Endoscopic transnasal prelacrimal recess approach via the orbital floor to the infraorbital region: an anatomical study.

PURPOSE: The aim of this study is to describe the maximum exposure of the infraorbital region via the orbital floor using the transnasal prelacrimal recess approach (PLRA), and to provide an anatomical basis for treating lesions in the infraorbital region. METHODS: Ten freshly injected frozen heads were dissected using the PLRA. The orbital floor was removed along the border of the medial infraorbital quadrangle, and the periorbita was opened to expose the infraorbital region. The areas of the medial infraorbital quadrangles were measured and analyzed. The PLRA was applied separately on the left and right sides of each cadaver head, resulting in a total of 20 prelacrimal recess approaches. RESULTS: The PLRA enabled visualization of the optic nerve and the central retinal artery through the orbital floor. By integrating both medial and lateral approaches in relation to the inferior rectus muscle, all crucial anatomical structures within the infraorbital region could be clearly identified. The area of the medial infraorbital quadrangle was 420.65 ± 24.03 mm2. CONCLUSION: The PLRA provides access through the orbital floor to the maximum boundary of the infraorbital region, including the lateral orbital wall at the outermost level, the superior rectus muscle at the topmost level, and the medial orbital wall at the innermost level.

Prelacrimal recess approach for maxillary sinus inverted papilloma: a 15-year experience from a single center.

PURPOSE: This large retrospective, single-center, follow-up study investigated the endoscopic prelacrimal recess approach (PLRA) for treating maxillary sinus inverted papilloma (MSIP). METHODS: Between January 2007 and November 2022, patients with MSIP treated with PLRA were enrolled. Data on clinical manifestations, imaging, and surgical procedures were collected. The visual analog scale (VAS) scores for maxillofacial numbness and nasal symptoms and the SNOT-22 nasal symptom scores were statistically analyzed. RESULT: Of 122 patients (68 males and 54 females) enrolled in the study, with a mean age of 50.75 ± 12.84 years (26-80 years), 111 patients underwent PLRA, nine underwent modified PLRA, one converted to an endoscopic medial maxillectomy (EMM), and one to an endoscopic modified Denker's approach. The average follow-up was 86.60 (13-192) months, the recurrence rate was 3.28%, and 29 patients (23.77%) complained of maxillofacial numbness one month postoperatively, which disappeared in most cases one year after surgery. Five patients (4.10%) experienced mild numbness at the end of the follow-up period. Maxillary sinus ostium contracture or atresia occurred in two cases (1.64%). After surgery, the VAS nasal symptom scores improved significantly (P < 0.001). SNOT-22 indicated that the most common postoperative symptom was thick nasal discharge. CONCLUSION: PLRA is a flexible first-choice surgical treatment for maxillary sinus inverted papilloma and can be modified according to the extent of the lesion, the surgeon's experience and technique, and surgical instruments. That can help achieve complete resection and reduce recurrence and surgical complications. Upper teeth numbness, the most common postoperative complication, tends to disappear after 1 year.

Prelacrimal Recess Approach in Unilateral Maxillary Sinus Lesions: What Is the Impact and Efficacy?

