Endoscopic Approaches To The Maxillary Sinus: A Comparative Study
- Conditions
- Maxillary Sinus Surgery
- Registration Number
- NCT03962413
- Lead Sponsor
- Assiut University
- Brief Summary
The aim of this study is to compare the outcomes of endoscopic pre lacrimal recess approach, canine fossa approach and middle meatal antrostomy approach regarding:
1. Assessment of the accessibility of each approach to visualize and reach the different walls and recesses of the maxillary sinus.
2. Any intraoperative or postoperative complications.
3. Any post-operative recurrence or residue detected by endoscopic examination or by MSCT scan.
- Detailed Description
The maxillary sinus is the sinus most commonly affected by disease.. It varies greatly in size, shape, position and pneumatisation, not only in different individuals, but also in different sides of the same individual .
A broad spectrum of disease processes can involve the maxillary sinus, such as infective, odontogenic and neoplastic. In simple cases, a standard uncinectomy and middle meatal antrostomy may be sufficient for visualisation and clearance of disease but despite this a drawback still exists in both external and intranasal surgical procedures. Compromise of the inferior turbinate (IT) and nasolacrimal duct (NLD) is often unavoidable .
According to the anatomy of MS and the feature of diseases originated from MS assessed with multi-angulated telescopes, including 30 ,45 and 70 telescopes, with kinds of curved instruments, there are still some areas which can not be viewed and handled . Such critical areas as the inferior, lateral, anterior wall, zygomatic recess, alveolar recess and prelacrimal recess of maxillary sinus are difficult to approach. For this reason other approaches are needed like canine fossa approach (CFA), prelacrimal recess approach (PLRA) and medial maxillectomy approach.
Review of the literature revealed no meta-analysis or evidence based medicine comparing different endoscopic approaches to maxillary sinus regarding feasibility of the access to different recesses and residual lesions.
The endonasal endoscopic prelacrimal recess approach (PLRA) provides a clear view through wide access to all walls of the maxillary sinus while still preserving the nasolacrimal duct and inferior turbinate.
It enables us to accurately, mini-invade and completely remove MS lesions. It is a physiological and functional surgery, and has great advantages in treating the diseases of the nasal cavity.
Canine fossa approach (CFA) has been proposed as an alternative method of obtaining access to the maxillary antrum. Although a few studies have demonstrated the benefits of CFA in management of the severely diseased maxillary sinus, the efficacy and superiority of this method compared with conventional MMA require further investigation above all considering new microdebrider blades that can be inserted through the antrostomy.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 100
- Age more than 18 years,
- Incidence of extensive denovo or recurrent sinonasal polyposis,
- Denovo or recurrent cases of antrochoanal polyp,
- Incidence of both denovo or recurrent allergic fungal rhinosinusitis,
- Maxillary sinus cysts and mucocoel,
- Presence of MS tumours such as inverted papilloma
- Presence of vascular tumours,
- Presence of sinonasal malignancies extending to the maxillary sinus,
- Having no contraindications for surgery under general anaesthesia.
- Age less than 18 years,
- Refusal of the patient,
- Having contraindications for surgery.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Primary Outcome Measures
Name Time Method accessibility of each endoscopic approach to visualize and reach the different walls and recesses of the maxillary sinus. assessment will be intraoperative only during conduction of the operation. assessment of the accessibility and feasibility of endoscopic pre lacrimal recess approach, canine fossa approach and middle meatal antrostomy approach which will be evaluated clinically by the surgeon intraoperatively by using different types of telescopes either 0 degree telescope or multi-angulated telescopes including 30 ,45 and 70 telescopes to visualize and reach the different walls and recesses of the maxillary sinus during treatment of maxillary sinus lesions.
- Secondary Outcome Measures
Name Time Method Rate of recurrence 6 months to assess the effect of each endoscopic approach on recurrence rate of maxillary sinus lesions. recurrence will be evaluated by clinical endoscopic evaluation of regular endoscopic examination first visit after one week, the second after 3 weeks and the third after 3 months. MSCT nose and paranasal sinuses will be done at the end of 6 month.
Trial Locations
- Locations (1)
Assiut University Hospital ,Otolaryngology department.
🇪🇬Assiut, Egypt
Assiut University Hospital ,Otolaryngology department.🇪🇬Assiut, Egypt