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Godse NR, Sreenath S, Lobo BC, Sindwani R. Management of the Nasolacrimal Duct in Expanded Endoscopic Approaches to the Maxillary Sinus: A Systematic Review with Evidence-based Recommendations. Am J Rhinol Allergy 2024:19458924241249802. [PMID: 38803159 DOI: 10.1177/19458924241249802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Utilizing expanded endoscopic approaches to the maxillary sinus for the endonasal management of a variety of tumors is increasing in popularity. The nasolacrimal duct (NLD) may be injured inadvertantly or need to be removed during tumor resection or to augment visualization. Management of the NLD can take the form of transection alone, transection with stenting, or performing a formal dacryocystorhinostomy to avoid postoperative sequelae of injury. The purpose of this study was to review the literature and determine the optimal management of the NLD during expanded maxillary sinus approaches. METHODS A systematic review of Ovid, Embase, Medline, and Cochrane databases was performed to identify studies involving expanded approaches to the maxillary sinus and that explicitly reported the status of the NLD and postoperative outcomes. RESULTS Nineteen studies were included in the analysis and divided into two groups: NLD-preserving (n = 9 studies; n = 191 patients in aggregate) and NLD-involving (n = 10 studies; n = 296 patients in aggregate). In the NLD-preserving subgroup, one patient out of a subgroup aggregate of 191 patients (0.5%) developed epiphora. In the NLD-involving subgroup, sharp transection alone was the most common method of NLD removal and was associated with a low rate of epiphora (study rates: 0 to 18.2%; aggregated subgroup rate: 7.0%, 21 / 296). Spontaneous resolution of symptoms was common (60%-100% cases). CONCLUSIONS The NLD should be preserved when feasible from an exposure and tumor-control perspective. When pathology or approach requires the removal of the NLD, rates of persistent epiphora are very low, regardless of surgical technique. When expanded maxillary approaches are employed, particularly for benign tumors, and require removal of the NLD, sharp transection is the simplest method of removal, provides a low rate of postoperative epiphora, and is supported by the available literature.
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Affiliation(s)
- Neal Rajan Godse
- Section of Rhinology & Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Satyan Sreenath
- Division of Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Brian C Lobo
- Division of Rhinology & Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Florida, Gainesville, FL, USA
| | - Raj Sindwani
- Section of Rhinology & Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Sheth RK, Choudhary DA, Vishnurag A, Thomas I, Pandey R, Arvind I. Unusual Locations of Inverted Papilloma. Indian J Otolaryngol Head Neck Surg 2024; 76:2057-2061. [PMID: 38566729 PMCID: PMC10982235 DOI: 10.1007/s12070-023-04398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/22/2023] [Indexed: 04/04/2024] Open
Abstract
Inverted papilloma is a tumor found involving the nasal cavity and paranasal sinuses. They are not cancerous but can be locally aggressive. They are most commonly seen involving the lateral wall of nose and maxillary sinus. When the tumor involves the frontal sinus and sphenoid sinus or the post ethmoid cells it presents a surgical challenge. Inverted papilloma almost always occur unilateraly and affect mainly the maxillary sinus. Inverted papilloma arising from the sphenoid and frontal sinuses are rare. Here we present two cases; one involving a 60 year man, with inverted papilloma originating from the frontal sinus and another case where it originated from the sphenoid sinus anterior wall and posterior ethmoidalcell (Onodi cell) and was resected endoscopically.
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Affiliation(s)
- Ritu K. Sheth
- Department of ENT, Seth V C Gandhi and M A Vora Muncipal General Hospital, Rajawadi, Mumbai India
| | - Deepika A. Choudhary
- Department of ENT, Seth V C Gandhi and M A Vora Muncipal General Hospital, Rajawadi, Mumbai India
| | - Athira Vishnurag
- Department of ENT, Seth V C Gandhi and M A Vora Muncipal General Hospital, Rajawadi, Mumbai India
| | - Irine Thomas
- Department of ENT, Seth V C Gandhi and M A Vora Muncipal General Hospital, Rajawadi, Mumbai India
| | - Roop Pandey
- Department of ENT, Seth V C Gandhi and M A Vora Muncipal General Hospital, Rajawadi, Mumbai India
| | - Isha Arvind
- Department of ENT, Seth V C Gandhi and M A Vora Muncipal General Hospital, Rajawadi, Mumbai India
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Hildenbrand T, Weber RK. [Inverted papilloma of the nose and paranasal sinuses : Diagnosis, treatment, and malignant transformation]. HNO 2024; 72:257-264. [PMID: 38214715 DOI: 10.1007/s00106-023-01406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
Inverted papilloma (IP) are benign tumors that show a locally aggressive behavior, a high rate of recurrence, and a potential for malignant transformation. Specific radiological signs such as hyperostosis at the origin of the IP and convoluted cerebriform patterns, as well as the typical endoscopic aspect, can lead to diagnosis and enable preoperative planning of surgical access and the extent of surgery. Endonasal endoscopic techniques are considered the gold standard and the introduction of extended surgical techniques such as the prelacrimal approach, frontal drillout, or orbital transposition facilitate complete subperiosteal resection with preservation of important physiological structures. There is a risk of synchronous and metachronous squamous cell carcinomas (IP-SCC). Research focuses on radiological criteria to differentiate benign IP from IP-SCC, genetic and epigenetic factors in the process of malignant transformation, and estimation of the risk of IP progressing to IP-SCC.