Background and Objectives: Chronic sinusitis is a commonly encountered diagnosis for otorhinolaryngologists. The profound negative effect of rhinosinusitis on patients' quality of life is frequently overlooked, and surgical lines of treatment are numerous. The aim of the study was to assess the comparative efficacy of endoscopic middle meatal antrostomy with the endoscopic prelacrimal recess approach, combined with middle meatal antrostomy in the treatment of unilateral chronic maxillary sinus lesion. Materials and Methods: Thirty patients with unilateral chronic maxillary sinus lesions enrolled in the study at Alahsa hospital. Patients were divided into two groups: 15 treated through a middle meatal antrostomy and 15 treated via a combined middle meatal antrostomy and prelacrimal recess approach. Demographic and clinical information of the patients, including the medical history, CT scan findings, diagnosis, recurrence, and complications, were gathered and analyzed. Pre- and postoperative clinical findings were graded utilizing the Lund-Kennedy Endoscopic Scoring System. Results: The enrolled patients varied in age from 18 to 56, with 60% being male and 40% being female. Antrochoanal polyp, maxillary sinus mucocele, and unilateral allergic fungal sinusitis were among the pathological diagnoses. The follow-up period averaged 14.3 months. Following surgery, two patients in Group II encountered nasal discomfort, which included synechia and epiphora. The success rate for preserving a patient's disease-free condition was 86.7%. A statistically significant difference in disease-free incidence was observed among the patients in group II. In group I, recurrence was identified in 26.7% of the patients. The postoperative symptoms diminished considerably, and the VAS score was reduced substantially. In Group II patients, however, there was no significant difference in scarring. Clinically significant differences were observed in the mean total Lund-Kennedy Endoscopic scores when compared to their preoperative values. Conclusions: Achieving endoscopic access to the sinus's anterior, lateral, inferior, and inferomedial regions is facilitated by operating via the prelacrimal recess, which is the most advantageous approach. This approach facilitates rapid mucosal healing by maintaining the integrity of the nasolacrimal duct and mucosal covering. The specific pathology, surgical objectives, surgeon expertise, and equipment accessibility influence the choice of endoscopic surgical technique.

Effect of anterior maxillary wall shape on ease of prelacrimal recess approach among Asians and Westerners.

PURPOSE: Endoscopic sinus surgery has been widely used in the treatment of most maxillary diseases, although the inability to access lesions in the anterior and inferior maxillary sinus walls is a major disadvantage. In few cases, the prelacrimal recess (PLR) approach can be used, which secures an overall view within the maxillary sinus. The distance between the anterior maxillary wall and lacrimal duct is related to the ease of the PLR approach. First we measured the distance between the anterior maxillary wall and lacrimal duct using anatomical image analysis to classify the types and then evaluated whether anatomical factors were related to the results. METHODS: Both sides of the sinuses were evaluated in 272 participants (544 sides). After marking a tangent line (line 1 [L1]) through the posterior surface of the anterior maxillary sinus wall and a parallel line (line 2 [L2]) to the anterior surface of the lacrimal duct, the vertical distance between L1 and L2 was measured. Vertical distances of < 3 mm, 3-7 mm, and > 7 mm were classified as PLR approach types I, II, and III, respectively. In the axial plane image, line 3 (L3) (a horizontal line starting from the inner anterior maxillary sinus wall) was drawn and the angle with L1 (L1-L3A) was measured. RESULTS: The proportions of types I, II, and III were 23.2% (126), 55.0% (299), and 21.8% (119), respectively. The mean L1-L3As for types I, II, and III were 12.87 ± 4.92°, 11.20 ± 5.08°, and 10.40 ± 4.47°, respectively, showing a significant difference in mean values (p < 0.001). The L1-L3A and vertical distance between L1 and L2 showed a significant negative correlation (r = - 0.201, p < 0.001). CONCLUSIONS: We observed a correlation between the distance from the anterior maxillary wall to the lacrimal duct and L1-L3A. The L1-L3A indicates the degree of curvature of the anterior maxillary wall; therefore, the smaller the L1-L3A, the easier it may be to access the PLR.

Assessment of the prelacrimal recess in different maxillary sinus pneumatizations in relation to endoscopic prelacrimal recess approaches: a computed tomography study.

