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Background: The pathology of the maxillary sinus (MS) can be treated using the prelacrimal recess approach, an intranasal method for accessing the MS. This approach exhibits significant individual variations in its prevalence and varying widths. Aim: To determine the occurrence of the prelacrimal recess (PLR) in the MS and explore its morphological variations. Methods: A retrospective analysis was performed on 225 cone beam computed tomography scans obtained from the department’s archives. The patients ranged in age from 18 to 78. Statistical analysis were conducted to evaluate the frequency of PLR occurrence in the MS. Data from both sides were compared between males and females. Results: The analysis of the data revealed that PLR was present in 84.9% of patients with MS. Each patient exhibited asymmetry between the left and right sides. Although PLR was less likely to occur in women, the difference was not statistically significant. Conclusion: The anatomical variations of the PLR in individuals should be considered prior to procedures to prevent complications.

Objective: Prelacrimal recess approach can be used to access lesions of the anterior wall of the maxillary sinus (MS). Moreover, the longer the prelacrimal recess window distance (PLRWD), the easier it is to access the anterior wall. This study aimed to define the correlation between maxillary sinus pneumatization (MSP) and PLRWD, a previously defined anatomic factor predictive of the ease of prelacrimal recess approach (PLRA). Methods: In total, 506 sides of 253 participants were studied. In the axial image, the PLRWD, the distance between the anterior wall of the MS and the lacrimal duct, was measured through radioanatomical analysis and classified as type I (<3 mm), type II (3-7 mm), or type III (>7 mm). On the coronal image, the distance between the nasal floor and the lower end of the MS was measured. When MSP did not reach the nasal floor, it was classified as grade I, as grade II when MSP reached the nasal floor, and grade III when the MS was pneumatized below the nasal floor. Results: Type I included 115 sides (22.7%); type II, 277 sides (54.7%); and type III, 114 sides (22.5%). Grade I was observed in 58 sides (11.5%), grade II in 38 sides (7.5%), and grade III in 410 sides (81.0%). The mean PLRWD of grade I was 2.35 ± 2.41 mm, II was 3.37 ± 2.46 mm, and III was 5.55 ± 2.54 mm, showing a significant difference (P <.001). Post hoc analysis showed significant differences in the mean PLRWD among grades I, II, and III. Two anatomical factors, the MSP and PLRWD, were positively correlated (r =.507, P <.001). Conclusions: This study demonstrates a correlation between the feasibility of MSP and PLRA. Both MSP and PLRWD are essential diagnostic parameters for preoperative planning and better surgical outcomes. [ABSTRACT FROM AUTHOR]

ObjectiveIn this paper, the goal of the authors is to present the anatomic nuances and their clinical experience with lesions of the pterygopalatine fossa and infratemporal fossa using an endoscopic transnasal prelacrimal recess transmaxillary approach (PLRMA).MethodsAn endoscopic anatomical dissection of three fresh cadaveric heads was performed bilaterally to evaluate the feasibility of the PLRMA. Prior to dissection, stereotactic computed tomography scans were obtained for each head to obtain anatomical measurements. The area of exposure on the posterior wall of the maxillary sinus was determined using stereotaxis. The cases of six patients with schwannomas or epidermoid cysts who underwent the transnasal PLRMA were illustrated.ResultsThe mean area of exposure on the posterior wall of the maxillary sinus was 9.55 cm2. Total resection was achieved in all six patients. The mean follow-up time was 16 months, and one patient complained of postoperative facial numbness, which resolved gradually. No cases of chronic sinusitis were reported.ConclusionsThe endoscopic transnasal PLRMA provides efficient operative exposure to the pterygopalatine fossa and infratemporal fossa. Preserving the integrity of the mucosa on the nasal lateral wall is an advantage of this approach.

