UNASSIGNED: In this paper, the goal of the authors is to present the anatomic nuances and their clinical experience with lesions of the pterygopalatine fossa and infratemporal fossa using an endoscopic transnasal prelacrimal recess transmaxillary approach (PLRMA).
UNASSIGNED: An endoscopic anatomical dissection of three fresh cadaveric heads was performed bilaterally to evaluate the feasibility of the PLRMA. Prior to dissection, stereotactic computed tomography scans were obtained for each head to obtain anatomical measurements. The area of exposure on the posterior wall of the maxillary sinus was determined using stereotaxis. The cases of six patients with schwannomas or epidermoid cysts who underwent the transnasal PLRMA were illustrated.
UNASSIGNED: The mean area of exposure on the posterior wall of the maxillary sinus was 9.55 cm2. Total resection was achieved in all six patients. The mean follow-up time was 16 months, and one patient complained of postoperative facial numbness, which resolved gradually. No cases of chronic sinusitis were reported.
UNASSIGNED: The endoscopic transnasal PLRMA provides efficient operative exposure to the pterygopalatine fossa and infratemporal fossa. Preserving the integrity of the mucosa on the nasal lateral wall is an advantage of this approach.

OBJECTIVE: To assist in planning before the endoscopic prelacrimal recess (PLR) approach, we aimed to investigate the relationship between morphometry and variations of PLR in maxillary sinus (MS) pneumatizations.
METHODS: Retrospective analysis of the paranasal sinus computed tomography images of 150 patients was conducted to determine the pneumatization patterns of the MS, PLR variations, and the applicability of the PLR approach. The results were compared based on lateralization, gender, and age groups.
RESULTS: The PLRwidth, the anteroposterior diameter of the nasolacrimal duct (NLD), the vertical and horizontal diameters of the MS were the highest in hyperplasic MS, and decreased significantly with increasing age (p = 0.005, p = 0.017, p = 0.000), respectively. Most of the morphometric measurements were higher in hyperplasic MS, while the medial wall thickness of PLR was higher in hypoplasic MS. The PLRwidth for feasibility of the PLR approach were Type I (48%) in hypoplasic MS and Type III (80%) in hyperplasic MS (p < 0.001), respectively. The PLR medial wall thickness was higher in Type I, while the piriform aperture angle (PAA), MS volume, length, and slope of the NLD were higher in Type III PLRwidth (p = 0.000), respectively. The highest anterior and separation-type variations of the PLR were observed in hyperplasic MS, whereas 31.0% of hypoplasic MS had no PLR (p < 0.001).
CONCLUSIONS: This study revealed that PLRwidth and PAA were the highest in hyperplasic MS, which allows the endoscopic PLR approach to be performed more easily. For safer and uncomplicated surgery, surgeon should be aware of the PLR anatomy in different MS pneumatization patterns.

Objective:To investigate the effectiveness of nasal endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum in resecting recurrent nasal inverted papilloma. Methods:Patients with recurrent nasal inverted papilloma who underwent reoperation in our hospital during the past 2 years were included . The nasal septum may hinder full access to and effective treatment of the lesions at the anterior and medial wall of the maxillary sinus by endoscope, aspirator and surgical instrument in the narrow aperture of the prelacrimal recess, although these lesions could be observed by 70° nasal endoscope. Results:The nasal septum is temporarily opened on the basis of the prelacrimal recess approach, and the nasal endoscope and instrument was introduced through trans-septal window, so as to provide a better view of the operative field and the angular range of the instrument\'s movement. Conclusion:The recurrent nasal inverted papilloma could be successfully managed by re-endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum, and no recurrence was observed during the 2-year follow-up. This surgical approach is recommended for the inverted papilla which originates from the anterior medial wall of the maxillary sinus, as the tumor can be removed completely using this surgical approach.
目的：探讨鼻内镜下泪前隐窝入路联合鼻中隔临时开窗在复发性鼻内翻性乳头状瘤切除术中的临床效果。 方法：对广东医科大学附属医院耳鼻咽喉科近2年收治复发的鼻内翻性乳头状瘤再次行手术切除的患者，考虑肿瘤基底部位于上颌窦前内侧壁，使用70°鼻内镜虽然能观察到上颌窦前内侧壁的病变，但在泪前隐窝这个狭小的孔径内，同时使用内镜、吸引器及手术器械处理上颌窦前内侧壁的病变难以完全到达并根治的部分原因是受中隔的限制。 结果：故此次采用在泪前隐窝入路的基础上加做鼻中隔临时开窗，利用开窗口从对侧鼻孔进入鼻内镜或器械，以提供更好视野广角和器械活动的角度范围。 结论：复发的鼻内翻性乳头状瘤经过再次鼻内镜下泪前隐窝入路联合鼻中隔临时开窗手术切除随访2年半未见复发，对于基底部位于上颌窦前内侧壁等难以处理的内翻性乳头状瘤能更彻底的切除，值得临床推广。.

