Assessment of Lacrimal Duct Patency in Patients Undergoing Endoscopic Medial Maxillectomy

Purpose: The risk of epiphora after medial maxillectomy with lacrimal duct transection is difficult to assess. The data available in the literature are inconclusive due to various operating techniques used by the authors of medical publications, different additional procedures aimed at improving tear drainage after maxillectomy, and a variety of lacrimal duct patency assessment techniques. The aim of our work was to assess the anatomical and functional patency of lacrimal ducts after medial maxillectomy without performing additional procedures to improve tear drainage as well as comparison of the results obtained with different assessment tests. Materials and methods: 21 patients who underwent medial maxillectomy in the years 2016–2019 were assessed for discomfort and epiphora based on patients’ own reports and basic clinical examination, lacrimal duct rinse test, the Munk score, and a modified endoscopic Jones I test. Results: Gradually increasing the sensitivity of the assessment method resulted in an increase in the number of patients with potential tear drainage disorders, starting from 0% in the rinsing test, 4.8% self-reported tearing complaints, 14.3% Munk score, and 19% modified endoscopic Jones I test. Conclusions: The study results revealed that a small fraction of patients tend to report epiphora as a consequence of medial maxillectomy themselves. Subtle functional disorders, which are not particularly bothersome to patients, are more common. More sensitive lacrimal duct patency tests reveal more cases of tear drainage disorders. The results of studies assessing the incidence of epiphora after medial maxillectomy appear to depend on the type of test used

Przeznosowe dostępy chirurgiczne w endoskopowych operacjach podstawy czaszki

Recent advances in surgical endoscopy have made it possible to reach nearly the whole cranial base through a transnasal approach. These ‘expanded approaches’ lead to the frontal sinuses, the cribriform plate and planum sphenoidale, the suprasellar space, the clivus, odontoid and atlas. By pointing the endoscope laterally, the surgeon can explore structures in the coronal plane such as the cavernous sinuses, the pyramid and Meckel cave, the sphenopalatine and subtemporal fossae, and even the middle fossa and the orbit. The authors of this contribution use most of these approaches in their endoscopic skull base surgery. The purpose of this contribution is to review the hitherto established endoscopic approaches to the skull base and to illustrate them with photographs obtained during self-performed procedures and/or cadaver studies.Postęp techniki endoskopowej, który dokonał się w ostatniej dekadzie, umożliwia dostęp do prawie całej podstawy czaszki przez jamę nosową. Tak zwane dostępy rozszerzone pozwalają dotrzeć do zatok czołowych, blaszki sitowej, planum sphenoidale, okolicy nadsiodłowej, stoku, a nawet kręgu szczytowego i obrotnika. Również w płaszczyźnie wieńcowej dojścia rozszerzone prowadzą do zatok jamistych, szczytu piramidy, jamy Meckela, dołu skrzydłowo-podniebiennego, dołu podskroniowego, a nawet do środkowego dołu czaszki czy oczodołu. Większość z tych dostępów wykorzystywana jest w praktyce przez autorów niniejszego doniesienia. Celem pracy jest usystematyzowanie dotychczas opracowanych dostępów i omówienie anatomii chirurgicznej oraz techniki operacyjnej na podstawie materiału ilustracyjnego uzyskanego podczas własnych operacji oraz z preparatów sekcyjnych