Extended Endoscopic Approaches to Non-malignant Maxillary Sinus Lesions Comparative

NCT ID: NCT05494099

Last Updated: 2022-08-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

75 participants

Study Classification

OBSERVATIONAL

Study Start Date

2022-09-30

Study Completion Date

2024-01-31

Brief Summary

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The aim of this study is to compare the outcomes of endoscopic middle meatus mega-antrostomy, endoscopic pre-lacrimal recess approach and endoscopic modified medial maxillectomy regarding: 1.Assessment of the accessibility of each approach to visualize and reach the different walls and recesses of the maxillary sinus. 2. Any intraoperative or postoperative complications. 3. Any post-operative recurrence or residue detected by endoscopic examination. 4. Symptomatic relief by pre- and post-operative Sino-Nasal Outcome Test 22, Arabic translation and validation (SNOT-22) which is a reliable and valid outcome measure for CRS patients.

Detailed Description

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A wide range of surgical ways to reach maxillary sinus. Historically, maxillary sinus was entered by external approaches such as lateral rhinotomy etc. in benign or malignant diseases, but now endoscopic approaches have recently replaced external approaches as the standard of treatment of maxillary sinus diseases due to reduced morbidity, improved visualisation and low recurrence rates of benign tumours.

Studies found that middle meatal antrostomy only provided access to about 24-34 percent of the total sinus volume only and rarely offer access to the anterior wall and sinus floor, regardless of the angled instruments used .Endoscopic maxillary mega-antrostomy is typically used as a revision procedure in patients with maxillary sinusitis refractory to surgery. The resulting antrostomy is greatly enlarged and allows the sinus to drain more easily by gravity, as well as admitting topical therapy more readily .

Radical endoscopic medial maxillectomy is indicated for the resection of benign and malignant sinonasal neoplasms when wide surgical access and tumor clearance is required However, resection of the inferior turbinate head may contributes to nasal crusting, dryness and empty nose syndrome ,so modified endoscopic medial maxillectomy gives better access to the maxillary sinus, with preserving the head of the inferior turbinate Pre-lacrimal recess approach allows for direct access to the sinus with 0-degree endoscopes and straight instruments, and thus improved visualisation of its contents especially anterior sinus wall, better handling of tools with preservation of inferior turbinate and nasolacrimal duct It is difficult to select suitable approach to maxillary sinus to ensure proper intraoperative visualization and better access to disease with fewer complications that is why we do this study.

Conditions

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Maxillary Sinus Disease Approach-Approach Conflict

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Group A (1st 25 patients)

The middle meatal mega-antrostomy approach.

endoscopic maxillary mega-antrostomy

Intervention Type PROCEDURE

a mucosal sparing technique that facilitates mucus clearance and sinus irrigation in terminally dysfunctional maxillary sinuses. EMMA involves extending the antrostomy through the posterior half of the inferior turbinate down to the floor of the nose, creating a significantly enlarged antrostomy.

Group B (2nd 25 patients)

The endoscopic modified medial maxillectomy approach.

Endoscopic Modified Medial Maxillectomy

Intervention Type PROCEDURE

In this approach, the maxillary sinus is operated upon, while the inferior turbinate and nasolacrimal duct are preserved.

Group C (3rd 25 patients)

The endoscopic prelacrimal recess approach.

Modified endoscopic pre-lacrimal approach

Intervention Type PROCEDURE

The approach involves making a curved mucosal incision on the lateral nasal wall just anterior to the head of the inferior turbinate. The nasal mucosa was then undermined off the lateral nasal wall. The maxillary sinus was entered with a chisel, and the medial bony wall of the maxillary sinus removed.

Interventions

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endoscopic maxillary mega-antrostomy

a mucosal sparing technique that facilitates mucus clearance and sinus irrigation in terminally dysfunctional maxillary sinuses. EMMA involves extending the antrostomy through the posterior half of the inferior turbinate down to the floor of the nose, creating a significantly enlarged antrostomy.

Intervention Type PROCEDURE

Endoscopic Modified Medial Maxillectomy

In this approach, the maxillary sinus is operated upon, while the inferior turbinate and nasolacrimal duct are preserved.

Intervention Type PROCEDURE

Modified endoscopic pre-lacrimal approach

The approach involves making a curved mucosal incision on the lateral nasal wall just anterior to the head of the inferior turbinate. The nasal mucosa was then undermined off the lateral nasal wall. The maxillary sinus was entered with a chisel, and the medial bony wall of the maxillary sinus removed.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Inflammatory disease of the maxillary sinus in the context of allergic or infective rhinosinusitis, with or without formation of inflammatory polyps. When such cases fail to respond to maximal medical therapy.
* Benign and locally malignant neoplasms of the maxillary sinus (ex: inverted papilloma) which are planned to be removed by extended endoscopic approach.