Purpose: To assist in planning before the endoscopic prelacrimal recess (PLR) approach, we aimed to investigate the relationship between morphometry and variations of PLR in maxillary sinus (MS) pneumatizations. Methods: Retrospective analysis of the paranasal sinus computed tomography images of 150 patients was conducted to determine the pneumatization patterns of the MS, PLR variations, and the applicability of the PLR approach. The results were compared based on lateralization, gender, and age groups. Results: The PLRwidth, the anteroposterior diameter of the nasolacrimal duct (NLD), the vertical and horizontal diameters of the MS were the highest in hyperplasic MS, and decreased significantly with increasing age (p = 0.005, p = 0.017, p = 0.000), respectively. Most of the morphometric measurements were higher in hyperplasic MS, while the medial wall thickness of PLR was higher in hypoplasic MS. The PLRwidth for feasibility of the PLR approach were Type I (48%) in hypoplasic MS and Type III (80%) in hyperplasic MS (p < 0.001), respectively. The PLR medial wall thickness was higher in Type I, while the piriform aperture angle (PAA), MS volume, length, and slope of the NLD were higher in Type III PLRwidth (p = 0.000), respectively. The highest anterior and separation-type variations of the PLR were observed in hyperplasic MS, whereas 31.0% of hypoplasic MS had no PLR (p < 0.001). Conclusion: This study revealed that PLRwidth and PAA were the highest in hyperplasic MS, which allows the endoscopic PLR approach to be performed more easily. For safer and uncomplicated surgery, surgeon should be aware of the PLR anatomy in different MS pneumatization patterns. [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic sinus surgery has been widely used in the treatment of most maxillary diseases, although the inability to access lesions in the anterior and inferior maxillary sinus walls is a major disadvantage. In few cases, the prelacrimal recess (PLR) approach can be used, which secures an overall view within the maxillary sinus. The distance between the anterior maxillary wall and lacrimal duct is related to the ease of the PLR approach. First we measured the distance between the anterior maxillary wall and lacrimal duct using anatomical image analysis to classify the types and then evaluated whether anatomical factors were related to the results. Methods: Both sides of the sinuses were evaluated in 272 participants (544 sides). After marking a tangent line (line 1 [L1]) through the posterior surface of the anterior maxillary sinus wall and a parallel line (line 2 [L2]) to the anterior surface of the lacrimal duct, the vertical distance between L1 and L2 was measured. Vertical distances of < 3 mm, 3–7 mm, and > 7 mm were classified as PLR approach types I, II, and III, respectively. In the axial plane image, line 3 (L3) (a horizontal line starting from the inner anterior maxillary sinus wall) was drawn and the angle with L1 (L1–L3A) was measured. Results: The proportions of types I, II, and III were 23.2% (126), 55.0% (299), and 21.8% (119), respectively. The mean L1–L3As for types I, II, and III were 12.87 ± 4.92°, 11.20 ± 5.08°, and 10.40 ± 4.47°, respectively, showing a significant difference in mean values (p < 0.001). The L1–L3A and vertical distance between L1 and L2 showed a significant negative correlation (r = − 0.201, p < 0.001). Conclusions: We observed a correlation between the distance from the anterior maxillary wall to the lacrimal duct and L1–L3A. The L1–L3A indicates the degree of curvature of the anterior maxillary wall; therefore, the smaller the L1–L3A, the easier it may be to access the PLR. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the current study is to determine the age-related feasibility rate of the intranasal endoscopic prelacrimal recess approach (PLRA) in pediatric patients.Methods: Computed tomography (CT) images of 379 patients under 18 years old were analyzed retrospectively. The anteroposterior dimensions of the medial bony wall of the prelacrimal recess (PLR) were measured on 758 sides. The feasibility of the PLRA was evaluated according to the criteria of Simmen et al., for each age and three age groups based on trends in the change of the width of the PLR.Results: Less than half (45.9%) of pediatric maxillary sinuses (MS) were found to have the favorable anatomy (width of PLR >3 mm) to perform the PLRA. The cut-off value for age regarding the feasibility of the PLRA was nine years old. Following an evaluation of the groups, the proportions of the MS with favorable anatomy for the PLRA were 5.7% in Group I (age 0-4 years), 33.3% in Group II (age 5-8 years), and 55.1% in Group III (age 9-17 years). In group III, the feasibility rate for the PLRA was greater in boys (62.1%) than in girls (48.3%). No difference in the feasibility rate was found between the right and left sides.Conclusion: The overall feasibility rate for the PLRA in pediatric patients under 18 years of age is 46%. In patients aged 9-17 years, the feasibility rate for the PLRA is >50%. [ABSTRACT FROM AUTHOR]

