Endoscopic Medial Maxillectomy Research Articles

Prelacrimal recess approach for maxillary sinus inverted papilloma: a 15-year experience from a single center.

This large retrospective, single-center, follow-up study investigated the endoscopic prelacrimal recess approach (PLRA) for treating maxillary sinus inverted papilloma (MSIP). Between January 2007 and November 2022, patients with MSIP treated with PLRA were enrolled. Data on clinical manifestations, imaging, and surgical procedures were collected. The visual analog scale (VAS) scores for maxillofacial numbness and nasal symptoms and the SNOT-22 nasal symptom scores were statistically analyzed. Of 122 patients (68 males and 54 females) enrolled in the study, with a mean age of 50.75 ± 12.84years (26-80years), 111 patients underwent PLRA, nine underwent modified PLRA, one converted to an endoscopic medial maxillectomy (EMM), and one to an endoscopic modified Denker's approach. The average follow-up was 86.60 (13-192) months, the recurrence rate was 3.28%, and 29 patients (23.77%) complained of maxillofacial numbness one month postoperatively, which disappeared in most cases one year after surgery. Five patients (4.10%) experienced mild numbness at the end of the follow-up period. Maxillary sinus ostium contracture or atresia occurred in two cases (1.64%). After surgery, the VAS nasal symptom scores improved significantly (P < 0.001). SNOT-22 indicated that the most common postoperative symptom was thick nasal discharge. PLRA is a flexible first-choice surgical treatment for maxillary sinus inverted papilloma and can be modified according to the extent of the lesion, the surgeon's experience and technique, and surgical instruments. That can help achieve complete resection and reduce recurrence and surgical complications. Upper teeth numbness, the most common postoperative complication, tends to disappear after 1year.

Combined Endoscopic Transmaxillary Approach for Resection of an Extracranial V3 Schwannoma: 2-Dimensional Operative Video.

Tumours of the pterygopalatine (PPF) and infratemporal fossa (ITF) are rare tumours and are difficult to access. The lateral cervical approach is hampered by the mandibular angle and the vascular nervous elements.1 The classic endonasal endoscopic medial maxillectomy approach has been developed over the past 2 decades but does not allow good control of the most lateral and inferior part of the ITF.2 The surgical video presents a 68-year-old woman with trigeminal neuralgia. The radiologic workup showed a trigeminal V3 schwannoma (TS) into the PPF and ITF. This tumor grew during the follow-up despite fractionated radiosurgery. A 2-dimensional intraoperative video illustrates the gross total removal of the TS through a combined endoscopic endonasal and transgingival transmaxillary approach. The combination of these 2 approaches allows on the one hand, a better view of the lateral and inferior part of the maxillary sinus and ITF and on the other hand, a gain of handling in the operating field and security for our surgical procedure.3 The mini-Caldwell-Luc approach gives good aesthetic results without stomatological complication. Neuralgia disappeared after the surgery, and a gross total resection was achieved, and no recurrence was observed during the follow-up. This combined approach is a good alternative of medial extended maxillectomy, which presents a risk for the lacrimal duct risk and postoperative aesthetic deformity because of the removal of the medial and anterior wall of the maxillary sinus. The patient consented to the procedure and publication of her image.

Prelacrimal window approach to the maxillary sinus: a systematic review and meta-analysis of the literature.

The prelacrimal window approach (PLWA) is a minimally invasive surgical technique that has been proposed as an alternative to the traditional approaches to access the maxillary sinus. A systematic review with meta-analysis was performed following PRISMA guidelines and identified 368 articles for initial review of which 14 (610 participants) met the criteria for meta-analysis. Four databases, including PubMed, Google Scholar, Web of Science and Scopus, were searched to identify relevant articles. Two independent reviewers conducted the eligibility as- sessment for the included studies. Methodology quality and risk of bias were evaluated by New Castle Ottawa scale. The outco- mes assessed were recurrence of the pathology, postoperative morbidity including epiphora, dry nose, facial, gingival numbness, epistaxis or local infection. The present data suggest a significant reduction in the recurrence rate of maxillary sinus pathology following PLWA when compared to conventional surgery (endoscopic medial maxillectomy, endoscopic sinus surgery and the Caldwell-Luc operation). The rates of epiphora, facial or gingival numbness, epistaxis or infection requiring intervention, were not significantly different between the procedures. Maxillary sinus pathology can be effectively treated using the PLWA technique, as it has been shown to result in a lower recurrence rate compared to conventional surgeries.

