This Italian review paper looks at five-year morbidity after extended endoscopic medial maxillectomy in 59 patients in a university teaching hospital setting. All patients underwent an extended approach medial maxillectomy for inverting papilloma, this included removal of the entire medial wall including inferior turbinate, sectioning of the lacrimal duct at the sac, widening of the pyriform aperture to the infraorbital foramen. Patients were evaluated by an endoscopic examination, lacrimal pathway assessment with saline irrigation and SNOT-22 questionnaire. Impairment of the infraorbital nerve was assessed using hot and cold sensitivity and cutaneous numbness in the malar region. Any other complaint, including aesthetics was also noted. Forty-three males and 16 females with an average age of 58 years and a mean follow up of 66 months were identified. Thirty-two were primary cases and 27 were revisions, 56 patients were disease free and three underwent further surgery for recurrence. Forty-eight patients completed the SNOT 22 with a mean score of 5.94, the most frequent symptoms reported were “need to blow the nose” and “thick nasal discharge”. Patients had been instructed to perform saline irrigations and use vaseline for their cavities which had commonly showed cicatrical shrinkage with reduction in volume of the maxillary sinus. Obstruction of the lacrimal system was identified in 12% of patients who subsequently underwent endoscopic dacryocystorhinostomy. Cutaneous hypoesthesia in the molar region was found in 8% of patients however 24% complained of paraesthesia of variable entity in the malar region and 29% of persistent numbness of the anterior superior dental hemi arch on the operated side, supplied by the anterior superior alveolar nerve, although problems caused by this were mild and not clinically relevant. One patient reported a slight depression of soft tissues on the affected side. The authors report a high incidence of neurological sequelae, although of no real clinical relevance and also of lacrimal duct problems which should be included in the consent process, otherwise nasal symptoms were satisfactory.

Postoperative long-term morbidity of extended endoscopic maxillectomy for inverted papilloma.
Bertazzoni G, Accorona R, Schreiber A, et al.
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Suki Ahluwalia

Cairns Hospital / James Cook University, Queensland, Australia.

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