J Oral Maxillofac Surg 67:689-692, 2009 Lateral Antrotomy as a Surgical Approach for Maxillary Sinus: A Modified Technique With Free Bone Flap Repositioning and Fixation With a Titanium Plate Paolo Scolozzi, MD, DMD,* Alvaro Martinez, MD, DMD,† Tommaso Lombardi, MD, DMD,‡ and Bertrand Jaques, MD, DMD§ Maxillary sinus foreign bodies (eg, endodontic ma- terials, dental amalgam fillings, teeth or dental roots, dental implants), odontogenic cysts, As- pergillus mycetoma (fungus ball), and benign neo- plasms (ie, polyps) are relatively common patholog- ical conditions encountered in dental and oral and maxillofacial practice. Surgical removal is the rec- ommended treatment as complications such as si- nusitis, bacterial or mycotic superinfections, and even neoplastic lesions could develop to the detri- ment of the surrounding bone and mucosa as well as, over the long term, to the adjacent vital struc- tures (ie, infraorbital nerve, orbit or nasal cavity). 1-3 For decades, the original Caldwell-Luc approach (anterior maxillary antrostomy with antronasal drainage) has been incontestably and universally considered the gold standard either for surgical management of chronic maxillary sinusitis or as a surgical approach for removal of maxillary sinus pathological lesions and foreign bodies or to access specific anatomical regions such as the pterygomax- illary fossa and the orbits. 2-5 However, the high compli- cation rate associated with this procedure (up to 40%), the advent of the endoscopic techniques, and the “bone lid” flap techniques have largely contributed to its de- cline, at least in the treatment of chronic maxillary si- nusitis. 2,3,6-17 The purpose of this article is to describe our experience using maxillary lateral antrotomy with bone flap repositioning and fixation with a titanium plate as a surgical approach for removal of maxil- lary sinus lesions. Patients and Methods Eight patients were seen at the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland be- tween 2001 and 2007 to remove maxillary lesions (5 Aspergillus mycetoma, 1 foreign body, 2 muco- celes, and 1 radicular cyst) using a maxillary lateral antrotomy with bone flap repositioning and fixation with a titanium plate. SURGICAL CONSIDERATIONS All of the operations were performed under gen- eral anesthesia. Upon admission, all patients were placed on parenteral antibiotics (either amoxicillin 1 g, 3 times daily or amoxicillin and clavulonic acid 1.2 g, 3 times daily IV), which were maintained for 3 days postoperatively. The anterior maxillary sinus wall site was exposed subperiostally by a standard intraoral vestibular ap- proach. The infraorbital foramen and nerve were identified and preserved. The limits of the future bone window were marked by 6 holes. Two vertical osteot- omies (mesial and distal) were first performed with a reciprocating saw. Thereafter, an AO 1.0 mm straight plate (Stratec Medical, Oberdorf, Switzerland) was adapted, the horizontal superior and inferior osteoto- mies completed and the bone flap removed with the *Associate Professor, Division of Maxillofacial and Oral Surgery, Hôpitaux Universitaire de Genève, Genève, Switzerland. †Chief Resident, Division of Oral and Maxillofacial Surgery, Cen- tre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. ‡Associate Professor, Laboratory of Oral Histopathology, Division of Stomatology, Faculty of Medicine, Genève, Switzerland. §Associate Professor, Division of Oral and Maxillofacial Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Address correspondence and reprint requests to Dr Scolozzi: Division of Oral and Maxillofacial Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; e-mail: Paolo. Scolozzi@chuv.ch © 2009 American Association of Oral and Maxillofacial Surgeons 0278-2391/09/6703-0038$36.00/0 doi:10.1016/j.joms.2008.09.016 689