Histopathology of Recalcitrant Maxillary Sinusitis Necessitating Endoscopic Medial Maxillectomy.

Endoscopic medial maxillectomy (EMM) is an effective intervention for patients with recalcitrant maxillary sinusitis after previous middle meatal antrostomy. The pathophysiology of refractory maxillary sinusitis is incompletely understood. We aim to identify trends in structured histopathology (SHP) to better understand how tissue architecture changes contribute to refractory sinusitis and impaired mucociliary clearance. All patients who underwent EMM or standard maxillary antrostomy for recalcitrant maxillary sinusitis of various forms were included. Retrospective chart review was conducted to collect information on demographics, disease characteristics, comorbid conditions, culture data, and SHP reports. Chi-squared and logistic regression analyses were performed for SHP variables. Forty-one patients who underwent EMM and 464 patients who underwent maxillary antrostomy were included. On average, the EMM cohort was 10 years older (60.9 years vs. 51.1 years; p = 0.001) and more often had a history of prior sinus procedures (73.2% vs. 40.9%; p < 0.001). EMM patients had higher rates of fibrosis (34.1% vs. 15.1%, p = 0.002), and this remained statistically significant when controlling for prior sinus procedures and nasal polyposis (p = 0.001). Cultures positive for pseudomonas aeruginosa (38.2% vs. 5.6%, p < 0.001) and coagulase negative staphylococcus (47.1% vs. 23.5%, p = 0.003) were more prevalent in the EMM group. Fibrosis and bacterial infections with Pseudomonas and coagulase negative Staphylococcus were more prevalent in patients requiring EMM. This may contribute to the multifactorial etiology of impaired mucociliary clearance in patients with recalcitrant maxillary sinusitis. 3 Laryngoscope, 134:2646-2652, 2024.

Malignant Mucosal Melanoma of the Nasal Cavity: No Local Recurrence with a Follow-Up of 3 Years: Case Report

Background: Malignant mucosal melanoma of the nasal cavity is a rare and aggressive tumor with a poor prognosis. Epistaxis and unilateral nasal obstruction are the most common presenting symptoms. Accurate diagnosis is immunohistochemical staining analysis for HMB-45 and S-100. The treatment of choice is surgical resection if the tumor is resectable. The 5-year survival rate is between 5% and 30%. Case Report: A 72-years-old male came with left epistaxis for two months. An endoscopic examination showed a bleeding tumor at the left inferior turbinate with protrusion into the left sided nasopharynx. Computed tomography scan revealed the enhancing mass in posterior left nasal cavity involving left inferior turbinate with protrusion into left sided nasopharynx, which measured about 3.3×1.5×1.4 cm. No gross bony destruction was detected. An incisional biopsy was performed and the immunohistochemical staining analyses were positive for HMB-45 and S-100. The findings indicated stage III, T3N0M0. Endoscopic medial maxillectomy with partial nasopharyngectomy with pressure equalization tube insertion was performed under general anesthesia and the frozen sections were negative intraoperative margins. He then received postoperative radiotherapy. At a 3-year follow-up, the patient showed no evidence of local recurrence. Conclusion: The author presented a rare case of malignant mucosal melanoma of the nasal cavity. Although the diagnosis of these tumors was challenged as the tumors were confused with other tumors when using immunohistochemistry, which lead to delay of treatment, this patient showed no evidence of local recurrence at 3-year follow-up after endoscopic resection and postoperative radiation. Keywords: Amelanotic melanoma; Nasal cavity; Transnasal endoscopic surgery

Angiofibroma of the maxillary sinus mimicking mucocele: a diagnostic challenge

BackgroundAngiofibroma is a rare, histologically benign but locally aggressive vascular tumour that typically arises within the nasopharynx. Angiofibroma in sites other than the nasopharynx is extremely uncommon. Despite the histological similarities, the clinical features of this tumour are very much different from the typical nasopharyngeal angiofibroma and pose a diagnostic challenge, hence emphasizing the importance of a thorough evaluation and high index of suspicion in establishing the correct diagnosis.Case presentationA 25-year-old gentleman presented with progressive right nasal blockage and intermittent nasal discharge for 3 years duration. He was clinically and radiologically diagnosed as a mucocele. Surgical excision was done via endoscopic medial maxillectomy with complete relief of all the symptoms.ConclusionAlthough uncommon, angiofibroma can occur outside the nasopharynx. Therefore, thorough evaluation and a high index of suspicion are crucial in establishing the correct diagnosis.

