Assessing Current Technical Limitations in the Small-Hole Endoscopic Approach to the Maxillary Sinus

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Abstract
Background: Endoscopic sinus surgery has evolved to become the standard surgical approach to address paranasal sinus disease. To access inflammatory mucosal disease and other benign processes, it is desirable to reach all parts of the maxillary sinus. This project explores the combination of three medial wall small-hole antrostomies with multiple angled microdebrider blades to determine if an ideal combination exists. A prospective cadaveric study was performed. Methods: Each 3.5-mm blade was passed through the natural ostium and two separate inferior meatal antrostomies. The space reached by the tip of four different microdebrider blades (12, 60, 90 and 120°) within each maxillary sinus was mapped using an image guidance system. Percent volume of the sinus reached and access to subsites were determined. Results: Regardless of instrument or antrostomy combination, mean percent volume of maxillary sinus reached was 28% (range, 24–34%). The anterior wall was rarely reached by any combination, with the best blade/antrostomy combination (90° blade/anterior inferior antrostomy) only reaching 28% of the anterior wall. Likewise, the floor of the maxillary sinus was also poorly reached in general. The lateral and posterior maxillary sinus walls were most reliably reached with the roof and medial walls being intermediate. Conclusion: Using the endoscopic small-hole approach to the maxillary sinus results in <⅓ of the sinus being routinely reached regardless of antrostomy or angled microdebrider instrument selected. Further study and development of new technologies to more thoroughly reach benign processes within the maxillary sinus via a small-hole approach is warranted.

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