Transnasal Endoscopic Medial Maxillectomy Research Articles

Modified transnasal endoscopic medial maxillectomy with inferior turbinate flap for dentigerous cyst

Background: Dentigerous cyst is one of the most frequent types of odontogenic cyst that usually involving an impacted, supernumerary or ectopically erupted tooth. One of the non-dental sites for ectopiceruption is the maxillary sinus. The traditional approach under such circumstances is a Caldwell-Luc maxillotomy, but this type of procedure may result in significant long-term complications. Endoscopic transnasal medial maxillectomy (ETMM) has several advantages, such as good il lumination, as wellas clear and magnified visualization. The new modified endoscopic transnasal medial maxillectomy(METMM) can provide good visualization and more functional result by preserving the nasolacrimalduct and the inferior turbinate. Purpose: We present this case to introduce the METMM technique forextirpation of any tumor in the maxillary sinus. Case: One case of dentigerous cyst with an ectopicleft maxillary 3 molar tooth in a 27 year old woman who presented with sinusitis. Management:Surgery with a METMM technique to enucleate the cyst, combined with functional endoscopic sinussurgery (FESS) for the sinusitis. The patient then evaluated subjectively for epiphora and objectivelywith nasoendoscopic examination. Conclusion: In this case, METMM was effective in accessing themaxillary sinus allowing for tumor extirpation, while preserving the function of the inferior tubinate andnasolacrimal duct. Keywords : Dentigerous cyst, maxillary ectopic tooth eruption, transnasal medial maxillectomy ABSTRAKLatar belakang: Kista dentigerous merupakan salah satu jenis kista otontogenik yang paling sering ditemukan, biasanya berhubungan dengan gigi impaksi, supernumeri atau gigi yang tumbuhektopik. Salah satu tempat erupsi ektopik adalah sinus maksilaris. Pendekatan tradisional dalamkeadaan ini adalah operasi Caldwell-Luc, tetapi teknik operasi ini dapat mengakibatkan komplikasijangka panjang. Maksilektomi medial transnasal dengan endoskopi (MMTE) memiliki beberapakeunggulan, seperti visualisasi yang jelas dan diperbesar. Teknik maksilektomi medial transnasaldengan endoskopi yang dimodifikasi (MMTEM) dapat memberikan visualisasi yang baik dan hasillebih fungsional dengan mempertahankan duktus nasolakrimal dan konka inferior. Tujuan: makalahini diajukan untuk memperkenalkan teknik MMTEM untuk ekstrirpasi massa yang berada di dalamsinus maksila, karena teknik ini memberikan hasil yang lebih fungsional. Kasus: melaporkan satu kasuskista dentigerous dengan gigi molar 3 yang erupsi ektopik pada sinus maksila kiri pada wanita 27tahun. Penatalaksanaan: kasus ini ditatalaksana dengan teknik MMTEM untuk mengenukleasi kistadan BSEF untuk sinusitis. Pasien kemudian dievaluasi secara subjektif dengan anamnesis mengenaiadanya epifora dan objektif dengan pemeriksaan nasoendoskopi. Kesimpulan: MMTEM terbukti efektifuntuk ekstirpasi tumor yang berada di dalam sinus maksila, dan teknik ini juga memberikan hasil yanglebih fungsional dengan dipertahankannya konka inferior dan duktus nasolakrimal. Kata kunci : Kista dentigerous, erupsi gigi ektopik di maksila, transnasal maksilektomi medial

PO-140: Transnasal endoscopic medial maxillectomy for maxillary and ethmoid sinus tumor- our three experience

PO-140: Transnasal endoscopic medial maxillectomy for maxillary and ethmoid sinus tumor- our three experience

Transnasal endoscopic medial maxillectomy in recurrent maxillary sinus inverted papilloma.