PURPOSE: To assist in planning before the endoscopic prelacrimal recess (PLR) approach, we aimed to investigate the relationship between morphometry and variations of PLR in maxillary sinus (MS) pneumatizations. METHODS: Retrospective analysis of the paranasal sinus computed tomography images of 150 patients was conducted to determine the pneumatization patterns of the MS, PLR variations, and the applicability of the PLR approach. The results were compared based on lateralization, gender, and age groups. RESULTS: The PLRwidth, the anteroposterior diameter of the nasolacrimal duct (NLD), the vertical and horizontal diameters of the MS were the highest in hyperplasic MS, and decreased significantly with increasing age (p = 0.005, p = 0.017, p = 0.000), respectively. Most of the morphometric measurements were higher in hyperplasic MS, while the medial wall thickness of PLR was higher in hypoplasic MS. The PLRwidth for feasibility of the PLR approach were Type I (48%) in hypoplasic MS and Type III (80%) in hyperplasic MS (p < 0.001), respectively. The PLR medial wall thickness was higher in Type I, while the piriform aperture angle (PAA), MS volume, length, and slope of the NLD were higher in Type III PLRwidth (p = 0.000), respectively. The highest anterior and separation-type variations of the PLR were observed in hyperplasic MS, whereas 31.0% of hypoplasic MS had no PLR (p < 0.001). CONCLUSION: This study revealed that PLRwidth and PAA were the highest in hyperplasic MS, which allows the endoscopic PLR approach to be performed more easily. For safer and uncomplicated surgery, surgeon should be aware of the PLR anatomy in different MS pneumatization patterns.

Prevalence of the prelacrimal recess in maxillary sinus and its medial bony wall dimensions.

OBJECTIVE: To investigate the occurrence rate of the prelacrimal recess (PLR) and its medial bony wall dimensions based on the radiological analysis to help surgeons enhance the understanding of anatomic structures for the endoscopic prelacrimal recess approach. METHODS: Cone-beam computed tomography images of 255 patients were evaluated retrospectively. The prevalence of the PLR in maxillary sinus was investigated and the thickness of its medial bony wall was measured and statistically assessed. Meanwhile, the width of the PLR was measured. The correlation between the width of the PLR and its medial bony wall thickness was assessed. The data were compared between the left side and right side, male and female. RESULTS: The PLR was present in 82.5% of the maxillary sinus, with no significant differences between the left and right sides, as well as different gender groups. The mean thickness of the medial bony wall of the PLR was 2.84 ± 1.41 mm, without statistical difference between the left and right sides but significantly larger in males than in females. The mean width of the PLR was 4.62 ± 1.74 mm and it had a significant negative correlation with the thickness of the medial bony wall of the PLR. CONCLUSION: A large individual variation exists in the anatomy of PLR, including its prevalence and dimensions of its medial bony wall. When considering the intranasal endoscopic prelacrimal recess approach, the surgeons should carefully evaluate the anatomical structure of the PLR preoperatively so as to minimize the risks of surgical complications.

Assessment of the prelacrimal recess in maxillary sinus in different sex and age groups using cone beam computed tomography (CBCT).

BACKGROUND: The intranasal endoscopic prelacrimal recess approach (PLRA) to the maxillary sinus (MS) has been reported to treat many MS and skull base diseases. However, previous studies revealed that the width of the prelacrimal recess (PLR) shows a large individual variation. The purpose of this study was to ascertain the prevalence of the PLR in MS according to gender and age. METHODS: A series of 701 maxillofacial cone beam computed tomography (CBCT) scans from adult patients were analyzed retrospectively. Patients were divided into five age groups (18-24 years, 25-34 years, 35-44 years, 45-54 years, and ≥ 55 years) and by sex. The frequencies of occurrence of the PLR in the MS were calculated and compared. RESULTS: According to the findings obtained from our study, PLR was present in 81.5% of maxillary sinuses. No differences were found when the data distributions of right and left sides were compared. For individuals, the right and left sides were not always symmetrical. The probability of PLR was lesser among women than among men, but this differences was not significant. Another finding of our study was that the percentage of PLR decreased with increasing age among patients aged < 55 years, however, increased again among patients aged ≥ 55 years. CONCLUSION: The anatomy of PLR varies among individuals. Careful analysis of individual anatomical structure characteristic is recommended when considering intranasal endoscopic PLRA to the MS. Besides, the age variation of PLR should be considered in order to avoid complications.

Anterior maxillary wall and lacrimal duct relationship in Orientals: CT analysis for prelacrimal access to the maxillary sinus.

