Modular Endoscopic Medial Maxillectomies: Quantitative Analysis of Surgical Exposure in a Preclinical Setting

The nomenclature adopted for endoscopic medial maxillectomies (EMMs) is exceedingly heterogeneous. The aim of this study was to objectively measure surgical exposure in a preclinical anatomic setting to validate a classification for modular EMMs.

Computed tomography was used to scan 6 cadaver heads, and images were uploaded on dedicated software. A neuronavigation system was used to measure areas and volumes of surgical corridors during dissection. Differences of >10% of area exposed and >3 cm³ of volume were considered to define incremental types of EMM. Specific anatomic targets were assessed on the axial and sagittal planes. Influence of anatomic variants on surgical exposure was evaluated.

There were 4 types of EMMs (A-D), with a transseptal variant for each, identified. In the axial plane, type A exposed the vidian canal and foramen rotundum, type B exposed the foramen ovale and foramen spinosum, and transseptal type C or type D exposed the coronoid process. In the sagittal plane, type A exposed the vidian canal, and type B exposed the foramen ovale and styloid process. Transseptal type C exposed the pterygomaxillary fissure, and type D exposed the inferior border of the lateral pterygoid plate. The nasal floor limits the downward angle in transseptal approaches. The width of the piriform aperture independently influenced surgical volume of types B and C.

This modular classification of EMMs, based on quantitative analysis in a preclinical setting, should allow for better personalized preoperative surgical planning and provides standardization of nomenclature.