Background: Conventional minimally invasive surgery has a high recurrence rate, and nasal morbidity can occur if the scope of surgery is expanded to complete removal of maxillary sinus inverted papilloma. Objective: To analyze the efficacy of the endoscopic prelacrimal recess approach (EPLRA) for maxillary sinus inverted papilloma removal. Methods: Eighteen studies were included in this meta-analysis. Articles comparing the prelacrimal recess approach with conventional surgery (endoscopic surgery or the Caldwell–Luc operation) for inverted papilloma removal were included. Outcomes of interest included recurrence and postoperative morbidities. The methodological quality was assessed using the Newcastle–Ottawa scale. Results: The recurrence rates of inverted papilloma, postoperative facial or gingival numbness, and alar collapse were 3.13% (95% confidence interval [CI]: 1.32, 7.27), 9.02% (95% CI: 3.70, 20.39), and 3.39% (95% CI: 1.28, 8.68), respectively. The recurrence rate of inverted papilloma was significantly lower after the EPLRA than after conventional surgery (odds ratio [OR] = 0.2290; 95% CI: 0.0808, 0.6489). However, there were no significant differences between the procedures in the rates of facial or gingival numbness (OR = 0.4567; 95% CI: 0.1497, 1.3933), epistaxis (OR = 0.3150; 95% CI: 0.0471, 2.1044), or periorbital swelling (OR = 1.2405; 95% CI: 0.1205, 12.7731). Conclusions: The EPLRA can preserve the lacrimal system and is useful for maxillary sinus inverted papilloma removal due to a lower recurrence rate compared with conventional surgeries. [ABSTRACT FROM AUTHOR]

Aim, To evaluate the treatment outcomes of endoscopic prelacrimal approach in managing various maxillary sinus pathologies, analyzing the associated adverse events and post treatment quality of life and also to compare surgical outcomes of prelacrimal approach with middle meatal antrostomy approach to remove various maxillary sinus pathologies. Materials and methods: A prospective study was conducted from January 2019 to April 2020. We took 60 patients with maxillary sinus pathologies and divided into two groups and done sinus surgery through middle meatal antrostomy approach (group A) and prelacrimal approach (group B). Post operative follow up done for one year and analyzed complications and recurrence. Results: We compared the recurrence rate of antrochoanal polyp in both groups. Out of 12 patients in group A, 6 patients (50%) got recurrence of polyp. In group B, only one patient (8%) got recurrence out of 12 patients of antrochoanal polyp. Conclusion: We conclude that prelacrimal recess approach is a better option than middle meatal antrostomy for complete removal of pathologies in maxillary sinus. [ABSTRACT FROM AUTHOR]

Background: The prelacrimal recess approach, is frequently preferred in creating a minimally invasive surgical corridors. Objective: The aim of this study was to evaluate the Prelacrimal recess (PLR) anatomy using Cone Beam Computed Tomography in patients with Maxillary Sinus Hypoplasia. Methods: The paranasal Cone Beam Computed Tomography series of 84 adults were analyzed retrospectively. The antero-posterior and mesio-distal widths of the PLR and the antero-posterior width of the naso-lacrimal duct were measured. The patients were divided into three groups according to the antero-posterior width of PLR to evaluate the feasibility of prelacrimal recess approach as Type 1 (0-3 mm), Type 2 (>3–7 mm) and Type 3 (>7 mm). Results: The mean antero-posterior width of PLR was 3.11 ± 1.49mm in the patients and 4.77 ± 1.76 mm in the controls. The mean mesio-distal width of PLR was 7.64 ± 1.49 mm in the patients and 3.17 ± 2.05 mm in the controls. The mean antero-posterior width of naso-lacrimal duct was 9.58 ± 2.80 mm in the patients and 9.46 ± 2.42 mm in the controls. Conclusions: The width of the antero-posterior PLR in patients with Maxillary Sinus Hypoplasia was found to be significantly lower in comparison to individuals with normal maxillary sinuses in the measurements performed on paranasal Cone Beam Computed Tomography scans. Hence, while planning a Functional Endoscopic Sinus Surgery with prelacrimal recess approach for maxillary sinus, the anatomical structure of the naso-sinusoidal region should be carefully analyzed, and individual anatomical variations such as Maxillary Sinus Hypoplasia should not be ignored. [ABSTRACT FROM AUTHOR]

