Translated Abstract
The benign occupying lesions of maxillary sinus generally include maxillary cyst, polyps, papilloma, bleeding necrotizing polyps and fungal infections. Early lesions limits in maxillary sinus, which cannot be found easily. Before the widespread applications of endoscopic technology, the maxillary sinus radical cure, which also called Caldwell-Luc way, was mainly taken to the proliferative diseases and benign tumor of maxillary sinus. Cut lip sulcus, in addition to cutting the anterior wall of the maxillary sinus, after cleaning the lesions of maxillary sinus,cut the lateral wall of the nasal bone down there and relevant mucosa, to make maxillary sinus and Inferior meatus can be interlinked. Caldwell-Luc way was raised by Caldwell(1893) and Henry Luc(1897), and after more than 110 years history, which has become the mature and standard surgery among the cure to the main indications of chronic suppurative frontal sinusitis. Although this surgery has being improved and completed a lot, still a few problems exist, such as open surgery make serious trauma, face will be swelling and up teeth feel nothing or in pain after the surgery. Because of the hurt of the surgery, to the two-side lesions patients, they need different surgery for times, which make them suffer and give them economic burden. And this surgery can easily lead cavity mucosa of maxillary sinus scarring, and make maxillary sinus drainage barriers, both of them increase the chance of getting sinusitis. For more extensive sinus disease benign lesions, like Inverted papilloma, the Denker surgery or nasal incision were adopted mostly in the past. With the widespread applications of endoscopic technology, the single Caldwell-Luc surgery and Denker surgery were less adopted, for dealing with some special lesions can combine the application of endoscopic technology, to make the traditional surgery become minimally invasive and clearly to be seen. Nowadays, there are many ways of maxillary sinus occupying lesions under the endoscopic, there are two classical surgery respectively are middle meatus natural sinus approach and window into the way Inferior meatus. With the widely application of endoscopic and the technology getting mature, middle meatus natural sinus approach and the Inferior meatus open way under the endoscopic in clinical use so far can replace the Caldwell-Luc and the Denker basically, which can finish the cut and keep the function. But because of the characteristics of maxillary sinus own netvibes, sinus opens at the inner wall’s up-backward, then there are some place cannot be seen and t to deal with, such as the inner wall and front wall of maxillary sinus, alveolar crypt and tears before crypt. So, the main point of maxillary sinus surgery is to open eye sight and working space based on the different approaches according to the lesions ‘s position and property. Because of the transmission and purge direction of maxillary sinus mucus indicate to the natural ostium, the direction of mucus cilia clean up won’t be changed even though after opening the under meatus, so under the endoscopic, the surgery of middle meatus is a basic one among the maxillary sinus surgery, which has minimal influence to maxillary sinus physical function. No matter which surgery way be adopted should follow the rule of sinus unobstructed drainage. Since the maxillary sinus surgical approach can only be used at anterior and medial wall,and because of the maxillary sinus surgery by Caldwell- Luc way, which after opening the anterior wall is basically vertical, the whole picture of maxillary sinus can be seen, but, because this surgery has many malpractice, which is rarely to be used. Therefore, the middle and inferior meatus approach has become a major surgical approach way to deal with the maxillary sinus benign lesions, but, because those two surgery cannot cut the lesions completely, the new surgical approach came out, like, lower meatus joint pathway, before the tears crypt pathway, middle meatus joint Ke-Lu way. As so far, there have been a unify sense to the maxillary sinus benign lesions, that is, in line with the state of nasal sinus anatomy and physiology is to through the approach of inner nasal wall. However, according to different lesions, which surgical approach should be taken and the problem of choosing surgical approach to the same lesion and different place, there is no unify standard. This search is making a comprehensive analysis about adopting different surgical approach to maxillary sinus benign lesions, to observe the efficacy of different approaches in the treatment of benign lesions of the maxillary sinus, to explore the best surgical approach of different lesions, so that can get the best surgical results and a good prognosis. Provide a basis and reference for clinical benign lesions sinus surgical approach.
Purpose:
To explore the best surgical approach of dealing with maxillary sinus benign occupying lesions and different place same lesion, and to observe the effects and complications after surgery.
1. Provide a basis and reference for clinical benign lesions sinus surgical approach.
2. For improve the effect of nasal endoscopic surgery and reduce the complications, to provide application anatomical reference, to standardize surgical procedure, in case of the serious complications caused by blindly surgery.
Method:
1. Pick the completely follow-up data of 92 maxillary sinus benign lesions patients from the Xi＇an Medical College Hospital Department of Otolaryngology during the time of March 2012 to October 2013, which contains 30Maxillary cyst patients, 15 papilloma patients, 17 maxillary Choanal polyp patients, 15 bleeding necrotic polyps patients and 15 fungal infections patients. To make a comprehensive evaluation about the effect of the surgery, need to take the surgical approach according to the different lesions, on the base of the case about postoperative endoscopic review, complications and sinus CT result, at the same time, considering with the Haikou standard and how the patients feel themselves.
2. Among the 92, there are 22 patients adopted by the middle meatus maxillary natural mouth approach, 10 through the inferior meatus open approach, 30 by using the combined approach meatus, and the other 30 using former tear crypt approach.
3. According to the different case of lesions, to make a better regular cure during the time of surgery time, standardized the medication use during the preoperative and postoperative time, and to do the postoperative nasal irrigation, regular cleaning of surgical cavity.
Result:
1. By postoperative follow-up from six months to one year, there are 3samples maxillary cyst recurrence, but considering the cyst is not big and patients have no obvious symptom, so there is no special measure to be taken. There are 2cases of recurrent papillomas, give reoperation and the bottom of the base to give coagulation process.The remaining patients were cured, there are 6 cases had nasal adhesions, an outpatient basis under local anesthesia was given in batches.
2. The statistical analysis showed that after treatment of the maxillary sinus benign lesions in different paths, there is no significant difference in cure rates, and there were no serious complications.
Conclusion:
1. Before sinus surgery of benign lesions, according to the the patient＇s condition, nature of the lesion, sinus CT, doctor should make a good preoperative evaluation, to choose proper surgical approach on the basis of different situation.the nasolacrimal duct, and other branches of the sphenopalatine artery damage should be avoided during the surgery, and in case of the serious complications.
2. Benign lesions maxillary sinus through the side wall to approach, which is consistent with nasal sinus anatomy physiological state most. On a natural port in the nasal sinus approach based procedure, and select the appropriate surgical approach depending on the lesions, can obtain satisfactory results.
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