Endoscopic medial maxillectomy augusta university research. 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. Functional deglutition and speech problems with a significant soft tissue deficit ensue. Article information, pdf download for treatment of recalcitrant maxillary. In this article, the authors describe the endoscopic medial maxillectomy for neoplastic diseases involving the maxillary sinus. Picture of lateral rhinotomy and medial maxillectomy for. 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.
Keywords maxillary sinus, chronic sinusitis, medial maxillectomy. 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. 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. Questions you might have maxillectomy will nickson. Many adjectives are used to describe maxillectomy procedures, such as radical, total, extended, subtotal, medial, partial, and limited. It is a true medial maxillectomy, involving resection of the entire lateral nasal wall. Effect of incremental endoscopic maxillectomy on surgical exposure. Fourteen patients with organised haematoma were treated. 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. From january 2005 to december 2016, the authors performed 27 endoscopic medial maxillectomy with preservation of inferior turbinate on 26 patients. 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.
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. 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. Transnasal endoscopic medial maxillectomy is an effective, reproducible technique with less operative time and morbidity and, possibly, better pathological tumor mapping than open medial. This study aimed to compare prelacrimal recess approach with the conventional caldwellluc approach cla to remove benign maxillary sinus tumors and to evaluate the usefulness of this approach based on our experience. Endoscopic prelacrimal medial maxillectomy epmm was previously reported to treat maxillary inverted papilloma. Endoscopic medial maxillectomy may be used as an alternative to more invasive external approaches while maintaining similar cure rates. 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. The new modified endoscopic transnasal medial maxillectomy metmm can provide.
Over the past decade, the role of endoscopic techniques in the excision of sinonasal neoplastic lesions has become widely recognized. Maxillectomy is potentially complicated by injuries to the orbital contents, lacrimal. Malignant tumors involving maxilla lateral nasal wall 2. 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. Its use as definitive treatment for inflammatory disease of the maxillary sinus. With the advent of nasal endoscope resection of tumors involving lateral nasal wall under endoscopic vision is the order of the day. The anterior cranial fossa dura was exposed, but was not involved. Although initially described with a lipsplitting technique, many authors subsequently described modifications which obviated this extension.
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. Medial maxillectomy is now the gold standard for ip. 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. Bilateral endoscopic medial maxillectomy for bilateral.
With more familiarity and expertise in endoscopic sinus surgery the endonasal approach. 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. Alternatively, this bone can be removed en bloc and later plated back. 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. Endoscopic medial maxillectomy with preservation of inferior. During inferior maxillectomy one can expect to encounter some bleeding. The procedure may create a connection between the nose, sinus and oral cavities which can make speech and swallowing challenging. An algorithm for maxillectomy defect reconstruction steven p. The anterior, inferior, and medial walls of the maxillary sinus could be observed endoscopically. 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. Recently, a new surgical approach named endoscopic modified medial maxillectomy emmm was proposed. Pdf modified transnasal endoscopic medial maxillectomy with.
It is increasingly being done by transnasal endoscopic technique for suitable cases. Endoscopic medial maxillectomy with preservation of. Modified medial maxillectomy differs from a traditional endoscopic medial maxillectomy by preserving the nasolacrimal duct and a portion of the inferior turbinate. The indications of medial maxillectomy are not only restricted for inverted papilloma but can be performed for.
Advances in endoscopic sinus surgery have enabled some of these same disease processes to be treated using endoscopic techniques. 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. Multidisciplinary decisionmaking in the management of the maxillectomy defect. 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. An algorithm for maxillectomy defect reconstruction. 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. A maxillectomy defect creates a communication from oral cavity to nasal cavity that may extend to the orbit. 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. Modified endoscopic medial maxillectomy providing full access to the maxillary and ethmoid sinuses is described in detail. Patients may be on 4b or rarely the intensive care unit 5d. Functional endoscopic sinus surgery fess has a longterm high rate of success for. In this patient, the sinonasal ip originated from the entire circumference of the maxillary. Bilateral, total maxillectomy is occasionally required and entails much greater complexity in reconstruction. Medial maxillectomy anterior wall of maxillary sinus is removed with osteotome and rongeurs.
Medial maxillectomy definition of medial maxillectomy by. The catheter will be removed when the patient is up. Abstract although transnasal endoscopic medial maxillectomy temm is effective for the treatment of inverted papilloma ip in maxillary sinus. 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. The variety of nomenclature in our own service database.
Transnasal endoscopic medial maxillectomy as the initial oncologic. For inverted papilloma involving the lateral nasal wall, endoscopic medial maxillectomy is the procedure of choice. Modified transnasal endoscopic medial maxillectomy with medial. Modified endoscopic medial maxillectomy for recalcitrant. In this presentation, a case series of 45 patients who underwent endoscopic medial maxillectomy is presented. If there is anything that i am not answering here, then please, contact me and i will answer you directly.
