An indication for a maxillectomy would be to remove cancer in the maxillary sinus. An algorithm for maxillectomy defect reconstruction steven p. Endoscopic modified medial maxillectomy for resection of. Neosoteogenesis at the postereolateral wall drilled to.
Recently, a new surgical approach named endoscopic modi ed medial maxillectomy emmm was proposed. Role of modified endoscopic medial maxillectomy in persistent. We previously reported a modified endoscopic medial maxillectomy modified transnasal endoscopic medial maxillectomy through prelacrimal duct approach mtemmpda to resect inverted papilloma ip, for which the inferior turbinate it and nasolacrimal duct nd can be preserved. Complications related to lacrimal drainage after endoscopic medial maxillectomy have been previously addressed in the literature and a variable rate of obstruction 016% has been reported 15. If there is anything that i am not answering here, then please, contact me and i will answer you directly.
During inferior maxillectomy one can expect to encounter some bleeding. Endoscopic medial maxillectomy after medial shifting of. In this article, the authors describe the endoscopic medial maxillectomy for neoplastic diseases involving the maxillary sinus. Bilateral, total maxillectomy is occasionally required and entails much greater complexity in reconstruction.
Lateral rhinotomy or sublabial degloving is the traditional approach used for an open medial maxillectomy. Following the adoption of endoscopic sinus surgery in the 1980s, there was a paradigm shift toward using endoscopic techniques for resecting select cases of benign and malignant tumors. Many adjectives are used to describe maxillectomy procedures, such as radical, total, extended, subtotal, medial, partial, and limited. Modified transnasal endoscopic medial maxillectomy through.
We successfully treated sinonasal ip with emmm in a yearold female patient. Advances in endoscopic sinus surgery have enabled some of these same disease processes to be treated using endoscopic techniques. The most frequent pathologies diagnosed were inverted papillomas 27 and antrochoanal polyps 727. Endoscopic medial maxillectomy s harvinder, mmed orlhns, s rosalind, mmed orlhns, s mallina, mbbs, s gurdeep, mshnorl department of ent, hospital ipoh, jalan hospital, 30990, ipoh, perak original article this article was accepted. Modified transnasal endoscopic medial maxillectomy with medial. One of these techniques that are widely implemented is endoscopic medial maxillectomy. It is a true medial maxillectomy, involving resection of the entire lateral nasal wall.
A radical procedure used to excise benign and lowgrade malignancies of the medial aspect of the maxilla, the lateral nasal wall, ethmoid sinuses and lacrimal sac, in which the maxilla is removed with the tumour. Transnasal endoscopic medial maxillectomy in inverted. Endoscopic prelacrimal medial maxillectomy epmm was previously reported to treat maxillary inverted papilloma. Intraoperatively, the entire medial wall of the maxillary sinus was removed and disease was cleared off the dental implants which were. Abstract although transnasal endoscopic medial maxillectomy temm is effective for the treatment of inverted papilloma ip in maxillary sinus. There were 21 primary lesions and 6 patients had been previously treated. Bilateral endoscopic medial maxillectomy for bilateral. With the advent of nasal endoscope resection of tumors involving lateral nasal wall under endoscopic vision is the order of the day.
Medial maxillectomy anterior wall of maxillary sinus is removed with osteotome and rongeurs. Oct 12, 2010 a medial maxillectomy mm consists of a complete resection of the medial wall of the maxillary sinus. Teaching and guidance as to the best technique, therefore, is based more on authority than clinical evidence. We have been billing an endoscopic medial maxillectomy as 31225. Recently, a new surgical approach named endoscopic modified medial maxillectomy emmm was proposed. Transnasal endoscopic medial maxillectomy as the initial. Maxillectomy is potentially complicated by injuries to the orbital contents, lacrimal.
A maxillectomy defect creates a communication from oral cavity to nasal cavity that may extend to the orbit. Medial maxillectomy definition of medial maxillectomy by. Endoscopic partial medial maxillectomy with mucosal flap for maxillary sinus mucoceles. Introduction medial maxillectomy is a procedure historically used for the removal of benign and lowgrade malignant tumors of the medial aspect of the maxilla, lateral nasal wall, ethmoid sinuses along the lamina papyracea, and the lacrimal sac. Abstract the technical aspects of the medial maxillectomy procedure have evolved over the last century to include modifications that permit improved cosmesis and patient morbidity. The endoscopic medial maxillectomy is also a useful approach for access to the pterygopalatine. The national center for biomedical ontology was founded as one of the national centers for biomedical computing, supported by the nhgri, the nhlbi, and the nih common fund under grant u54hg004028. The indications of medial maxillectomy are not only restricted for inverted papilloma but can be performed for.
