Maxillary Sinus Surgery Clinical Trial
Official title:
Endoscopic Approaches To The Maxillary Sinus: A Comparative Study
The aim of this study is to compare the outcomes of endoscopic pre lacrimal recess approach,
canine fossa approach and middle meatal antrostomy approach regarding:
1. Assessment of the accessibility of each approach to visualize and reach the different
walls and recesses of the maxillary sinus.
2. Any intraoperative or postoperative complications.
3. Any post-operative recurrence or residue detected by endoscopic examination or by MSCT
scan.
The maxillary sinus is the sinus most commonly affected by disease.. It varies greatly in
size, shape, position and pneumatisation, not only in different individuals, but also in
different sides of the same individual .
A broad spectrum of disease processes can involve the maxillary sinus, such as infective,
odontogenic and neoplastic. In simple cases, a standard uncinectomy and middle meatal
antrostomy may be sufficient for visualisation and clearance of disease but despite this a
drawback still exists in both external and intranasal surgical procedures. Compromise of the
inferior turbinate (IT) and nasolacrimal duct (NLD) is often unavoidable .
According to the anatomy of MS and the feature of diseases originated from MS assessed with
multi-angulated telescopes, including 30 ,45 and 70 telescopes, with kinds of curved
instruments, there are still some areas which can not be viewed and handled . Such critical
areas as the inferior, lateral, anterior wall, zygomatic recess, alveolar recess and
prelacrimal recess of maxillary sinus are difficult to approach. For this reason other
approaches are needed like canine fossa approach (CFA), prelacrimal recess approach (PLRA)
and medial maxillectomy approach.
Review of the literature revealed no meta-analysis or evidence based medicine comparing
different endoscopic approaches to maxillary sinus regarding feasibility of the access to
different recesses and residual lesions.
The endonasal endoscopic prelacrimal recess approach (PLRA) provides a clear view through
wide access to all walls of the maxillary sinus while still preserving the nasolacrimal duct
and inferior turbinate.
It enables us to accurately, mini-invade and completely remove MS lesions. It is a
physiological and functional surgery, and has great advantages in treating the diseases of
the nasal cavity.
Canine fossa approach (CFA) has been proposed as an alternative method of obtaining access to
the maxillary antrum. Although a few studies have demonstrated the benefits of CFA in
management of the severely diseased maxillary sinus, the efficacy and superiority of this
method compared with conventional MMA require further investigation above all considering new
microdebrider blades that can be inserted through the antrostomy.
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