Background: Prelacrimal approach to maxillary sinus provides a wide access to all walls of maxillary sinus while still preserving the nasolacrimal duct and inferior turbinate. This study aimed to asses prelacrimal approach outcome in anterior maxillary lesion according to completeness of removal and surgical morbidity. Patients and Methods: This prospective cohort study included 12 patients with maxillary sinus lesions. The study included 8 (55%) patients were men, and 4 (45%) were women. Their ages ranged from 12 to 60 years with an average age of (35.9±18.8) and (75%) of them were above forty years old. The study work was done in Otorhiriolaryngology Department in Zagazig University Hospitals in the period from March 2019 to March 2020. The patients were clinically evaluated by history, endoscopic and radiological examination. All surgeries was done under general anesthesia and the pre lacrimal recess approach was used after failure of complete removal of the lesions through widened Middle Meatal Antrostomy (MMA). Results: The intranasal pathologies included antrochoanal polyp (ACP) which was present in six patients (50.0%) followed by Inverted papilloma (IP) in three patients (25.0%) then dental cyst among two patients (16.7%) and the least one was maxillary cyst present in one patient (8.3%). Conclusions: This study showed that the PLRA was successful in complete removal of the lesions in all cases with minimal morbidity and no recurrence.