In this presentation, a case series of 45 patients who underwent endoscopic medial maxillectomy is presented. A total maxillectomy is the resection of the entire maxilla, whereas a limited maxillectomy is only a partial resection, involving the removal of only the medial wall or the floor of the maxillary sinus. The new modified endoscopic transnasal medial maxillectomy metmm can provide. Although initially described with a lipsplitting technique, many authors subsequently described modifications which obviated this extension.
A maxillectomy is a surgical procedure used to treat oral cavity cancer and cancers affecting the jaw and sinus cavity. The patient will have a foley catheter to drain your bladder in place after surgery. Endoscopic medial maxillectomy as a means of treating recalcitrant maxillary sinusitis was performed on 24 patients between 2009 and 2012 in the sinus and nose hospital santhome, chennai, india, which is a tertiary care center for nasal and sinus diseases. An algorithm for maxillectomy defect reconstruction steven p. Modified endoscopic medial maxillectomy providing full access to the maxillary and ethmoid sinuses is described in detail. We previously reported a modified endoscopic medial maxillectomy modified transnasal endoscopic medial maxillectomy through prelacrimal duct approach mtemmpda to resect inverted papilloma ip, for which the inferior turbinate it and nasolacrimal duct nd can be preserved. This extended endoscopic technique is suitable for the removal of benign maxillary sinus tumors as well as lowgrade maxillary sinus cancers. Endoscopic medial maxillectomy emm is a radical proce dure that involves. Contrastenhanced computed tomography showed heterogeneous enhancement in all patients. A maxillectomy is the partial removal of the upper jaw bone.
Abstract the technical aspects of the medial maxillectomy procedure have evolved over the last century to include modifications that permit improved cosmesis and patient morbidity. Functional endoscopic sinus surgery fess has a longterm high rate of success for. It is increasingly being done by transnasal endoscopic technique for suitable cases and when the. Role of modified endoscopic medial maxillectomy in persistent. The tumor was successfully treated by bilateral endoscopic medial maxillectomy emm. Treatment of recalcitrant maxillary sinusitis with endoscopic. Bilateral ip, involving both sides of the nasal cavity and sinuses, is extremely rare. Role of modified endoscopic medial maxillectomy in. Modified endoscopic medial maxillectomy for recalcitrant. This paper describes a large ip that filled in both sides of the nasal cavity and sinuses, mimicking association with malignancy.
An algorithm for maxillectomy defect reconstruction. Endoscopic medial maxillectomy, since reported first in 1992, has advanced tremendously and has been advocated by a number of authors for the fact that it prevents the morbidity of open approach. The amount of lateral exposure is dependent on the extent of the medial maxillectomy. Following the adoption of endoscopic sinus surgery in the 1980s, there was a paradigm shift toward using endoscopic techniques for resecting select cases of benign and malignant tumors. Abstract although transnasal endoscopic medial maxillectomy temm is effective for the treatment of inverted papilloma ip in maxillary sinus. In this article, the authors describe the endoscopic medial maxillectomy for neoplastic diseases involving the maxillary sinus. Functional deglutition and speech problems with a significant soft tissue deficit ensue. Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy. Recently, a new surgical approach named endoscopic modified medial maxillectomy emmm was proposed. The catheter will be removed when the patient is up. Complications related to lacrimal drainage after endoscopic medial maxillectomy have been previously addressed in the literature and a variable rate of obstruction 016% has been reported 15. Modified transnasal endoscopic medial maxillectomy through. Medial maxillectomy is performed for the removal of benign and malignant tumors that involve the lateral nasal wall medial maxilla and to gain access to tumors in the masticator space and infratemporal skull base floor of middle cranial fossa.
Anatomy the lateral nasal wall includes the inferior turbinate, infundibulum with maxillary ostium, uncinate process, and nasolacrimal duct. Effect of incremental endoscopic maxillectomy on surgical exposure. Endoscopic medial maxillectomy for inverted papilloma. Advances in endoscopic sinus surgery have enabled some of these same disease processes to be treated using endoscopic techniques.
The aim of this study was to describe the endoscopic medial maxillectomy technique with preservation of the inferior turbinate in patients affected by maxillary sinonasal inverted papilloma. Combine with the sublabial approach for anterior and inferior and lateral recess and nasolacrimal duct disease combine with open approach for superior lateral orbit disease follow up. Endoscopic medial maxillectomy after medial shifting of. Transnasal endoscopic medial maxillectomy in inverted. Modified transnasal endoscopic medial maxillectomy with medial. This may leave the medial buttress piriform aperture strut intact, if not involved or not hindering exposure. Malignant tumors involving maxilla lateral nasal wall 2. Transnasal endoscopic medial maxillectomy for inverting. Introduction medial maxillectomy is a procedure historically used for the removal of benign and lowgrade malignant tumors of the medial aspect of the maxilla, lateral nasal wall, ethmoid sinuses along the lamina papyracea, and the lacrimal sac. Endoscopic sinus surgery, in particular endoscopic medial maxillectomy, is currently the gold standard for treatment of maxillary sinus papilloma. The endoscopic medial maxillectomy approach was modified by making an incision in the pyriform aperture and removing part of the anterolateral wall of the maxilla bone en bloc. Neosoteogenesis at the postereolateral wall drilled to.
