Complete and successful resection of antrochoanal polyps using endoscopic modified medial maxillectomy

Antrochoanal polyps (ACPs) are benign lesions of the maxillary sinus mucosa that are often treated with endoscopic sinus surgery using middle meatal antrostomy (MMA). However, MMA alone may not provide sufficient access to the mucosal attachment site of polyp, particularly at the anterior or inferior wall of the maxillary sinus, and additional procedures may be required to achieve complete resection. Although many reports have described ACP resection with MMA in combination with supplementary procedures, no study has evaluated whether ACPs can be effectively removed using a single approach without MMA. Endoscopic modified medial maxillectomy (EMMM) provides wide access to the maxillary sinus without additional procedures. This study aimed to evaluate the efficacy of EMMM alone, without MMA, in achieving complete resection of ACPs.

A retrospective review was conducted using data of 13 patients with ACPs treated surgically (EMMM, n = 8; MMA with or without additional procedures, n = 5) between October 2019 and May 2023. Surgical outcomes, including operative time, blood loss, mucosal healing, complications, and recurrence, were compared between the two groups.

Intraoperative blood loss was significantly reduced and mucosal healing was significantly rapid in the patients in the EMMM group (p < 0.05). No complications occurred in both groups. Recurrence occurred in the MMA group only (n = 1). Postoperatively, the patients in the EMMM group had improved preservation of sinonasal structures and wound healing since the procedure avoided middle meatus manipulation.

In the present study, EMMM could be a safe and effective technique for complete ACP resection. It might minimizes tissue trauma, promote rapid healing, reduce the risk of recurrence, and have the potential to become a standard procedure for ACP removal, especially when preservation of nasal structures is prioritized.