Surgical Approaches to Tackling Pathology Anywhere in the Maxillary Sinus

PROGRAM DESCRIPTION: The anatomy and physiology of the maxillary sinus makes it one of the most challenging sinuses to approach endoscopically. Despite its complexity, management of maxillary sinus pathology is often taken for granted. However, key steps to the standard maxillary antrostomy and use of more advanced approaches to address diseases along the floor, anterior and lateral walls of the maxillary sinuses are critical in minimizing recurrences.

In this expert lecture, we will highlight critical steps in completing an endoscopic maxillary antrostomy including appreciation of pre-operative imaging for variations in maxillary sinus anatomy, use of angled instrumentations, and appropriate management of the uncinate and middle turbinate. We will discuss silent sinus syndrome and surgical implications and outcomes when performing a maxillary antrostomy related to this diagnosis. Maxillary antrostomies are often performed for chronic rhinosinusitis. Eosinophilic mucin can be associated with more severe forms of CRS and critical to clear to minimize risk of recurrent disease. We will discuss techniques to remove and visualize mucin in these hard to access areas of the maxillary sinus. We will then discuss challenging locations to address and highlight advantages of a mega-antrostomy and Denker’s approach. In addition to reviewing the surgical approach, we will review key angled instrumentations to utilize when approaching the maxillary sinus.

OUTCOME OBJECTIVE 1: Understand the key surgical steps in completing a successful maxillary antrostomy

OUTCOME OBJECTIVE 2: Evaluate clinical scenarios requiring considerations when performing a maxillary antrostomy to minimize complications and maximize outcomes as in cases of silent sinus and chronic rhinosinusitis with eosinophilic mucin, and when more than a standard maxillary antrostomy is needed.

OUTCOME OBJECTIVE 3: Appreciate how to complete a mega-antrostomy and Denker’s approach to the maxillary sinus

BACKGROUND STATEMENT: Maxillary sinus pathology is challenging given the sinus’s anatomy. This challenge is highlighted by common pathologies such as inverted papillomas, silent sinus and chronic rhinosinusitis with mucin that require individualized approaches and techniques to minimize complications.

Comprehensive Otolaryngology Track Statement :