Surgical access options for various conditions of the maxillary sinus

Interventions on the paranasal sinuses (PSs) are among the most common surgical procedures performed in otorhinolaryngological departments, which is primarily associated with the high prevalence of chronic rhinosinusitis and various tumors in this area. Surgery of the maxillary sinus (MS) deserves special attention due to its complexity and uniqueness, caused not only by the anatomical peculiarities of the maxillary sinus and the presence of hardto- reach areas for visualization, but also by the variety of diseases encountered. Since the first mention of surgical treatment of the MS, at the turn of the 19th and 20th centuries, there has been an evolution in the visualization of the PSs, and at the same time, knowledge of the anatomy and physiology of the area has expanded. The search for new techniques and modifications of existing methods was primarily driven by the desire of surgeons to find the most optimal approach to surgery for various MS diseases. While some approaches are designed to minimize invasiveness, others are aimed at a wide opening of the sinus and radical removal of the pathological substrate from it. We described the most common surgical techniques and their modifications used in various pathological conditions of the MS in this literature review. All approaches to the MS were conventionally divided into intranasal and extranasal. Among the intranasal techniques of the MS surgery, we reported middle meatal antrostomy, mega-antrostomy, endoscopic medial maxillectomy, prelacrimal recess approach and approach via inferior meatus. As part of our discussion of extranasal techniques, we described the Caldwell-Luc operation, canine fossa trephine and access via the anterolateral wall of the MS. Based on world literature data, we have compiled a list of indications, advantages and disadvantages for each technique. Debatable issues and controversies have been highlighted within individual techniques for surgical treatment of the MS diseases.
Keywords: maxillary sinus, endoscopic sinus surgery, medial maxillectomy, prelacrimal recess approach, megaantrostomy
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study