BACKGROUND: The pre-lacrimal window approach (PLWA) is a promising technique in approaching lesions of the anterior wall and floor of the maxillary sinus. Simmen et al. previously reported that this approach is feasible in only 2/3 of their patients. This percentage appears to be lower than that of our local (mainly Chinese) population based on our clinical experience. Our study aims to measure the distance between the anterior maxillary wall and lacrimal duct in ethnic Chinese. A higher incidence of sphenoid-ethmoidal cells has been reported in Orientals. We postulate that there is also a higher incidence of wider pre-lacrimal recesses in Orientals thus making the PLWA more feasible to perform in Orientals. METHODS: 100 consecutive sinus CT scans of adult patients with various rhinologic diseases that did not distort the bony anatomy of the maxilla were reviewed (2 sides each). The distance between the anterior maxillary wall and the anterior border of the lacrimal duct was measured in 200 sides. We have adopted the methodology of measurements previously published by Simmen et al.  This is so that we could compare between Oriental and Occidental paranasal sinuses. RESULTS: A distance of more than 7 mm was found in 39.5% of our subjects and a distance of > 3-7 mm was seen in 53.5%. In 6.5% of our subjects we found a prelacrimal recess < 3 mm. CONCLUSION: The PLWA could have been performed without removal of the bony lacrimal canal in 39.5% of our subjects ( > 7 mm). Good access to the anterior maxilla wall could also have been possible for 53.5% with sub-periosteal removal of the bony lacrimal canal and medial maxillary wall. Thus, the PLWA would have been feasible for 93% of our subjects. These percentages are significantly higher than Simmen's study of 68.5% in an Occidental population.

Intranasal endoscopic prelacrimal recess approach for maxillary sinus inverted papilloma.

PURPOSE: This study aims to determine the indications and effectiveness of transnasal endoscopic prelacrimal recess approach (PLRA) in patients with maxillary sinus inverted papilloma (IP). METHODS: We retrospectively analyzed 71 patients treated in our institution for maxillary sinus IP between August 2008 and April 2015. 20 patients underwent endoscopic surgery via PLRA. All the patients who had postoperative follow-up for 3 years were enrolled. Demographic data, surgical technique, location of IP attachment, intra- and postoperative complications, follow-up duration and recurrence were recorded. RESULTS: The outpatient follow-up period was 3-10 years after surgery. Recurrence of IP was seen in 6 (8.5%) of 71 patients, including 1 patient in the PLRA group. The recurrence rate was 5% in the PLRA group. Six of 71 patients experienced postoperative complications, but none was observed in the PLRA group. CONCLUSION: Transnasal endoscopic PLRA is a minimally invasive, safe and effective method for maxillary sinus IP. The indication for PLRA is tumor pedicle located on the antero-inferior or infero-lateral wall or at multiple attachment sites of the maxillary sinus.

[Application experience of prelacrimal recess combined with septotomy in resection of recurrent inverted papilloma].

Objective:To investigate the effectiveness of nasal endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum in resecting recurrent nasal inverted papilloma. Methods:Patients with recurrent nasal inverted papilloma who underwent reoperation in our hospital during the past 2 years were included . The nasal septum may hinder full access to and effective treatment of the lesions at the anterior and medial wall of the maxillary sinus by endoscope, aspirator and surgical instrument in the narrow aperture of the prelacrimal recess, although these lesions could be observed by 70° nasal endoscope. Results:The nasal septum is temporarily opened on the basis of the prelacrimal recess approach, and the nasal endoscope and instrument was introduced through trans-septal window, so as to provide a better view of the operative field and the angular range of the instrument's movement. Conclusion:The recurrent nasal inverted papilloma could be successfully managed by re-endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum, and no recurrence was observed during the 2-year follow-up. This surgical approach is recommended for the inverted papilla which originates from the anterior medial wall of the maxillary sinus, as the tumor can be removed completely using this surgical approach.

An endoscopic transnasal prelacrimal recess transmaxillary approach to the pterygopalatine fossa and infratemporal fossa.

