The Modified Medial Maxillectomy as a Radical or Extended,-yet Still Functional,-Technique in Sinus Surgery

Area of Science:

• Otolaryngology
• Rhinology
• Surgical Innovation

Background:

• Middle meatal antrostomy, a common endoscopic sinus surgery for maxillary pathologies, primarily aims for sinus ventilation.
• Persistent mucociliary dysfunction can occur despite conventional ventilatory surgery.
• The endoscopic modified medial maxillectomy (MMM), initially for tumor surgery, presents a functional alternative for chronic sinus dysfunction.

Purpose of the Study:

• To evaluate the functional outcomes of the maxillary sinus cavity after modified medial maxillectomy (MMM).

Main Methods:

• Retrospective review of patients undergoing unilateral MMM by tertiary rhinologists.
• Prospective data collection included demographics, disease factors, microbiology, SNOT-22 scores, and radiology.
• Primary outcome: sinus dysfunction (mucostasis/pooling); Secondary outcomes: revision surgery rates and SNOT-22 score improvement.

Main Results:

• 551 MMMs performed; 10.2% experienced sustained post-operative mucostasis, and 5.0% required revision surgery.
• COPD and asthma were associated with increased mucostasis risk.
• Significant improvement in SNOT-22 scores (45.9 pre-op vs. 23.6 post-op) was observed.

Conclusions:

• The MMM procedure, used for access or to prevent mucous pooling, results in a long-term functional maxillary sinus cavity.
• This technique demonstrates minimal morbidity and improved patient-reported outcomes.