Maxillary sinus inverted papilloma entails medial maxillectomy and is associated with high incidence of recurrence. To study the impact of prior surgery on recurrence rate after transnasal endoscopic medial maxillectomy. Eighteen patients with primary and 33 with recurrent maxillary sinus inverted papilloma underwent transnasal endoscopic medial maxillectomy. Caldwell-Luc operation was the primary surgery in 12 patients, transnasal endoscopic resection in 20, and midfacial degloving technique in one. The follow-up period ranged between 2 to 19.5 years with an average of 8.8 years. Recurrence was detected in 8/51 maxillary sinus inverted papilloma patients (15.7 %), 1/18 of primary cases (5.5 %), 7/33 of recurrent cases (21.2 %); 3/20 of the transnasal endoscopic resection group (15%) and 4/12 of the Caldwell-Luc group (33.3%). Redo transnasal endoscopic medial maxillectomy was followed by a single recurrence in the Caldwell-Luc group (25%), and no recurrence in the other groups. Recurrence is more common in recurrent maxillary sinus inverted papilloma than primary lesions. Recurrent maxillary sinus inverted papilloma after Caldwell-Luc operation has higher incidence of recurrence than after transnasal endoscopic resection.

Transnasal endoscopic medial maxillectomy in recurrent maxillary sinus inverted papilloma

Maxillary sinus inverted papilloma entails medial maxillectomy and is associated with high incidence of recurrence. To study the impact of prior surgery on recurrence rate after transnasal endoscopic medial maxillectomy. Eighteen patients with primary and 33 with recurrent maxillary sinus inverted papilloma underwent transnasal endoscopic medial maxillectomy. Caldwell-Luc operation was the primary surgery in 12 patients, transnasal endoscopic resection in 20, and midfacial degloving technique in one. The follow-up period ranged between 2 to 19.5 years with an average of 8.8 years. Recurrence was detected in 8/51 maxillary sinus inverted papilloma patients (15.7 %), 1/18 of primary cases (5.5 %), 7/33 of recurrent cases (21.2 %); 3/20 of the transnasal endoscopic resection group (15%) and 4/12 of the Caldwell-Luc group (33.3%). Redo transnasal endoscopic medial maxillectomy was followed by a single recurrence in the Caldwell-Luc group (25%), and no recurrence in the other groups. Recurrence is more common in recurrent maxillary sinus inverted papilloma than primary lesions. Recurrent maxillary sinus inverted papilloma after Caldwell-Luc operation has higher incidence of recurrence than after transnasal endoscopic resection.

Two Cases of the Inverted Papilloma in the Maxillary Sinus Treated by Modified Transnasal Endoscopic Medial Maxillectomy

반전성 유두종은 비강 및 부비동에 발생하는 모든 종양의 0.5~4%를 차지하는 비강의 양성 종양 중에서 가장 흔한 종양 이다. 병리학적으로는 양성이나 골 파괴, 수술 후 높은 재발률, 악성 종양과의 연관성 등으로 임상적으로는 악성 종양과 같이 취급되고 있다. 이러한 종양의 특성 때문에 과거에는 비외접근법을 통한 상 악골 내측절제술과 같은 광범위한 수술이 최선의 치료법으로 생각되어 왔으나, 최근 비강 및 부비동의 수술에 비내시경이 널 리 이용되면서 반전성 유두종의 수술에도 내시경을 이용한 절 제술이 가장 흔히 이용되고 있으며 고식적인 수술의 경우와 유사한 치료 성적을 거두고 있다. 경비강 내시경하 상악골 내 측절제술(transnasal endoscopic medial maxillectomy, TEMM)은 상악동에서 기원한 반전성 유두종의 효과적인 수술적 치료법이나 하비갑개와 비강 측벽, 비루관을 제거하기 때문에 위축성 비염, 빈코 증후군(empty nose syndrome), 과도한 가 피형성, 유루증 등 여러 부작용을 야기할 수 있다. 최근 이러 한 부작용을 피하기 위해 하비갑개와 비루관을 보존하는 변 형 경비강 내시경하 상악골 내측절제술(modified TEMM)이 소개되었으며, 상악동에서 기원한 반전성 유두종의 성공적인 치료결과를 보고하였다. 우리나라에서 반전성 유두종을 변형 경비강 내시경하 상악 골 내측절제술을 이용해 성공적인 치료 결과를 보고한 경우는 없었다. 최근 저자들은 상악동에 발생한 반전성 유두종 2예에 대해 변형 경비강 내시경하 상악골 내측절제술로 성공적으로 치료하였기에 문헌고찰과 함께 보고하는 바이다. Two Cases of the Inverted Papilloma in the Maxillary Sinus Treated by Modified Transnasal Endoscopic Medial Maxillectomy

