Im Yeon Hee, Kim Soo Whan, Park Chan-Soon, Kim Dong-Hyun
Department of Otorhinolaryngology-Head and Neck Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Rhinol. 2025 Mar;32(1):17-27. doi: 10.18787/jr.2024.00041. Epub 2025 Mar 21.
The prelacrimal recess approach (PLRA) has advanced endoscopic sinonasal surgery by providing improved access to the maxillary sinus and adjacent anatomical regions while preserving critical structures such as the inferior turbinate (IT) and nasolacrimal duct (NLD). First introduced in 2013, the PLRA has become an important technique for addressing various sinonasal pathologies. This review comprehensively evaluates the advancements, applications, and outcomes associated with the PLRA. The PLRA enables superior visualization and access to regions that are traditionally difficult to reach with conventional techniques. Standardized surgical steps emphasize meticulous preservation of the NLD and IT, while technical modifications have broadened its feasibility in patients with narrow prelacrimal recesses. Applications of the PLRA span diverse pathologies, including sinonasal inverted papilloma, fungal infections, odontogenic cysts, and tumors of the lacrimal system, orbit, and skull base. Anatomical studies reveal significant variations in prelacrimal recess dimensions across populations, affecting surgical feasibility. Sex-specific differences, ethnic variations, and age-related factors are important in patient selection. Clinical outcomes from multiple investigations validate the PLRA's efficacy in maintaining sinonasal function while achieving comprehensive lesion removal. Comparative analyses with traditional approaches underscore the PLRA's advantages in reducing postoperative morbidity and recurrence rates. Integration of the PLRA with complementary surgical approaches further expands its therapeutic applications while maintaining favorable safety profiles. The PLRA is a safe and effective surgical method that offers favorable outcomes in disease management, symptom resolution, and anatomical preservation. With ongoing innovations and refinements, the PLRA is poised to remain a cornerstone of minimally invasive sinonasal surgery, enabling the precise and safe treatment of complex pathologies.
泪前隐窝入路（PLRA）通过改善对上颌窦及相邻解剖区域的暴露，同时保留诸如下鼻甲（IT）和鼻泪管（NLD）等关键结构，推动了鼻内镜鼻窦手术的发展。PLRA于2013年首次引入，已成为处理各种鼻窦病变的重要技术。本文综述全面评估了与PLRA相关的进展、应用及结果。PLRA能够对上颌窦及相邻解剖区域提供传统技术难以企及的良好视野和手术入路。标准化的手术步骤强调精心保护NLD和IT，而技术改良拓宽了其在泪前隐窝狭窄患者中的可行性。PLRA的应用涵盖多种病变，包括鼻窦内翻性乳头状瘤、真菌感染、牙源性囊肿以及泪器、眼眶和颅底肿瘤。解剖学研究显示，不同人群的泪前隐窝尺寸存在显著差异，这会影响手术可行性。性别差异、种族差异和年龄相关因素在患者选择中很重要。多项研究的临床结果证实了PLRA在实现病变彻底切除的同时维持鼻窦功能的有效性。与传统手术方法的对比分析突出了PLRA在降低术后发病率和复发率方面的优势。将PLRA与辅助手术方法相结合，在保持良好安全性的同时进一步扩大了其治疗应用范围。PLRA是一种安全有效的手术方法，在疾病管理、症状缓解和解剖结构保留方面均取得了良好效果。随着不断的创新和改进，PLRA有望继续成为微创鼻窦手术的基石，实现对复杂病变的精确、安全治疗。
