The Modified Medial Maxillectomy as a Radical or Extended,-yet Still Functional,-Technique in Sinus Surgery.

IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY American Journal of Rhinology & Allergy Pub Date : 2023-07-01 DOI:10.1177/19458924231168219
Eugene H Wong, Marina N Cavada, Carolyn A Orgain, Jessica W Grayson, Raquel Alvarado, Raewyn G Campbell, Richard Harvey, Raymond Sacks, Larry H Kalish
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引用次数: 1

Abstract

Background: Endoscopic sinus surgery with a middle meatal antrostomy is a common intervention in the treatment algorithm for maxillary sinus pathologies. However, this procedure has its origins in a time when simple ventilation of the sinus cavity was the primary (and only often) goal of surgery. In some patients, persistent mucociliary dysfunction occurs despite ventilatory surgery. Although the endoscopic modified medial maxillectomy (MMM) was originally described for tumour surgery, it provides a radical yet still functional option to overcome chronic sinus dysfunction.

Objective: The goal of this study was to describe the functional status of a post-MMM sinus cavity.

Methods: A consecutive series of patients who underwent at least a unilateral MMM by three tertiary rhinologists were retrospectively reviewed. Prospectively collected data included patient demographics (including age, gender, smoking status and comorbidities), disease-specific factors, microbiology, and preoperative patient-reported symptoms based on the 22-item Sinonasal Outcome Test-22 (SNOT-22) and radiology. The primary outcome of the study was the presence of sinus dysfunction, defined by mucostasis or pooling on endoscopic examination at the last follow-up. Secondary outcomes included the need for revision surgery as a result of sinus dysfunction and the improvement in SNOT-22 score.

Results: A total of 551 medial maxillectomies (47.0% female, 52.9 ± 16.8 years) were performed. Very few patients experienced post-operative sustained mucostasis following MMM (10.2%) and even fewer required revision surgery (5.0%). Chronic obstructive pulmonary disease (odds ratio (OR) = 6.82, P < 0.002.) and asthma (OR = 2.48, P = 0.03) were associated with mucostasis. Patients who underwent an MMM experienced a notable postoperative improvement in SNOT-22 score (45.9 ± 23.7 (pre-op) vs. 23.6 ± 19.4 (post-op); paired t-test, P < 0.0001).

Conclusion: The MMM, whether performed for access to pathology or with the intent to avoid mucous 'sumping' with the sinus, can provide a long-term functional maxillary sinus cavity with minimal morbidity.

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改良上颌骨内侧切除术作为鼻窦手术的根治性或延伸性技术。
背景:鼻内窥镜手术加中颅窦造口术是治疗上颌窦病变的常用方法。然而,当单纯的鼻窦腔通气是手术的主要目标时,这种手术就有了它的起源。在一些患者中,尽管进行了通气手术,但仍存在持续的纤毛粘膜功能障碍。虽然内窥镜改良上颌骨内侧切除术(MMM)最初被描述为肿瘤手术,但它提供了一种根治性的功能选择,以克服慢性鼻窦功能障碍。目的:本研究的目的是描述mmm后窦腔的功能状态。方法:对三名三级鼻科医生连续接受至少单侧MMM手术的患者进行回顾性分析。前瞻性收集的数据包括患者人口统计数据(包括年龄、性别、吸烟状况和合并症)、疾病特异性因素、微生物学和术前患者报告的症状,这些数据基于22项鼻窦预后测试-22 (SNOT-22)和放射学。该研究的主要结果是鼻窦功能障碍的存在,在最后一次随访时通过粘膜静止或内窥镜检查来定义。次要结果包括由于窦功能障碍和SNOT-22评分的改善而需要翻修手术。结果:共行上颌内侧切除术551例(女性47.0%,年龄52.9±16.8岁)。很少有患者在术后出现持续的粘膜稳定(10.2%),甚至更少的患者需要翻修手术(5.0%)。慢性阻塞性肺疾病(优势比(OR) = 6.82, P = 0.03)与粘膜冻结相关。接受MMM治疗的患者术后SNOT-22评分显著改善(术前45.9±23.7 vs术后23.6±19.4);结论:无论是为了病理检查还是为了避免粘膜与鼻窦“淤积”,MMM都可以提供一个长期功能良好的上颌窦腔,且发病率最低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.60
自引率
11.50%
发文量
82
审稿时长
4-8 weeks
期刊介绍: The American Journal of Rhinology & Allergy is a peer-reviewed, scientific publication committed to expanding knowledge and publishing the best clinical and basic research within the fields of Rhinology & Allergy. Its focus is to publish information which contributes to improved quality of care for patients with nasal and sinus disorders. Its primary readership consists of otolaryngologists, allergists, and plastic surgeons. Published material includes peer-reviewed original research, clinical trials, and review articles.
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