Objective: In this paper, the goal of the authors is to present the anatomic nuances and their clinical experience with lesions of the pterygopalatine fossa and infratemporal fossa using an endoscopic transnasal prelacrimal recess transmaxillary approach (PLRMA). Methods: An endoscopic anatomical dissection of three fresh cadaveric heads was performed bilaterally to evaluate the feasibility of the PLRMA. Prior to dissection, stereotactic computed tomography scans were obtained for each head to obtain anatomical measurements. The area of exposure on the posterior wall of the maxillary sinus was determined using stereotaxis. The cases of six patients with schwannomas or epidermoid cysts who underwent the transnasal PLRMA were illustrated. Results: The mean area of exposure on the posterior wall of the maxillary sinus was 9.55 cm2. Total resection was achieved in all six patients. The mean follow-up time was 16 months, and one patient complained of postoperative facial numbness, which resolved gradually. No cases of chronic sinusitis were reported. Conclusions: The endoscopic transnasal PLRMA provides efficient operative exposure to the pterygopalatine fossa and infratemporal fossa. Preserving the integrity of the mucosa on the nasal lateral wall is an advantage of this approach.

Effect of Maxillary Sinus Pneumatization on the Ease of Access to Prelacrimal Recess.

OBJECTIVE: Prelacrimal recess approach can be used to access lesions of the anterior wall of the maxillary sinus (MS). Moreover, the longer the prelacrimal recess window distance (PLRWD), the easier it is to access the anterior wall. This study aimed to define the correlation between maxillary sinus pneumatization (MSP) and PLRWD, a previously defined anatomic factor predictive of the ease of prelacrimal recess approach (PLRA). METHODS: In total, 506 sides of 253 participants were studied. In the axial image, the PLRWD, the distance between the anterior wall of the MS and the lacrimal duct, was measured through radioanatomical analysis and classified as type I (<3 mm), type II (3-7 mm), or type III (>7 mm). On the coronal image, the distance between the nasal floor and the lower end of the MS was measured. When MSP did not reach the nasal floor, it was classified as grade I, as grade II when MSP reached the nasal floor, and grade III when the MS was pneumatized below the nasal floor. RESULTS: Type I included 115 sides (22.7%); type II, 277 sides (54.7%); and type III, 114 sides (22.5%). Grade I was observed in 58 sides (11.5%), grade II in 38 sides (7.5%), and grade III in 410 sides (81.0%). The mean PLRWD of grade I was 2.35 ± 2.41 mm, II was 3.37 ± 2.46 mm, and III was 5.55 ± 2.54 mm, showing a significant difference (P < .001). Post hoc analysis showed significant differences in the mean PLRWD among grades I, II, and III. Two anatomical factors, the MSP and PLRWD, were positively correlated (r = .507, P < .001). CONCLUSIONS: This study demonstrates a correlation between the feasibility of MSP and PLRA. Both MSP and PLRWD are essential diagnostic parameters for preoperative planning and better surgical outcomes.

Anterior maxillary wall and lacrimal duct relationship in pediatric patients - CT analysis for the feasibility of the prelacrimal recess approach.

OBJECTIVE: The purpose of the current study is to determine the age-related feasibility rate of the intranasal endoscopic prelacrimal recess approach (PLRA) in pediatric patients. METHODS: Computed tomography (CT) images of 379 patients under 18 years old were analyzed retrospectively. The anteroposterior dimensions of the medial bony wall of the prelacrimal recess (PLR) were measured on 758 sides. The feasibility of the PLRA was evaluated according to the criteria of Simmen et al., for each age and three age groups based on trends in the change of the width of the PLR. RESULTS: Less than half (45.9%) of pediatric maxillary sinuses (MS) were found to have the favorable anatomy (width of PLR >3 mm) to perform the PLRA. The cut-off value for age regarding the feasibility of the PLRA was nine years old. Following an evaluation of the groups, the proportions of the MS with favorable anatomy for the PLRA were 5.7% in Group I (age 0-4 years), 33.3% in Group II (age 5-8 years), and 55.1% in Group III (age 9-17 years). In group III, the feasibility rate for the PLRA was greater in boys (62.1%) than in girls (48.3%). No difference in the feasibility rate was found between the right and left sides. CONCLUSION: The overall feasibility rate for the PLRA in pediatric patients under 18 years of age is 46%. In patients aged 9-17 years, the feasibility rate for the PLRA is >50%.

