Complications and Clinical Outcomes Following Modified Endoscopic Denker's With Pyriform Aperture Preservation: A Prospective Analysis

BACKGROUND: The modified endoscopic Denker's (MED) approach provides access to all maxillary sinus (MS) walls for resection of various MS and retromaxillary pathologies, but the anteromedial maxilla has historically been resected. This study determined complication rates and outcomes following MED with pyriform aperture (PA) preservation (MEDPAP). METHODS: A prospective study was conducted on all adults who underwent MEDPAP for different MS or retromaxillary pathologies over 7.5 years. The following complications were collected at all postoperative visits: epiphora, hypesthesia or complete numbness (teeth, upper lip, lateral nasal sidewall, and cheek), crusting, nasal valve collapse (NVC), and empty nose syndrome 6-item questionnaire (ENS6Q). Complications and disease recurrence rates were determined at a minimum 1 year for most complications and outcomes and 2 years for hypesthesia if hypesthesia had not resolved. RESULTS: Of 52 MEDPAP patients, median age was 58.5 years; 55.8% were male. Of 34.6% who experienced epiphora postoperatively, 7.7% persisted. When epiphora resolved, it did so by median 63.0 days. Sites of initial postoperative hypesthesia or numbness included teeth (23%-50%), upper lip (42%), nasal (22%), and cheek (30%). Hypesthesia resolved in 88%-100% of subsites by median 89.5-167.0 days. Hypesthesia persisted in 12% of patients (mainly anterior teeth). Crusting resolved in 97.8% by median 91.0 days. No patients developed NVC, and median final ENS6Q = 0.5 (range = 0-8). Non-tumor disease and tumor recurrence rates were 0%. CONCLUSIONS: MEDPAP was 100% successful at managing benign and select malignant MS pathologies during the study period. MEDPAP patients frequently experienced temporary epiphora and dentofacial hypesthesia or numbness that resolved by 2-6 months postoperatively. Epiphora and hypesthesia or numbness persisted in 7.7% and 12% of patients, respectively. No patients developed NVC or ENS.