Translacrimal Antrostomy: An Augmented Endoscopic Approach to the Maxillary Sinus

Conventional middle meatal antrostomy has limitations in surgical accessibility and may be associated with postoperative stenosis. Alternative approaches that improve access to the maxillary sinus while maintaining long-term patency are therefore needed. This study aimed to evaluate the safety and efficacy of a novel technique, translacrimal antrostomy (TLA). Unlike standard middle meatal antrostomy (MMA), TLA involves the removal of the inferior lacrimal bone to facilitate access to the anterior maxillary recesses. A retrospective review was conducted of 64 patients (81 sinuses) who underwent TLA at Seoul National University Hospital between March 2019 and January 2022. For comparison, 35 patients who underwent conventional MMA during the same period were also reviewed. Postoperative patency, mucosal status, and complications were evaluated at 1, 3, and 6 months using validated endoscopic criteria by 2 independent rhinologists. Indications for TLA included noninvasive fungal sinusitis (38%), odontogenic sinusitis (7%), and chronic rhinosinusitis (54%). Postoperatively, 85.2% of sinuses remained patent without narrowing, 74.1% demonstrated no mucosal edema, and 80.2% showed no discharge. The chronic rhinosinusitis group exhibited higher rates of mucosal edema and polypoid changes compared with the fungal sinusitis group (P=0.014). No postoperative epiphora, numbness, or epistaxis was observed. The mean procedural time was 5 minutes 11 seconds (±1.10 min). Compared with conventional MMA, the TLA group demonstrated a lower incidence of postoperative mucosal edema (9.7% versus 34.2%, P = 0.050). In conclusion, TLA is a safe and effective procedure that allows additional access to the maxillary sinus.