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Affiliation(s)
- Tanja Hildenbrand
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - Rainer K Weber
- Sektion Nasennebenhöhlen- und Schädelbasischirurgie, Traumatologie, Klinik für Hals‑, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
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Park MJ, Cho W, Kim JH, Chung YS, Jang YJ, Yu MS. Preoperative Prediction of Sinonasal Inverted Papilloma-associated Squamous Cell Carcinoma (IP-SCC). Laryngoscope 2023; 133:2502-2510. [PMID: 36683553 DOI: 10.1002/lary.30583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/28/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Sinonasal inverted papillomas (IP) can undergo transformation into IP-squamous cell carcinomas (IP-SCC). More aggressive treatment plan should be established when IP-SCC is suspected. Nevertheless, inaccuracy of the preoperative punch biopsy results to detect IP-SCC from IP raises the need for an additional strategy. The present study aimed to investigate significant clinicoradiological remarks associated with IP-SCC than IP. MATERIAL AND METHODS Postoperative surgical specimens obtained from patients with confirmed IP or IP-SCC at a single tertiary medical center from 1997 to 2018 were retrospectively evaluated. Patients' demographic and clinical characteristics, preoperative in-office punch biopsy results, and preoperative computed tomography (CT) or magnetic resonance images were reviewed. Univariate and multivariate analyses were performed to assess the odds ratio (OR) associated with IP-SCC. The area under the curve (AUC) in the receiver Operating Characteristic (ROC) curve was calculated in the prediction model to discriminate IP-SCC from IP. RESULTS The study included 44 IP-SCC and 301 patients with IP. The diagnostic sensitivity of in-office punch biopsy to detect IP-SCC was 70.7%. Multivariate analysis showed that factors significantly associated with IP-SCC included tobacco smoking >10PY (adjusted-OR [aOR]: 4.1), epistaxis (aOR: 3.4), facial pain (aOR: 4.2), bony destruction (aOR: 37.6), bony remodeling (aOR: 36.3), and invasion of adjacent structures (aOR: 31.6) (all p < 0.05). Combining all significantly related clinicoradiological features, the ability to discriminate IP-SCC from IP reached an AUC of 0.974. CONCLUSION IP patients with a history of tobacco smoking, facial pain, epistaxis, and bony destruction, remodeling, or invasion of an adjacent structure on preoperative images may be at higher risk for IP-SCC. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2502-2510, 2023.
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Affiliation(s)
- Marn Joon Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University Medical Center, Inha University School of Medicine, Incheon, South Korea
| | - Wonki Cho
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Heui Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoo-Sam Chung
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong Ju Jang
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myeong Sang Yu
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Takakura H, Tachino H, Oi Y, Do TA, Shojaku H. Novel Application of an Ultrasonic Bone Aspirator for Endoscopic Modified Medial Maxillectomy. Front Surg 2022; 9:870380. [PMID: 35722534 PMCID: PMC9198444 DOI: 10.3389/fsurg.2022.870380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background Endoscopic modified medial maxillectomy (EMMM) is a surgical technique developed to approach maxillary sinus lesions, such as papilloma and postoperative maxillary cyst, while preserving the postoperative nasal morphology and nasal function. In this technique, a diamond burr is used to remove the bone, which may damage adjacent soft tissue. We developed EMMM using an ultrasonic bone aspirator (UBA) instead of a conventional diamond burr. The purpose of this study was to clarify the effectiveness of the UBA in EMMM in comparison to the conventional diamond burr technique in terms of operative time, intraoperative complications, postoperative symptoms, and recurrence. Methods The medical records of all patients who underwent EMMM at Toyama University Hospital between June 2014 and December 2021 were reviewed. Patients who met the inclusion criteria were separated into Group 1, in which the UBA was used for EMMM, and Group 2, in which a drill with a diamond burr was used. Data on patient demographics, operation time, frequency of intraoperative complications and postoperative symptoms, and recurrence were statistically compared between the two groups. Results There were no significant differences between the two groups in the patient demographic data, operative time, postoperative symptoms, or frequency of recurrence. The frequency of intraoperative damage to adjacent soft tissues was significantly lower in patients who underwent EMMM with the UBA in comparison to those who underwent EMMM with a conventional diamond burr. Conclusion The application of the UBA to EMMM can improve surgical safety and facilitate surgical procedures.
