Prelacrimal Recess Approach for Benign Maxillary Sinus Disease

Background: The conventional middle meatal antrostomy provides limited access to the anterior, lateral and inferior walls of the maxillary sinus, potentially leaving behind residual disease.The prelacrimal recess approach may offer improved anterior access while preserving the nasolacrimal duct and inferior turbinate.This study assessed the short-term (one-month) feasibility of the prelacrimal recess approach in benign maxillary sinus disease with extensive polyposis, where access to the anterolateral wall of the maxillary sinus is required.Materials and methods: Twenty adults with benign maxillary sinus pathology underwent endoscopic surgery using the prelacrimal recess approach in this prospective interventional study.Preoperative computed tomography and visual analogue scale scoring were performed.Nasal endoscopy and visual analogue scale (VAS) scores were repeated at one month.Results: All maxillary sinus walls could be visualised in all patients.Allergic fungal rhinosinusitis was the most common diagnosis (11 patients, 55%), followed by antrochoanal polyp (four patients, 20%).The median VAS score improved from 8 preoperatively to 2 at one month (Wilcoxon signed-rank test, Z = -3.92,p < 0.001; r = 0.88).No patient developed epiphora, cheek numbness, or nasolacrimal duct injury.Two patients (10%) developed synechiae.Early disease persistence/relapse at one month was observed in two patients (10%), both with chronic rhinosinusitis with nasal polyposis.Conclusion: The prelacrimal recess approach may be a feasible option for access to the anterolateral aspects of the maxillary sinus, with symptom improvement and low morbidity observed in this small series.Larger studies with longer follow-up are needed.