Objective: To investigate the occurrence rate of the prelacrimal recess (PLR) and its medial bony wall dimensions based on the radiological analysis to help surgeons enhance the understanding of anatomic structures for the endoscopic prelacrimal recess approach. Methods: Cone-beam computed tomography images of 255 patients were evaluated retrospectively. The prevalence of the PLR in maxillary sinus was investigated and the thickness of its medial bony wall was measured and statistically assessed. Meanwhile, the width of the PLR was measured. The correlation between the width of the PLR and its medial bony wall thickness was assessed. The data were compared between the left side and right side, male and female. Results: The PLR was present in 82.5% of the maxillary sinus, with no significant differences between the left and right sides, as well as different gender groups. The mean thickness of the medial bony wall of the PLR was 2.84 ± 1.41 mm, without statistical difference between the left and right sides but significantly larger in males than in females. The mean width of the PLR was 4.62 ± 1.74 mm and it had a significant negative correlation with the thickness of the medial bony wall of the PLR. Conclusion: A large individual variation exists in the anatomy of PLR, including its prevalence and dimensions of its medial bony wall. When considering the intranasal endoscopic prelacrimal recess approach, the surgeons should carefully evaluate the anatomical structure of the PLR preoperatively so as to minimize the risks of surgical complications. [ABSTRACT FROM AUTHOR]

Background: The intranasal endoscopic prelacrimal recess approach (PLRA) to the maxillary sinus (MS) has been reported to treat many MS and skull base diseases. However, previous studies revealed that the width of the prelacrimal recess (PLR) shows a large individual variation. The purpose of this study was to ascertain the prevalence of the PLR in MS according to gender and age. Methods: A series of 701 maxillofacial cone beam computed tomography (CBCT) scans from adult patients were analyzed retrospectively. Patients were divided into five age groups (18–24 years, 25–34 years, 35–44 years, 45–54 years, and ≥ 55 years) and by sex. The frequencies of occurrence of the PLR in the MS were calculated and compared. Results: According to the findings obtained from our study, PLR was present in 81.5% of maxillary sinuses. No differences were found when the data distributions of right and left sides were compared. For individuals, the right and left sides were not always symmetrical. The probability of PLR was lesser among women than among men, but this differences was not significant. Another finding of our study was that the percentage of PLR decreased with increasing age among patients aged < 55 years, however, increased again among patients aged ≥ 55 years. Conclusion: The anatomy of PLR varies among individuals. Careful analysis of individual anatomical structure characteristic is recommended when considering intranasal endoscopic PLRA to the MS. Besides, the age variation of PLR should be considered in order to avoid complications. [ABSTRACT FROM AUTHOR]