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Inverted Papilloma of the Maxillary Sinus: A Recurrence Analysis According to Surgical Approaches. J Clin Med 2022; 11:jcm11113020. [PMID: 35683409 PMCID: PMC9181515 DOI: 10.3390/jcm11113020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Various surgical approaches have been introduced to resect inverted papillomas (IP) stemming from the maxillary sinus (MS). This study aimed to compare the recurrence rates of IPs originating from the MS according to various surgical modalities. (2) Methods: A total of 155 surgical cases of sinonasal IPs originating from the MS were categorized into three groups according to the surgical approach adopted: endoscopic resection via middle or inferior meatus antrostomy (ESS), ESS with Caldwell−Luc approach or canine fossa trephination (ESS with CL), and expanded endoscopic approaches (ExEA) including endoscopic medial maxillectomy or a prelacrimal recess approach. A Kaplan−Meier curve was generated to examine the recurrence rates. (3) Results: The overall recurrence rate was 5.8% (9/155) with a mean follow-up period of 24.2 months. The recurrence rates for the ESS, ESS with CL, and ExEA groups were 10.0% (7/70), 3.5% (2/57), and 0% (0/28), respectively. The ExEA group had a significantly lower recurrence rate than the ESS group (p = 0.024) and there was a tendency for lower recurrence compared to the ESS within the CL group (p = 0.145). The ExEA required a shorter postoperative hospitalization period than in ESS with CL (p < 0.001). (4) Conclusions: ExEAs to the maxillary sinus such as the PLR and EMM approaches are excellent surgical options for IPs originating from the MS.
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A miniature robotic steerable endoscope for maxillary sinus surgery called PliENT. Sci Rep 2022; 12:2299. [PMID: 35145155 PMCID: PMC8831515 DOI: 10.1038/s41598-022-05969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
In endoscopic maxillary sinus surgery, the maxillary sinus is accessed through the nasal cavity which constitutes a narrow and tortuous pathway. However, surgeons still use rigid endoscopes and rigid, straight or pre-bent instruments for this procedure. Resection of the uncinate process and creation of a medial antrostomy is warranted to access the pathology inside the maxillary sinus and depending on the location of the pathology (lateral, inferior or anterior wall), additional resection of healthy tissue and/or functional structures like the lacrimal duct and/or inferior turbinate is necessary to gain optimal access. In order to avoid this additional resection, a functional single-handed, steerable endoscope for endoscopic maxillary sinus surgery has been designed and built. This endoscope is, to our knowledge, the most slender active steerable endoscope ever reported for maxillary sinus surgery. The performance of the endoscope was validated by two surgeons on a cadaver. An increased field of view was found in comparison to currently used endoscopes. As a direct consequence, a reduced need for resection of healthy tissue was confirmed.
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Mo Y, Long D, Li L, Zheng Y. A case report of exophytic nasal papilloma with acute dacryocystitis as the first symptom. BMC Ophthalmol 2021; 21:458. [PMID: 34965868 PMCID: PMC8715150 DOI: 10.1186/s12886-021-02223-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/17/2021] [Indexed: 12/05/2022] Open
Abstract
Background This study aims to explore a case of exophytic nasal papilloma with acute dacryocystitis as the first symptom. Case presentation A 72-year-old male patient complaining of “a 10-year history of tearing and purulent discharge from the right eye, with subsequent redness and pain in the inner canthus for three days” was initially diagnosed with acute dacryocystitis of the right eye. The patient was treated with anti-inflammatory therapy. However, the redness and swelling of the inner canthus continued to increase. An endoscopic dacryocystorhinostomy of the right eye was performed under general anesthesia. A large amount of purulent secretion was drained during the operation. As a result, the swelling of the inner canthus was significantly reduced. A routine intra-operative biopsy of the wall of the lacrimal sac revealed an exophytic nasal papilloma. A second biopsy, 1 week after the surgery, revealed the same result. The patient was advised to undergo a dacryocystectomy once the swelling had subsided. However, the patient was reluctant to undergo this surgery and remains under clinical observation. Conclusion It is rare for an exophytic nasal papilloma, which is a benign tumor in the lacrimal sac, which has the potential for recurrence and malignant transformation, to manifest with acute dacryocystitis as the first symptom. Therefore, this case report could provide a reference for the future clinical diagnosis of this disease.