The Effects of Various Maxillary Sinus Antrostomy Techniques on Modifying the Ventilation and Air-Conditioning Characteristics of the Maxillary Sinus: A Numerical Study

Background and Objectives: Endoscopic sinus surgery is commonly performed for maxillary sinus (MS) disease, and the surgical extent of the MS medial wall or ostium varies. We examined the effect of MS surgery on nasal airflow and air-conditioning using computational fluid dynamics in five nasal cavity numerical models.Methods: Four types of unilateral virtual MS surgery were conducted on the right MS based on computed tomography images of a 49-year-old man with normal anatomy. The five models were as follows: baseline (normal), middle meatal antrostomy (MMA), MMA with inferior meatal antrostomy (MMA+IMA), mega-antrostomy (MEGA), and endoscopic medial maxillectomy (EMM). Virtual simulator software and a stereoscopic display with haptic device were used for virtual surgery. Meshing software and computer fluid dynamics software were used to generate meshes and analyze airflow.Results: The MMA and MMA+IMA results were similar to the baseline model. However, EMM and MEGA exhibited some physiological changes. The amount of airflow moving into the MS was largest in the EMM model, followed by the MEGA model. The distributions of wall shear stress and surface water-vapor increased near the enlarged MS ostium in EMM and MEGA. Skewed airflow partition and different airflow rates between the operated and unoperated sites of the nose also changed the air-conditioning characteristics. EMM substantially reduced the relative humidity in the nasopharynx, and MEGA showed a smaller reduction.Conclusion: Among four surgery techniques, EMM produced the largest increase in wall shear stress and surface water vapor flux on the posterior surface of the MS and the greatest deterioration in the nasal cavity’s air-conditioning capacity. MEGA reduced the local airflow disturbance inside the MS and prevented excessive degeneration of the cavity’s overall air-conditioning capacity. In conclusion, MEGA and modified EMM approaches have physiological advantages over EMM, while securing a sufficient spatial extent of resection for surgery.

Endoscopic resection of type D trigeminal schwannoma through nasal sinus approach

Objective: To examine the feasibility and surgical approach of removing type D trigeminal schwannoma through nasal cavity and nasal sinus under endoscope. Methods: Eleven patients with trigeminal schwannoma who were treated in the Department of Otorhinolaryngology, Qilu Hospital of Shandong University from December 2014 to August 2021 were analyzed retrospectively in this study. There were 7 males and 4 females, aged (47.5±13.5) years (range: 12 to 64 years). The neoplasm involved the pterygopalatine fossa, infratemporal fossa, ethmoidal sinus, sphenoid sinus, cavernous sinus, and middle cranial fossa. The size of tumors were between 1.6 cm×2.0 cm×2.0 cm and 5.7 cm×6.0 cm×6.0 cm. Under general anesthesia, the tumors were resected through the transpterygoid approach in 4 cases, through the prelacrimal recess approach in 4 cases, through the extended prelacrimal recess approach in 2 cases, and through the endoscopic medial maxillectomy approach in 1 case. The nasal endoscopy and imaging examination were conducted to detect whether neoplasm recurred or not, and the main clinical symptoms during follow-up. Results: All the surgical procedures were performed under endonasal endoscope, including Gross total resection in 10 patients. The tumor of a 12-year-old patient was not resected completely due to huge tumor size and limited operation space. One patient was accompanied by two other schwannomas located in the occipital region and the ipsilateral parotid gland region originating from the zygomatic branch of the facial nerve, both of which were removed concurrently. After tumor resection, the dura mater of middle cranial fossa was directly exposed in the nasal sinus in 2 cases, including 1 case accompanied by cerebrospinal fluid leakage which was reconstructed by a free mucosal flap obtained from the middle turbinate, the other case was packed by the autologous fat to protect the dura mater. The operation time was (M(IQR)) 180 (160) minutes (range: 120 to 485 minutes). No complications and deaths were observed. No recurrence was observed in the 10 patients with total tumor resection during a 58 (68) months' (range: 10 to 90 months) follow-up. No obvious change was observed in the facial appearance of all patients during the follow-up. Conclusion: Type D trigeminal schwannoma involving pterygopalatine fossa and infratemporal fossa can be removed safely through purely endoscopic endonasal approach by selecting the appropriate approach according to the size and involvement of the tumor.