A Comparative Study between Endoscopic Prelacrimal Approach and Middle Meatal Antrostomy for Maxillary Sinus Pathologies.

Aim, To evaluate the treatment outcomes of endoscopic prelacrimal approach in managing various maxillary sinus pathologies, analyzing the associated adverse events and post treatment quality of life and also to compare surgical outcomes of prelacrimal approach with middle meatal antrostomy approach to remove various maxillary sinus pathologies. MATERIALS AND METHODS: A prospective study was conducted from January 2019 to April 2020. We took 60 patients with maxillary sinus pathologies and divided into two groups and done sinus surgery through middle meatal antrostomy approach (group A) and prelacrimal approach (group B). Post operative follow up done for one year and analyzed complications and recurrence. RESULTS: We compared the recurrence rate of antrochoanal polyp in both groups. Out of 12 patients in group A, 6 patients (50%) got recurrence of polyp. In group B, only one patient (8%) got recurrence out of 12 patients of antrochoanal polyp. CONCLUSION: We conclude that prelacrimal recess approach is a better option than middle meatal antrostomy for complete removal of pathologies in maxillary sinus.

Endoscopic Repair of Spontaneous Cerebrospinal Fluid Leaks in the Lateral Recess of the Sphenoid Sinus.

OBJECTIVE: This study aimed to assess the effectiveness of 3 endoscopic endonasal approaches for the management of cerebrospinal fluid (CSF) leaks and meningoencephaloceles in the lateral recess of the sphenoid sinus (LRSS). STUDY DESIGN: Retrospective study. SETTING: University hospital. METHODS: This study retrospectively reviewed 49 patients with CSF leaks and meningoencephaloceles in the LRSS. Three endoscopic surgical repair approaches were indicated based on 5 different Rhoton's types of the LRSS. The postoperative symptoms, complications, and follow-up outcomes were investigated and evaluated. RESULTS: The success rate of endoscopic surgical repair was 100% at a median follow-up of 75.06 (12-203.4) months. Endoscopic approaches to the LRSS included the prelacrimal recess (PLR) (18.37%), transsphenoidal (18.37%), and transpterygoid approaches (64.26%). All patients in the PLR approach (PLRA) group and most of the patients in the transpterygoid approach group had a full lateral type LRSS. Hypoesthesia and dry eyes were reported in 5 patients (55.56%) and 1 (11.12%) patient, respectively, from the PLRA group and in 6 (19.35%) and 5 (16.12%) patients, respectively, from the transpterygoid approach group. CONCLUSIONS: Endoscopic closure is a safe and effective method for the treatment of CSF leaks and meningoencephaloceles in the LRSS. The transpterygoid approach and PLRA offer adequate exposure of the LRSS with extensive lateral pneumatization or a full LRSS. The endoscopic route of the PLRA is more direct than that of the transpterygoid approach. Careful preoperative imaging evaluation is crucial while selecting the optimal surgical approach for the repair of a skull base defect.

Effectiveness of the Endoscopic Prelacrimal Recess Approach for Maxillary Sinus Inverted Papilloma Removal: A Systematic Review and Meta-Analysis.

BACKGROUND: Conventional minimally invasive surgery has a high recurrence rate, and nasal morbidity can occur if the scope of surgery is expanded to complete removal of maxillary sinus inverted papilloma. OBJECTIVE: To analyze the efficacy of the endoscopic prelacrimal recess approach (EPLRA) for maxillary sinus inverted papilloma removal. METHODS: Eighteen studies were included in this meta-analysis. Articles comparing the prelacrimal recess approach with conventional surgery (endoscopic surgery or the Caldwell-Luc operation) for inverted papilloma removal were included. Outcomes of interest included recurrence and postoperative morbidities. The methodological quality was assessed using the Newcastle-Ottawa scale. RESULTS: The recurrence rates of inverted papilloma, postoperative facial or gingival numbness, and alar collapse were 3.13% (95% confidence interval [CI]: 1.32, 7.27), 9.02% (95% CI: 3.70, 20.39), and 3.39% (95% CI: 1.28, 8.68), respectively. The recurrence rate of inverted papilloma was significantly lower after the EPLRA than after conventional surgery (odds ratio [OR] = 0.2290; 95% CI: 0.0808, 0.6489). However, there were no significant differences between the procedures in the rates of facial or gingival numbness (OR = 0.4567; 95% CI: 0.1497, 1.3933), epistaxis (OR = 0.3150; 95% CI: 0.0471, 2.1044), or periorbital swelling (OR = 1.2405; 95% CI: 0.1205, 12.7731). CONCLUSIONS: The EPLRA can preserve the lacrimal system and is useful for maxillary sinus inverted papilloma removal due to a lower recurrence rate compared with conventional surgeries.

