The Maxillary Lid Approach to Intra-Antral Pathology

The primary objective of this series is to describe the adaptation of a common dental procedure (the maxillary bony window approach) to clinical otolaryngology for a variety of pathologies affecting the maxillary sinus. While the sublabial approach to the maxillary sinus has been widely described, contemporary plating methods may reduce historical drawbacks which include oroantral fistula, maxillary sinusitis, and facial asymmetry.

Four patients underwent en bloc removal of the antero-lateral maxillary wall for removal of intra-antral pathology, with bony lid reconstruction using contemporary plating methods. Clinical course, complications, and follow-up information were examined.

Diagnoses included keratocystic odontogenic tumor, foreign body (displaced tooth), bony cyst, and juvenile nasopharyngeal angiofibroma. All patients underwent successful surgery with excellent exposure of the maxillary sinus and reapproximation of the bony lid. Long-term follow-up radiograph of 1 patient showed excellent position of the bony lid with no mucosal thickening.

Re-apposition of a bony lid after a sublabial approach to the maxillary sinus could ameliorate historical drawbacks of the procedure, possibly expanding its application. Larger cohorts and long-term follow-up will further characterize ideal indications and potential pitfalls of the approach.