Powered endoscopic removal of a maxillary sinus cyst.

A 44-year-old man came to the office with a history of recurring sinus infections on the right side, with intermittent facial pain. He had been treated medically on numerous occasions. A computed tomography (CT) scan of the paranasal sinuses showed a large, polypoid cystic mass in the right maxillary sinus and scattered opacification of both ethmoid sinuses (figure, A).

[FIGURE A OMITTED]

The patient elected to undergo right endoscopic sinus surgery. A right middle meatal antrostomy was performed through a retrograde approach. (1,2)

At the time of surgery, a large, distinct cystic mass was found in the right maxillary sinus (figure, B). A curved microdebrider was used to remove the mass (figure, C and D). Very adequate removal was accomplished with excellent hemostasis. Healthy maxillary sinus mucosa was preserved (figure, D).

[FIGURES B-D OMITTED]

Maxillary sinus lesions are frequently seen on CT scans of the paranasal sinuses. Many of these maxillary sinus lesions are asymptomatic and require no surgical treatment. When the lesions are symptomatic and recurring infections result, surgical removal of the lesions is indicated. Removal via middle meatal antrostomy with an angled microdebrider is a useful and safe method for maxillary sinus cyst or polyp removal. (3) When the maxillary sinus is well hyperpneumatized in the superomedial portion, as in this case (figure, A), it is predicted that excision via a middle meatal antrostomy will be performed with relative ease.

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante); and from the Section of Otolaryngology, Hospital of St. Raphael, Section of Otolaryngology, Yale University School of Medicine, and Southern New England Ear, Nose, Throat and Facial Plastic Surgery Group, New Haven, Conn. (Dr. Yanagisawa)

References

(1.) Christmas DA, Yanagisawa E, Joe JK. Transnasal endoscopic identification of the natural ostium of the maxillary sinus: A retrograde approach. Ear Nose Throat J 1998;77:454-5.

(2.) Owen RG, Kuhn FA. The maxillary sinus ostium: Demystifying middle meatal antrostomy. Am J Rhinol 1995;9:313-20.

(3.) Christmas DA, Krouse JH. Powered instrumentation in functional endoscopic sinus surgery. I: Surgical technique. Ear Nose Throat J 1996:75:33-40.