required additional topical medical management prior to resolution of their inflammatory disease. When the culture was negative, resolution of disease was seen in 90% of patient. However if P. aeruginosa was cultured, the rate of disease resolution dropped to 75%. Similarly if S. aureus was culture, only 56% of patient demonstrated complete disease resolution. Of patients who had previous Caldwell-Luc procedures, 73% were successfully salvaged. No revision surgeries were required. The mean follow-up time was 35 months. MEMM is an effective and acceptable alternative treatment for chronic maxillary sinusitis refractory to standard medical treatment and endoscopic surgical treatment. Cultures positive for P. aeruginosa and S. aureus may be associated with worse outcomes.