Introduction
Sinonasal tumour surgery typically necessitates a 24 to 48 hour inpatient admission due to the complexity of surgery and postoperative care. We present a preliminary patient series using the novel ‘Riviera’ technique offering the potential to shift towards safe, effective day-case surgery.
Methods
Four patients were selected and underwent endoscopic medial maxillectomy utilising the specific six-point Riviera technique system for consistency. This includes infiltration of the axilla of the middle turbinate with 2% lidocaine with 1:80000 adrenaline, clamping of the inferior turbinate insertion, monopolar suction diathermy to the inferior turbinate stump root, use of 70 degree scopes for enhanced visualization, utilisation of topical adrenaline patties and induction of monitored normotension at the end of the operation to assess haemostasis. Patients were discharged on the same day with a 24-hour nurse led telephone follow-up.
Results
All patients successfully underwent the procedure without intraoperative complications and were discharged safely on the day. No significant postoperative complications were reported at 24-hours and a 2 week face-toface follow up. Patients appreciated recovering at home in a calm environment and reported excellent satisfaction scores. No additional specialist equipment was required and scrub staff were quickly trained in the new technique. Close MDT liaison at multiple points with anaesthetists, scrub staff and recovery teams was essential to success.
Conclusions
The ‘Riviera’ six-point technique demonstrates promise as a day-case approach for medial maxillectomy, offering a safe and efficient alternative to traditional inpatient management of sinonasal tumours. Larger cohort studies are warranted to validate its broader implementation.
Authors
Matthew Hewton
Torbay and South Devon NHSFT, Torquay, United Kingdom
Dema Motter
Torbay and South Devon NHSFT, Torquay, United Kingdom
Theresa Hinde
Torbay and South Devon NHSFT, Torquay, United Kingdom
Vinay Varadarajan
Torbay and South Devon NHSFT, Torquay, United Kingdom