Surgical outcomes between two endoscopic approaches for maxillary cysts

Endoscopic Approach to Postoperative Maxillary Cysts Ensuring Infraorbital Nerve Safety With Direct Approach to the Anterior and Lateral Part of the Maxillary Sinus With an Endoscope (DALMA): A Case Report

Postoperative maxillary cysts (POMCs) present significant challenges, especially when located laterally or when the infraorbital nerve's course is unclear on imaging. Traditional endoscopic approaches are often limited by a high risk of recurrence and potential nerve injury. Here, we report a case of a 72-year-old woman with a right maxillary cyst, which caused pain and swelling. Imaging revealed a cyst with infraorbital wall defects and uncertain nerve positioning. Using the direct approach to the anterior and lateral maxillary sinus with an endoscope (DALMA), we successfully identified and preserved the infraorbital nerve while opening the cyst wall. A mucosal flap from the nasolacrimal duct was utilized to cover the cyst opening, secured by suturing with the medial cyst wall to prevent recurrence. Postoperative recovery was uneventful, with significant relief of symptoms. Eight-month follow-up imaging confirmed an open cyst without recurrence or nerve damage. This case demonstrates the efficacy of the DALMA technique in managing complex POMCs, offering a safe and effective method for cases with challenging anatomical features. Using a nasolacrimal duct mucosal flap provided the necessary coverage and stability to prevent recurrence. This approach significantly reduces the risk of infraorbital nerve injury and recurrence, making it a valuable advancement in endoscopic sinus surgery.

Facial Pain Triggered by Inferior Turbinate Partial Resection in a Patient with a Previous History of Inferior Meatal Antrostomy: A Case Report

OBJECTIVES

Inferior meatal antrostomy (IMA) is regarded as a safe method, with minimal complications, for managing various lesions in the maxillary sinus. However, in patients with persisting IMA window, resection of the inferior turbinate may result in direct airflow into the antrum, irritating the antral mucosa.

METHODS

Case report and review of literature.

RESULTS/CASE

The present report describes a 29-year-old man who previously underwent unilateral IMA for the excision of a dentigerous cyst. The patient did not report any facial pain following the excision of the cyst. One year later, this patient underwent partial resection of the inferior turbinate for the resolution of nasal stuffiness by another surgeon. Soon after surgery, the patient developed severe facial and ocular pain on the side of the IMA, with the pain being especially aggravated upon inhalation. Endoscopy and computed tomography (CT) revealed a persisting IMA window. The patient's severe discomfort was thought to result from direct airflow into the maxillary sinus, as the resected turbinate may have altered normal nasal airflow. A unilateral inferior meatal augmentation procedure (IMAP) with an autologous ear cartilage implant was performed, resulting in complete relief of pain and discomfort.

CONCLUSIONS

Although IMA alone is a relatively safe surgical procedure, care should be taken when performing inferior turbinoplasty in patients with persistent IMA opening.

Extended middle meatal antrostomy via antidromic extended medial wall for the treatment of fungal maxillary sinusitis

Objective

The objective of this study was to compare the long-term results of extended middle meatal antrostomy (MMA) and MMA combined with inferior meatal antrostomy (IMA, combined approach) for the treatment of fungal maxillary sinusitis (FMS).

Methods and materials

A retrospective analysis including 90 patients with non-invasive FMS was treated with endoscopic extended MMA via antidromic extended medial wall (extended MMA group), or with both MMA and IMA (combined approach group). The recurrence rate, operation time, and complications were evaluated at postoperative 12 and 36 months.

Results

Of the 90 patients, 52 patients were in the extended MMA group and 38 patients in the combined approach group. CT revealed the thin medial wall or bone defect in 63.33% (57/90) patients. The mean operation time in the extended MMA group was significantly shorter than that of combined approach group (42.5 ± 6.5 vs 57.4 ± 4.9, P < 0.01). At postoperative 12 months postoperatively, the recurrence rate was 3.85% (2/52) in the extended MMA group and 0.0% (0/38) in the combined approach group, the difference wasn’t significant (X² = 0.618, P > 0.05). The recurrence rate wasn’t increased during the follow-up period over time in both groups.13.5% (7/52) patients complained of cheek numbness in the extended MMA group, 60.5% (23/38) patients complained of cheek numbness and epiphora in 5.3% (2/38) patients in the combined approach group, the difference was significant (X² test, P < 0.01). However, no major complications were observed in both groups. In addition, IMA closure was observed in 4 (10.5%) in the combined approach group at 12 months postoperatively and in 9 (23.6%) at 36 months postoperatively.

Conclusions

Extended MMA via antidromic extended medial wall may effectively prevent the recurrence and reduce the complications of FMS, IMA wasn’t necessary for the treatment of FMS in most cases.