The ethmoid sinus and frontonasal duct were also accessible from this incision. Transnasal endoscopic medial maxillectomy as the initial oncologic. This paper describes a large ip that filled in both sides of the nasal cavity and sinuses, mimicking association with malignancy. An algorithm for maxillectomy defect reconstruction. A maxillectomy is a surgical procedure used to treat oral cavity cancer and cancers affecting the jaw and sinus cavity. Modified endoscopic medial maxillectomy memm is an accepted alternative treatment for benign sinonasal neoplasms. Picture of lateral rhinotomy and medial maxillectomy for. Aug 02, 2014 maxillectomy partial maxillectomy hemi maxillectomy full maxillectomy maxillectomy is the removal of damaged parts in maxilla due to cancerous tissue being present and damaging the hard palate size spread 5 extended maxillectomy radical maxillectomy size spread 7. Transnasal endoscopic medial maxillectomy is an effective, reproducible technique with less operative time and morbidity and, possibly, better pathological tumor mapping than open medial. Its use as definitive treatment for inflammatory disease of the maxillary sinus. A lateral rhinotomy provided access to the tumor, the lateral wall of the nasal cavity and maxilla. Dentigerous cyst is one of the most frequent types of odontogenic cyst that. Questions you might have maxillectomy will nickson.
The aim of this study was to describe the endoscopic medial maxillectomy technique with preservation of the inferior turbinate in patients affected by maxillary sinonasal inverted papilloma. Module 7 endoscopic medial maxillectomy captured from the advanced skull base rhinology dissection workshop august 2018, university of malaya medical centre, kuala lumpur, malaysia dissector and. Fourteen patients with organised haematoma were treated. The variety of nomenclature in our own service database. Functional endoscopic sinus surgery fess has a longterm high rate of success for. Six of them were tumours that involved the anteromedial wall of. Endoscopic medial maxillectomy may be used as an alternative to more invasive external approaches while maintaining similar cure rates. Vasculature around the orbit the arterial blood supply to the maxilla and paranasal sinuses originates from both the external and internal carotid artery systems. Maxillary sinus involvement with inverting papilloma is not a.
The tumor was successfully treated by bilateral endoscopic medial maxillectomy emm. Malignant tumors involving maxilla lateral nasal wall 2. The endoscopic medial maxillectomy is the modern adaptation of the more historical open medial maxillectomy. Contrastenhanced computed tomography showed heterogeneous enhancement in all patients. Endoscopic medial maxillectomy, since reported first in 1992, has advanced tremendously and has been advocated by a number of authors for the fact that it prevents the morbidity of open approach. Transnasal endoscopic medial maxillectomy temm is effective for the treatment of inverted papilloma ip in the maxillary sinus ms.
Anatomy the lateral nasal wall includes the inferior turbinate, infundibulum with maxillary ostium, uncinate process, and nasolacrimal duct. Alternatively, this bone can be removed en bloc and later plated back. The new modified endoscopic transnasal medial maxillectomy metmm can provide. Combine with the sublabial approach for anterior and inferior and lateral recess and nasolacrimal duct disease combine with open approach for superior lateral orbit disease follow up. Effect of incremental endoscopic maxillectomy on surgical exposure.
Modified endoscopic medial maxillectomy for recalcitrant. Modified medial maxillectomy differs from a traditional endoscopic medial maxillectomy by preserving the nasolacrimal duct and a portion of the inferior turbinate. Although initially described with a lipsplitting technique, many authors subsequently described modifications which obviated this extension. A total maxillectomy is the resection of the entire maxilla, whereas a limited maxillectomy is only a partial resection, involving the removal of only the medial wall or the floor of the maxillary sinus.
Multidisciplinary decisionmaking in the management of the maxillectomy defect. Endoscopic medial maxillectomy augusta university research. It is increasingly being done by transnasal endoscopic technique for suitable cases and when the. The patient will have a foley catheter to drain your bladder in place after surgery. Others 16 have supported this notion that an endoscopic medial maxillectomy is completed only with resection of the medial wall of the maxilla including the inferior turbinate up to its anterior wall. Case of recurrent inverted papilloma of left paranasal sinuses. 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. Endoscopic medial maxillectomy with preservation of. Jun 15, 2016 medial maxillectomy is performed for the removal of benign and malignant tumors that involve the lateral nasal wall medial maxilla and to gain access to tumors in the masticator space and infratemporal skull base floor of middle cranial fossa. Jcm free fulltext surgery of inverted papilloma of the maxillary.
In this presentation, a case series of 45 patients who underwent endoscopic medial maxillectomy is presented. Endoscopic medial maxillectomy emm is a radical proce dure that involves. Endoscopic medial maxillectomy for inverted papilloma. In this patient, the sinonasal ip originated from the entire circumference of the maxillary. Historically, neoplastic processes of the lateral nasal wall and maxillary sinus have been treated with external procedures. Does anyone know the cpt code s for an endoscopic medial maxillectomy with drainage of extramaxillary sinus mucocele. Therefore, the classical medial maxillectomy with resection of the medial wall of the maxillary sinus including the inferior turbinate and the nasolacrimal duct or a. The endoscopic medial maxillectomy approach was modified by making an incision in the pyriform aperture and removing part of the anterolateral wall of the maxilla bone en bloc. Over the past decade, the role of endoscopic techniques in the excision of sinonasal neoplastic lesions has become widely recognized. The amount of lateral exposure is dependent on the extent of the medial maxillectomy. Modified medial maxillectomy for recalcitrant maxillary.
