title: "TuNa-saving" endoscopic medial maxillectomy: a surgical technique for maxillary inverted papilloma.
abstract: The maxillary sinus is the most common site of sinonasal inverted papilloma. Endoscopic sinus surgery, in particular endoscopic medial maxillectomy, is currently the gold standard for treatment of maxillary sinus papilloma. Although a common technique, complications such as stenosis of the lacrimal pathway and consequent development of epiphora are still possible. To avoid these problems, we propose a modification of this surgical technique that preserves the head of the inferior turbinate and the nasolacrimal duct. A retrospective analysis was performed on patients treated for maxillary inverted papilloma in three tertiary medical centres between 2006 and 2014. Pedicle-oriented endoscopic surgery principles were applied and, in select cases where the tumour pedicle was located on the anterior wall, a modified endoscopic medial maxillectomy was carried out as described in this paper. From 2006 to 2014 a total of 84 patients were treated. A standard endoscopic medial maxillectomy was performed in 55 patients (65.4%), while the remaining 29 (34.6%) had a modified technique performed. Three recurrences (3/84; 3.6%) were observed after a minimum follow-up of 24 months. A new surgical approach for select cases of maxillary sinus inverted papilloma is proposed in this paper. In this technique, the endoscopic medial maxillectomy was performed while preserving the head of the inferior turbinate and the nasolacrimal duct ("TuNa-saving"). This technique allowed for good visualization of the maxillary sinus, good oncological control and a reduction in the rate of complications.
authors.affiliation: Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pagella
authors.affiliation: Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy. ale.pusateri@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pusateri
authors.affiliation: Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy.
authors.forename: Elina
authors.initials: E
authors.lastname: Matti
authors.affiliation: Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Avato
authors.affiliation: Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Zaccari
authors.affiliation: Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera Policlinico of Padova, University of Padova, Padua, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Emanuelli
authors.affiliation: Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera Policlinico of Padova, University of Padova, Padua, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Volo
authors.affiliation: Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera Policlinico of Padova, University of Padova, Padua, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Cazzador
authors.affiliation: Otorhinolaryngology, Lecce, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Citraro
authors.affiliation: Section of Otolaryngology-Head and Neck Surgery, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Ricci
authors.affiliation: Section of Otolaryngology-Head and Neck Surgery, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy.
authors.forename: Giovanni Leo
authors.initials: GL
authors.lastname: Tomacelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000601:surgery*; D008444:Maxillary Sinus Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery; D018308:Papilloma, Inverted / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014420:Turbinates / Q000601:surgery
keywords: Endoscopic sinus surgery; Epiphora; Inverted papilloma; Maxillary sinus; Medial maxillectomy; Nasolacrimal duct