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Medial Maxillectomy

Odontogenic Maxillary Sinus Cyst

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.
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.
5. Incision for the maxillectomy. 6. Cutting the head of the inferior concha.
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.
9. A view of the operating field. 10. The suction-elevator reaches the posterior limit of the antrostomy.
11. Medial maxillectomy. Removing the bone medially and anteriorly the nasolacrimal duct. 12. Revealing the lacrimal sac with a Hajek punch.
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.
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.
17. Change of field. Revealing the agger nasi cell. 18. Opening the agger nasi to receive the flap of the lacrimal sac.
19. Cutting the nasolacrimal duct to separate it from the cyst. 20. Probing the nasolacrimal sac with a sinus seeker to verify its patency.
21. Removing the tissue of the inferior concha and medial maxillary wall to create space. 22. Working through the opposite nasal cavity.
23. Having difficulties to dissect the anterior wall of the cyst … 24. … further bone removal from the medial and anterior maxillary wall is undertaken.
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.
27. Dissection along the posterolateral maxillary wall. 28. Further enlargement of the superior limit of the antrostomy.
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.
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.
33. Removal of the cyst. 34. Opening the lacrimal sac to create the dacryocystorhinostomy.
35. Removing the remnant of the medial maxillary wall. 36. Suturing the septum.