الفهرس 
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Abstract
This is a prospective randomized comparative study which was conducted in the Otolaryngology departments of Assiut and Alexandria University Hospitals during the period from October 2019 to October 2021. In our study a group of 60 patients who had anterior maxillary sinus lesions randomly assigned into three matched groups, underwent either Middle meatal antrostomy (n=20), Prelacrimal rcess approach (n=20) and Canine fossa approach (n=20). There were 38 (63.3%) males and 22 (36.7%) females with mean age of patients around 32 years. In our study we found that: Although anterior wall, medial wall and prelacrimal recess were not reached by the middle meatal antrostomy approach, all walls and different recesses were accessed by both PLRA & CFA. (15%) of patients who underwent middle meatal antrostomy approach had evident radiological and endoscopic recurrence, on the other hand none of those who underwent other approaches developed any postoperative recurrence. Complications occurred in our study were quite few and not dangerous. PLRA is a safe, pain free technique for manipulation of maxillary sinus lesions with best accessibility, minimal postoperative complications and has the advantage of good disease control. The following conclusions were achieved: Out of the three approaches, the PLRA is a safe technique for manipulation of maxillary sinus lesions with minimal postoperative complications. Although further study of a large population is needed to establish definite indications and limitations of PLRA & CFA, our study offers a comparison between the two ap¬proaches, showing that disease control is comparable. PLRA & CFA are useful methods for diverse maxillary sinus lesions with excellent accessibility to all walls and recesses without lacrimal duct or inferior tur¬binate injury. The occurrence of facial numbness & pain after surgery was insignificant in PLRA when compared with CFA. CFA is a useful approach in difficult surgical situations and it can be done without compromising the sinus physiology. It is simple, less invasive and also is more functional but it has somewhat high incidence of postoperative complications like facial pain, swelling and numbness. PLRA can preserve the periosteum of the canine fossa area, which is the manipulated site of the CFA. Periosteum plays a role as a primary barrier to prevent maxillary sinus disease from invading the skin of the cheek. When CFA is performed for maxillary sinus inverted papilloma, if the final pathology result is confirmed as squamous cell carcinoma, the approach site could become a spreading route. Therefore, PLRA has an advantage that the periosteum of the canine fossa area can be left as a barrier Further study with long follow up duration and wide number of patients should be done to precisely evaluate the impact of the three approaches Further studies should also be done to study the advantages and disadvantages of sublabial and transnasal methods of canine fossa approach. Training to perform PLRA & CFA is mandatory to avoid trauma to the NLD, inferior tur¬binate & infraorbital nerve.