Endoscopic Trans-Turbinal Medial Maxillectomy: A Modified Endoscopic Medial Maxillectomy Technique to Preserve the Inferior Turbinate

Abstract

Endoscopic medial maxillectomy (EMM) and its modifications are surgical techniques areused to treat recalcitrant maxillary sinusitis as well as maxillary sinus tumors. In this report,we propose a simple and efficient modification of EMM, called endoscopic trans-turbinal medialmaxillectomy (ETTMM), by which the inferior turbinate (IT), nasolacrimal duct, and anatomicalintegrity of the nasal valve area are preserved. A total of 10 patients (five tumorousand five nontumorous maxillary diseases) underwent ETTMM. Briefly, a turbinate mucosalflap on the superior aspect of the IT was elevated after middle meatal antrostomy. Then atrans-turbinal window was developed to expose the inferior meatus, after which an extendedmaxillary antrostomy was generated. Finally, the turbinate mucosal flap was repositioned aftercomplete removal of the antral lesions. All lesions were successfully treated using ETTMM. Our modification was easy to perform, and we achieved good endoscopic visualizationand accessibility throughout the whole antrum by creating a trans-turbinal window and extendedmaxillary antrostomy. We could perform postoperative surveillance easily through thewide antrostomy using rigid endoscopes of various angles. ETTMM is a simple and usefulmodification of EMM that provides clear visualization and great accessibility to most aspectsof the maxillary antrum while preserving the nasal functional units, including the IT and nasalvalve area.