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<p>The pre-lacrimal window approach (PLWA) offers minimally invasive access to the anterior and inferior maxillary sinus, areas inadequately visualized with conventional medial meatal antrostomy (MMA). Surgical feasibility depends on the pre-lacrimal recess (PLR) width and the antero-medial maxillary sinus angle (AMMSA). This study aimed to evaluate these parameters in an Indian cohort using CT imaging. A retrospective review of 100 patients who underwent CT paranasal sinuses between May and July 2025 was performed. PLR width (D value) was classified according to Simmen et al., while AMMSA was categorized as Type A (&lt;70°) or Type B (≥70°). The Modified Simmen classification (width + angle) was applied. Statistical correlations with age, sex, and side were analyzed. A measurable PLR was present in 96.25% of sinuses; 3.75% lacked a recess (D = 0). By Simmen’s classification, 90% were Type II/III, suggesting high feasibility for PLWA. However, 67.1% of cases demonstrated unfavourable AMMSA (≥70°), indicating restricted anterior wall visibility despite favourable recess width. Regression analysis showed age had a modest but significant negative correlation with D, while sex and side showed no effect. PLR thickness remained stable across age groups. Indian patients demonstrated favourable PLR widths comparable to East Asian cohorts but predominantly unfavourable AMMSA, limiting surgical exposure. The Modified Simmen classification, incorporating both width and angle, provides a more accurate predictor of PLWA feasibility and should be included in preoperative planning.</p>

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Retrospective CT PNS Study of the Pre-Lacrimal Recess and Antero-Medial Maxillary Sinus Angle: Implications for the Pre-Lacrimal Window Approach in the Indian Subcontinent

  • 期刊论文

  • 发表日期：

    2025年11月18日

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  • G. V. K. Chaitanya,
  • Lavanya Reddy Yannamreddy,
  • G. V. S. Rao,
  • Shree Rao Cuddapah

摘要

The pre-lacrimal window approach (PLWA) offers minimally invasive access to the anterior and inferior maxillary sinus, areas inadequately visualized with conventional medial meatal antrostomy (MMA). Surgical feasibility depends on the pre-lacrimal recess (PLR) width and the antero-medial maxillary sinus angle (AMMSA). This study aimed to evaluate these parameters in an Indian cohort using CT imaging. A retrospective review of 100 patients who underwent CT paranasal sinuses between May and July 2025 was performed. PLR width (D value) was classified according to Simmen et al., while AMMSA was categorized as Type A (<70°) or Type B (≥70°). The Modified Simmen classification (width + angle) was applied. Statistical correlations with age, sex, and side were analyzed. A measurable PLR was present in 96.25% of sinuses; 3.75% lacked a recess (D = 0). By Simmen’s classification, 90% were Type II/III, suggesting high feasibility for PLWA. However, 67.1% of cases demonstrated unfavourable AMMSA (≥70°), indicating restricted anterior wall visibility despite favourable recess width. Regression analysis showed age had a modest but significant negative correlation with D, while sex and side showed no effect. PLR thickness remained stable across age groups. Indian patients demonstrated favourable PLR widths comparable to East Asian cohorts but predominantly unfavourable AMMSA, limiting surgical exposure. The Modified Simmen classification, incorporating both width and angle, provides a more accurate predictor of PLWA feasibility and should be included in preoperative planning.