Application of an Intranasal Drill on Transnasal Endoscopic Marsupialization of Postoperative Maxillary Mucoceles

ObjectivePostoperative maxillary mucoceles occur as a delayed complication of radical surgical intervention in the maxillary sinus. Conventionally, the recommended procedure for treating this entity has been the revised Caldwell-Luc operation. In this study, we present a less invasive treatment methodology which is as safe and effective.Materials and MethodsBetween January 1988 and December 2006, inclusively, 36 patients (47 sides) were enrolled in the study. Twenty-eight patients (38 sides) underwent the endoscopic marsupialization technique. Eight patients (9 sides) received a revised Caldwell-Luc operation, and this group was used as the control. Under nasoendoscopic guidance, an antrostoma was created through the inferior (29/38) or middle (9/38) meatus, and the opening was then enlarged to a diameter almost equal to that of the mucocele itself. A 15° intranasal drill was used where the medial wall of the maxillary sinus was bony.ResultsOnly one patient complained of mild cheek pain after marsupialization surgery. The opening remained patent in 89.5% (34/38) of the mucoceles 1 year after the transnasal endoscopic operation. Twenty of the 38 maxillary sinus mucoceles had a bony wall between the membranous mucocele and the nasal cavity, while the wall was membranous in the remaining 18. Stoma closure was noted in four mucoceles at an average of 4.1 weeks after the operation. A statistically significant tendency for stoma closure was observed for mucoceles with bony walls adjacent to the inferior or middle meatus compared with membranous ones.ConclusionThe transnasal approach using a powered instrument has the advantage of decreased postoperative suffering. Based on the results of this study, it appears reasonable to suggest that this is a useful treatment method for a unilocular mucocele adjacent to the medial wall of the antrum.