J Neurol Surg B Skull Base 2015; 76 - P028
DOI: 10.1055/s-0035-1546656

Endoscopic Medial Maxillectomy Approach for Removal of Ectopic Tooth in the Maxillary Sinus

Jose G. Gurrola II1, Eric Mason 2, C. Arturo Solares 2
  • 1University of Virginia Health System, Virginia, United States
  • 2Georgia Regents University, Georgia, United States

Objective: The occurrence of ectopic teeth involving the maxillary sinus reported in the literature remains relatively low. Instances of complications related to ectopic teeth in the maxillary sinus include associated dentigerous cysts, maxillary sinus mucoceles, chronic sinusitis, pain/pressure, and occasionally osteomeatal complex obstruction and nasolacrimal duct obstruction. Although the standard of care historically has involved a Caldwell-Luc approach, advances in endoscopic surgical approaches have led to use and report in the literature of both endoscopic and combined endoscopic and open approaches. In this study, we describe the specific use of the endoscopic medial maxillectomy to approach ectopic teeth within the maxillary sinuses of two different patients.

Study Design: This study us a case report.

Methods: Patients presented to the senior author's practice for evaluation of respective maxillary sinus masses as noted on CT scan. On patient decision to have respective masses removed, the decision was independently made by each to proceed with endoscopic medial maxillectomy. Patients underwent routine transoral intubation and general anesthesia. Intraoperative CT-guided navigation was utilized in the instance with the tooth was impacted in the floor of the orbit. Endoscopic medial maxillectomy was performed with a combination of through cutting instruments, rongeurs, microdebrider, and a high speed drill. Utilization of both angled scopes and curved instrumentation in combination with the wide exposure provided by the medial maxillectomy allowed for adequate exposure and complete removal of the masses in both the cases.

Results: Successful completion of endoscopic medial maxillectomy and ectopic tooth extraction was achieved in both cases. There were no postoperative complications. This approach, combined with the use of angled scopes (45 and 70degrees) allowed for lateral maxillary sinus visualization. Curved instrumentation permitted safe and efficient extraction of the ectopic masses. Both patients tolerated the procedure well.

Conclusion: Endoscopic medial maxillectomy allows for the safe and efficient removal of the ectopic teeth from the maxillary sinus. Appropriate selection of patients allows for this technique to be applied without need for Caldwell-Luc or other open procedures.