Maxilectomía Medial Endoscópica

Seno Maxilar

Fosa Pterigoplatina

Introducción

La cirugía endoscópica nasal ha progresado en la última década

Nuevas técnicas facilitan la resección de tumores en regiones de difícil acceso

Para evaluar la resecabilidad endoscópica de un tumor se necesitan estudios de imagen (TAC y MRI)

Esto le permite al cirujano determinar si los senos opacificados contienen secreciones o un tumor

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Papiloma inveritdo

Se extiende lateralmente mas alla de los límites del seno maxilar

Erosiona la pared lateral (flecha blanca)

Tumor se originaba del piso del seno y de cornete inferior

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Introducción

Al difinir con exactitud la extención del tumor, la resección puede ser planeada

La resección endoscópica de la maxila medial es útil para el acceso a las paredes anteroposterior y lateral del seno maxilar

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Maxilectomía

Indicaciones: tumores grandes o anteriores del seno maxilar y tumores que involucran la fosa pterigopalatina

Los tumores benignos más comunes que involucran al seno maxilar son:

Pólipos antrocoanales

Papilomas invertidos

Ambos tumores son adecuados para resección endoscópica

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Tumores de Seno Maxilar

Los tumores pequeños del seno maxilar pueden ser resecados al crear una antrostomía grande en el meato medio

Combinandolo con una punción en la fosa canina

El endoscopio se coloca en la antrostomía maxilar

El instrumento disecante se coloca a través de la punción en la fosa canina

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Maxilectomía

El área en la que esta técnica no logra accesar bien es la pared anterior del seno maxilar

Los tumores localizados en la cara anterior puede que requieran maxilectomía medial endoscopica para su resección completa

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Maxilectomía

Si luego de la maxilectomía no se puede accesar a la cara anterior se realiza una incisión de hemitransfixión

Se realiza en la fosa nasal opuesta

Luego se realiza una pequeña resección del cartilago septal

Esto permite colocar los instrumentos desde la fosa nasal opuesta e incrementa el ángulo del instrumento

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Tumores de fosa pterigopalatina

El tumor benigno más común que involucra la fosa pterigopalatina (fosa infratemporal) es el angiofibroma juvenil

Generalmente se originan en la región del foramen esfenopalatino

Crecen hasta expanderse a la fosa pterigopalatina

Los tumores grandes se pueden extender a la fosa infratemporal

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Tumores de fosa pterigopalatina

Pueden tener un componente intranasal y extenderse a los senos

Con mayor frecuencia al seno esfenoidal

Otros tumores benignos de esta región son los papilomas invertidos, schwannomas, de cartilago o músculo

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Angiofibroma

Corte coronal de fosa pterigopalatina

Muestra angiofibroma que se extiende hacia la fosa infratemporal

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.

Wormald, P. (2005). Endoscopic Medial Maxillectomy for Maxillary and Pterygopalatine Fossa Tumors. In P. Wormald, Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique (p. 154). Adelaide, Australia: Thieme.