We have been billing an endoscopic medial maxillectomy as 31225. The anterior cranial fossa dura was exposed, but was not involved. Pdf modified transnasal endoscopic medial maxillectomy with. Medial maxillectomy definition of medial maxillectomy by. Intraoperatively, the entire medial wall of the maxillary sinus was removed and disease was cleared off the dental implants which were. The most frequent pathologies diagnosed were inverted papillomas 27 and antrochoanal polyps 727. Maxillary sinus involvement with inverting papilloma is not a. Clinic endoscopic follow up is critical to detecting recurrence early. Multidisciplinary decisionmaking in the management of the maxillectomy defect. For inverted papilloma involving the lateral nasal wall, endoscopic medial maxillectomy is the procedure of choice. Recently, a new surgical approach named endoscopic modi ed medial maxillectomy emmm was proposed. Medial maxillectomy anterior wall of maxillary sinus is removed with osteotome and rongeurs. Sep 24, 2019 in 1977, sessions and larson coined the term medial maxillectomy to describe a partial maxillectomy indicated for benign and malignant lesions of the lateral nasal wall. Jun 03, 2016 likewise, tumors involving only the medial maxillary wall or lateral nasal wall, such as an inverted papilloma, can be treated with a medial maxillectomy.
The variety of nomenclature in our own service database. In this patient, the sinonasal ip originated from the entire circumference of the maxillary. Transnasal endoscopic medial maxillectomy as the initial oncologic. Module 7 endoscopic medial maxillectomy captured from the advanced skull base rhinology dissection workshop august 2018, university of malaya medical centre, kuala lumpur, malaysia dissector and. If there is anything that i am not answering here, then please, contact me and i will answer you directly. Tae kyung cha, ju hun song, jee hye wee and jae goo kang, two cases of the inverted papilloma in the maxillary sinus treated by modified transnasal endoscopic medial maxillectomy, korean journal of otorhinolaryngologyhead and neck surgery, 57, 12, 874, 2014. Endoscopic medial maxillectomy augusta university research. There were 21 primary lesions and 6 patients had been previously treated. Vasculature around the orbit the arterial blood supply to the maxilla and paranasal sinuses originates from both the external and internal carotid artery systems. Jcm free fulltext surgery of inverted papilloma of the maxillary.
Endoscopic medial maxillectomy s harvinder, mmed orlhns, s rosalind, mmed orlhns, s mallina, mbbs, s gurdeep, mshnorl department of ent, hospital ipoh, jalan hospital, 30990, ipoh, perak original article this article was accepted. Others 16 have supported this notion that an endoscopic medial maxillectomy is completed only with resection of the medial wall of the maxilla including the inferior turbinate up to its anterior wall. Modified transnasal endoscopic medial maxillectomy with. Transnasal endoscopic medial maxillectomy is an effective, reproducible technique with less operative time and morbidity and, possibly, better pathological tumor mapping than open medial. Bilateral, total maxillectomy is occasionally required and entails much greater complexity in reconstruction. Endoscopic prelacrimal medial maxillectomy epmm was previously reported to treat maxillary inverted papilloma. Modified medial maxillectomy for recalcitrant maxillary. Case report endoscopic modified medial maxillectomy for. The ethmoid sinus and frontonasal duct were also accessible from this incision.
A maxillectomy defect creates a communication from oral cavity to nasal cavity that may extend to the orbit. The procedure may create a connection between the nose, sinus and oral cavities which can make speech and swallowing challenging. Alternatively, this bone can be removed en bloc and later plated back. I have tried to answer questions that i thought about before i had the operation and also questions that i still ask myself hopefully some of these may help you. We successfully treated sinonasal ip with emmm in a yearold female patient. Its use as definitive treatment for inflammatory disease of the maxillary sinus. Over the past decade, the role of endoscopic techniques in the excision of sinonasal neoplastic lesions has become widely recognized. Modified endoscopic medial maxillectomy memm is an accepted alternative treatment for benign sinonasal neoplasms. A radical procedure used to excise benign and lowgrade malignancies of the medial aspect of the maxilla, the lateral nasal wall, ethmoid sinuses and lacrimal sac, in which the maxilla is removed with the tumour. The endoscopic medial maxillectomy is the modern adaptation of the more historical open medial maxillectomy. With the advent of nasal endoscope resection of tumors involving lateral nasal wall under endoscopic vision is the order of the day. Aug 02, 2014 maxillectomy partial maxillectomy hemi maxillectomy full maxillectomy maxillectomy is the removal of damaged parts in maxilla due to cancerous tissue being present and damaging the hard palate size spread 5 extended maxillectomy radical maxillectomy size spread 7.