Synchronous nasal mass: a wolf in sheep’s disguise

Aim: To highlight the possibility of synchronous benign and malignant nasal masses. Schneiderian papilloma, also known as inverted papilloma, despite being a common benign epithelial sinonasal tumour, remains a conundrum to otorhinolaryngologists due to its locally aggressive nature, tendency to recur as well as potential of malignant transformation. A synchronous nasal lesion adds on to the complexity of patient management. Case presentation: Herein, we are reporting an unusual case of synchronous lesions: sinonasal inverted papilloma and low-grade mucoepidermoid carcinoma. Initial biopsy of the sinonasal mass revealed inverted papilloma. However, histopathological examination post endoscopic medial maxillectomy revealed evidence of both inverted papilloma and low-grade mucoepidermoid carcinoma. Conclusion: We want to highlight that seemingly benign sinonasal inverted papillomas ought to be taken seriously considering the possibility of a synchronous malignant nasal mass, as in our case.

Surgical morbidity of endoscopic medial maxillectomy and endoscopic pre-lacrimal recess approach: A comparative study.

Upon reasonable request.

A Case of Rapid Growing Myoepithelioma of the Maxillary Sinus

Myoepithelioma is a rare tumor of the salivary glands. Occurrence of myoepithelioma in the nasal cavity is even rarer, and there has been no case wherein the change in the size of the tumor was confirmed by imaging. In this report, a 84-year-old female was found to have a rapidly enlarged tumor on the preoperative image, but she had shown no significant size change in a medical examination six months ago or in the paranasal sinuses view three months ago. The image showed a rapid increase in the size of the cystic component, so the endoscopic medial maxillectomy was performed. There was no recurrence of the tumor at follow-up six months after surgery. Although myoepithelioma is rarely found in the maxillary sinus of the sinonasal cavity, it is important to suspect myoepithelioma and consult a pathologist if it shows a similar pattern to the current case.

Endoscopic medial maxillectomy for antrochoanal polyp

Antrochoanal polyp (ACP) are benign lesions that originate from the mucosa of the maxillary sinus, and extend into the nasal cavity to reach the choana and nasopharynx. The treatment of ACP is surgical, endoscopic medial maxillectomy (EMM) is one of the options for surgical therapy. ACP generally affects adolescents but in this case by adults. To report and analyze ACP in adult patient with EMM technique. A 45-year-old man with an ACP completely removed by EMM technique. The evidence-based literature regarding the ACP, their management, and its complications were conducted on the Pubmed Medline, PMC and Google Scholar database. Based on the inclusion and exclusion criteria, two studies were found relevant to our case. From sources in two journals, both are retrospective studies with the ACP completely removed with endoscopic medial maxillectomy technique and the other is a retrospective descriptive study. Complete ACP removal with the EMM technique. There was no complications during and after surgery and we had no recurrences during the control period.

Inverted Papilloma of the Maxillary Sinus: A Recurrence Analysis According to Surgical Approaches.

(1) Background: Various surgical approaches have been introduced to resect inverted papillomas (IP) stemming from the maxillary sinus (MS). This study aimed to compare the recurrence rates of IPs originating from the MS according to various surgical modalities. (2) Methods: A total of 155 surgical cases of sinonasal IPs originating from the MS were categorized into three groups according to the surgical approach adopted: endoscopic resection via middle or inferior meatus antrostomy (ESS), ESS with Caldwell–Luc approach or canine fossa trephination (ESS with CL), and expanded endoscopic approaches (ExEA) including endoscopic medial maxillectomy or a prelacrimal recess approach. A Kaplan–Meier curve was generated to examine the recurrence rates. (3) Results: The overall recurrence rate was 5.8% (9/155) with a mean follow-up period of 24.2 months. The recurrence rates for the ESS, ESS with CL, and ExEA groups were 10.0% (7/70), 3.5% (2/57), and 0% (0/28), respectively. The ExEA group had a significantly lower recurrence rate than the ESS group (p = 0.024) and there was a tendency for lower recurrence compared to the ESS within the CL group (p = 0.145). The ExEA required a shorter postoperative hospitalization period than in ESS with CL (p < 0.001). (4) Conclusions: ExEAs to the maxillary sinus such as the PLR and EMM approaches are excellent surgical options for IPs originating from the MS.

