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Abdulla M, Refaat O, Alahmer M, Yehia A, Abdelsalam H, Abdelaal K, Shams Eldin M. Prelacrimal Recess Approach in Unilateral Maxillary Sinus Lesions: What Is the Impact and Efficacy? MEDICINA (KAUNAS, LITHUANIA) 2024; 60:222. [PMID: 38399510 PMCID: PMC10890376 DOI: 10.3390/medicina60020222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Chronic sinusitis is a commonly encountered diagnosis for otorhinolaryngologists. The profound negative effect of rhinosinusitis on patients' quality of life is frequently overlooked, and surgical lines of treatment are numerous. The aim of the study was to assess the comparative efficacy of endoscopic middle meatal antrostomy with the endoscopic prelacrimal recess approach, combined with middle meatal antrostomy in the treatment of unilateral chronic maxillary sinus lesion. Materials and Methods: Thirty patients with unilateral chronic maxillary sinus lesions enrolled in the study at Alahsa hospital. Patients were divided into two groups: 15 treated through a middle meatal antrostomy and 15 treated via a combined middle meatal antrostomy and prelacrimal recess approach. Demographic and clinical information of the patients, including the medical history, CT scan findings, diagnosis, recurrence, and complications, were gathered and analyzed. Pre- and postoperative clinical findings were graded utilizing the Lund-Kennedy Endoscopic Scoring System. Results: The enrolled patients varied in age from 18 to 56, with 60% being male and 40% being female. Antrochoanal polyp, maxillary sinus mucocele, and unilateral allergic fungal sinusitis were among the pathological diagnoses. The follow-up period averaged 14.3 months. Following surgery, two patients in Group II encountered nasal discomfort, which included synechia and epiphora. The success rate for preserving a patient's disease-free condition was 86.7%. A statistically significant difference in disease-free incidence was observed among the patients in group II. In group I, recurrence was identified in 26.7% of the patients. The postoperative symptoms diminished considerably, and the VAS score was reduced substantially. In Group II patients, however, there was no significant difference in scarring. Clinically significant differences were observed in the mean total Lund-Kennedy Endoscopic scores when compared to their preoperative values. Conclusions: Achieving endoscopic access to the sinus's anterior, lateral, inferior, and inferomedial regions is facilitated by operating via the prelacrimal recess, which is the most advantageous approach. This approach facilitates rapid mucosal healing by maintaining the integrity of the nasolacrimal duct and mucosal covering. The specific pathology, surgical objectives, surgeon expertise, and equipment accessibility influence the choice of endoscopic surgical technique.
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Affiliation(s)
- Mohamed Abdulla
- Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo 11675, Egypt
| | - Osama Refaat
- Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo 11675, Egypt
| | - Mohamed Alahmer
- Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo 11675, Egypt
| | - Ayman Yehia
- Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo 11675, Egypt
| | - Hesham Abdelsalam
- Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo 11675, Egypt
| | - Khaled Abdelaal
- EPCRS Excellence Center, Plant Pathology and Biotechnology Lab., Faculty of Agriculture, Kafrelsheikh University, Kafr El-Sheikh 33516, Egypt
| | - Mohamed Shams Eldin
- Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo 11675, Egypt
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Soyal R, Açar G, Çiçekcibaşı AE, Gökşan AS, Aydoğdu D. Assessment of the prelacrimal recess in different maxillary sinus pneumatizations in relation to endoscopic prelacrimal recess approaches: a computed tomography study. Surg Radiol Anat 2023:10.1007/s00276-023-03181-0. [PMID: 37306725 DOI: 10.1007/s00276-023-03181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE To assist in planning before the endoscopic prelacrimal recess (PLR) approach, we aimed to investigate the relationship between morphometry and variations of PLR in maxillary sinus (MS) pneumatizations. METHODS Retrospective analysis of the paranasal sinus computed tomography images of 150 patients was conducted to determine the pneumatization patterns of the MS, PLR variations, and the applicability of the PLR approach. The results were compared based on lateralization, gender, and age groups. RESULTS The PLRwidth, the anteroposterior diameter of the nasolacrimal duct (NLD), the vertical and horizontal diameters of the MS were the highest in hyperplasic MS, and decreased significantly with increasing age (p = 0.005, p = 0.017, p = 0.000), respectively. Most of the morphometric measurements were higher in hyperplasic MS, while the medial wall thickness of PLR was higher in hypoplasic MS. The PLRwidth for feasibility of the PLR approach were Type I (48%) in hypoplasic MS and Type III (80%) in hyperplasic MS (p < 0.001), respectively. The PLR medial wall thickness was higher in Type I, while the piriform aperture angle (PAA), MS volume, length, and slope of the NLD were higher in Type III PLRwidth (p = 0.000), respectively. The highest anterior and separation-type variations of the PLR were observed in hyperplasic MS, whereas 31.0% of hypoplasic MS had no PLR (p < 0.001). CONCLUSION This study revealed that PLRwidth and PAA were the highest in hyperplasic MS, which allows the endoscopic PLR approach to be performed more easily. For safer and uncomplicated surgery, surgeon should be aware of the PLR anatomy in different MS pneumatization patterns.
