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Medial Maxillectomy
Odontogenic Maxillary Sinus Cyst
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| 1. Grasping the head of the inferior concha to reduce vascularity. The cyst is seen protruding to the nasal cavity beneath the concha. | 2. The marks produced by the forceps. A septal incision is made to introduce instruments from the opposite nasal cavity. |
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| 3. Middle concha. Incisions for the creation of an axillary flap. | 4. Position of the axillary flap between the septum and the middle concha. Preparing the field for dacryocystorhinostomy. |
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| 5. Incision for the maxillectomy. | 6. Cutting the head of the inferior concha. |
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| 7. Elevating the inferior concha and the medial wall of the maxillary sinus which has been reduced to an eggshell. | 8. Identification of the nasolacrimal duct. |
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| 9. A view of the operating field. | 10. The suction-elevator reaches the posterior limit of the antrostomy. |
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| 11. Medial maxillectomy. Removing the bone medially and anteriorly the nasolacrimal duct. | 12. Revealing the lacrimal sac with a Hajek punch. |
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| 13. Drilling in front of the nasolacrimal duct. | 14. Elevating the medial wall of the cyst passing the suction-elevator laterally to the nasolacrimal duct. |
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| 15. Dissection along the medial wall of the cyst. Over the cyst still remains an eggshell of the medial maxillary wall. | 16. Another view of the dissection along the medial wall. |
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| 17. Change of field. Revealing the agger nasi cell. | 18. Opening the agger nasi to receive the flap of the lacrimal sac. |
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| 19. Cutting the nasolacrimal duct to separate it from the cyst. | 20. Probing the nasolacrimal sac with a sinus seeker to verify its patency. |
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| 21. Removing the tissue of the inferior concha and medial maxillary wall to create space. | 22. Working through the opposite nasal cavity. |
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| 23. Having difficulties to dissect the anterior wall of the cyst … | 24. … further bone removal from the medial and anterior maxillary wall is undertaken. |
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| 25. Unfortunately, during dissection the cyst’s wall ruptures and thick pus is seen coming out. | 26. For reasons of complete removal, the dissection must now proceed taking into consideration the ruptured wall. |
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| 27. Dissection along the posterolateral maxillary wall. | 28. Further enlargement of the superior limit of the antrostomy. |
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| 29. Detachment of the cyst from the roof and the lateral wall of the maxillary sinus. The dissection is facilitated by the shrinkage of the cyst. | 30. Working at the floor of the sinus, a depression is encountered which probably corresponds to an empty tooth socket. |
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| 31. The cyst is now fully collapsed. Working at the floor of the sinus several gutta percha points are encountered. | 32. The final attachment and probably the site of origin of the cyst. The root of a tooth. |
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| 33. Removal of the cyst. | 34. Opening the lacrimal sac to create the dacryocystorhinostomy. |
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| 35. Removing the remnant of the medial maxillary wall. | 36. Suturing the septum. |
