Transnasal endoscopic partial maxillectomy: Operative nuances and proposal for a comprehensive classification system based on 1378 cases

Head Neck. 2017 Apr;39(4):754-766. doi: 10.1002/hed.24676. Epub 2016 Dec 29.

Abstract

Background: Despite the development of functional endoscopic endonasal surgery, there are still areas of the maxillary sinus that remain technically difficult to access using a standard middle meatal antrostomy as well as deep-seated skull base lesions requiring expanded transmaxillary approaches.

Methods: All patients who underwent transnasal endoscopic partial maxillectomy (TEPM) in a single institution from 2000 to 2014 were retrospectively reviewed. The TEPM was classified into 5 types according to the anatomic structures progressively removed and to the access provided.

Results: The TEPM was performed in 1378 patients for the management of: inflammatory diseases in 513 cases (37%), benign sinonasal tumors in 425 cases (31%), skull base malignancies in 285 cases (21%), and as a corridor to address deep-seated skull base lesions in 155 cases (11%).

Conclusion: The TEPM is a stepwise approach offering increasing access that can be tailored to different maxillary, sinonasal, and skull base pathologies with minimal morbidity for patients. © 2016 Wiley Periodicals, Inc. Head Neck 39: 754-766, 2017.

Keywords: endoscopic endonasal; maxillary sinus; maxillectomy; maxillotomy; skull base.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Anesthesia, General / methods
  • Cohort Studies
  • Endoscopy / adverse effects
  • Endoscopy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Maxilla / diagnostic imaging
  • Maxilla / surgery*
  • Maxillary Sinus Neoplasms / diagnostic imaging*
  • Maxillary Sinus Neoplasms / surgery*
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods
  • Nasal Cavity / surgery
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging
  • Patient Safety
  • Retrospective Studies
  • Risk Assessment
  • Time Factors
  • Treatment Outcome