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Affiliation(s)
- Rukiye Soyal
- Department of Radiology, Meram Faculty of Medicine, Necmettin Erbakan University, 42090, Meram, Konya, Turkey
| | - Gülay Açar
- Department of Radiology, Meram Faculty of Medicine, Necmettin Erbakan University, 42090, Meram, Konya, Turkey.
| | - Aynur Emine Çiçekcibaşı
- Department of Radiology, Meram Faculty of Medicine, Necmettin Erbakan University, 42090, Meram, Konya, Turkey
| | - Ahmet Safa Gökşan
- Department of Radiology, Meram Faculty of Medicine, Necmettin Erbakan University, 42090, Meram, Konya, Turkey
| | - Demet Aydoğdu
- Department of Radiology, Meram Faculty of Medicine, Necmettin Erbakan University, 42090, Meram, Konya, Turkey
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Anterior maxillary wall and lacrimal duct relationship in pediatric patients - CT analysis for the feasibility of the prelacrimal recess approach. Auris Nasus Larynx 2021; 49:618-624. [PMID: 34920908 DOI: 10.1016/j.anl.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/13/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of the current study is to determine the age-related feasibility rate of the intranasal endoscopic prelacrimal recess approach (PLRA) in pediatric patients. METHODS Computed tomography (CT) images of 379 patients under 18 years old were analyzed retrospectively. The anteroposterior dimensions of the medial bony wall of the prelacrimal recess (PLR) were measured on 758 sides. The feasibility of the PLRA was evaluated according to the criteria of Simmen et al., for each age and three age groups based on trends in the change of the width of the PLR. RESULTS Less than half (45.9%) of pediatric maxillary sinuses (MS) were found to have the favorable anatomy (width of PLR >3 mm) to perform the PLRA. The cut-off value for age regarding the feasibility of the PLRA was nine years old. Following an evaluation of the groups, the proportions of the MS with favorable anatomy for the PLRA were 5.7% in Group I (age 0-4 years), 33.3% in Group II (age 5-8 years), and 55.1% in Group III (age 9-17 years). In group III, the feasibility rate for the PLRA was greater in boys (62.1%) than in girls (48.3%). No difference in the feasibility rate was found between the right and left sides. CONCLUSION The overall feasibility rate for the PLRA in pediatric patients under 18 years of age is 46%. In patients aged 9-17 years, the feasibility rate for the PLRA is >50%.
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Arosio AD, Valentini M, Canevari FR, Volpi L, Karligkiotis A, Terzakis D, Battaglia P, Georgalas C, Bignami M, Castelnuovo P, Turri-Zanoni M. Endoscopic Endonasal Prelacrimal Approach: Radiological Considerations, Morbidity, and Outcomes. Laryngoscope 2021; 131:1715-1721. [PMID: 33336816 DOI: 10.1002/lary.29330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE/HYPOTHESIS This study describes a multicentric experience with the use of prelacrimal approach (PLA), focusing on preoperative radiological parameters potentially associated with surgical outcomes and postoperative morbidity. STUDY DESIGN Retrospective case-series. METHODS A retrospective review of patients undergoing PLA in three European referral centers was performed. The post-operative morbidity was analyzed in relation to two radiological parameters: width of prelacrimal recess (WPR) and internal angle of pyriform notch (APN). RESULTS The study included 28 patients affected by Schneiderian papilloma (20 cases), inflammatory disease (6 cases), schwannoma (1 case), and osteoma (1 case). The most reported sequela was paresthesia of ipsilateral anterior superior alveolar process (25% of the cases). An association between post-operative morbidity and APN was observed (P = .047). CONCLUSIONS Preoperative radiological evaluation of WPR is crucial in understanding the feasibility of the approach, while APN measurement may predict postoperative morbidity, which is paramount in the patients' counseling. LEVEL OF EVIDENCE 4 case-series Laryngoscope, 131:1715-1721, 2021.
