Chirurgie des tumeurs sinusiennes

An original procedure for orbitonasal cutaneous infiltrative tumor repair, using combined forehead and melolabial propeller flaps

INTRODUCTION

Resections of cutaneous tumors in the medial orbitonasal region can be transfixing. Repairs using a single local flap run the risk of failure and that of secondary sinonasal fistula, especially in cases of surgery on a radiated field. We propose an original and reliable repair procedure using two pedicled regional flaps vascularized by two distinct arterial systems clinched together to reconstruct the mucosal and cutaneous planes.

MATERIALS AND METHODS

A first melolabial propeller flap (MPF) with a superior perforating pedicle was elevated and the cutaneous side was sutured to the deep plane of the loss of substance (mucosal lining). A second homolateral or contralateral paramedian forehead flap (PFF) was then lifted and sutured over the first flap (superficial plane). The forehead pedicle flap was divided at 1 month.

RESULTS

No trophic complication or failure was recorded on two patients. The 7-year carcinologic, aesthetic, and functional results were satisfying.

CONCLUSION

This technique involving the superimposition of two local flaps, vascularized by two different arterial systems, appears to offer a simple and reliable repair technique for transfixing cutaneous losses of substance in the medial orbitonasal region. It could be used in the first-line treatment, particularly if an additional radiotherapy is to be performed.

Adenocarcinoma of the ethmoid sinus: retrospective study of 42 cases

OBJECTIVES

Retrospective analysis of the oncological results and morbidity of ethmoid sinus adenocarcinoma surgery, and identification of survival factors.

MATERIAL AND METHODS

Forty-two patients were treated from 1990 to 2009. The study covered clinical presentation, medical imaging, histologic data, TNM grade, treatment, morbidity and overall recurrence-free survival.

RESULTS

Forty-one men and one woman, with mean age at diagnosis of 61.5 years, were included. 85.7% had been exposed to wood dust. Twenty patients (47.6%) were graded T4 at diagnosis. Thirty-three (78.5%) were treated by surgery followed by radiation therapy; nearly half of these showed recurrence. Overall specific 5-year survival was 44.2% at 5 years and recurrence-free 5-year survival 46.4%. The factors of poor prognosis found were cerebromeningeal or orbital invasion and local recurrence.

CONCLUSION

This series confirms the epidemiological literature on ethmoid adenocarcinoma and the influence of poor prognosis factors. Survival depended directly on local tumor control and seemed to be enhanced on an isolated transfacial approach.