[The maxillary sinus via a prelacrimal approach as a gateway to the retromaxillary space and orbital floor].

Endonasal surgery has emerged as the standard procedure for the majority of nasal and paranasal sinus pathologies. However, some pathological changes beyond the maxillary sinus seem to be out of the instrumental range and are addressed by open approaches. The prelacrimal approach to the maxillary sinus published by Zhou and coworkers has stimulated a rapid development of various procedures in this field. In the current work, the possibilities of the prelacrimal approach are illustrated by means of three clinical cases. The prelacrimal approach enables isolated fractures of the orbital floor to be reconstructed without the risk of lower eyelid complications. Meningo- or encephaloceles in the far lateral aspects of the sphenoid sinus are comparatively well reached via endonasal, transantral, and transpterygoid approaches. Until recently, tumors beyond the maxillary sinus were the domain of open surgery, particularly when they extended laterally of the maxillary sinus. The technique of choice was either a Caldwell-Luc or a midfacial degloving approach. Many of these operations can now be performed via the endonasal prelacrimal approach, with lower morbidity and more rapid postoperative healing. The approach described herein is equal if not superior to the traditional approaches in terms of overview and accessibility.