The endoscopic endonasal prelacrimal recess approach to the maxillary sinus provides wide access to the walls and recesses of the maxillary sinus, and its use has been reported in many maxillary sinus and skull base diseases. The objective of this study was to determine the indication and feasibility of endoscopic sinus surgery using the prelacrimal recess approach in unilateral maxillary sinus diseases. We reviewed 192 cases of unilateral maxillary sinus diseases; over 2 years, 15 cases underwent endoscopic surgery via the prelacrimal recess approach. Data regarding preoperative computed tomography scans, operative findings, postoperative pathological diagnoses, postoperative complications, and disease recurrences were obtained from medical records. Patients who underwent surgery via the prelacrimal recess approach did so mostly because tumors were present in the maxillary sinuses (12/15; 80%), while most of the patients in this study underwent surgery because of chronic inflammation (122/177; 68.9%) and fungal infections (40/177; 22.6%). Among 15 patients undergoing surgery via the prelacrimal recess approach, 9 were cases of inverted papilloma. The mean follow-up period was 16.5 months (range, 6 to 28 months). No postoperative complications occurred after the prelacrimal recess approach. One out of the 15 cases undergoing the prelacrimal recess approach had tumor recurrence CONCLUSION: Most chronic inflammation and fungal infections of the unilateral maxillary sinuses can be managed through a middle meatal antrostomy. The endoscopic prelacrimal recess approach is a reliable and effective method used to approach maxillary sinus diseases.