Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, c/ Villarroel 170, 08036, Barcelona, Catalonia, Spain.
Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Ramón y Cajal, Madrid, Spain.
Eur Arch Otorhinolaryngol. 2021 Oct;278(10):3813-3820. doi: 10.1007/s00405-021-06604-z. Epub 2021 Jan 22.
OBJECTIVES/HYPOTHESIS: To present a modified endoscopic medial maxillectomy (MEMM) approach to control maxillary sinus pathologies.
MEMM was completed in 13 fresh-frozen specimens. An MEMM includes cutting the nasolacrimal duct, inferior meatus flap, and repositioning the inferior turbinate (IT). The following measurements were obtained: length of IT, height from the nasal floor to valve of Hasner, height of the IT at the level of valve of Hasner, height of the IT at the insertion of the middle turbinate, and distance from the piriform aperture to the posterior wall of maxillary sinus and to the posterior border of palatine bone. Similar measurements were also performed on craniofacial computed tomography (CT) scans (n = 50). The surgical technique was performed in a case series (n = 8).
The mean of the specimens was 82 (range 70-95) years old. The average area of the harvested inferior meatus flap area was 9.6 ± 1.0 cm. In the radiologic study, the mean maximum antrostomy area was 8.8 ± 1.7 cm and the IT area overlapping the antral window was 5.8 ± 1.1 cm, the area allowing a double window control was 3.1 ± 1.9 cm, the posterior IT insertion length was 0.7 ± 0.4 cm, and the inferior meatus flap covering the inferior meatotomy had an area measuring 6.7 ± 1.7 cm. Eight patients underwent MEMM for various benign conditions showing no recurrence after 26 month follow-up.
The proposed modifications of MEMM provide a "double" window maxillary sinus control with access to all maxillary walls and preservation of the IT.
目的/假设：介绍一种改良的内镜上颌窦内侧切开术（MEMM）方法，以控制上颌窦病变。
在 13 个新鲜冷冻标本中完成 MEMM。MEMM 包括切断鼻泪管、下鼻甲瓣和重新定位下鼻甲（IT）。获得以下测量值：IT 的长度、从鼻底到 Hasner 瓣的高度、Hasner 瓣水平的 IT 高度、中鼻甲插入处的 IT 高度以及从梨状孔到上颌窦后壁和腭骨后缘的距离。还对颅面计算机断层扫描（CT）扫描（n = 50）进行了类似的测量。该手术技术在病例系列（n = 8）中进行。
标本的平均年龄为 82 岁（范围 70-95 岁）。收获的下鼻甲瓣面积平均为 9.6 ± 1.0 cm。在放射学研究中，平均最大窦口面积为 8.8 ± 1.7 cm，IT 面积重叠窦口为 5.8 ± 1.1 cm，允许双窗控制的面积为 3.1 ± 1.9 cm，后 IT 插入长度为 0.7 ± 0.4 cm，下鼻甲瓣覆盖下鼻甲切开术的面积为 6.7 ± 1.7 cm。8 例患者因各种良性疾病接受 MEMM 治疗，随访 26 个月后无复发。
所提出的 MEMM 改良方法提供了一种“双”窗口上颌窦控制，可到达所有上颌壁并保留 IT。
