The incidence of complications using new landmarks and a modified technique of canine fossa puncture

Background: Canine fossa puncture (CFP) is a technique that improves access to the maxillary sinus and may be required to ensure complete disease removal from this sinus. Traditional approaches through the canine fossa often have resulted in injury to branches of the infraorbital nerve. The aim of this study was to determine the frequency, severity, and duration of complications using recently described landmarks for determining the optimal site for anatomically directed CFP (aCFP) and a new endoscopic retractor and drill guide that enable endoscopically guided canine fossa trephination (eCFT). These complication rates have been compared with those that we have described previously using a standard technique of CFP. Methods: A total of 63 patients were included with 36 bilateral procedures giving a total number of 99 procedures performed. Of these, 32 procedures were performed using anatomic landmarks (aCFP) and 67 were performed with additional endoscopic guidance (eCFT). Patients were assessed at a mean time of 12.6 months (range, 3-26 months) after surgery by telephonic survey and their complications were assessed and graded for severity on a 0- to 10-point scale. Results: The combined frequency of adverse events after aCFP and eCFT were 45% compared with the previously reported 76% with the traditional technique (p = 0.001). The number of patients complaining of persisting adverse effects was reduced from 29% after CFP to 5% after aCFP and eCFT (p < 0.001). The 67 eCFT technique had a significantly lower frequency of adverse events (40%) than the aCFP technique (53%; p < 0.05). Conclusion: The recently described landmarks to site the CFP result in statistically fewer complications. This complication rate is further reduced if CFT is performed under direct endoscopic vision.