Modified transnasal endoscopic medial maxillectomy with. 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. Anatomy the lateral nasal wall includes the inferior turbinate, infundibulum with maxillary ostium, uncinate process, and nasolacrimal duct. Contrastenhanced computed tomography showed heterogeneous enhancement in all patients.
An advanced technique used for the management of recalcitrant chronic maxillary sinusitis and certain maxillary sinus tumors e. It is increasingly being done by transnasal endoscopic technique for suitable cases and when the. We have been billing an endoscopic medial maxillectomy as 31225. 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. The patient will have a foley catheter to drain your bladder in place after surgery. Modified transnasal endoscopic medial maxillectomy through. 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. Recently, a new surgical approach named endoscopic modi ed medial maxillectomy emmm was proposed.
Role of modified endoscopic medial maxillectomy in. Endoscopic medial maxillectomy after medial shifting of. 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. Endoscopic modified medial maxillectomy for resection of. This may leave the medial buttress piriform aperture strut intact, if not involved or not hindering exposure. Intraoperatively, the entire medial wall of the maxillary sinus was removed and disease was cleared off the dental implants which were. Neosoteogenesis at the postereolateral wall drilled to. We successfully treated sinonasal ip with emmm in a yearold female patient. A maxillectomy is the partial removal of the upper jaw bone. Materials and methods patients and tumour characteristics from january 2005 to december 2008, 27 patients with inverted papilloma were treated in our institution. The endoscopic medial maxillectomy is the modern adaptation of the more historical open medial maxillectomy. Role of modified endoscopic medial maxillectomy in persistent. Vasculature around the orbit the arterial blood supply to the maxilla and paranasal sinuses originates from both the external and internal carotid artery systems. 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.
He did an endoscopic endonasal resection of the mass with drainageexcision of the parasinus mass and use of intraoperative. This extended endoscopic technique is suitable for the removal of benign maxillary sinus tumors as well as lowgrade maxillary sinus cancers. The most frequent pathologies diagnosed were inverted papillomas 27 and antrochoanal polyps 727. Endoscopic partial medial maxillectomy with mucosal flap for maxillary sinus mucoceles. Endoscopic sinus surgery, in particular endoscopic medial maxillectomy, is currently the gold standard for treatment of maxillary sinus papilloma. Historically, neoplastic processes of the lateral nasal wall and maxillary sinus have been treated with external procedures. The ethmoid sinus and frontonasal duct were also accessible from this incision. An indication for a maxillectomy would be to remove cancer in the maxillary sinus. 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. This chapter will only deal with the open surgical medial maxillectomy technique. Transnasal endoscopic medial maxillectomy in inverted.
Case report endoscopic modified medial maxillectomy for. Modified medial maxillectomy for recalcitrant maxillary. This paper describes a large ip that filled in both sides of the nasal cavity and sinuses, mimicking association with malignancy. The amount of lateral exposure is dependent on the extent of the medial maxillectomy. Endoscopic medial maxillectomy for inverted papilloma.
Modified endoscopic medial maxillectomy memm is an accepted alternative treatment for benign sinonasal neoplasms. Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy. Teaching and guidance as to the best technique, therefore, is based more on authority than clinical evidence. Medial maxillectomy is the procedure designed to en bloc resect the party wall between the nasal cavity, maxillary antrum, and adjacent ethoid labyrinth along with the tumor within the nose and sinus. Oct 12, 2010 a medial maxillectomy mm consists of a complete resection of the medial wall of the maxillary sinus. A maxillectomy is a surgical procedure used to treat oral cavity cancer and cancers affecting the jaw and sinus cavity. Lateral rhinotomy or sublabial degloving is the traditional approach used for an open medial maxillectomy. Pdf endoscopic partial medial maxillectomy with mucosal. Maxillary sinus involvement with inverting papilloma is not a. Let us use the example of endoscopic transnasal sphenopalatine artery ligation and examine the following options. Transnasal endoscopic medial maxillectomy for inverting. Clinic endoscopic follow up is critical to detecting recurrence early. Treatment of recalcitrant maxillary sinusitis with endoscopic. The tumor was successfully treated by bilateral endoscopic medial maxillectomy emm.
Traditionally the surgery is performed via an open approach. The endoscopic medial maxillectomy is also a useful approach for access to the pterygopalatine. A lateral rhinotomy provided access to the tumor, the lateral wall of the nasal cavity and maxilla. Endoscopic medial maxillectomy emm is a radical proce dure that involves. There were 21 primary lesions and 6 patients had been previously treated. Bilateral ip, involving both sides of the nasal cavity and sinuses, is extremely rare. Jcm free fulltext surgery of inverted papilloma of the maxillary. Dentigerous cyst is one of the most frequent types of odontogenic cyst that. Six of them were tumours that involved the anteromedial wall of. A medial maxillectomy mm consists of a complete resection of the medial wall of the maxillary sinus. Transnasal endoscopic medial maxillectomy temm is effective for the treatment of inverted papilloma ip in the maxillary sinus ms. Although a common technique, complications such as stenosis of the lacrimal pathway and consequent development of epiphora are still possible.
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