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Prelacrimal Approach to Maxillary Sinus Pathology.

Kachorn Seresirikachorn1,2,3,4, Mickey Kondo1,5, Lu Hui Png1,6

  • 1Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.

American Journal of Rhinology & Allergy
|December 12, 2022
PubMed
Summary

The prelacrimal approach (PLA) offers excellent access to the maxillary sinus, preserving the nasolacrimal duct. This surgical technique demonstrates successful lateral nasal wall restoration with low patient morbidity.

Keywords:
endoscopic endonasal surgeryendoscopic nasal and sinus surgerymaxillary sinus neoplasmsparanasal sinus diseasesparanasal sinus neoplasms

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Area of Science:

  • Otolaryngology
  • Endoscopic Sinus Surgery

Background:

  • Traditional middle meatal antrostomy has limitations in accessing various maxillary sinus regions.
  • Expanded techniques like modified medial maxillectomy require remucosalization and can lead to crusting.
  • The prelacrimal approach (PLA) provides direct endoscopic access while preserving the nasolacrimal duct and mucosa.

Purpose of the Study:

  • To describe the surgical technique of the prelacrimal approach (PLA) for maxillary sinus access.
  • To evaluate the outcomes of patients undergoing PLA surgery.

Main Methods:

  • Assessment of consecutive adult patients undergoing PLA for maxillary sinus pathology.
  • Primary outcome: restoration of the lateral nasal wall.
  • Secondary outcomes: early (<90 days) and late (>90 days) morbidity.

Main Results:

  • Successful restoration of the lateral nasal wall in all 40 patients (100%).
  • Mean patient age was 52.8 years, with 62.5% females.
  • Complications included dysesthesia (10% early, 2.5% late).

Conclusions:

  • The PLA provides effective access to anterior, lateral, inferior, and inferomedial maxillary sinus areas.
  • PLA facilitates rapid mucosal recovery and preserves normal physiology and lacrimal function.
  • The prelacrimal approach demonstrates low morbidity for maxillary sinus surgery.