This chapter will only deal with the open surgical medial maxillectomy. In our small series of patients endoscopic medial maxillectomy was a good surgical option with complete excision and very few complications. Endoscopic medial maxillectomy is a good surgical option in the management of benign sino nasal lesions. The tumor was successfully treated by bilateral endoscopic medial maxillectomy emm. However, emm usually removes the inferior turbinate and nasolacrimal duct. The patient is without evidence of the disease 24 months after surgery. Objectiveto demonstrate an anatomic basis for endoscopic medial maxillectomy with excision of the lateral nasal wall to the nasal floor, including the inferior. Gradually the domain of endoscopic surgery extended to the management of sino nasal tumours. The aim of this study is to demonstrate the effectiveness of the endoscopic medial maxillectomy technique with the preservation of the nasal anatomy and function of the inferior turbinate. External medial maxillectomy operative techniques in. Pdf on jan 1, 2019, muhammadnuaim ishak and others published open and endoscopic medial maxillectomy for maxillary tumors a. Endoscopic medial maxillectomy breaking new frontiers. Dissection of the apertura piriformis and anterior maxillary. Transnasal endoscopic medial maxillectomy is an effective, reproducible technique with less operative time and morbidity and, possibly, better pathological tumor mapping than open medial.
Conclusions transnasal endoscopic medial maxillectomy providing full access to the maxillary and ethmoid sinuses is described in detail. The pyriform aperture and the mucosa of the inferior turbinate were sutured and the surgery was completed. Patients may be on 4b or rarely the intensive care unit 5d. With the improved visualization of endoscopic techniques and outcomes comparable to those of the external approach, endoscopic transnasal resection of these tumors is quickly becoming the standard of care. Medial maxillectomy anterior wall of maxillary sinus is removed with osteotome and rongeurs. Pdf endoscopic partial medial maxillectomy with mucosal.
Sinus surgeries were the first to get the benefit of endoscope. Endoscopic medial maxillectomy breaking new frontiers ncbi. Radical medial maxillectomy is reserved for maxillary sinus tumors, which falls outside the range of discussion in this article. It is concluded that endoscopic medial maxillectomy is an effective technique for benign and low grade malignant lesions arising from the medial part of the maxillary sinus. Alternatively, this bone can be removed en bloc and later plated back. There is no appropriate cpt code for endoscopic maxillectomy. In this presentation, a case series of 45 patients who underwent endoscopic medial maxillectomy is presented. Medial maxillectomy refers to surgical resection of the medial and superomedial walls of the maxillary antrum.
Traditionally the surgery is performed via an open approach. This may leave the medial buttress piriform aperture strut intact, if not involved or not hindering exposure. Endoscopic medial maxillectomy is a radical procedure that includes removal of uncinate process, bulla, inferior turbinate, middle turbinate, and medial maxillary wall with the nasolacrimal duct. Design volumetric analysis of the maxillary sinus was performed on axial and coronal computed tomographic scans of 19 adult patients for a total. Introduction medial maxillectomy is a procedure historically used for the removal of benign and lowgrade malignant tumors of the medial aspect of the maxilla, lateral nasal wall, ethmoid sinuses along the lamina papyracea, and the lacrimal sac. Medial maxillectomy definition of medial maxillectomy by. It has revolutionised the surgical management of sinonasal disorders. With the advent of nasal endoscope resection of tumors involving lateral nasal wall under endoscopic vision is the order of the day. It is increasingly being done by transnasal endoscopic technique for suitable cases and when the required expertise and technology are available. Endoscopic medial maxillectomy may be used as an alternative to more invasive external approaches while maintaining similar cure rates.
Approach lateral rhinotomy incision or midfacial degloving. Medial maxillectomy is the procedure designed to en bloc resect the party wall between the nasal cavity, maxillary antrum, and adjacent ethoid labyrinth along with the tumor within the nose and sinus. Ers london 2018, h briner, indications for medial maxillectomy duration. Inverted papilloma of the maxillary sinus and endoscopic endonasal. Transnasal endoscopic medial maxillectomy provides exposure for endoscopic resection of the orbital wall, pterygopalatine fossa, pterygoid plates, nasopharynx, and anterior skull base when indicated. From january 2005 to december 2016, the authors performed 27 endoscopic medial maxillectomy with preservation of inferior turbinate on 26 patients. A medial maxillectomy can be performed as an open procedure through an incision next to the side wall of the nose on the face or, in some cases, endoscopically through the nostril using an endoscope and endoscopic instruments. The catheter will be removed when the patient is up. Review included preoperative symptoms and snot20 scores. It is increasingly being done by transnasal endoscopic technique for suitable cases.
A medial maxillectomy mm consists of a complete resection of the medial wall of the maxillary sinus. An endoscopic medial maxillectomy can sometimes also be called a modified medial maxillectomy when the. Endoscopic medial maxillectomy otolaryngology coding. Welch 21 introduction n medial maxillectomy is a procedure commonly used for the removal of benign and lowgrade malignant tumors of the medial aspect of the maxilla, the lateral nasal wall, the ethmoid sinuses, and the lacrimal sac. Pdf introduction the endoscopic access has reduced the morbidity associated with external approaches in diseases of the maxillary sinus. All patients were managed with an endoscopic approach, and all required an endoscopic medial maxillectomy to facilitate access to the maxillary sinus. History the symptoms of a sinonasal tumor are often nonspecific and include nasal obstruction, epistaxis, epiphora, hearing loss, and sinus headache. Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy. A maxillectomy is the partial removal of the upper jaw bone.
