Transnasal Endoscopic Medial Maxillectomy for Inverting Papilloma

• Published in: The Laryngoscope 2003-04, Vol.113 (4), p.749-753
• Main Authors: Sadeghi, Nader, Al-Dhahri, Saleh, Manoukian, John J.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; endoscopic medial maxillectomy; Endoscopy - methods; Follow-Up Studies; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Inverting papilloma; Magnetic Resonance Imaging; Maxillary Sinus - diagnostic imaging; Maxillary Sinus - pathology; Maxillary Sinus - surgery; Maxillofacial surgery. Dental surgery. Orthodontics; medial maxillectomy; Medical sciences; Neoplasm Invasiveness; Neoplasm Staging; Nose; Otorhinolaryngology. Stomatology; Papilloma, Inverted - diagnostic imaging; Papilloma, Inverted - pathology; Papilloma, Inverted - surgery; Paranasal Sinus Neoplasms - diagnostic imaging; Paranasal Sinus Neoplasms - pathology; Paranasal Sinus Neoplasms - surgery; sinonasal papilloma; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-200304000-00031

Objective To describe the new technique of transnasal endoscopic medial maxillectomy. Study Design Study design included application of the new technique in the management of five patients with inverting papilloma; retrospective review of five patients who had lateral rhinotomy with medial maxillectomy for inverting papilloma; comparison of transnasal endoscopic medial maxillectomy to open medial maxillectomy for scope of resection, margin control, operative time, and surgical access; and detailed description of transnasal endoscopic medial maxillectomy. Methods Charts were reviewed and tabulated for operative time, duration of follow‐up, and recurrence. Pathology reports were reviewed for number and orientation of the specimens and for margin control. Results Operative time was shorter for patients managed with transnasal endoscopic medial maxillectomy. All patients with transnasal endoscopic medial maxillectomy had one large, well‐oriented specimen with margin control. There was no recurrence in either group. Conclusions Transnasal endoscopic medial maxillectomy providing full access to the maxillary and ethmoid sinuses is described in detail. Transnasal endoscopic medial maxillectomy is an effective, reproducible technique with less operative time and morbidity and, possibly, better pathological tumor mapping than open medial maxillectomy for selected patients. Maxillary sinus involvement with inverting papilloma is not a contraindication for this technique. Strong illumination, superior resolution, and angled visualization, coupled with exact osteotomies, make transnasal endoscopic medial maxillectomy an efficacious technique for inverting papilloma with extension limited to the maxillary and ethmoid sinuses.