Oncologic Safety of Endoscopic Removal of Infiltrated Tumor Onto the Periorbita Using Bipolar Cauterization Technique in Sinonasal Malignancy

다국어 초록 (Multilingual Abstract)

The periorbita has been regarded as the crucial structure in decision of orbital exenteration in the patients with sinonasal malignancies. The purpose of this study is to evaluate the oncological safety of endoscopic removal using bipolar cauterization in tumor encroaching on the periorbita without orbital sacrifice through analysis of long-term follow-up results of 5 cases. Methods：Retrospective review including demographic data, followup results, and local recurrence were performed on the 5 patients of advanced sinonasal cancer who showed bony orbital wall destruction and infiltration onto the periorbita but not transgressing into the orbital fat. Partial or total maxillectomy with orbital preservation was conducted in each patient. The tumor was dissected along the periorbita using bipolar nasal coagulation forceps by one senior surgeon under the endoscope. Preoperative CT and MRI scan were performed in all cases and retrospectively compared with intraoperative and permanent pathologic reports. Results：The mean age of tumor onset was 51.8 (39-74) years. Histopathology included four squamous cell carcinomas and one adenoid cystic carcinoma. Follow-up period ranged from 31 to 219 months (mean 112.6months). All cases showed no local recurrence in the orbit but one patient had local recurrence in the pterygopalatine fossa and the other had local recurrence in the neck. Conclusions：Endoscopic removal of infiltrated tumor onto the periorbita using bipolar cauterization technique might be oncologically safe technique in advanced maxillary cancer infiltrated onto the periorbita which is not invading the orbital fat.

참고문헌 (Reference)

1 Ketcham AS, "The ethmoid sinuses: a re-evaluation of surgical resection" 126 (126): 469-476, 1973

2 Som ML, "Surgical management of carcinoma of the maxilla" 99 (99): 270-273, 1974

3 Weisman RA, "Surgical anatomy of the orbit" 21 (21): 1-12, 1988

4 Tiwari R, "Studies of the anatomy and pathology of the orbit in carcinoma of the maxillary sinus and their impact on preservation of the eye in maxillectomy" 20 (20): 193-196, 1998

5 Brunton CE, "Smooth muscle of the periorbita and the mechanism of exophthalmos" 22 (22): 257-268, 1938

6 Harrison DF, "Problems in surgical management of neoplasms arising in the paranasal sinuses" 90 (90): 69-74, 1976

7 Larson DL, "Preservation of the orbital contents in cancer of the maxillary sinus" 108 (108): 370-372, 1982

8 McCary WS, "Preservation of the eye in the treatment of sinonasal malignant neoplasms with orbital involvement. a confirmation of the original treatise" 122 (122): 657-659, 1996

9 Perry C, "Preservation of the eye in paranasal sinus cancer surgery" 114 (114): 632-634, 1988

10 Eisen MD, "Preoperative imaging to predict orbital invasion by tumor" 22 (22): 456-462, 2000

11 Kim HJ, "Periorbita:computed tomography and magnetic resonance imaging findings" 20 (20): 371-374, 2006

12 Sisson GA, "Paranasal sinus malignancy:a comprehensive update" 99 (99): 143-150, 1989

13 Imola MJ, "Orbital preservation in surgical management of sinonasal malignancy" 112 (112): 1357-1365, 2002

14 Stern SJ, "Orbital preservation in maxillectomy" 109 (109): 111-115, 1993

15 Jackson RT, "Malignant neoplasms of the nasal cavities and paranasal sinuses: (a retrospective study)" 87 (87): 726-736, 1977

16 Thaler ER, "Endoscopically assisted anterior cranial skull base resection of sinonasal tumors" 13 (13): 303-310, 1999

17 Casiano RR, "Endoscopic resection of esthesioneuroblastoma" 15 (15): 271-279, 2001

18 Senior BA, "Computer-assisted resection of benign sinonasal tumors with skull base and orbital extension" 123 (123): 706-711, 1997

19 Weymuller EA, "A comparison of treatment modalities in carcinoma of the maxillary antrum" 106 (106): 625-629, 1980