Role of Modified Endoscopic Medial Maxillectomy in Persistent Chronic Maxillary Sinusitis
27 September 2013
19 December 2013
13 February 2014 (eFirst)
Introduction Functional endoscopic sinus surgery has a long-term high rate of success for symptomatic improvement in patients with medically refractory chronic rhinosinusitis. As the popularity of the technique continues to grow, however, so does the population of patients with postsurgical persistent sinus disease, especially in those with a large window for ventilation and drainage. In addition, chronic infections of the sinuses especially fungal sinusitis have a higher incidence of recurrence even though a wide maxillary ostium had been performed earlier. This subset of patients often represents a challenge to the otorhinolaryngologist.
Objectives To identify the patients with chronic recalcitrant maxillary sinusitis and devise treatment protocols for this subset of patients.
Methods A retrospective review was done of all patients with persistent maxillary sinus disease who had undergone modified endoscopic medial maxillectomy between 2009 and 2012. We studied patient demographics, previous surgical history, and follow-up details and categorized the types of endoscopic medial maxillectomies performed in different disease situations.
Results We performed modified endoscopic medial maxillectomies in 37 maxillary sinuses of 24 patients. The average age was 43.83 years. Average follow-up was 14.58 months. All patients had good disease control in postoperative visits with no clinical evidence of recurrences.
Conclusion Modified endoscopic medial maxillectomy appears to be an effective surgery for treatment of chronic, recalcitrant maxillary sinusitis.
- 1 Richtsmeier WJ. Top 10 reasons for endoscopic maxillary sinus surgery failure. Laryngoscope 2001; 111 (11 Pt 1) 1952-1956
- 2 Unlü HH, Caylan R, Nalça Y, Akyar S. An endoscopic and tomographic evaluation of patients with sinusitis after endoscopic sinus surgery and Caldwell-Luc operation: a comparative study. J Otolaryngol 1994; 23 (3) 197-203
- 3 Houser SM, Corey JP. Allergic fungal rhinosinusitis: pathophysiology, epidemiology, and diagnosis. Otolaryngol Clin North Am 2000; 33 (2) 399-409
- 4 Kuhn FA, Javer AR. Allergic fungal rhinosinusitis: perioperative management, prevention of recurrence, and role of steroids and antifungal agents. Otolaryngol Clin North Am 2000; 33 (2) 419-433
- 5 Marple BF. Allergic fungal rhinosinusitis: current theories and management strategies. Laryngoscope 2001; 111 (6) 1006-1019
- 6 Ferguson BJ. What role do systemic corticosteroids, immunotherapy, and antifungal drugs play in the therapy of allergic fungal rhinosinusitis?. Arch Otolaryngol Head Neck Surg 1998; 124 (10) 1174-1178
- 7 Kamel RH. Transnasal endoscopic medial maxillectomy in inverted papilloma. Laryngoscope 1995; 105 (8 Pt 1) 847-853
- 8 Cohen NA, Kennedy DW. Revision endoscopic sinus surgery. Otolaryngol Clin North Am 2006; 39 (3) 417-435 , vii
- 9 Sessions RB, Humphreys DH. Technical modifications of the medial maxillectomy. Arch Otolaryngol 1983; 109 (9) 575-577
- 10 Sessions RB, Larson DL. En bloc ethmoidectomy and medial maxillectomy. Arch Otolaryngol 1977; 103 (4) 195-202
- 11 Woodworth BA, Parker RO, Schlosser RJ. Modified endoscopic medial maxillectomy for chronic maxillary sinusitis. Am J Rhinol 2006; 20 (3) 317-319
- 12 Wang EW, Gullung JL, Schlosser RJ. Modified endoscopic medial maxillectomy for recalcitrant chronic maxillary sinusitis. International Forum of Allergy & Rhinology 2011; 1 (6) 493-497
- 13 Cho DY, Hwang PH. Results of endoscopic maxillary mega-antrostomy in recalcitrant maxillary sinusitis. Am J Rhinol 2008; 22 (6) 658-662
- 14 Shatz A. Management of recurrent sinus disease in children with cystic fibrosis: a combined approach. Otolaryngol Head Neck Surg 2006; 135 (2) 248-252
- 15 Simmen D, Jones NS. Manual of endoscopic sinus surgery and its extended applications. New York: Tieme; 2005: pp. 50-51