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In spite of development of curved instrument, a reaching hidden area in the maxillary sinus (MS) is still problematic. Prelacrimal recess (PLR) is a concavity in the medial, anterosuperior part of the MS. It is located in front of the eminence of the lacrimal passages on the medial sinus wall ( Fig. 1) (Hosemann W et. al 2003). Good visualization is provided for complete excision of the lesion, from the viewpoint of minimal invasion, a drawback still exists in both external and intranasal surgical procedures. Compromise of the inferior turbinate (IT) and nasolacrimal duct (NLD) is often unavoidable (Brors D, et. al 1999).The aim of the study was to assess the role of the intranasal prelacrimal recess approach (PLRA) in complete removal of anterior maxillary lesions.This was a prospective study in which 20 patients were recruited between July 2013 and September 2014 from the Otorhinolaryngology outpatient clinic, kasr Al-Ainy hospital , Cairo University.Patients with anterior maxillary sinus (MS) lesions underwent endoscopic sinus surgery and had their lesions removed through the maxillary ostium. The PLRA was then performed to assess the presence of any anterior maxillary remnants, which were then removed. The operation was performed under general hypotensive anaesthesia, in supine head-up position. The nasal cavity was decongested and the middle meatus lesion was removed. Uncinectomy was performed and the MS ostium identified, which was then widened posteroinferiorly and also anteriorly using backbiting forceps while ensuring that the nasolacrimal duct (NLD) was not injured. After complete removal of the sinus lesion using different angled nasal endoscopes, when cannot completely remove the maxillary sinus lesion, the PLRA was performed. The incisionThe incision site was infiltrated with 1% lidocaine (xylocaine) with 1: 100 000 epinephrine solution. A curved mucosal incision was made on the lateral wall of the nasal cavity between the anterior aspect of the IT and the posterior end of the nasal vestibule, so that the depth of the incision reached the underlying bone (Fig.1). Mucoperiosteal elevationUsing a chisel, the mucoperiosteum was lifted posteriorly until the attachment of inferior turbinate (IT) to the lateral nasal wall and then the bony attachment of IT were disconnected (Fig. 2). Bone removal Bone removal was achieved using a gauch and hammer and a high-speed electric drill, the anterior bony portion of the medial wall of the MS (parts of the frontal process of the maxilla) was chiseled off, as this part forms the medial part of the prelacrimal recess (Fig. 3). Inferior turbinate-nasolacrimal duct flap medialization:-Chiseling the bone posteriorly exposed the NLD and then the IT-NLD flap was formed. It was pushed medially and medial mucosal wall of the MS was exposed (Fig. 4). Widening the prelacrimal recess:-The anteromedial bony wall of maxillary sinus was partially removed according to the extent of maxillary sinus pneumatization or the location of lesion (Fig 5). At this step we assessed if there...

Gigantomastia is a rare mastopathy of unknown cause. Due to mechanical and psychological complications related to excessive breast weights and volume, effective surgical treatment is required. Most cases of gigantomastia in the literature are associated with pregnancy or puberty and very rare cases of spontaneous gigantomastia have been reported We report a 38 years old woman with an idiopathic gigantomastia treated successfully with Thorek technique.