title: Endoscopic medial maxillectomy with preservation of inferior turbinate and nasolacrimal duct.
abstract: BACKGROUND
  Endoscopic medial maxillectomy (EMM) is a safe and effective procedure for treatment of inverted papilloma (IP) originating from the maxillary sinus. However, EMM usually removes the inferior turbinate and nasolacrimal duct. The inferior turbinate has a critical  function in conditioning of the nasal airflow, and resection of the nasolacrimal ducts has a risk of epiphora. We developed a newly derived surgical technique, endoscopic modified medial maxillectomy (EMMM), which enables preservation of the inferior turbinate and nasolacrimal duct.
  
  
  METHODS
  A retrospective case series of six patients with IP and nine patients with mucoceles of the maxillary sinus after a Caldwell-Luc operation, who underwent surgery using the EMMM technique, were reviewed.
  
  
  RESULTS
  In patients with IP, there were no recurrences  for a mean follow-up of 16.7 months. Eight of nine patients with mucoceles of the maxillary sinus showed patency. All patients showed preservation of the inferior turbinate. One patient with mucocele was referred for dacryocystorhinostomy because of epiphora.
  
  
  CONCLUSIONS
  EMMM  produces access to the maxillary sinus identically to conventional EMM, despite preservation of the inferior turbinate and nasolacrimal duct.
authors.affiliation: Department of Otorhinolaryngology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan. nakayama-t@jikei.ac.jp
authors.forename: Tsuguhisa
authors.initials: T
authors.lastname: Nakayama
authors.forename: Daiya
authors.initials: D
authors.lastname: Asaka
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Okushi
authors.forename: Mamoru
authors.initials: M
authors.lastname: Yoshikawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Moriyama
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Otori
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008443:Maxillary Sinus / Q000601:surgery*; D008444:Maxillary Sinus Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009078:Mucocele / Q000601:surgery*; D009301:Nasolacrimal Duct / Q000601:surgery; D018308:Papilloma, Inverted / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D012008:Recurrence; D012189:Retrospective Studies; D014420:Turbinates / Q000601:surgery