Assessing current technical limitations in the small-hole endoscopic approach to the maxillary sinus

Area of Science:

• Otolaryngology
• Minimally Invasive Surgery
• Surgical Anatomy

Background:

• Endoscopic sinus surgery is standard for paranasal sinus disease.
• Accessing the entire maxillary sinus is crucial for treating mucosal disease.
• This study evaluates techniques for improving maxillary sinus access.

Purpose of the Study:

• To assess the efficacy of combining three medial wall small-hole antrostomies with angled microdebrider blades.
• To determine the ideal combination for maximizing maxillary sinus access.
• To map the reach of different microdebrider blades and antrostomy configurations.

Main Methods:

• A prospective cadaveric study was conducted.
• 3.5-mm blades were used through the natural ostium and two inferior meatal antrostomies.
• Image guidance mapped the space reached by 12°, 60°, 90°, and 120° microdebrider blades.

Main Results:

• Mean maxillary sinus volume reached was 28% (24-34%), irrespective of instrument or antrostomy.
• The anterior wall and floor were poorly accessed; the best combination reached only 28% of the anterior wall.
• Lateral and posterior walls were most accessible, with roof and medial walls intermediate.

Conclusions:

• The endoscopic small-hole approach to the maxillary sinus routinely accesses less than one-third of the sinus volume.
• Current antrostomy and microdebrider technologies offer limited reach within the maxillary sinus.
• Further research and new technologies are needed for comprehensive access via small-hole endoscopic approaches.