Transnasal inferior meatal antrostomy with a mucosal flap for post-Caldwell-Luc mucoceles in the maxillary sinus

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.

The Combined Middle and Inferior Antrostomy for Fungal Maxillary Sinusitis Treatment

Aims: The objective of this study is to assess the effectiveness of the combined middle and inferior meatal antrostomy (MIMA) in management of patients with maxillary fungal sinusitis. Material and Methods: Design: retrospective cross sectional study. Setting and subjects: From September 2018 to March 2021, fifty-five patients with non-invasive maxillary fungal sinusitis, who underwent transnasal endoscopic combined MIMA. Methods: The study compared patients' pre- and post-operative subjective symptoms, including nasal obstruction, discharge, facial pain or pressure, halitosis, anosmia, and other non-specific symptoms. Endoscopic characteristics of recurrent fungal maxillary sinusitis and postoperative complications were also observed. Closure of the IMA site was evaluated at three and six months post-surgery and patients were categorized into three groups based on closure degree. Results: All clinical symptoms, including nasal discharge, nasal obstruction, nasal pruritus, anosmia, halitosis, sneezing, facial pain, ophthalmic and otologic symptoms, were resolved over six months after combined MIMA in majority of cases (94 - 100%). After three and six months, the postoperative endoscopic evaluation revealed recurrent fungal maxillary sinusitis in 1.8% and 5.4% of cases, respectively. Partial stenosis of the inferior antrostomy was observed in 7.2% and 16% of cases, while complete stenosis was noted in 3.6% and 7.2% of cases after three months and six months. Conclusions: The combined MIMA is effective and has better outcomes than the medial meatal antrostomy approach alone without additional operative time.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03863-6.