Exclusion Criteria

* Patients who are unfit to surgery (ex: with bleeding disorders or severe systemic diseases).
* Patients who refuse surgery or difficult to be followed up.
* Patients with minimal lesions who respond to medical treatment.
* Patients with malignant tumor of maxillary sinus proved by histopathology.
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Tanta University

OTHER

Sponsor Role lead

Responsible Party

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Eslam Mohamed Shata

doctor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Hassan Mu Hegazy, MD

Role: STUDY_DIRECTOR

Tanta University Hospital, Egypt.

Ahmed Mo Gamea, MD

Role: STUDY_DIRECTOR

Tanta University Hospital, Egypt.

Mohamed Os Tomom, MD

Role: STUDY_DIRECTOR

Tanta University Hospital, Egypt.

Locations

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Faculty of medicine

Tanta, Gharbia Government, Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Eslam mo Shata, MSc

Role: CONTACT

020102362407

Mohamed Ha Askar, MD

Role: CONTACT

0201227744576

Facility Contacts

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Eslam Mo Shata, Msc

Role: primary

0201092362407

References

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Goudakos JK, Blioskas S, Nikolaou A, Vlachtsis K, Karkos P, Markou KD. Endoscopic Resection of Sinonasal Inverted Papilloma: Systematic Review and Meta-Analysis. Am J Rhinol Allergy. 2018 May;32(3):167-174. doi: 10.1177/1945892418765004. Epub 2018 Apr 12.

Reference Type BACKGROUND
PMID: 29649889 (View on PubMed)

Robey A, O'Brien EK, Leopold DA. Assessing current technical limitations in the small-hole endoscopic approach to the maxillary sinus. Am J Rhinol Allergy. 2010 Sep-Oct;24(5):396-401. doi: 10.2500/ajra.2010.24.3486.

Reference Type BACKGROUND
PMID: 21244743 (View on PubMed)

Cho DY, Hwang PH. Results of endoscopic maxillary mega-antrostomy in recalcitrant maxillary sinusitis. Am J Rhinol. 2008 Nov-Dec;22(6):658-62. doi: 10.2500/ajr.2008.22.3248.

Reference Type BACKGROUND
PMID: 19178809 (View on PubMed)

Woodworth BA, Parker RO, Schlosser RJ. Modified endoscopic medial maxillectomy for chronic maxillary sinusitis. Am J Rhinol. 2006 May-Jun;20(3):317-9. doi: 10.2500/ajr.2006.20.2850.

Reference Type BACKGROUND
PMID: 16871936 (View on PubMed)

Gosau M, Rink D, Driemel O, Draenert FG. Maxillary sinus anatomy: a cadaveric study with clinical implications. Anat Rec (Hoboken). 2009 Mar;292(3):352-4. doi: 10.1002/ar.20859.

Reference Type BACKGROUND
PMID: 19248167 (View on PubMed)

Sadeghi N, Al-Dhahri S, Manoukian JJ. Transnasal endoscopic medial maxillectomy for inverting papilloma. Laryngoscope. 2003 Apr;113(4):749-53. doi: 10.1097/00005537-200304000-00031.

Reference Type BACKGROUND
PMID: 12671441 (View on PubMed)

Wormald PJ, Ooi E, van Hasselt CA, Nair S. Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy. Laryngoscope. 2003 May;113(5):867-73. doi: 10.1097/00005537-200305000-00017.

Reference Type BACKGROUND
PMID: 12792324 (View on PubMed)

Luong A, Citardi MJ, Batra PS. Management of sinonasal malignant neoplasms: defining the role of endoscopy. Am J Rhinol Allergy. 2010 Mar-Apr;24(2):150-5. doi: 10.2500/ajra.2010.24.3451.

Reference Type BACKGROUND
PMID: 20338116 (View on PubMed)

Kastl KG, Rettinger G, Keck T. The impact of nasal surgery on air-conditioning of the nasal airways. Rhinology. 2009 Sep;47(3):237-41. doi: 10.4193/Rhin08.014.

Reference Type BACKGROUND
PMID: 19839243 (View on PubMed)

Dayal A, Rhee JS, Garcia GJ. Impact of Middle versus Inferior Total Turbinectomy on Nasal Aerodynamics. Otolaryngol Head Neck Surg. 2016 Sep;155(3):518-25. doi: 10.1177/0194599816644915. Epub 2016 May 10.

Reference Type BACKGROUND
PMID: 27165673 (View on PubMed)

Morrissey DK, Wormald PJ, Psaltis AJ. Prelacrimal approach to the maxillary sinus. Int Forum Allergy Rhinol. 2016 Feb;6(2):214-8. doi: 10.1002/alr.21640. Epub 2015 Sep 8. No abstract available.

Reference Type BACKGROUND
PMID: 26346189 (View on PubMed)

Other Identifiers

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maillary sinus approaches

Identifier Type: -

Identifier Source: org_study_id

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