Management of the Nasolacrimal System during Transnasal Endoscopic Medial Maxillectomy

During transnasal endoscopic medial maxillectomy (TEMM) for sinonasal tumors, the nasolacrimal duct (NLD) is resected as it forms part of the medial wall of the maxillary sinus. This disrupts the nasolacrimal drainage system. To ensure that epiphora does not develop after such resection, an endoscopic dacryocystorhinostomy (DCR) is traditionally performed. This is based primarily on prior experience with open medial maxilloethmoidectomy. It is unclear whether a concurrent DCR during endoscopic medial maxillectomy is necessary, however. This study was designed to compare patients undergoing TEMM with or without concurrent DCR for postoperative patency of the NLD. This is a prospective cohort study comparing12 patients undergoing TEMM, 5 with concurrent DCR and 7 without, to assess for patency of the NLD system. In the group that underwent a concurrent DCR, a Jones silastic stent was inserted for 2-3 months. Patients were followed for a minimum of 1 year for assessment of epiphora. The patency of the NLD was judged by clinical and qualitative evidence for epiphora. None of the patients in either group developed epiphora. All were completely symptom free for epiphora during the follow-up period. It appears that after TEMM, patients do not develop epiphora, whether or not a concurrent DCR is performed. Hence, a concurrent DCR does not seem necessary during TEMM.

Transnasal Endoscopic Medial Maxillectomy for Sinonasal Inverted Papilloma

Sinonasal inverted papilloma, an uncommon benign neoplasm, tends to recur and is associated with malignancy. As endoscopic visualization has improved, inverted papilloma has been managed endoscopically through a transnasal approach, with recurrence rate similar to that in extranasal surgery. Transnasal endoscopic medial maxillectomy (TEMM) enables tumors to be removed completely, and lets the nasal cavity be better visualized postoperatively without skin or sublabial incision. Thus preserving the unaffected sinonasal framework, such as the anterior maxillary sinus wall, helps keep recurrent tumors from finding a preformed gateway for invading extranasal tissue. Our analysis of 5 such cases surgically resected with TEMM showed that. All tumors had been extirpated endoscopically and no recurrence was observed in follow-up. We find TEMM to be efficacious in treating inverted papilloma. Avoiding possible complications requires appropriate experience in endoscopic sinus surgery, and long-term follow-up is crucial to reporting long-term results.

Modified transnasal endoscopic medial maxillectomy with medial shift of preserved inferior turbinate and nasolacrimal duct

Although transnasal endoscopic medial maxillectomy (TEMM) is effective for the treatment of inverted papilloma (IP) in maxillary sinus (MS), it involves resection of the inferior turbinate (IT). TEMM also involves resection of the nasolacrimal duct (ND) in many cases to gain better access. Therefore, we developed a novel procedure in which the preserved IT and ND are shifted medially for a complete resection of IP in the MS. Incision was made in the mucosa of the lateral wall along the anterior margin of the IT. After removal of the medial maxillary wall except the ND and the lateral nasal mucosa, the anterior lateral mucosa of the nose, including the IT and the ND, was shifted in the medial direction to allow wider access to the MS. The tumor was removed together with the attachment through the anterior side of the ND. This modified TEMM was performed in 10 patients with IP. The IT and ND were preserved in all patients. We have not observed epiphora after this surgery. The advantages of the novel approach presented herein include: 1) preservation of the IT, ND, and lateral nasal mucosa; 2) wide access to the MS by shifting the IT, ND, and lateral nasal mucosa in the medial direction; and 3) direct access to the MS through anterior space of the ND, resulting in easier operation with a straight endoscope and instruments. This approach is a safe and effective method to obtain wide and straight access to the MS and to resect IP in the MS.