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Affiliation(s)
- Alberto Daniele Arosio
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
| | - Marco Valentini
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
| | - Frank Rikki Canevari
- Department of Otorhinolaryngology Head and Neck Surgery, University of Genova, Genova, Italy
| | - Luca Volpi
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
| | - Apostolos Karligkiotis
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
| | - Dimitris Terzakis
- Endoscopic Skull Base Centre Athens, Hygeia Hospital, Athens, Greece
| | - Paolo Battaglia
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Christos Georgalas
- Endoscopic Skull Base Centre Athens, Hygeia Hospital, Athens, Greece
- Department of Otolaryngology Head and Neck Surgery, University of Nicosia, Nicosia, Cyprus
| | - Maurizio Bignami
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Department of Otolaryngology Head and Neck Surgery, University of Insubria, Como, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Prevalence of the prelacrimal recess in maxillary sinus and its medial bony wall dimensions. Eur Arch Otorhinolaryngol 2020; 278:1099-1105. [PMID: 33001292 DOI: 10.1007/s00405-020-06400-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the occurrence rate of the prelacrimal recess (PLR) and its medial bony wall dimensions based on the radiological analysis to help surgeons enhance the understanding of anatomic structures for the endoscopic prelacrimal recess approach. METHODS Cone-beam computed tomography images of 255 patients were evaluated retrospectively. The prevalence of the PLR in maxillary sinus was investigated and the thickness of its medial bony wall was measured and statistically assessed. Meanwhile, the width of the PLR was measured. The correlation between the width of the PLR and its medial bony wall thickness was assessed. The data were compared between the left side and right side, male and female. RESULTS The PLR was present in 82.5% of the maxillary sinus, with no significant differences between the left and right sides, as well as different gender groups. The mean thickness of the medial bony wall of the PLR was 2.84 ± 1.41 mm, without statistical difference between the left and right sides but significantly larger in males than in females. The mean width of the PLR was 4.62 ± 1.74 mm and it had a significant negative correlation with the thickness of the medial bony wall of the PLR. CONCLUSION A large individual variation exists in the anatomy of PLR, including its prevalence and dimensions of its medial bony wall. When considering the intranasal endoscopic prelacrimal recess approach, the surgeons should carefully evaluate the anatomical structure of the PLR preoperatively so as to minimize the risks of surgical complications.
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Duman SB, Gumussoy İ. Assesment of Prelacrimal Recess in Patients With Maxillary Sinus Hypoplasia Using Cone Beam Computed Tomography. Am J Rhinol Allergy 2020; 35:361-367. [PMID: 32927966 DOI: 10.1177/1945892420959592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prelacrimal recess approach, is frequently preferred in creating a minimally invasive surgical corridors. OBJECTIVE The aim of this study was to evaluate the Prelacrimal recess (PLR) anatomy using Cone Beam Computed Tomography in patients with Maxillary Sinus Hypoplasia. METHODS The paranasal Cone Beam Computed Tomography series of 84 adults were analyzed retrospectively. The antero-posterior and mesio-distal widths of the PLR and the antero-posterior width of the naso-lacrimal duct were measured. The patients were divided into three groups according to the antero-posterior width of PLR to evaluate the feasibility of prelacrimal recess approach as Type 1 (0-3 mm), Type 2 (>3-7 mm) and Type 3 (>7 mm). RESULTS The mean antero-posterior width of PLR was 3.11 ± 1.49mm in the patients and 4.77 ± 1.76 mm in the controls. The mean mesio-distal width of PLR was 7.64 ± 1.49 mm in the patients and 3.17 ± 2.05 mm in the controls. The mean antero-posterior width of naso-lacrimal duct was 9.58 ± 2.80 mm in the patients and 9.46 ± 2.42 mm in the controls. CONCLUSIONS The width of the antero-posterior PLR in patients with Maxillary Sinus Hypoplasia was found to be significantly lower in comparison to individuals with normal maxillary sinuses in the measurements performed on paranasal Cone Beam Computed Tomography scans. Hence, while planning a Functional Endoscopic Sinus Surgery with prelacrimal recess approach for maxillary sinus, the anatomical structure of the naso-sinusoidal region should be carefully analyzed, and individual anatomical variations such as Maxillary Sinus Hypoplasia should not be ignored.
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Affiliation(s)
- Suayip Burak Duman
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - İsmail Gumussoy
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Sakarya University, Sakarya, Turkey
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