An indication for a maxillectomy would be to remove cancer in the maxillary sinus. Historically, neoplastic processes of the lateral nasal wall and maxillary sinus have been treated with external procedures. An advanced technique used for the management of recalcitrant chronic maxillary sinusitis and certain maxillary sinus tumors e. Keywords maxillary sinus, chronic sinusitis, medial maxillectomy.
During inferior maxillectomy one can expect to encounter some bleeding. From january 2005 to december 2016, the authors performed 27 endoscopic medial maxillectomy with preservation of inferior turbinate on 26 patients. Modified medial maxillectomy differs from a traditional endoscopic medial maxillectomy by preserving the nasolacrimal duct and a portion of the inferior turbinate. Jun 15, 2016 medial maxillectomy is performed for the removal of benign and malignant tumors that involve the lateral nasal wall medial maxilla and to gain access to tumors in the masticator space and infratemporal skull base floor of middle cranial fossa. Lateral rhinotomy or sublabial degloving is the traditional approach used for an open medial maxillectomy. Endoscopic medial maxillectomy with preservation of inferior. One of these techniques that are widely implemented is endoscopic medial maxillectomy. Traditionally the surgery is performed via an open approach. Endoscopic medial maxillectomy with preservation of.
The indications of medial maxillectomy are not only restricted for inverted papilloma but can be performed for. The anterior, inferior, and medial walls of the maxillary sinus could be observed endoscopically. With the improved visualization of endoscopic techniques and outcomes comparable to those of the external approach, endoscopic transnasal resection of these tumors is quickly becoming the standard of care. With more familiarity and expertise in endoscopic sinus surgery the endonasal approach. Medial maxillectomy is now the gold standard for ip. Endoscopic partial medial maxillectomy with mucosal flap for maxillary sinus mucoceles. The endoscopic medial maxillectomy is also a useful approach for access to the pterygopalatine. Case of recurrent inverted papilloma of left paranasal sinuses. Endoscopic medial maxillectomy may be used as an alternative to more invasive external approaches while maintaining similar cure rates. Oct 12, 2010 a medial maxillectomy mm consists of a complete resection of the medial wall of the maxillary sinus. The national center for biomedical ontology was founded as one of the national centers for biomedical computing, supported by the nhgri, the nhlbi, and the nih common fund under grant u54hg004028. It is a true medial maxillectomy, involving resection of the entire lateral nasal wall. Materials and methods patients and tumour characteristics from january 2005 to december 2008, 27 patients with inverted papilloma were treated in our institution.
Endoscopic medial maxillectomy for infected dental implants decision was made to proceed with a left emm to allow for wide open irrigation and drainage of the left maxillary sinus. Endoscopic modified medial maxillectomy for resection of. He did an endoscopic endonasal resection of the mass with drainageexcision of the parasinus mass and use of intraoperative. It is increasingly being done by transnasal endoscopic technique for suitable cases. Maxillectomy is potentially complicated by injuries to the orbital contents, lacrimal. Fourteen patients with organised haematoma were treated. Six of them were tumours that involved the anteromedial wall of. Approach lateral rhinotomy incision or midfacial degloving.
Bilateral endoscopic medial maxillectomy for bilateral. For treatment of a sinonasal inverted papilloma ip, it is essential to have a definite diagnosis, to identify its origin by computed tomography ct and magnetic resonance imaging mri, and to select the appropriate surgical approach based on the staging system proposed by krouse. Transnasal endoscopic medial maxillectomy as the initial. Eight patients underwent modified transnasal endoscopic medial maxillectomy, without complications such as facial numbness, tooth numbness, facial tingling, lacrimation and eye discharge.
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. Picture of lateral rhinotomy and medial maxillectomy for. Transnasal endoscopic medial maxillectomy temm is effective for the treatment of inverted papilloma ip in the maxillary sinus ms. A lateral rhinotomy provided access to the tumor, the lateral wall of the nasal cavity and maxilla. Therefore, the classical medial maxillectomy with resection of the medial wall of the maxillary sinus including the inferior turbinate and the nasolacrimal duct or a. Teaching and guidance as to the best technique, therefore, is based more on authority than clinical evidence. Endoscopic modified medial maxillectomy for resection of an. This chapter will only deal with the open surgical medial maxillectomy technique.
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