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| Name | Modified Endoscopic Denker's Approach |
| Video Uploader | Video From John Craig, Rhinology-Skull Base Surgery |
| Upload Date | This Video Uploaded At 05-03-2017 17:01:41 |
| Video Discription | Maxillary sinus tumors based off the anterior and anteroinferior walls of the maxillary sinuses are very challenging if not impossible to resect with routine endoscopic maxillary antrostomy or medial maxillectomy procedures. Historically surgeons have relied on adjunctive external approaches such as a Caldwell-Luc antrostomy to gain access to these tumors. A Caldwell-Luc procedure requires an incision under the lip to gain access to, and penetrate through, the anterior wall of the maxillary sinus. Not only does this bring risks of oroantral fistula, cheek and lip numbness, and chronic facial pain, it does not allow easy access for tumor resection. The endoscopic Denker's approach provides direct access to ALL the walls of the maxillary sinus, and importantly the anterior wall. This is achieved by transecting the nasolacrimal duct and drilling away the entire medial wall of the maxillary sinus. The endoscopic Denker's approach brings legitimate concerns of epiphora (tearing onto one's face instead of into the nose as is normal, due to scarring of the duct), but case series to date have found extremely low if not 0% epiphora rates after this operation. Dr. Craig at Henry Ford tries to prevent epiphora after these cases by stenting the nasolacrimal duct with a silastic stent which patients tolerate very well. There is also a concern of disruption and collapse of the external nasal valve due to drilling of the pyriform aperture, which could cause nasal obstruction. In the classically described Denker’s approach, the bone of the pyriform aperture is removed, which would place the patient at higher risk for external nasal valve collapse. This has not been studied rigorously, but one way to avoid this complication is to avoid drilling away the bony pyriform aperture. Dr. Craig is careful to avoid removing the bone at the pyriform aperture, and this should prevent external nasal valve collapse and nasal obstruction. The patient presented here had an inverted papilloma based off the anterolateral wall of the maxillary sinus, and a modified endoscopic Denker’s approach was therefore performed, so as to avoid a Caldwell-Luc procedure. It’s been termed “modified” in this case because the bone of the pyriform aperture was preserved. |
| Category | Science & Technology |
| Tags | inverted papilloma | medial maxillectomy | endoscopic medial maxillectomy | denker's appproach | endoscopic denker's approach | maxillary sinus | maxillary sinus tumor | lacrimal stent | John Craig | henry ford | henry ford rhinology |
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