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Huang AE, Low CM, Stokken JK. Extended Anterior Inferior Approach to Endoscopic Medial Maxillectomy for Maxillary Sinus Lesions. Am J Rhinol Allergy 2021; 35:895-901. [PMID: 34236250 DOI: 10.1177/19458924211025371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Myriad open and endoscopic approaches are employed to resect maxillary sinus lesions, each with associated advantages and disadvantages. The inferior and anterior portion of the sinus remains a challenging space to access. OBJECTIVES To describe the extended anterior inferior approach to endoscopic medial maxillectomy (EAMM) as a novel and valuable addition to a stepwise approach for minimizing surgical morbidity without compromising tumor outcomes. To report the outcomes of patients treated with this approach. METHODS A retrospective case series study of 9 patients who underwent EAMM between 2016 and 2019 at a tertiary care referral center was performed. The endoscopic technique is described. The duration of follow-up ranged from 1 to 53 months. Intraoperative steps, including transection of the nasolacrimal duct and execution of an intraoperative dacryocystorhinostomy, were reviewed. Postoperative outcomes, including patient symptoms at follow-up and tumor recurrence, were recorded. RESULTS Adequate exposure with gross total tumor resection or margin-negative tumor resection was achieved in all cases. Sparing of the nasolacrimal duct was achieved in 2 patients. No patients reported persistent epiphora, empty nose syndrome, or changes in cosmesis such as alar or nasal tip collapse. One patient reported unilateral V2 hypoesthesia at 6 months postoperatively that had resolved by his next follow-up 18 months after surgery. Postoperative tumor surveillance was achieved by endoscopic examinations in all patients and there was no evidence of tumor recurrence at a median follow-up of 22 months. CONCLUSIONS The EAMM provides improved access to the inferior-posterior-medial maxillary sinus. This approach minimizes the risk of hypoesthesia and change in cosmesis present in other approaches, and obviates division of the nasolacrimal duct for inferior, posterior-medial attached lesions. This progressive escalation of approach for maxillary sinus lesions minimizes injury to nasal and nasolacrimal structures without compromising tumor outcomes.
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Affiliation(s)
- Alice E Huang
- Department of Otolaryngology-Head and Neck Surgery, 10624Stanford University, Palo Alto, California
| | - Christopher M Low
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Janalee K Stokken
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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He X, Wang Y. Clinical characteristics of sinonasal inverted papilloma associated with recurrence and malignant transformation. Auris Nasus Larynx 2021; 48:1105-1108. [PMID: 33965286 DOI: 10.1016/j.anl.2021.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/05/2021] [Accepted: 04/15/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Sinonasal inverted papilloma is a benign tumor but has a potential for recurrence and malignant transformation. The aim of this article is to analyze the clinical characteristics of sinonasal inverted papilloma associated with recurrence and malignant transformation. MATERIAL AND METHODS A retrospective study was performed in all patients with sinonasal inverted papilloma diagnosed between in our hospital during May 2013 and May 2018. RESULTS A total of 151 patients were enrolled in this study. The average age of these patients was 52.24 years, with a male-to-female ratio of 2.775:1, and the most frequent clinical symptom was nasal obstruction. The recurrence rate was 39.07% (59/151), the mean time of recurrence was 35.8 months and most recurrences occur within the first three years after surgery. There was no significant difference in recurrence rate between all four stages and between after endoscopic surgery and a combined endoscopic and external approach. The malignant transformation rate was 5.96% (9/151) and the mean time of malignant transformation was 9.06 months. CONCLUSIONS Because of its high recurrence rate and the potential of malignant transformation, so it is important to determine the primary site of the tumor and to make a complete removal and a follow-up of at least five years after surgery is recommended.
