Classification of the Travel of the Anterior Superior Alveolar Nerve and Postoperative Symptoms in Endoscopic Modified Medial Maxillectomy

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  • Yamamoto Keisuke
    Department of Otolaryngology, Sapporo Medical University School of Medicine
  • Okuni Tsuyoshi
    Department of Otolaryngology, Sapporo Medical University School of Medicine
  • Takano Kenichi
    Department of Otolaryngology, Sapporo Medical University School of Medicine

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  • Endoscopic modified medial maxillectomyにおける術後症状と前上歯槽神経の走行分類の検討

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Abstract

<p>Endoscopic modified medial maxillectomy (EMMM) is a direct endoscopic approach to the maxillary sinus that preserves the nasal structure and allows for a large working space. EMMM is considered to have relatively few complications because it preserves the nasal structure, but sometimes patients experience pain and numbness in the lips, teeth, and cheeks. The cause of these symptoms is thought to be damage to the anterior superior alveolar nerve (ASAN), but the symptoms and the pathway of the ASAN have not been sufficiently investigated. In this study, we investigated the relationship between the presence or absence of symptoms after EMMM surgery and the travel classification of the ASAN. A total of 58 patients who underwent EMMM at the Department of Otorhinolaryngology, Sapporo Medical University between April 2013 and August 2019 were included in the study, excluding postoperative maxillary cysts and trauma cases in which the anterior wall of the maxillary sinus could not be evaluated. The total number of patients with nasolabial pain or numbness, dental pain or numbness, and buccal pain or numbness, which may be related to ASAN injury, was 7 (17.5%). Sinus CT revealed that 18 patients (45.0%) had no ASAN exposure in the maxillary sinus, and 22 patients (55.0%) had some ASAN exposure in the maxillary sinus. Statistical analysis showed a significant association between the presence of symptoms and ASAN travel classification. In papilloma cases with long-term persistent symptoms, the tumor was located directly above the “exposed” ASAN. Although ASAN injury in EMMM is one of the sequelae that has not received much attention, it is important to evaluate the risk of ASAN injury preoperatively based on the ASAN travel classification, and to obtain adequate explanation and consent from patients.</p>

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