Endoscopic removal of a dental implant displaced into the maxillary sinus: A case presentation and a review of the literature / Arcüregbe diszlokált fogimplantátum eltávolítása endoszkópos ellenorzéssel: Esetismertetés a szakirodalom tükrében

Összefoglaló. Az utóbbi idoben egyre gyakoribbá vált fogászati implantáció egyik nem kívánt szövodménye az arcüregbe került implantátum, amely a maxilla molaris, esetenként praemolaris régiójának implantációjakor fordulhat elo. Ennek oka lehet a kúpsugaras komputertomográfia nélküli, azaz nem megfelelo tervezés, fennálló arcüreggyulladás és -ventilációs probléma, kevés, puha csont, a fúrási vagy implantátumbehelyezési sebészi gyakorlat hiánya, észre nem vett membránperforáció arcüreg-csontfeltöltés esetén. Esetünkben implantáció elott a beteg szájsebész orvosa kúpsugaras komputertomográfia alapján sinusventilációs zavart és arcüreggyulladást véleményezett. Az arcüreggyulladás funkcionális endoszkópos sinussebészeti mutéttel történo kezelését és gyógyulását követoen két lépésben, eloször arcüreg-csontfeltöltést, majd 6 hónappal késobb implantációt végeztek. 4 hónap panasz- és tünetmentes gyógyulást követoen az implantátumfeltárás elott derült fény az arcüregbe került implantátumra, amelyet funkcionális endoszkópos sinussebészeti eljárással, transnasalis (Lothrop) és intraoralis behatolás kombinációjával távolítottunk el. Az implantátumok arcüregbe kerülésének gyakorisága továbbra is ismeretlen, a szakirodalomban kb. 70 közölt esetrol tudunk; a leggyakrabban egy-egy implantátummal kapcsolatban születnek cikkek, ami az összes beültetett implantátum számához képest elenyészo. Az arcüregben lévo szabad implantátum arcüreggyulladást okoz, eltávolítása szükséges, kötelezo. A sinus hátsó részében elhelyezkedo implantátum esetén elsosorban funkcionális endoszkópos sinussebészeti eljárás javasolt. Az elso recessusban lévo implantátum eltávolítására a legjobbnak a praelacrimalis recessusból végzett korszeru behatolás tunik. Tradicionális transoralis/Luc-Caldwell-féle behatolást a friss sinuslift utáni gyulladt csontexcochleatio esetén javasolunk, illetve ha fennálló oroantralis fistulát is zárnunk kell. Orv Hetil. 2022; 163(13): 527-531. Summary. Accidental implant displacement into the maxillary sinus is often due to inappropriate surgical planning or technique, unrecognised sinus disease, failure to recognise low residual bone quality and quantity during implant-supported maxillary molars and premolars rehabilitation. Secondary implant migration can be attributed to the risk of failing osteointegration due to unnoticed sinus membrane rupture during surgery, incomplete soft tissue closure over the implant's site, preexistent sinus ventilation problems. In this study, we present the case of a patient with a symptomless preexistent sinus infection, which had been treated with functional endoscopic sinus surgery. After the healing period, the following two-stage procedures were performed: 1) maxillary sinus bone augmentation, 2) 6 months later dental implant placement, based on a routine orthopantomogram. At the end of the 4-month planned healing period, the implant displacement was noticed in the sinus cavity. The implant was removed with a combination of endoscopic surgery, transnasal and transoral Luc-Caldwell approach. The possible reasons for displaced implant into the sinus cavity, the treatment decision tree and lessons we learned, updated by the international literature, are discussed. Our recommendation for displaced implant removal is primarily transnasal under general anaesthesia. In the case of the implant in the anterior recess of the maxillary sinus, the functional endoscopic sinus surgery through the prelacrimal recess approach seems to be the preferred approach. A transoral approach should be the chosen method in the case of present oro-anthral fistulae or recent sinus bone graft, when the infected graft should also be removed. Orv Hetil. 2022; 163(13): 527-533.