S278 – Management Strategies for Sinonasal Inverted Papilloma

Objectives 1) To compare endoscopic and external approaches in the management of sinonasal inverted papilloma at our institution. 2) To discuss the relationship of these management strategies to disease stage and malignancy. Methods Retrospective chart review of 18 patients who had operations performed to remove sinonasal inverted papilloma. Demographic, imaging and intraoperative data were collected from clinic charts. All patients had a definitive procedure performed between 2001 and 2007, with preoperative staging by CT, MRI or both. The primary outcome measure was recurrence and secondary outcome measures included association with malignancy and intraoperative complications. Results CT and MRI scanning were utilized for staging in 88% and 53% of cases, respectively. Mean follow-up was 16.3 months. All T1 lesions were managed by functional endoscopic sinus surgery (FESS). 71% of T3 lesions were managed by transnasal endoscopic medial maxillectomy (TEMM). 33% and 67% of large T3 and T4 lesions were managed with external procedures and TEMM, respectively. Recurrence rates for T1, T3, and T4 lesions were 0%, 16.7%, and 100%, respectively. Recurrence by surgical method were 0%, 18% (1 T3 and 1 T4), and 0% for FESS, TEMM and external approaches, respectively. Conclusions Inverted papilloma tended to present at more advanced stage. T1 and T3 lesions were generally managed by FESS and TEMM, respectively. Large T3 and T4 lesions were generally managed via external approaches or required further definitive management via an external approach. MRI, especially with frontal disease, may augment CT scanning, identifying true tumor mass, and thus provide indications for or against supplementary procedures.

Transnasal Endoscopic Medial Maxillectomy as the Initial Oncologic Approach to Sinonasal Neoplasms: The Anatomic Basis

Transnasal Endoscopic Medial Maxillectomy as the Initial Oncologic Approach to Sinonasal Neoplasms: The Anatomic Basis

Transnasal Endoscopic Medial Maxillectomy as the Initial Oncologic Approach to Sinonasal Neoplasms

To demonstrate an anatomic basis for endoscopic medial maxillectomy with excision of the lateral nasal wall to the nasal floor, including the inferior turbinate, and nasolacrimal duct. Transnasal endoscopic medial maxillectomy involves complete resection of the lateral nasal wall with boundaries that are inferior to the nasal floor; superior to the cribriform plate and fovea ethmoidalis; anterior to the anterior maxillary wall, including the nasolacrimal duct; and posterior to within 5 mm of the eustachian tube. Transnasal endoscopic medial maxillectomy provides exposure for endoscopic resection of the orbital wall, pterygopalatine fossa, pterygoid plates, nasopharynx, and anterior skull base when indicated. Volumetric analysis of the maxillary sinus was performed on axial and coronal computed tomographic scans of 19 adult patients for a total of 38 maxillary sinuses. Tertiary care medical center. Nineteen adult patients with tumors of the head (but outside the sinonasal region). Radiographic analysis. The total volume of the maxillary sinus, volume above and below the superior attachment of the inferior turbinate, and volume anterior to the nasolacrimal duct were measured. The mean (SD) total volume of the maxillary sinus was 20.1 (4.2) cm(3), whereas its volume inferior to the superior attachment of the inferior turbinate was 12.9 (3.7) cm(3) and anterior to the nasolacrimal duct was 1.1 (0.6) cm(3). The mean (SD) volume of the maxillary sinus inferior to the superior attachment of the inferior turbinate was 64% (12%), whereas the nasolacrimal duct obscured the transnasal anterior exposure of the maxillary sinus. Without excision of the lateral nasal wall inferiorly to the nasal floor and anteriorly, including the nasolacrimal duct, over half of the maxillary sinus would be inaccessible for procedures directed at neoplasms within the maxillary sinus.

