Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris · 2005
[Surgical treatment of malignant sinonasal tumors with orbital extension: 20 patients].
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Chambres O, Huy Nguyen H, Schultz P, Wiorowski M, Hemar P, Gentine A, Debry C
Аннотация
OBJECTIVE: The purpose of this work was to assess changes in surgical treatment of malignant sinonasal tumors with orbital extension, with or without orbital exenteration, on the basis of clinical, radiological and preoperative data.
MATERIAL AND METHODS: We conducted a retrospective analysis of twenty patients with malignant sinonasal tumors with orbital extension operated on from 1995 to 2002 in the ENT and head and neck department of the Strasbourg University Hospital. CT-scan and MRI were performed before surgery. When periorbital invasion was observed without orbital extension and confirmed by histological examination in the operative theatre, the orbit was preserved during the surgical procedure. Orbital exenteration was necessary for the other patients. Adjunct postoperative radiotherapy was performed in all patients (n=20). Clinical, radiological and surgical data were compared with patient follow-up to search for correlations between radiological signs and the difficult surgical decision for orbital exenteration.
RESULTS: For orbital extension, the histological examination performed in the operative theatre did not confirm the results of the preoperative CT-scan in 15% of patients and the preoperative MRI in 11%. In a first group of nine patients with bony wall extension (78%, 7/9) or periorbital extension (22%, 2/9), there were no cases of recurrence at six years follow-up. In a second group of eleven patients with intraorbital extension, orbital exenteration was not performed in two (18%) because of surgically unresectable massive extension. Four of the nine other patients who underwent orbital exenteration were free of local recurrence at ten months follow-up and five were considered to have achieved oncological cure at four years follow-up.
CONCLUSION: Preoperative CT and MRI are essential but the decision for orbital exenteration must be made on the basis of the histological examination performed during the operative procedure because imaging often underestimates tumor extension.
MATERIAL AND METHODS: We conducted a retrospective analysis of twenty patients with malignant sinonasal tumors with orbital extension operated on from 1995 to 2002 in the ENT and head and neck department of the Strasbourg University Hospital. CT-scan and MRI were performed before surgery. When periorbital invasion was observed without orbital extension and confirmed by histological examination in the operative theatre, the orbit was preserved during the surgical procedure. Orbital exenteration was necessary for the other patients. Adjunct postoperative radiotherapy was performed in all patients (n=20). Clinical, radiological and surgical data were compared with patient follow-up to search for correlations between radiological signs and the difficult surgical decision for orbital exenteration.
RESULTS: For orbital extension, the histological examination performed in the operative theatre did not confirm the results of the preoperative CT-scan in 15% of patients and the preoperative MRI in 11%. In a first group of nine patients with bony wall extension (78%, 7/9) or periorbital extension (22%, 2/9), there were no cases of recurrence at six years follow-up. In a second group of eleven patients with intraorbital extension, orbital exenteration was not performed in two (18%) because of surgically unresectable massive extension. Four of the nine other patients who underwent orbital exenteration were free of local recurrence at ten months follow-up and five were considered to have achieved oncological cure at four years follow-up.
CONCLUSION: Preoperative CT and MRI are essential but the decision for orbital exenteration must be made on the basis of the histological examination performed during the operative procedure because imaging often underestimates tumor extension.