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Affiliation(s)
- Xindi He
- Department of Rhinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ying Wang
- Department of Rhinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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Endoscopic maxillectomy: anatomo-radiological description of the "double" maxillary sinus window. Eur Arch Otorhinolaryngol 2021; 278:3813-3820. [PMID: 33481079 DOI: 10.1007/s00405-021-06604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS To present a modified endoscopic medial maxillectomy (MEMM) approach to control maxillary sinus pathologies. METHODS MEMM was completed in 13 fresh-frozen specimens. An MEMM includes cutting the nasolacrimal duct, inferior meatus flap, and repositioning the inferior turbinate (IT). The following measurements were obtained: length of IT, height from the nasal floor to valve of Hasner, height of the IT at the level of valve of Hasner, height of the IT at the insertion of the middle turbinate, and distance from the piriform aperture to the posterior wall of maxillary sinus and to the posterior border of palatine bone. Similar measurements were also performed on craniofacial computed tomography (CT) scans (n = 50). The surgical technique was performed in a case series (n = 8). RESULTS The mean of the specimens was 82 (range 70-95) years old. The average area of the harvested inferior meatus flap area was 9.6 ± 1.0 cm2. In the radiologic study, the mean maximum antrostomy area was 8.8 ± 1.7 cm2 and the IT area overlapping the antral window was 5.8 ± 1.1 cm2, the area allowing a double window control was 3.1 ± 1.9 cm2, the posterior IT insertion length was 0.7 ± 0.4 cm, and the inferior meatus flap covering the inferior meatotomy had an area measuring 6.7 ± 1.7 cm2. Eight patients underwent MEMM for various benign conditions showing no recurrence after 26 month follow-up. CONCLUSION The proposed modifications of MEMM provide a "double" window maxillary sinus control with access to all maxillary walls and preservation of the IT.
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Assessment of Lacrimal Duct Patency in Patients Undergoing Endoscopic Medial Maxillectomy. J Clin Med 2021; 10:jcm10020245. [PMID: 33445480 PMCID: PMC7827647 DOI: 10.3390/jcm10020245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: The risk of epiphora after medial maxillectomy with lacrimal duct transection is difficult to assess. The data available in the literature are inconclusive due to various operating techniques used by the authors of medical publications, different additional procedures aimed at improving tear drainage after maxillectomy, and a variety of lacrimal duct patency assessment techniques. The aim of our work was to assess the anatomical and functional patency of lacrimal ducts after medial maxillectomy without performing additional procedures to improve tear drainage as well as comparison of the results obtained with different assessment tests. Materials and methods: 21 patients who underwent medial maxillectomy in the years 2016–2019 were assessed for discomfort and epiphora based on patients’ own reports and basic clinical examination, lacrimal duct rinse test, the Munk score, and a modified endoscopic Jones I test. Results: Gradually increasing the sensitivity of the assessment method resulted in an increase in the number of patients with potential tear drainage disorders, starting from 0% in the rinsing test, 4.8% self-reported tearing complaints, 14.3% Munk score, and 19% modified endoscopic Jones I test. Conclusions: The study results revealed that a small fraction of patients tend to report epiphora as a consequence of medial maxillectomy themselves. Subtle functional disorders, which are not particularly bothersome to patients, are more common. More sensitive lacrimal duct patency tests reveal more cases of tear drainage disorders. The results of studies assessing the incidence of epiphora after medial maxillectomy appear to depend on the type of test used.
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Legrand J, Niu K, Qian Z, Denis K, Vander Poorten V, Van Gerven L, Vander Poorten E. A Method Based on 3D Shape Analysis Towards the Design of Flexible Instruments for Endoscopic Maxillary Sinus Surgery. Ann Biomed Eng 2021; 49:1534-1550. [PMID: 33403453 DOI: 10.1007/s10439-020-02700-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/23/2020] [Indexed: 02/02/2023]
Abstract
The emergence of steerable flexible instruments has widened the uptake of minimally invasive surgical techniques. In sinus surgery, such flexible instruments could enable the access to difficult-to-reach anatomical areas. However, design-oriented metrics, essential for the development of steerable flexible instruments for maxillary sinus surgery, are still lacking. This paper proposes a method to process measurements and provides the instrument designer with essential information to develop adapted flexible instruments for limited access surgery. This method was applied to maxillary sinus surgery and showed that an instrument with a diameter smaller than 2.4 mm can be used on more than 72.5% of the subjects' set. Based on the statistical analysis and provided that this flexible instrument can bend up to [Formula: see text] it is estimated that all areas within the maxillary sinus could be reached through a regular antrostomy without resorting to extra incision or tissue removal in 94.9% of the population set. The presented method was partially validated by conducting cadaver experiments.