Endoscopic Management of Maxillary Sinus Schwannoma.

Schwannomas are benign tumors originate from nerve sheath. In this article, the authors aimed to share our experience and review the literature on endonasal endoscopic intervention for a maxillary sinus schwannoma. A 30-year-old Caucasian female patient applying to ophthalmology clinic due to exophthalmos and proptosis in her left eye for the last 6 months. A well-defined mass was detected in left maxillary sinus that was filling and expanding the sinus. Endoscopic biopsy from the patient was reported as ancient schwannoma. The encapsulated mass was completely removed by performing a combined endoscopic medial maxillectomy and Caldwell-Luc procedure under general anesthesia. The authors have been following the patient for 2 years and there was no evidence of recurrence, however, a decrease in the volume of the maxillary sinus occurred, suggesting chronic maxillary atelectasis. In conclusion, schwannoma should be considered in the differential diagnosis of sinonasal masses.

Endoscopic Trans-Turbinal Medial Maxillectomy: A Modified Endoscopic Medial Maxillectomy Technique to Preserve the Inferior Turbinate

Endoscopic medial maxillectomy (EMM) and its modifications are surgical techniques are used to treat recalcitrant maxillary sinusitis as well as maxillary sinus tumors. In this report, we propose a simple and efficient modification of EMM, called endoscopic trans-turbinal medial maxillectomy (ETTMM), by which the inferior turbinate (IT), nasolacrimal duct, and anatomical integrity of the nasal valve area are preserved. A total of 10 patients (five tumorous and five nontumorous maxillary diseases) underwent ETTMM. Briefly, a turbinate mucosal flap on the superior aspect of the IT was elevated after middle meatal antrostomy. Then a trans-turbinal window was developed to expose the inferior meatus, after which an extended maxillary antrostomy was generated. Finally, the turbinate mucosal flap was repositioned after complete removal of the antral lesions. All lesions were successfully treated using ETTMM. Our modification was easy to perform, and we achieved good endoscopic visualization and accessibility throughout the whole antrum by creating a trans-turbinal window and extended maxillary antrostomy. We could perform postoperative surveillance easily through the wide antrostomy using rigid endoscopes of various angles. ETTMM is a simple and useful modification of EMM that provides clear visualization and great accessibility to most aspects of the maxillary antrum while preserving the nasal functional units, including the IT and nasal valve area.

Extended Anterior Inferior Approach to Endoscopic Medial Maxillectomy for Maxillary Sinus Lesions.

Myriad open and endoscopic approaches are employed to resect maxillary sinus lesions, each with associated advantages and disadvantages. The inferior and anterior portion of the sinus remains a challenging space to access. To describe the extended anterior inferior approach to endoscopic medial maxillectomy (EAMM) as a novel and valuable addition to a stepwise approach for minimizing surgical morbidity without compromising tumor outcomes. To report the outcomes of patients treated with this approach. A retrospective case series study of 9 patients who underwent EAMM between 2016 and 2019 at a tertiary care referral center was performed. The endoscopic technique is described. The duration of follow-up ranged from 1 to 53 months. Intraoperative steps, including transection of the nasolacrimal duct and execution of an intraoperative dacryocystorhinostomy, were reviewed. Postoperative outcomes, including patient symptoms at follow-up and tumor recurrence, were recorded. Adequate exposure with gross total tumor resection or margin-negative tumor resection was achieved in all cases. Sparing of the nasolacrimal duct was achieved in 2 patients. No patients reported persistent epiphora, empty nose syndrome, or changes in cosmesis such as alar or nasal tip collapse. One patient reported unilateral V2 hypoesthesia at 6 months postoperatively that had resolved by his next follow-up 18 months after surgery. Postoperative tumor surveillance was achieved by endoscopic examinations in all patients and there was no evidence of tumor recurrence at a median follow-up of 22 months. The EAMM provides improved access to the inferior-posterior-medial maxillary sinus. This approach minimizes the risk of hypoesthesia and change in cosmesis present in other approaches, and obviates division of the nasolacrimal duct for inferior, posterior-medial attached lesions. This progressive escalation of approach for maxillary sinus lesions minimizes injury to nasal and nasolacrimal structures without compromising tumor outcomes.

