Background: Treatment of inflammatory and neoplastic diseases of maxillary sinus requires appropriate surgical exposure. Despite the use of multi-angulated endoscopes and curved instruments, there are some areas which still cannot be handled or viewed. So, further approaches other than the standard technique are needed to improve visualization and access to make possible disease control.
Aim: To compare the outcomes of middle meatal antrostomy approach (group A), endoscopic prelacrimal recess approach (group B) and canine fossa approach (group C). 
Patients and methods: Sixty patients with maxillary sinus lesions justifying surgery were included in this study. Patients were classified into 3 groups A, B and C, each one included 20 patients and were subjected to middle meatal antrostomy approach, endoscopic prelacrimal recess approach, and canine fossa approach respectively. Comparison between groups was done regarding ability of each approach to access, visualize and reach different recesses and walls of the maxillary sinus, postoperative or intraoperative complications and postoperative recurrence.
Results: There was no significant difference found between group B and C regarding complete accessibility to different recesses and walls of the maxillary sinus. Only three (15%) patients from those who underwent middle meatal antrostomy approach had radiological and endoscopic recurrence, on the other hand none of those who underwent other approaches developed recurrence. Complications occurred in our study were quite few and not dangerous.
Conclusion: Prelacrimal recess approach and canine fossa approach are useful methods for diverse maxillary sinus lesions with excellent accessibility to all walls and recesses without lacrimal duct or inferior tur­binate injury and less recurrence.