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Affiliation(s)
- Julie Legrand
- Department of Mechanical Engineering Technology, KU Leuven, Leuven, Belgium.
| | - Kenan Niu
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.
| | - Zhen Qian
- Department of Otorhinolaryngology, Head Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kathleen Denis
- Department of Mechanical Engineering Technology, KU Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology, Head Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Laura Van Gerven
- Department of Otorhinolaryngology, Head Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Allergy and Clinical Immunology Research Unit, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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Abstract
PURPOSE OF REVIEW The endoscopic medial maxillectomy (EMM) has remained a relevant procedure for certain sinus diseases and at the same time reemerged as a salvage technique or even as a primary procedure for other diseases. Several mucosal-sparing techniques have also been described and the outcome of the surgeries is available for review. RECENT FINDINGS Modifications of the EMM technique in the last two decades, aimed at mucosal preservation of the inferior turbinate, nasolacrimal duct, and medial maxillary wall have been successful in addressing a multitude of diseases. There are also evidences to support adjunct procedures/methods to improve access, healing, and to address associated dysfunction such as impaired mucociliary clearance. Tailored approaches have shown favourable outcomes with a low rate of adverse effects. SUMMARY The EMM is appropriate for selected indications, in particular lesions causing medial wall destruction or extensive tumour involving the anterior wall or the prelacrimal recess. As for other maxillary sinus diseases including those identified to a limited site, a modified EMM is a reasonable consideration. The choice is appropriate provided instrument access, visualization, the ability for complete resection, postoperative care, and the requirement for surveillance is not compromised. A tailored approach with or without adjunct procedures is recommended.
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Sommer F, Hoffmann T, Lindemann J, Hahn J, Theodoraki MN. [Radicality of maxillary sinus surgery and size of the maxillary sinus ostium]. HNO 2020; 68:573-580. [PMID: 32405682 DOI: 10.1007/s00106-020-00870-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Until the 1990s, radical sinus surgery was considered a standard procedure for maxillary sinus diseases, but it is no longer favored due to the high morbidity. Today, functional endoscopic sinus surgery (FESS) is considered the gold standard in sinus surgery. Modifications of surgical approaches also allow access to regions of the maxillary sinus that were previously difficult to reach. Depending on anatomy and pathology, different methods for widening the maxillary ostium can be selected. In type I sinusotomy, the natural ostium is widened dorsally by a maximum of 1 cm. Sinusotomy type II involves widening the natural ostium up to a maximum diameter of 2 cm. In sinusotomy type III, the natural ostium is widened dorsally to the posterior wall of the maxillary sinus and caudally to the base of the inferior turbinate. Beside the prelacrimal approach, more invasive approaches are the medial maxillectomy, in which the dorsal part of the inferior turbinate and the adjacent medial wall of the maxillary sinus is resected, as well as its modifications "mega antrostomy" and "extended maxillary antrostomy." Correct selection of the size of the maxillary sinus window is prerequisite for successful treatment and long-term postoperative success. Isolated purulent maxillary sinusitis can usually be treated by a type I sinusotomy. Sinusotomy type II addresses nasal polyps with involvement of the mucosa of the ostium, recurrent stenosis after previous surgery, chronic maxillary sinusitis due to cystic fibrosis, and purulent maxillary sinusitis with involvement of other adjacent sinuses. Sinusotomy type III is required for choanal polyps with attachment to the floor of the maxillary sinus, for extensive polyposis and fungal sinusitis, and for inverted papilloma. Particularly for (recurrent) disease and extensive interventions in the maxillary sinus, medial maxillectomy or a modification thereof may be required.
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Affiliation(s)
- F Sommer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland.
| | - T Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - J Lindemann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - J Hahn
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - M-N Theodoraki
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland
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16
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Nakayama T, Tsunemi Y, Kuboki A, Asaka D, Okushi T, Tsukidate T, Otori N, Kojima H, Haruna SI. Prelacrimal approach vs conventional surgery for inverted papilloma in the maxillary sinus. Head Neck 2020; 42:3218-3225. [PMID: 32639072 DOI: 10.1002/hed.26376] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 02/08/2020] [Accepted: 06/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prelacrimal approach, termed endoscopic modified medial maxillectomy (EMMM), has recently been applied for treatment of inverted papilloma (IP) in the maxillary sinus. EMMM provides wider access to the maxillary sinus while preserving the inferior turbinate and nasolacrimal duct. METHODS We reviewed patients with IP in the maxillary sinus to compare the surgical results obtained by conventional surgery (ie, endoscopic maxillary sinus antrostomy or in combination with the Caldwell-Luc approach) with those obtained by EMMM. RESULTS All patients had a T3 on the Krouse staging system, and the average follow-up time was 46.0 months. Of the 18 patients in the conventional group, recurrence was seen in 3 patients (16.6%). No recurrence was seen in the 27 patients who showed preservation of the inferior turbinate and nasolacrimal duct, and no complications occurred in the EMMM group. CONCLUSIONS EMMM is an effective surgical approach that reduces recurrence with fewer complications.
