Surgical Technique: Surgery was performed under general anesthesia. Merocel
® (Medtronic Xomed Inc., Jacksonville, FL, USA) soaked in adrenaline solution (1:1000) was used for local vasoconstriction. On the right side, minimal remnant of uncinate was removed. Following maxillary antrostomy, an incision was made anterior to the inferior turbinate and extended along the floor of the nose posteriorly (
Fig. 3). The flap was then elevated exposing the entire lateral wall of the nose (
Fig. 4). A 3 mm gouge was used to excise bone anterior to the nasolacrimal duct in a careful manner so as to avoid injury to the duct. The nasolacrimal duct was identified and transposed medially. This provided access to the anterior part of the maxillary sinus where the tumour remained hidden. Using burrs (Sinus Burr 35k, Karl Storz, Tuttlingen, Germany), the bone was drilled opening up the medial wall of the maxillary sinus. The visualised part of the tumour was removed using angled instruments (Heuweiser Forceps, Karl Storz, Tuttlingen, Germany). To gain access to the anteromedial wall and medial buttress, a hemitranfixation incision is made in the contralateral nasal cavity (left side) at the mucocutaneous junction. This incision was extended posteriorly, horizontal along the superior part of nasal septum beneath the nasal roof (
Fig. 5). Mucoperichondrial and mucoperiosteal flaps were elevated on the contralateral side and folded posteroinferiorly. The flap falls downwards, allowing space for instrumentation. From the ipsilateral side, a needle (Ethilon 3-0, Ethicon, Johnson and Johnson, Piscataway, NJ, USA) was passed through the septum, corresponding to the opening made on the medial wall of maxillary sinus (
Fig. 6). Once the needle pierced beyond the septum on the contralateral side, a cruciate incision was made on the cartilage (0.3 cm× 0.3 cm) (
Fig. 7). Curved instruments (Rad Blades 15, 40 and 60 degree, Medtronic Xomed Inc., Jacksonville, FL, USA) of the powered debrider (Medtronic Xomed Inc., Jacksonville, FL, USA) were introduced through this incision providing access to the entire anterior wall of the maxillary sinus on the diseased side (
Fig. 8). After tumour removal, the bone underneath its attachments was also drilled using a variety of angled burrs (The DrillCut-X
® II-35 Handpiece with 35k Sinus Burrs, Karl Storz, Tuttlingen, Germany) in the range of 15°, 40°and 60° (
Fig. 9). 3-0 Vicryl Rapide
TM (Vicryl Rapide, Ethicon, Johnson and Johnson, Piscataway, NJ, USA) with a knot at one end [
5] was used for septal suturing after replacing the mucoperichondrial and mucoperiosteal flaps (
Figs. 10 and
11). The lateral wall flap was repositioned and the inferior turbinate was sutured anteriorly. Follow up period showed no crusting, perforation or epiphora. There were no signs of recurrence after a follow up period of one, three and six months. Due to drilling of bone, some degree of maxillary contracture was observed.