Inverted Papilloma: New Classification and Guidelines for Endoscopic Surgery

Surgery is the gold standard in the management of inverted papilloma (IP); however, the approach and extent of the surgical procedure are still controversial. Moreover, there is still no universal staging system of IP to plan surgery and/or evaluate results. We performed a retrospective study. A new classification depending on the origin of the lesion was used to plan surgery in 70 cases of IP. Conservative transnasal endoscopic excision was performed in lesions arising from the nasal septum and lateral nasal wall (type I IP, 42 cases) and radical transnasal endoscopic medial maxillectomy was performed in lesions arising from the maxillary sinus (type 1 IF, 28 cases). Excluding cases with a follow-up of <2 years, follow-up for periods ranging between 2 and 13.3 years with a median of 78 months showed recurrence in a single case of type I (3.2%) and 2 cases of type II (9.5%). The new classification system, based on the origin of IP, is a simple tool for grading IP. It can be used to define cases suitable for conservative excision or radical medial maxillectomy. Both could be performed transnasally and endoscopically.

Ｔｒａｎｓｎａｓａｌ Ｅｎｄｏｓｃｏｐｉｃ Ｍｅｄｉａｌ Ｍａｘｉｌｌｅｃｔｏｍｙ３例の経験―鼻副鼻腔乳頭腫に対する手術法―

This study was performed to review the experience of 3 patients with sinonasal inverted papilloma who underwent transnasal endoscopic medial maxillectomy. The average operative time was 1 hour 38 minutes and the average blood loss was 123ml. There was no recurrence with average follow-up of 28.7 months. I discuss the management of the medial wall of the maxillary sinus during resection of the tumor. Transnasal endoscopic medial maxillectomy is an effective technique for inverted papilloma with extension to the maxillary sinus.

Transnasal endoscopic medial maxillectomy for inverting papilloma.

To describe the new technique of transnasal endoscopic medial maxillectomy. Study design included application of the new technique in the management of five patients with inverting papilloma; retrospective review of five patients who had lateral rhinotomy with medial maxillectomy for inverting papilloma; comparison of transnasal endoscopic medial maxillectomy to open medial maxillectomy for scope of resection, margin control, operative time, and surgical access; and detailed description of transnasal endoscopic medial maxillectomy. Charts were reviewed and tabulated for operative time, duration of follow-up, and recurrence. Pathology reports were reviewed for number and orientation of the specimens and for margin control. Operative time was shorter for patients managed with transnasal endoscopic medial maxillectomy. All patients with transnasal endoscopic medial maxillectomy had one large, well-oriented specimen with margin control. There was no recurrence in either group. Transnasal endoscopic medial maxillectomy providing full access to the maxillary and ethmoid sinuses is described in detail. Transnasal endoscopic medial maxillectomy is an effective, reproducible technique with less operative time and morbidity and, possibly, better pathological tumor mapping than open medial maxillectomy for selected patients. Maxillary sinus involvement with inverting papilloma is not a contraindication for this technique. Strong illumination, superior resolution, and angled visualization, coupled with exact osteotomies, make transnasal endoscopic medial maxillectomy an efficacious technique for inverting papilloma with extension limited to the maxillary and ethmoid sinuses.

Transnasal endoscopic medial maxillectomy in inverted papilloma.

This study comprised 17 cases of inverted papilloma, which were divided into two groups. The first group included 8 cases that lacked maxillary sinus involvement. They were subjected to intranasal endoscopic resection with safety margin. The second group included 9 cases involving the maxillary sinus with or without nasal extension. They were subjected to transnasal endoscopic medial maxillectomy. Follow-up for an average of 43 months in group 1 and 28 months in group 2 (excluding the 5 cases with less than 2 years of follow-up) showed no recurrence. The author realized that inverted papilloma can be divided into two groups from the anatomic and behavioral points of view and accordingly should be managed differently. For those lesions without involvement of the maxillary sinus, intranasal endoscopic resection is effective; for those lesions with maxillary sinus involvement, transnasal medial maxillectomy, which could be performed safely under endoscopic control, is recommended.