Mini-Invasive Endoscopic Approaches to the Maxillary Sinus Floor: A Comparative Anatomical Study

Area of Science:

• Otolaryngology
• Surgical Anatomy
• Endoscopic Sinus Surgery

Background:

• Middle antrostomy (MA) is standard for maxillary sinus (MS) surgery but offers limited visualization of the inferior and anterior MS.
• Alternative approaches like inferior antrotomy (IA) and canine fossa access (CFA) have been proposed to improve MS inspection.

Purpose of the Study:

• To systematically compare the visualization capabilities of MA, IA, and CFA on the maxillary sinus floor in a cadaveric setting.
• To evaluate the effectiveness of different endoscopic angles in assessing MS floor visibility across the three surgical approaches.

Main Methods:

• Eight cadaver heads underwent CT scanning and preparation with fixtures representing key anatomical landmarks.
• Three surgical approaches (MA, IA, CFA) were created, and endoscopic visualization was performed using 0°, 30°, 45°, and 70° scopes.
• Visibility of MS floor fixtures and canine fossa fixtures was recorded for each approach and angle.

Main Results:

• Inferior antrotomy (IA) demonstrated superior visualization, successfully identifying nearly all fixtures (14/16) with a 70° endoscope.
• Middle antrostomy (MA) yielded poor results (3/16), while canine fossa access (CFA) also failed to provide complete visualization (7/16).
• IA significantly outperformed MA and CFA in visualizing MS floor landmarks and canine fossa fixtures (p < .001).

Conclusions:

• Inferior antrotomy (IA) offers a statistically significant improvement in surgical field vision within the maxillary sinus compared to MA and CFA.
• The findings suggest IA may be a more advantageous approach for comprehensive maxillary sinus examination.
• Further in vivo studies are warranted to validate these cadaveric findings in clinical practice.