Seresirikachorn Kachorn, Kondo Mickey, Png Lu Hui, Kalish Larry, Campbell Raewyn G, Alvarado Raquel, Harvey Richard J
Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.
Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Am J Rhinol Allergy. 2023 May;37(3):369-373. doi: 10.1177/19458924221144860. Epub 2022 Dec 12.
Access to the anterior, lateral, inferior, and inferomedial maxillary sinus has been a limitation of the middle meatal antrostomy. Expanded techniques such as the modified medial maxillectomy provide access to many of these areas but require remucosalization, and crusting can occur during the recovery phase. The prelacrimal approach (PLA) offers direct 0° endoscope access to these areas. Additionally, PLA can preserve the nasolacrimal duct and mucosal coverage.
We describe the current surgical technique and outcomes of PLA patients.
Consecutive adult patients with pathology addressed by PLA to the maxillary sinus were assessed. The primary outcome was the restoration of the lateral wall, and the secondary outcomes were early (< 90 days) and late morbidity (> 90 days).
Forty patients (52.8 ± 17 years, 62.5% female) were assessed. All patients had successful restoration of the lateral nasal wall (100% [95CI: 91.2%-100%]). The complications reported were primarily dysesthesia (early 10% and late 2.5%).
The PLA provides robust access to the anterior, lateral, inferior, and inferomedial maxilla. PLA offers rapid mucosal recovery while preserving the normal physiology and the lacrimal systems with low morbidity.
进入上颌窦的前壁、外侧壁、下壁和内侧下壁一直是中鼻道上颌窦造口术的一个限制因素。诸如改良内侧上颌骨切除术等扩展技术可进入其中许多区域，但需要重新黏膜化，且在恢复阶段可能会出现结痂。泪前入路（PLA）可提供0°内镜直接进入这些区域。此外，PLA可保留鼻泪管和黏膜覆盖。
我们描述了PLA患者目前的手术技术及结果。
对通过PLA治疗上颌窦病变的连续成年患者进行评估。主要结局是外侧壁的恢复情况，次要结局是早期（<90天）和晚期发病率（>90天）。
评估了40例患者（年龄52.8±17岁，62.5%为女性）。所有患者的鼻外侧壁均成功恢复（100%[95%CI：91.2%-100%]）。报告的并发症主要是感觉异常（早期10%，晚期2.5%）。
PLA可有效进入上颌骨的前壁、外侧壁、下壁和内侧下壁。PLA可使黏膜快速恢复，并保留正常生理功能和泪液系统，发病率较低。