Endoscopic medial maxillectomy for infected dental implants decision was made to proceed with a left emm to allow for wide open irrigation and drainage of the left maxillary sinus. Role of modified endoscopic medial maxillectomy in. Pdf modified transnasal endoscopic medial maxillectomy with. The procedure may create a connection between the nose, sinus and oral cavities which can make speech and swallowing challenging. Treatment of recalcitrant maxillary sinusitis with endoscopic. Approach lateral rhinotomy incision or midfacial degloving.
Modified endoscopic medial maxillectomy providing full access to the maxillary and ethmoid sinuses is described in detail. With the improved visualization of endoscopic techniques and outcomes comparable to those of the external approach, endoscopic transnasal resection of these tumors is quickly becoming the standard of care. Bilateral ip, involving both sides of the nasal cavity and sinuses, is extremely rare. From january 2005 to december 2016, the authors performed 27 endoscopic medial maxillectomy with preservation of inferior turbinate on 26 patients. Tae kyung cha, ju hun song, jee hye wee and jae goo kang, two cases of the inverted papilloma in the maxillary sinus treated by modified transnasal endoscopic medial maxillectomy, korean journal of otorhinolaryngologyhead and neck surgery, 57, 12, 874, 2014.
Medial maxillectomy is now the gold standard for ip. Transnasal endoscopic medial maxillectomy for inverting. Modified transnasal endoscopic medial maxillectomy with. The anterior, inferior, and medial walls of the maxillary sinus could be observed endoscopically. Endoscopic medial maxillectomy with preservation of inferior. Endoscopic modified medial maxillectomy for resection of an. This study aimed to compare prelacrimal recess approach with the conventional caldwellluc approach cla to remove benign maxillary sinus tumors and to evaluate the usefulness of this approach based on our experience. For treatment of a sinonasal inverted papilloma ip, it is essential to have a definite diagnosis, to identify its origin by computed tomography ct and magnetic resonance imaging mri, and to select the appropriate surgical approach based on the staging system proposed by krouse. He did an endoscopic endonasal resection of the mass with drainageexcision of the parasinus mass and use of intraoperative. Functional deglutition and speech problems with a significant soft tissue deficit ensue. It is increasingly being done by transnasal endoscopic technique for suitable cases. Pdf endoscopic partial medial maxillectomy with mucosal. Article information, pdf download for treatment of recalcitrant maxillary. Clinic endoscopic follow up is critical to detecting recurrence early.
A maxillectomy is the partial removal of the upper jaw bone. Case report endoscopic modified medial maxillectomy for. An advanced technique used for the management of recalcitrant chronic maxillary sinusitis and certain maxillary sinus tumors e. Endoscopic sinus surgery, in particular endoscopic medial maxillectomy, is currently the gold standard for treatment of maxillary sinus papilloma. For inverted papilloma involving the lateral nasal wall, endoscopic medial maxillectomy is the procedure of choice.
The catheter will be removed when the patient is up. Traditionally the surgery is performed via an open approach. Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy. Endoscopic medial maxillectomy as a means of treating recalcitrant maxillary sinusitis was performed on 24 patients between 2009 and 2012 in the sinus and nose hospital santhome, chennai, india, which is a tertiary care center for nasal and sinus diseases. Medial maxillectomy is the procedure designed to en bloc resect the party wall between the nasal cavity, maxillary antrum, and adjacent ethoid labyrinth along with the tumor within the nose and sinus. Materials and methods patients and tumour characteristics from january 2005 to december 2008, 27 patients with inverted papilloma were treated in our institution.
This may leave the medial buttress piriform aperture strut intact, if not involved or not hindering exposure. Medial maxillectomy is performed for the removal of benign and malignant tumors that involve the lateral nasal wall medial maxilla and to gain access to tumors in the masticator space and infratemporal skull base floor of middle cranial fossa. With more familiarity and expertise in endoscopic sinus surgery the endonasal approach. This extended endoscopic technique is suitable for the removal of benign maxillary sinus tumors as well as lowgrade maxillary sinus cancers. I have tried to answer questions that i thought about before i had the operation and also questions that i still ask myself hopefully some of these may help you. Let us use the example of endoscopic transnasal sphenopalatine artery ligation and examine the following options. Jun 03, 2016 likewise, tumors involving only the medial maxillary wall or lateral nasal wall, such as an inverted papilloma, can be treated with a medial maxillectomy. The anterior cranial fossa dura was exposed, but was not involved.