Removal of Displaced Dental Implants in the Maxillary Sinus Using Endoscopic Approaches.

With the broad indications for dental implantation, complications rates have increased. Dental implant displacement into the maxillary sinus, although rare, can occur during the restoration of maxillary posterior teeth. We performed a 6-year retrospective review and found 3 cases with displaced implants in the maxillary sinus. Detailed information, including surgical indications and dental implant removal methods, is provided. Dental implants can be dislocated to the maxillary sinus perioperatively or postoperatively. Endoscopic sinus surgery can be performed to remove the implant and restore sinus patency. If the implant is displaced to deeper areas (commonly anterior and inferior) of the maxillary sinus, a prelacrimal recess approach can provide a panoramic view of the maxillary sinus and is a good alternative to the Caldwell-Luc operation in terms of mucosal preservation and postoperative complications.

Modified endoscopic medial maxillectomy for a mixed maxillary inverted papilloma and mycetoma with absent prelacrimal recess.

Endoscopic prelacrimal recess approach is a promising technique for treating various maxillary sinus diseases because it allows for adequate visualization and wide access to the entire maxillary sinus. However, the incidence of absent prelacrimal recess (PLR) has ranged from 7% to 17.5%, implying that there is a limitation for the application of EPLA in this population. Here, a male patient with concomitant Krouse T2 maxillary inverted papilloma and mycetoma presenting with unilateral nasal obstruction and blood-tinged secretion is described. The presurgical computed tomography showed no recess. By dislocating the nasolacrimal duct from the bony canal and removing the medial maxillary wall sufficiently to extend the surgical corridor; and by preserving the inferior turbinate, nasal mucosa, and nasolacrimal duct, the patient did not experience any postoperative complications. In conclusion, our modified technique may be an effective and safe strategy for treating maxillary sinus disease without prelacrimal recess.

The endoscopic prelacrimal recess approach to the paramedian middle cranial base: An anatomical study.

BACKGROUND: Endoscopic endonasal approach to paramedian cranial base implies sacrifice of the nasal structures. OBJECTIVE: The present study aimed to illustrate the anatomy and provide critical anatomical landmarks for the endoscopic prelacrimal recess approach (PLRA) to the paramedian middle cranial base. METHODS: Anatomical dissections were performed in 10 cadaveric specimens. RESULTS: Successful access to the paramedian middle cranial base was achieved in all dissections via the PLRA with the removal of the pterygoid process. For the dissection of the infratemporal fossa and pterygopalatine fossa, the buccal nerve and infraorbital neurovascular bundle can serve as important anatomic landmarks to identify the detailed structures. In the upper parapharyngeal space, the stylopharyngeal aponeurosis can present as anatomical barriers to protect the parapharyngeal segment of the internal carotid artery (PPICA); while the levator veli palatini muscle can be considered as a landmark to locate the PPICA. For the dissection of the Eustachian tube (ET), the isthmus of the ET and ET sulcus can serve as useful landmarks to identify the posterior genu of the ICA and horizontal segment of the petrous ICA respectively. CONCLUSION: The PLRA to the paramedian middle cranial base is anatomically feasible and can facilitate preservation of the integrity of nasal structures. The buccal nerve, infraorbital neurovascular bundle, levator veli palatini muscle, stylopharyngeal aponeurosis, the isthmus of the ET, and ET sulcus can serve as critical anatomic landmarks in their respective region and may facilitate the application of this approach.