Preservation of the nasolacrimal duct during endoscopic medial maxillectomy for sinonasal inverted papilloma

Background: To assess the efficacy of a new endonasal medial maxillectomy technique (EMM) for the treatment of inverted papilloma (IP). Methodologies: A prospective series of 55 consecutive patients diagnosed with IP between March 2002 and April 2009 were entered into this study. The new surgical technique was applied to tumours arising from the anterior part of the maxilla, sinus. After conventional EMM, the entire nasolacrimal duct was separated from the bony component of the nasolacrimal canal and preserved. Schirmer's test and a visual analog scale (VAS) score were used to assess the lacrimal duct function after surgery. Results: Ten of the 55 patients underwent the new surgical procedure. All patients were categorized with stage T3 or T4 tumours. No patient suffered tumour recurrence. There was no difference in lacrimal duct function between the diseased and healthy side of the nasolacrimal duct. The mean VAS score was 2.8/100. Conclusions: This new surgical technique preserves the whole length of the nasolacrimal unit. It also offers several advantages including good visualization, nasolacrimal function after surgery and fewer adverse effects such as facial numbness and epiphora.