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Adjunctive techniques to improve access of the endoscopic prelacrimal recess approach.

Abstract

OBJECTIVES

To determine whether adjunctive surgical techniques could improve access of instruments provided by the endoscopic prelacrimal recess approach to the anatomical boundaries of the maxillary sinus, and pterygopalatine and infratemporal fossa.

METHODS

Ten fresh-frozen adult cadaver heads were utilized. The anatomical areas of interest were fixed, bony boundaries of the maxillary sinus, infratemporal fossa, and pterygopalatine fossa: alveolar recess (AR), zygomatic recess (ZR), perpendicular plate of the palatine bone (PB), ascending ramus of mandible (RM), floor of the orbit medial and lateral to infraorbital nerve (M-ION and L-ION, respectively). Access to the areas were compared using standard sinus surgery instruments (straight and 45° forceps) introduced via the prelacrimal recess approach, trans-septal window and canine fossa puncture.

RESULTS

The prelacrimal recess approach successfully provided access to the PB and M-ION in >90% of dissections when using both the straight and 45° forceps. With the straight forceps, the ability to successfully access to the AR and ZR was the lowest at 50% and 35% respectively, although improving to 75% and 60% respectively with the 45° forceps. Access to the AR, ZR, and L-ION improved significantly when the 45° forceps was introduced through the trans-septal window. Frequency of access to the RM when either instruments when introduced through the canine fossa puncture was no greater than 60% of the dissections.

CONCLUSIONS

The addition of a small trans-septal window for instruments significantly improved access of the prelacrimal recess approach especially to the orbital floor, lateral margins of the maxillary sinus, and retromaxillary space.

LEVEL OF EVIDENCE

4 Laryngoscope, 2019.

Authors+Show Affiliations

Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.Human Anatomy Resource Centre, Faculty of Health and Life Science, University of Liverpool, Liverpool, United Kingdom.Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31487048

Citation

Khong, Grace C., et al. "Adjunctive Techniques to Improve Access of the Endoscopic Prelacrimal Recess Approach." The Laryngoscope, 2019.
Khong GC, Medikeri G, Tierney C, et al. Adjunctive techniques to improve access of the endoscopic prelacrimal recess approach. Laryngoscope. 2019.
Khong, G. C., Medikeri, G., Tierney, C., & Leong, S. C. (2019). Adjunctive techniques to improve access of the endoscopic prelacrimal recess approach. The Laryngoscope, doi:10.1002/lary.28259.
Khong GC, et al. Adjunctive Techniques to Improve Access of the Endoscopic Prelacrimal Recess Approach. Laryngoscope. 2019 Sep 5; PubMed PMID: 31487048.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adjunctive techniques to improve access of the endoscopic prelacrimal recess approach. AU - Khong,Grace C, AU - Medikeri,Gaurav, AU - Tierney,Claire, AU - Leong,Samuel C, Y1 - 2019/09/05/ PY - 2019/04/03/received PY - 2019/07/13/revised PY - 2019/08/09/accepted PY - 2019/9/6/entrez KW - Endoscopy KW - maxillary sinus KW - nasal septum KW - paranasal sinus KW - skull base JF - The Laryngoscope JO - Laryngoscope N2 - OBJECTIVES: To determine whether adjunctive surgical techniques could improve access of instruments provided by the endoscopic prelacrimal recess approach to the anatomical boundaries of the maxillary sinus, and pterygopalatine and infratemporal fossa. METHODS: Ten fresh-frozen adult cadaver heads were utilized. The anatomical areas of interest were fixed, bony boundaries of the maxillary sinus, infratemporal fossa, and pterygopalatine fossa: alveolar recess (AR), zygomatic recess (ZR), perpendicular plate of the palatine bone (PB), ascending ramus of mandible (RM), floor of the orbit medial and lateral to infraorbital nerve (M-ION and L-ION, respectively). Access to the areas were compared using standard sinus surgery instruments (straight and 45° forceps) introduced via the prelacrimal recess approach, trans-septal window and canine fossa puncture. RESULTS: The prelacrimal recess approach successfully provided access to the PB and M-ION in >90% of dissections when using both the straight and 45° forceps. With the straight forceps, the ability to successfully access to the AR and ZR was the lowest at 50% and 35% respectively, although improving to 75% and 60% respectively with the 45° forceps. Access to the AR, ZR, and L-ION improved significantly when the 45° forceps was introduced through the trans-septal window. Frequency of access to the RM when either instruments when introduced through the canine fossa puncture was no greater than 60% of the dissections. CONCLUSIONS: The addition of a small trans-septal window for instruments significantly improved access of the prelacrimal recess approach especially to the orbital floor, lateral margins of the maxillary sinus, and retromaxillary space. LEVEL OF EVIDENCE: 4 Laryngoscope, 2019. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/31487048/Adjunctive_techniques_to_improve_access_of_the_endoscopic_prelacrimal_recess_approach L2 - https://doi.org/10.1002/lary.28259 DB - PRIME DP - Unbound Medicine ER -