Background The aim of the study was to evaluate the treatment outcomes of endoscopic prelacrimal recess approaches (EPLAs) in managing different sinus pathologies, analyzing associated adverse events and post-treatment quality-of-life. Methods We enrolled 21 consecutive patients (22 lesions) who received endoscopic sinus surgical procedures with EPLAs in two tertiary medical institutes between 2015 and 2018. Quality-of-life and self-rated symptom severity data were collected using the 22-item Sino-Nasal Outcomes Test (SNOT-22) and 10-point visual analog scales (VAS), respectively. Results A total of 21 patients (mean age (standard deviation) 51.7 (14.5) years; 16(76.2%) male) were followed up for 12.7 months. The most common symptoms were nasal discharge and nasal airway obstructions. Nine lesions (40.9%) were sinonasal papilloma’s, seven lesions were other types of neoplasms (31.8%; five benign and two malignant), two were trauma-related (9.1%), and four inflammatory diseases (18.2%). Patients with non-papilloma lesions had higher presurgical SNOT-22 than those with papillomas (P-value = 0.021). After EPLAs, non-papilloma patients had significant improvements in SNOT-22 and VAS (P-values = 0.012 and 0.012, respectively), while those with papillomas had only marginally significant improvements in VAS (P-value = 0.061). The most common adverse events was temporary cheek/tooth numbness (n = 11), and patients with sinonasal papillomas were more likely to have post-treatment complications than those with other disease entities. Conclusions EPLAs were found to effectively manage various sinus diseases. Short-term life-quality improvements were promising. Future large-scale studies with longer follow-up periods are recommended.

Endoscopic prelacrimal recess approach is a promising technique for treating various maxillary sinus diseases because it allows for adequate visualization and wide access to the entire maxillary sinus. However, the incidence of absent prelacrimal recess (PLR) has ranged from 7% to 17.5%, implying that there is a limitation for the application of EPLA in this population. Here, a male patient with concomitant Krouse T2 maxillary inverted papilloma and mycetoma presenting with unilateral nasal obstruction and blood-tinged secretion is described. The presurgical computed tomography showed no recess. By dislocating the nasolacrimal duct from the bony canal and removing the medial maxillary wall sufficiently to extend the surgical corridor; and by preserving the inferior turbinate, nasal mucosa, and nasolacrimal duct, the patient did not experience any postoperative complications. In conclusion, our modified technique may be an effective and safe strategy for treating maxillary sinus disease without prelacrimal recess. [ABSTRACT FROM AUTHOR]

Background: The pre-lacrimal window approach (PLWA) is a promising technique in approaching lesions of the anterior wall and floor of the maxillary sinus. Simmen et al. previously reported that this approach is feasible in only 2/3 of their patients. This percentage appears to be lower than that of our local (mainly Chinese) population based on our clinical experience. Our study aims to measure the distance between the anterior maxillary wall and lacrimal duct in ethnic Chinese. A higher incidence of sphenoid–ethmoidal cells has been reported in Orientals. We postulate that there is also a higher incidence of wider pre-lacrimal recesses in Orientals thus making the PLWA more feasible to perform in Orientals. Methods: 100 consecutive sinus CT scans of adult patients with various rhinologic diseases that did not distort the bony anatomy of the maxilla were reviewed (2 sides each). The distance between the anterior maxillary wall and the anterior border of the lacrimal duct was measured in 200 sides. We have adopted the methodology of measurements previously published by Simmen et al. This is so that we could compare between Oriental and Occidental paranasal sinuses. Results: A distance of more than 7 mm was found in 39.5% of our subjects and a distance of > 3–7 mm was seen in 53.5%. In 6.5% of our subjects we found a prelacrimal recess < 3 mm. Conclusion: The PLWA could have been performed without removal of the bony lacrimal canal in 39.5% of our subjects (> 7 mm). Good access to the anterior maxilla wall could also have been possible for 53.5% with sub-periosteal removal of the bony lacrimal canal and medial maxillary wall. Thus, the PLWA would have been feasible for 93% of our subjects. These percentages are significantly higher than Simmen's study of 68.5% in an Occidental population. [ABSTRACT FROM AUTHOR]

