Surgical Relationship of the Nasolacrimal System to the Anterior Maxillary Line: Performing Safe Mega‐antrostomy. (23rd August 2013)

• Record Type: Journal Article
• Authors: Sarber, Kathleen M.; Weitzel, Erik K.; O'Connor, Peter
• Is Part Of: Otolaryngology--head and neck surgery. Volume 149(2013)Supplement 2
• Page Start: P135
• Page End: P136
• Publication Date: 2013-08-23
• Subjects: Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599813495815a303
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objectives: In patients with chronically diseased maxillary sinuses, poor mucociliary clearance may result from long‐standing inflammation or scarring from previous surgery. Endoscopic extended maxillary mega‐antrostomy is a recently described technique that facilitates mucus clearance and sinus irrigation in terminally dysfunctional maxillary sinuses by allowing the sinus to drain by gravity alone. As the procedure is a modification of the medial maxillectomy and it is standard to perform dacryocystorhinostomy (DCR) at the end of a medial maxillectomy procedure, it was our intent to determine if a DCR is likewise indicated after mega‐antrostomy. As a first step towards this answer, we aimed to study the relationship of the lacrimal system to the mega‐antrostomy procedure using cadaveric dissection. Methods: In 12 operated sides, the nasolacrimal duct was violated 42% of the time during anterior dissection. The average anterior‐posterior distance was 29.8mm. Lacrimal system violation occurred at an average of 3.7mm posterior to the anterior maxillary line. Unpaired Student t‐test was performed to determine if the limit of anterior dissection was associated with lacrimal system penetration. Results: More anterior dissection was significantly associated with lacrimal system penetration (6.1mm negative penetration to 4.6mm positive penetration p=0.038) however the overall AP diameter was not significantly related to penetration (p=0.511). Conclusions: Our results indicate that lacrimal system injury is highly likely to occur during mega‐antrostomy. To this end, DCR is indicated after mega‐antrostomy. However, using the maxillary line as a surgical landmark, damage may be avoided by maintaining a distance of >7mm from the anterior most aspect of the dissection.