Endoscopic Surgical Treatment of Maxillary Sinus Organized Hematoma.

The purpose of this study was to analyze the clinical characteristics and treatment outcomes of patients who underwent endoscopic surgery for a maxillary sinus organized hematoma during a 15-year period in our hospital. The authors analyzed 25 patients who underwent endoscopic surgery for a maxillary sinus organized hematoma from January 2004 to December 2019. Twenty-five patients with a maxillary sinus organized hematoma underwent endoscopic surgical treatment and complete removal of the maxillary sinus organized hematoma was achieved in all cases. The main symptoms were nasal bleeding in 14 patients, followed by a nasal obstruction in nine, and facial swelling in 2. Of the 25 patients, 13 underwent endoscopic medial maxillectomy and 12 underwent endoscopic sinus surgery. There were no major surgical complications or recurrences. The authors demonstrated that endoscopic surgery is a safe and reliable treatment method for a maxillary sinus organized hematoma.

Endoscopic maxillectomy: anatomo-radiological description of the “double” maxillary sinus window

To present a modified endoscopic medial maxillectomy (MEMM) approach to control maxillary sinus pathologies. MEMM was completed in 13 fresh-frozen specimens. An MEMM includes cutting the nasolacrimal duct, inferior meatus flap, and repositioning the inferior turbinate (IT). The following measurements were obtained: length of IT, height from the nasal floor to valve of Hasner, height of the IT at the level of valve of Hasner, height of the IT at the insertion of the middle turbinate, and distance from the piriform aperture to the posterior wall of maxillary sinus and to the posterior border of palatine bone. Similar measurements were also performed on craniofacial computed tomography (CT) scans (n = 50). The surgical technique was performed in a case series (n = 8). The mean of the specimens was 82 (range 70–95) years old. The average area of the harvested inferior meatus flap area was 9.6 ± 1.0 cm2. In the radiologic study, the mean maximum antrostomy area was 8.8 ± 1.7 cm2 and the IT area overlapping the antral window was 5.8 ± 1.1 cm2, the area allowing a double window control was 3.1 ± 1.9 cm2, the posterior IT insertion length was 0.7 ± 0.4 cm, and the inferior meatus flap covering the inferior meatotomy had an area measuring 6.7 ± 1.7 cm2. Eight patients underwent MEMM for various benign conditions showing no recurrence after 26 month follow-up. The proposed modifications of MEMM provide a “double” window maxillary sinus control with access to all maxillary walls and preservation of the IT.

Assessment of Lacrimal Duct Patency in Patients Undergoing Endoscopic Medial Maxillectomy.

Purpose: The risk of epiphora after medial maxillectomy with lacrimal duct transection is difficult to assess. The data available in the literature are inconclusive due to various operating techniques used by the authors of medical publications, different additional procedures aimed at improving tear drainage after maxillectomy, and a variety of lacrimal duct patency assessment techniques. The aim of our work was to assess the anatomical and functional patency of lacrimal ducts after medial maxillectomy without performing additional procedures to improve tear drainage as well as comparison of the results obtained with different assessment tests. Materials and methods: 21 patients who underwent medial maxillectomy in the years 2016–2019 were assessed for discomfort and epiphora based on patients’ own reports and basic clinical examination, lacrimal duct rinse test, the Munk score, and a modified endoscopic Jones I test. Results: Gradually increasing the sensitivity of the assessment method resulted in an increase in the number of patients with potential tear drainage disorders, starting from 0% in the rinsing test, 4.8% self-reported tearing complaints, 14.3% Munk score, and 19% modified endoscopic Jones I test. Conclusions: The study results revealed that a small fraction of patients tend to report epiphora as a consequence of medial maxillectomy themselves. Subtle functional disorders, which are not particularly bothersome to patients, are more common. More sensitive lacrimal duct patency tests reveal more cases of tear drainage disorders. The results of studies assessing the incidence of epiphora after medial maxillectomy appear to depend on the type of test used.

A Case of Solitary Fibrous Tumor of the Maxillary Sinus Resected by Endoscopic Medial Maxillectomy

A Case of Solitary Fibrous Tumor of the Maxillary Sinus Resected by Endoscopic Medial Maxillectomy