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Affiliation(s)
- Tsuguhisa Nakayama
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yasuhiro Tsunemi
- Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Akihito Kuboki
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Daiya Asaka
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Tetsushi Okushi
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Toshiharu Tsukidate
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Shin-Ichi Haruna
- Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
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17
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Extended endoscopic approaches to the maxillary sinus. The Journal of Laryngology & Otology 2020; 134:473-480. [PMID: 32508301 DOI: 10.1017/s0022215120000882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Treatment of inflammatory and neoplastic disease in the maxillary sinus, pterygopalatine and infratemporal fossae requires appropriate surgical exposure. As modern rhinology evolves, so do the techniques available. This paper reviews extended endoscopic approaches to the maxillary sinus and the evidence supporting each technique. METHODS A literature search of the Ovid Medline and PubMed databases was performed using appropriate key words relating to endoscopic approaches to the maxillary sinus. RESULTS Mega-antrostomy and medial maxillectomy have a role in the surgical treatment of refractory inflammatory disease and sinonasal neoplasms. The pre-lacrimal fossa approach provides excellent access but can be limited because of anatomical variations. Both the transseptal and endoscopic Denker's approaches were reviewed; these appear to be associated with morbidity, without any significant increase in exposure over the afore-described approaches. CONCLUSION A range of extended endoscopic approaches to the maxillary sinus exist, each with its own anatomical limitations and potential complications.
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18
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Surgical Management of Bilateral Venous Malformation (Cavernous Hemangiomas) of the Maxillary Sinus. Case Rep Otolaryngol 2020; 2020:8606103. [PMID: 32095305 PMCID: PMC7035503 DOI: 10.1155/2020/8606103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Abstract
According to International Society for the Study of Vascular Anomalies classification 2018, "hemangioma" should be classified as either vascular tumor or vascular malformation (VM). So-called "cavernous hemangioma" is categorized as VM. VM rarely involves the mucous membranes of the sinonasal cavity and typically arises unilaterally from the sinonasal cavity. Bilateral VM of the maxillary sinus is extremely rare. To the best of our knowledge, there is no previous report of bilateral VM of the maxillary sinus. Here, we describe the surgical treatment of bilateral cavernous hemangiomas of the maxillary sinus. These tumors were successfully resected by endoscopic modified medial maxillectomy (EMMM) after embolization. Endoscopic sinus surgery, particularly EMMM, produces access to the bilateral maxillary sinus and can prevent several complications.
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19
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Al Momen A, Alenzi HL, Al Eid M. Bilateral simultaneous sino-nasal inverted papilloma; A report of two cases and literature review. Int J Surg Case Rep 2020; 67:71-75. [PMID: 32028092 PMCID: PMC7005342 DOI: 10.1016/j.ijscr.2019.12.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/15/2019] [Accepted: 12/20/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Inverted Papilloma is a benign sinonasal tumor with a high recurrence rate and potential for malignant transformation, it typically presents as an obstructing unilateral nasal mass, atypical presentations include bilateral involvement which occurs in up to 5 % of cases. Case presentation Here we present two different cases of bilateral inverted papilloma, both presented complaining of bilateral nasal obstruction, the second case also had associated nasal polyposis and history of multiple previous endoscopic sinus surgeries, both cases were managed with endoscopic medial maxillectomy and tumor removal, with no signs of recurrence on follow up. Conclusion Bilateral involvement is an uncommon, atypical presentation of inverted papilloma, endoscopic surgery is a safe, reliable approach and it is the mainstay of treatment, regular endoscopic and clinical follow up is important for detection of recurrence.
