Value of Inferior Meatal Window with Mucosal Flap as an Adjuvant to Middle Meatal Antrostomy in Managing Maxillary Sinus Lesions: A Randomized Controlled Trial

Background: Several approaches for the maxillary sinus were described. Currently, endoscopic Middle Meatal Antrostomy (MMA) is the gold standard for managing maxillary sinus lesions. Unfortunately, there are some limitations especially in hidden areas. This research elucidates the advantages and disadvantages of adding IMF to the MMA for managing maxillary sinus lesions. Patients and Methods: This study was a randomized controlled trial, conducted on sixty patients, divided into 2 groups: Group (A) included 30 patients underwent IMF after MMA, while group (B) involved 30 patients subjected to MMA only for managing the maxillary sinus. Patients were assessed for the accessibility of the antero-inferior area of the maxillary sinus, residual lesion after performing IMF and evidence of recurrence. Results: The antero-inferior area accessibility in group (A) was difficult in 10 patients (33%) compared to 20 patients (66%) of group (B) (P =0.004). Residual was detected after performing the IMF in 12 patients (40%). Postoperative 1 year Lund Mackay score comparison between both groups was statistically insignificant (P=0.6). Recurrence was noted in 4 cases of group (A) and 2 cases of group (B), (P=0.7). Conclusion: Inferior meatal window with mucosal flap is helpful approach to maxillary sinus hidden areas when added to standard MMA. It is best suited for complete removal of small hidden lesions (e.g. foreign bodies, fungal ball and odontogenic cysts) which could be hardly handled through MMA.