Background: Addressing anterior maxillary sinus pathology endoscopically that is inaccessible with an endoscopic modified medial maxillectomy requires either a prelacrimal approach (PLA) or an endoscopic Denker's approach (EDA). The PLA involves removing the medial wall of the prelacrimal recess (PLR), which is the bone between the pyriform aperture (PA) and nasolacrimal duct (NLD), from nasal floor to orbital floor. The PLA preserves the inferior turbinate and NLD, whereas both are sacrificed during an EDA. The purpose of this computed tomography (CT)‐based study was to determine the anteroposterior and superoinferior dimensions of the medial wall of the PLR. Methods: One hundred thirty‐one triplanar sinus CT scans of patients with various rhinologic diseases, but with intact bony PLR walls, were reviewed to assess dimensions of the medial wall of the PLR. The anteroposterior distances from the PA to the inferior‐most, middle, and superior‐most aspects of the NLD were measured. The height from the nasal floor to orbital floor was also measured. Combining left and right sides, there were 262 measurements. Results: The anteroposterior distances between the PA and the NLD were as follows: inferior: mean, 8.4 mm (standard error [SE], 0.2; range, 1.9–14.2); middle: mean, 7.6 mm (SE, 0.2; range, 0–13.6); and superior: mean, 5.5 mm (SE, 2.5; range, 0–11.9). The mean height of the medial wall of the PLR was 26.5 mm (SE, 0.2; range, 18.5–39.9). Conclusion: The anteroposterior and superoinferior dimensions of the medial wall of the PLR are variable, with the anteroposterior dimension being widest inferiorly. Its dimensions should be evaluated preoperatively when considering endoscopic approaches to or through the anterior maxillary sinus. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of nasal endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum in resecting recurrent nasal inverted papilloma. Methods: Patients with recurrent nasal inverted papilloma who underwent reoperation in our hospital during the past 2 years were included . The nasal septum may hinder full access to and effective treatment of the lesions at the anterior and medial wall of the maxillary sinus by endoscope, aspirator and surgical instrument in the narrow aperture of the prelacrimal recess, although these lesions could be observed by 70° nasal endoscope. Results: The nasal septum is temporarily opened on the basis of the prelacrimal recess approach, and the nasal endoscope and instrument was introduced through trans-septal window, so as to provide a better view of the operative field and the angular range of the instrument's movement. Conclusion: The recurrent nasal inverted papilloma could be successfully managed by re-endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum, and no recurrence was observed during the 2-year follow-up. This surgical approach is recommended for the inverted papilla which originates from the anterior medial wall of the maxillary sinus, as the tumor can be removed completely using this surgical approach., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

An external approach for resection of sinonasal tumors is associated with increased morbidity. Therefore, we employed a modified transnasal endoscopic maxillectomy combined with pre and/or postoperative radiotherapy for early stage maxillary carcinomas. It aims to evaluate our early experience with endoscopic resection of selected malignant sinonasal tumors. The medical and radiology records of patients who underwent endonasal endoscopic resection of malignant sinonasal tumors between 2008 and 2012 were retrospectively reviewed. Ten cases of selected malignant tumor were performed to resect by modified transnasal endoscopic maxillectomy. All the patients were without evidence of disease at a mean follow-up of 26.8 months. No major complications were recorded. The mean hospitalization stay was 6.6 days. In very carefully selected cases of malignant tumors, modified transnasal endoscopic maxillectomy is acceptable. The postoperative complication rate is low, cosmetic outcome is excellent and patients do not require a long hospitalization. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to analyze the results of a novel surgical method-the endoscopic prelacrimal recess approach (PLRA)-in patients with tumors involving the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). The surgical technique and indications for this approach are also discussed., Methods: The authors analyzed data from 7 cases involving patients who underwent resection of PPF and ITF tumors by means of the endoscopic PLRA from 2004 to 2013. Preoperative and postoperative imaging studies were available in all cases and were reviewed. The surgical specimens were all confirmed to be schwannomas., Results: All tumors were completely resected via endoscopic PLRA. There were no recurrences noted over a 28-month follow-up period. In 4 cases, the patients experienced postoperative facial numbness during the first two weeks after surgery, which gradually lessened thereafter. One patient continued to have mild facial numbness at most recent follow-up. The numbness had fully resolved in the other 3 cases., Conclusions: The intranasal endoscopic removal of schwannoma from PPF and ITF via PLRA can spare the whole lateral nasal wall, resulting in a reduction in morbidity. This is a novel minimally invasive surgical method for PPF and ITF tumors.