Endoscopic combined middle and inferior meatal antrostomies approach in treatment of maxillary sinus inverting papilloma

Introduction
Endoscopic medial maxillectomy is currently the most commonly used endoscopic approach to the maxillary sinus inverting papilloma. The possible complications of this procedure include epiphora, crusting and empty nose syndrome. Another method, a prelacrimal recess approach, enables preservation of the nasolacrimal duct and inferior nasal turbinate, but offers limited possibility of postoperative endoscopic follow-up.

Aim
To evaluate the combined middle and inferior meatus antrostomy approach to treat the maxillary sinus inverting papilloma.

Material and methods
A retrospective assessment of the medical records of consecutive patients operated on due to the maxillary sinus inverting papilloma in a single centre was performed.

Results
Fourteen patients operated on using combined antrostomies, with a follow-up of 2 years, are presented. In 2 patients, the tumor involved the prelacrimal recess. One of these patients was successfully operated on using combined antrostomies. In the second patient combined antrostomies were accompanied by a prelacrimal recess approach. None of the 14 patients had intraoperative complications. No recurrence was observed. No drying, empty nose syndrome, lacrimation, floppy turbinate or mucus recirculation was observed. Two patients complained of permanent cheek numbness. Follow-up endoscopy was easily performed with a rigid endoscope through both antrostomies in all patients except one.

Conclusions
Combined antrostomies appear effective to treat the maxillary sinus inverted papilloma. They are associated with minimal invasiveness and complications and enable easy endoscopic follow-up. In patients with prelacrimal recess involvement, it can be supplemented by the prelacrimal recess approach or, if needed, converted to an endoscopic Denker procedure.