110	D.T. Ginat et al.

3.18\ Maxillary Swing

3.18.1\ Discussion

The maxillary swing approach is sometimes used to resect nasopharyngeal and pterygopalatine fossa tumors. The technique includes several

a

c

osteotomies through and around the maxillary sinus in order to free the structure and rotate it laterally and expose the underlying lesions (Fig. 3.58). The infraorbital nerve is often sacrificed during the procedure. Recurrent tumors can spread through the osteotomy sites (Figs. 3.58 and 3.59).

b

d

Fig. 3.58  Maxillary swing. The patient has a history of nasopharyngeal carcinoma, which was resected via the maxillary swing approach. Axial (a, b) and coronal (c, d) CT images show multiple osteotomy sites, most of which are secured by microfixation plates, including the left

nasal process of the maxillary bone, the posterior maxillary wall, the zygomatic process, and the midline hard palate, in order to allow the maxillary sinus to rotate laterally (curved yellow arrows). The left infraorbital nerve was sacrificed by the osteotomy

3  Imaging the Paranasal Sinuses and Nasal Cavity	111
a	b

c

d

Fig. 3.59  Recurrent tumor. The patient has a history of nasopharyngeal carcinoma resected via a maxillary swing approach. Axial CT image (a) demonstrates a nodular lesion (arrows) that insinuates across the left posterior

maxillary wall osteotomy defect. The corresponding axial T2-weighted (b), T1-weighted (c), and post-contrast T1-weighted (d) MR images show that the intermediate T2 signal lesion enhances (arrows)