Transnasal endoscopic medial maxillectomy as the initial. For treatment of a sinonasal inverted papilloma ip, it is essential to have a definite diagnosis, to identify its origin by computed tomography ct and magnetic resonance imaging mri, and to select the appropriate surgical approach based on the staging system proposed by krouse. Endoscopic modified medial maxillectomy for resection of an. Endoscopic management of sinonasal inverted papilloma. Lateral rhinotomy with medial maxillectomy has served as the standard for surgical management of inverted papilloma ip in the pre endoscopic era. An advanced technique used for the management of recalcitrant chronic maxillary sinusitis and certain maxillary sinus tumors e. Malignant tumors involving maxilla lateral nasal wall 2. Agesex origin krouse staging endoscopic procedure current follow up hospitalization days 1 35m maxillary sinus krouse ii medial maxillectomy disease free 6. Original article 16 med j malaysia vol 66 no 1 march 2011 no. With more familiarity and expertise in endoscopic sinus surgery the endonasal approach is feasible. If preoperative diagnosis does not confirm the association with malignancy in ip, endoscopic sinus surgery ess should be selected, and ess, including emm, is a good first choice of the.
The surgeon is removing the maxilla not tissue from the maxillary sinus. Role of modified endoscopic medial maxillectomy in. Commonly used procedures include endoscopic sinus surgery ess, caldwellluc surgery, endoscopic medial maxillectomy emm, and lateral. Lateral rhinotomy with medial maxillectomy has served as the standard for surgical management of inverted papilloma ip in the preendoscopic era. Endoscopic medial maxillectomy pdf admin august 18, 2019 leave a comment. Recently, a new surgical approach named endoscopic modified medial maxillectomy emmm was proposed. Endoscopy has changed the perspective of rhinologist towards the nose. Endoscopic modified medial maxillectomy for resection of. Traditionally medial maxillectomy was performed through lateral rhinotomy or mid. Endoscopic medial maxillectomy can also be applied to other benign tumors such as angiofibromas and selected sinonasal malignancies.
Transnasal endoscopic medial maxillectomy is an effective, reproducible technique with less operative time and morbidity and, possibly, better pathological tumor mapping than open medial maxillectomy for. Pdf open and endoscopic medial maxillectomy for maxillary. A radical procedure used to excise benign and lowgrade malignancies of the medial aspect of the maxilla, the lateral nasal wall, ethmoid sinuses and lacrimal sac, in which the maxilla is removed with the tumour. Endoscopic medial maxillectomy combines outsidein draf 3. We have been billing an endoscopic medial maxillectomy as 31225. Endoscopic medial maxillectomy with preservation of. I think the endoscopic code is 31267 which seems to be partial, but 31225 is not an endoscopic code. Open and endoscopic medial maxillectomy for maxillary tumors a. It is increas ingly being done by transnasal endoscopic technique for suitable cases and.
Endoscopic partial medial maxillectomy with mucosal flap for maxillary sinus mucoceles. For inverted papilloma involving the lateral nasal wall, endoscopic medial maxillectomy is the procedure of choice. I have an insurance company what feels that an endoscopic medial maxillectomy should be compared to 31267. The present study proposes a transnasal endoscopic approach to the maxillary sinus through a reversible endoscopic medial maxillectomy remm as an alternative for the treatment of benign maxillary diseases. Endoscopic medial maxillectomy can be successfully performed for the resection of inverting papilloma involving the maxillary sinus andor the intersinonasal. The patient will have a foley catheter to drain your bladder in place after surgery. Ips with single 46% and multifocal 54% attachments were predominately to the medial and lateral walls. Eight patients underwent modified transnasal endoscopic medial maxillectomy, without complications such as facial numbness, tooth numbness, facial tingling, lacrimation and eye discharge.
Endoscopic medial maxillectomy as a means of treating recalcitrant maxillary sinusitis was performed on 24 patients between 2009 to 2012 in the sinus and nose hospital, santhome, chennai which is a tertiary care centre for nasal and sinus diseases. Although many advocate for an endoscopic approach to these tumors, there are still tumors that may lend themselves to an external medial maxillectomy. Historically, neoplastic processes of the lateral nasal wall and maxillary sinus have been treated with external procedures. Advances in endoscopic sinus surgery have enabled some of these same disease processes to be treated using endoscopic techniques. Bilateral endoscopic medial maxillectomy for bilateral. Endoscopic medial maxillectomy emm is a safe and effective procedure for treatment of inverted papilloma ip originating from the maxillary sinus. Transnasal endoscopic medial maxillectomy as the initial oncologic. Transnasal endoscopic medial maxillectomy for inverting. The indications of medial maxillectomy are not only restricted for inverted papilloma but can be performed for. The endoscopic medial maxillectomy is the preferred option for the treatment of benign sinonasal neoplasm involving the medial wall of maxilla.
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