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