Clinical Analysis Of Transnasal Endoscopic Prelacrimal Recess Approach For Maxillary Sinus Benign Lesions Resection

1 BackgroundThe maxillary sinus lesions is more common in nasal diseases.Benign tumors were including maxillary sinus polyp,maxillary sinus inverted papilloma,fungal maxillary sinusitis,hemorrhagic necrotic nasal polyp,maxillary sinus cyst,osteoma and fracture of maxillary sinus;malignant ones including:malignant melanoma andsquamous carcinoma,adenocarcinoma,adenoid cystic carcinoma,etc.Because of the recurrence and refractory of these lesions,how to eradicate lesions and improve prognosis become more and more important for otolaryngology doctors.As Zhou bing has proposed in 2007 that the lateral nasal wall incision approach(now it is called prelacrimal recess approach)for removal of complex maxillary sinus lesions to provide more reliable and simple operation method,it is worth our study.2 ObjectiveDiscussion of cases of transnasal endoscopic prelacrimal recess approach for maxillary sinus benign resection to study its indications and key points,so that can provide better guidance for future clinical works.3 Methods84 cases of transnasal endoscopic prelacrimal recess approach for maxillary sinus benign resection in August 2010 to December 2016 were retrospectively analyzed.Including 44 cases of maxillary inverted papilloma,15 cases of maxillary sinus cyst(including bone cyst,mucous cyst,dentigerous cyst)9 3 cases of hemorrhagic necrotic nasal polyp,4 cases of antrochoanal polyp,11 cases of maxillary sinus polyp or inflammatory granulation,cholesteatoma in 1 case,cerebrospinal fluid leak in 1 case,wing palatine nest schwannoma in 2 cases,wall of maxillary sinus and orbital floor fractures in 2 cases,oroantral fistula in 1 case.All the patients were intratracheal intubated under combination of intravenous-inhalation general anesthesia.After transnasal endoscopic prelacrimal recess approach for maxillary sinus benign resection,open the window of inferior nasal meatus,evaluate the operation time,length of hospital stays,intraoperative situation and observe the recovery by nasal endoscopy after operation,sum up experience and the curative effect.4 Results4 cases of 84 patients suffered from papillary tumor recurrence,follow-up did not recur after surgery.Time of operation84 cases was 50-225 minutes,90 minutes on average,length of hospital stays was 3 to 28 days,7.6 days on average,no significant postoperative complications occurred.5 ConclusionAdoption of transnasal endoscopic prelacrimal recess approach for maxillary sinus complex benign resection can thoroughly remove benign located in the anterior wall,the internal wall,the alveolar recess,the prelacrimal fossae of the maxillary,which can’t be removed from the natural entrance and open window of the inferior nasal meatus.Expanding the window to fully expose lesions,thoroughly remove the abnormal mucosa and a range of bone under the mucosa is the key to successful operation.The operation time and hospital stays were relatively reasonable and no obvious complications occurred.