Postoperative Maxillary Cyst Located Outside of the Ductus Nasolacrimalis Treated with Endoscopic Modified Medial Maxillectomy: A Case Report

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  • Mihashi Ryouta
    Department of Otolaryngology and Heat and Neck Surgery, Kurume University School of Medicine
  • Mihashi Hiroyuki
    Department of Otolaryngology and Heat and Neck Surgery, Kurume University School of Medicine
  • Umeno Hirohito
    Department of Otolaryngology and Heat and Neck Surgery, Kurume University School of Medicine

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  • Endoscopic Modified Medial Maxillectomy（EMMM）アプローチでの嚢胞の摘出が有用であった鼻涙管外側に位置する術後性上顎嚢胞症例

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Abstract

<p>A postoperative paranasal sinus cyst may occur at various sites and can be difficult to treat surgically due to difficulty obtaining a good field of view, despite use of a 30° endoscope. The utility of endoscopic modified medial maxillectomy (EMMM) for these cases has recently been reported. Here, we report an operation performed with EMMM for a case of postoperative maxillary cyst located outside of the ductus nasolacrimalis. The patient was a 64-year-old woman with a chief complaint of right cheek pain. Her history included bilateral Caldwell-Luc surgery at age 20 years old. Computed tomography identified two cystic lesions of the pars maxillaries: a lesion of 20mm in diameter in contact with the inferior meatus, and a lesion of 10mm diameter outside the ductus nasolacrimalis and in contact with the inside of the infraobital nerve and inferior wall of the orbit. We initially performed fenestration of the large cyst close to the inferior meatus under local anesthesia. However, relapse of right cheek pain occurred eight months later. Therefore, we performed fenestration of the osseous cystic wall in the meatus nasi medius with a drill using a navigation system. A mucoperiostium flap was inserted into the cyst to prevent restenosis. However, cheek pain recurred one month later, and complete resection of the cystic wall was subsequently performed using EMMM with a navigation system. At 19 months after surgery, the cyst has not occluded again. We review the utility of the EMMM with a navigation system for treatment of a nasolacrimal lateral small osseous cyst.</p>

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