It is widely accepted that the gold standard treatment of inverted papilloma of the maxillary sinus (IPMS) is endoscopic excision via medical maxillectomy or mega antrostomy, and these approaches can be augmented by a Caldwell-Luc or canine fossa trephination if necessary. This paper describes an approach via the prelacrimal recess, which has the benefit of preserving the inferior turbinate and the nasolacrimal duct. The authors describe 81 cases, with a recurrence rate of 7% and no occurrence of nasolacrimal duct injury or intraoperative complications. The approach is recommended for those difficult to access tumours arising from the anterior wall of the maximally sinus, and the results demonstrate that it is a potentially useful technique to consider.