UNASSIGNED: Prelacrimal recess approach can be used to access lesions of the anterior wall of the maxillary sinus (MS). Moreover, the longer the prelacrimal recess window distance (PLRWD), the easier it is to access the anterior wall. This study aimed to define the correlation between maxillary sinus pneumatization (MSP) and PLRWD, a previously defined anatomic factor predictive of the ease of prelacrimal recess approach (PLRA).
UNASSIGNED: In total, 506 sides of 253 participants were studied. In the axial image, the PLRWD, the distance between the anterior wall of the MS and the lacrimal duct, was measured through radioanatomical analysis and classified as type I (<3 mm), type II (3-7 mm), or type III (>7 mm). On the coronal image, the distance between the nasal floor and the lower end of the MS was measured. When MSP did not reach the nasal floor, it was classified as grade I, as grade II when MSP reached the nasal floor, and grade III when the MS was pneumatized below the nasal floor.
UNASSIGNED: Type I included 115 sides (22.7%); type II, 277 sides (54.7%); and type III, 114 sides (22.5%). Grade I was observed in 58 sides (11.5%), grade II in 38 sides (7.5%), and grade III in 410 sides (81.0%). The mean PLRWD of grade I was 2.35 ± 2.41 mm, II was 3.37 ± 2.46 mm, and III was 5.55 ± 2.54 mm, showing a significant difference (P < .001). Post hoc analysis showed significant differences in the mean PLRWD among grades I, II, and III. Two anatomical factors, the MSP and PLRWD, were positively correlated (r = .507, P < .001).
UNASSIGNED: This study demonstrates a correlation between the feasibility of MSP and PLRA. Both MSP and PLRWD are essential diagnostic parameters for preoperative planning and better surgical outcomes.

OBJECTIVE: Endoscopic sinus surgery has been widely used in the treatment of most maxillary diseases, although the inability to access lesions in the anterior and inferior maxillary sinus walls is a major disadvantage. In few cases, the prelacrimal recess (PLR) approach can be used, which secures an overall view within the maxillary sinus. The distance between the anterior maxillary wall and lacrimal duct is related to the ease of the PLR approach. First we measured the distance between the anterior maxillary wall and lacrimal duct using anatomical image analysis to classify the types and then evaluated whether anatomical factors were related to the results.
METHODS: Both sides of the sinuses were evaluated in 272 participants (544 sides). After marking a tangent line (line 1 [L1]) through the posterior surface of the anterior maxillary sinus wall and a parallel line (line 2 [L2]) to the anterior surface of the lacrimal duct, the vertical distance between L1 and L2 was measured. Vertical distances of < 3 mm, 3-7 mm, and > 7 mm were classified as PLR approach types I, II, and III, respectively. In the axial plane image, line 3 (L3) (a horizontal line starting from the inner anterior maxillary sinus wall) was drawn and the angle with L1 (L1-L3A) was measured.
RESULTS: The proportions of types I, II, and III were 23.2% (126), 55.0% (299), and 21.8% (119), respectively. The mean L1-L3As for types I, II, and III were 12.87 ± 4.92°, 11.20 ± 5.08°, and 10.40 ± 4.47°, respectively, showing a significant difference in mean values (p < 0.001). The L1-L3A and vertical distance between L1 and L2 showed a significant negative correlation (r = - 0.201, p < 0.001).
CONCLUSIONS: We observed a correlation between the distance from the anterior maxillary wall to the lacrimal duct and L1-L3A. The L1-L3A indicates the degree of curvature of the anterior maxillary wall; therefore, the smaller the L1-L3A, the easier it may be to access the PLR.

Aim, To evaluate the treatment outcomes of endoscopic prelacrimal approach in managing various maxillary sinus pathologies, analyzing the associated adverse events and post treatment quality of life and also to compare surgical outcomes of prelacrimal approach with middle meatal antrostomy approach to remove various maxillary sinus pathologies.
METHODS: A prospective study was conducted from January 2019 to April 2020. We took 60 patients with maxillary sinus pathologies and divided into two groups and done sinus surgery through middle meatal antrostomy approach (group A) and prelacrimal approach (group B). Post operative follow up done for one year and analyzed complications and recurrence.
RESULTS: We compared the recurrence rate of antrochoanal polyp in both groups. Out of 12 patients in group A, 6 patients (50%) got recurrence of polyp. In group B, only one patient (8%) got recurrence out of 12 patients of antrochoanal polyp.
CONCLUSIONS: We conclude that prelacrimal recess approach is a better option than middle meatal antrostomy for complete removal of pathologies in maxillary sinus.

OBJECTIVE: The purpose of the current study is to determine the age-related feasibility rate of the intranasal endoscopic prelacrimal recess approach (PLRA) in pediatric patients.
METHODS: Computed tomography (CT) images of 379 patients under 18 years old were analyzed retrospectively. The anteroposterior dimensions of the medial bony wall of the prelacrimal recess (PLR) were measured on 758 sides. The feasibility of the PLRA was evaluated according to the criteria of Simmen et al., for each age and three age groups based on trends in the change of the width of the PLR.
RESULTS: Less than half (45.9%) of pediatric maxillary sinuses (MS) were found to have the favorable anatomy (width of PLR >3 mm) to perform the PLRA. The cut-off value for age regarding the feasibility of the PLRA was nine years old. Following an evaluation of the groups, the proportions of the MS with favorable anatomy for the PLRA were 5.7% in Group I (age 0-4 years), 33.3% in Group II (age 5-8 years), and 55.1% in Group III (age 9-17 years). In group III, the feasibility rate for the PLRA was greater in boys (62.1%) than in girls (48.3%). No difference in the feasibility rate was found between the right and left sides.
CONCLUSIONS: The overall feasibility rate for the PLRA in pediatric patients under 18 years of age is 46%. In patients aged 9-17 years, the feasibility rate for the PLRA is >50%.