Extended endoscopic approaches to the maxillary sinus

ObjectivesTreatment of inflammatory and neoplastic disease in the maxillary sinus, pterygopalatine and infratemporal fossae requires appropriate surgical exposure. As modern rhinology evolves, so do the techniques available. This paper reviews extended endoscopic approaches to the maxillary sinus and the evidence supporting each technique.MethodsA literature search of the Ovid Medline and PubMed databases was performed using appropriate key words relating to endoscopic approaches to the maxillary sinus.ResultsMega-antrostomy and medial maxillectomy have a role in the surgical treatment of refractory inflammatory disease and sinonasal neoplasms. The pre-lacrimal fossa approach provides excellent access but can be limited because of anatomical variations. Both the transseptal and endoscopic Denker's approaches were reviewed; these appear to be associated with morbidity, without any significant increase in exposure over the afore-described approaches.ConclusionA range of extended endoscopic approaches to the maxillary sinus exist, each with its own anatomical limitations and potential complications.

Adenoid Cystic Carcinoma of the Lacrimal Gland in a 45 Years Old Male: Case Report and Review of Literature

Adenoid cystic carcinoma (ACC) is a rare malignant tumor that can manifests as proptosis in adult population. They account for 1.6% of all orbital tumors. Despite their rarity, they are the second most frequent epithelial neoplasms occurring in the lacrimal gland after pleomorphic adenomas. This kind of tumors are commonly occur in the salivary glands but can metastasize to lung, breast ,brain and sinuses in hematogenous route.We describe a patient who presented with protrusion of right eyeball, developing over 8 years with history of intermittent watery discharge for 4 years. His magnetic resonance imaging showed a retrobulbarextraconal soft tissue lesion around the lacrimal fossa with invasion and erosion of the adjacent bone. The patient underwent right sided orbito-pterional craniotomy and gross total removal of tumor. Pathologic analysis showed neoplastic cells in a predominantly cribriform pattern with features of perineural invasion and diagnosed as a case adenoid cystic carcinoma of the lacrimal gland. We review the incidence, clinical features, radiographic and histopathologic features of these rare, aggressive malignancies along with current treatment options with reference to the relevant literatures. Bang. J Neurosurgery 2019; 9(1): 49-53