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Affiliation(s)
- Ali Al Momen
- Consultant ENT, Rhinology and Skull Base Surgery at King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | | | - Mohammad Al Eid
- ENT Resident, Saudi Commission of Health Specialties Eastern Province Program, Saudi Arabia
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20
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Lin YH, Chen WC. Clinical outcome of endonasal endoscopic prelacrimal approach in managing different maxillary pathologies. PeerJ 2020; 8:e8331. [PMID: 31915590 PMCID: PMC6944117 DOI: 10.7717/peerj.8331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background The aim of the study was to evaluate the treatment outcomes of endoscopic prelacrimal recess approaches (EPLAs) in managing different sinus pathologies, analyzing associated adverse events and post-treatment quality-of-life. Methods We enrolled 21 consecutive patients (22 lesions) who received endoscopic sinus surgical procedures with EPLAs in two tertiary medical institutes between 2015 and 2018. Quality-of-life and self-rated symptom severity data were collected using the 22-item Sino-Nasal Outcomes Test (SNOT-22) and 10-point visual analog scales (VAS), respectively. Results A total of 21 patients (mean age (standard deviation) 51.7 (14.5) years; 16(76.2%) male) were followed up for 12.7 months. The most common symptoms were nasal discharge and nasal airway obstructions. Nine lesions (40.9%) were sinonasal papilloma's, seven lesions were other types of neoplasms (31.8%; five benign and two malignant), two were trauma-related (9.1%), and four inflammatory diseases (18.2%). Patients with non-papilloma lesions had higher presurgical SNOT-22 than those with papillomas (P-value = 0.021). After EPLAs, non-papilloma patients had significant improvements in SNOT-22 and VAS (P-values = 0.012 and 0.012, respectively), while those with papillomas had only marginally significant improvements in VAS (P-value = 0.061). The most common adverse events was temporary cheek/tooth numbness (n = 11), and patients with sinonasal papillomas were more likely to have post-treatment complications than those with other disease entities. Conclusions EPLAs were found to effectively manage various sinus diseases. Short-term life-quality improvements were promising. Future large-scale studies with longer follow-up periods are recommended.
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Affiliation(s)
- Yu Hsuan Lin
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Otolaryngology, Chung Shan Medical University Hospital and School of Medicine, Taichung, Taiwan.,Department of Otolaryngology, Head and Neck surgery, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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21
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Li W, Lu H, Zhang H, Sun X, Hu L, Wang D. Squamous cell carcinoma associated with inverted papilloma: Recurrence and prognostic factors. Oncol Lett 2019; 19:1082-1088. [PMID: 31885722 DOI: 10.3892/ol.2019.11185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/11/2019] [Indexed: 12/14/2022] Open
Abstract
The purpose of the present study was to review the recurrence and prognostic factors of squamous cell carcinoma (SCC) associated with inverted papilloma (IP). A retrospective chart review was conducted on 21 patients with SCC associated with IP, in the nasal cavity and paranasal sinuses, between March 2007 to March 2017. All patients underwent surgical treatment: Surgery prior to or following adjuvant therapy was performed in 17 patients (81.0%). During a mean follow-up time of 47.4 months (range, 3-123 months), 9 patients (42.9%) experienced local recurrence, and the risk factors of T4 stage and invasive orbital cavity had a significant influence on recurrence. The 1-, 3-, and 5-year overall survival rates were 90.5, 75.4 and 68.5%, and the 1-, 3-, and 5-year disease-specific survival (DSS) rates were 90.5, 80.4 and 80.4%, respectively. The prognosis of patients with stage T4 was not satisfactory compared with those with stage T3 or less, and a positive surgical margin was also significantly associated with poor survival. Overall, SCC associated with IP has a favorable DSS, early diagnosis and complete resection of lesions is required for a good prognosis. Furthermore, aggressive surgical approaches combined with postoperative adjuvant therapy seem to be effective in tumors at stage T4.
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Affiliation(s)
- Wanpeng Li
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Hanyu Lu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Huankang Zhang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Xicai Sun
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Li Hu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Dehui Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
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22
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Surgery of Inverted Papilloma of the Maxillary Sinus via Translacrimal Approach-Long-Term Outcome and Literature Review. J Clin Med 2019; 8:jcm8111873. [PMID: 31694225 PMCID: PMC6912689 DOI: 10.3390/jcm8111873] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/21/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022] Open
Abstract
There are several differential diagnoses of unilateral sinus disease. One of these is inverted papilloma (IP) of the maxillary sinus, which is a common benign tumor with a substantial rate of malignant transformation. In general, endoscopic endonasal techniques for addressing the tumor are favored nowadays instead of classical external approaches. The aim of this retrospective study was to investigate the long-term outcome of inverted papilloma treated endoscopically via the prelacrimal approach. We reviewed 17 patients with primary or recurrent IP of the maxillary sinus that were treated via the prelacrimal endoscopic endonasal technique. After a median follow-up period of 45.9 months (3.8 years), none of the 17 included patients showed signs of recurrent disease and no serious complications were reported. Hypoesthesia of the incisors was reported by four patients and was resolved with time in one. All of the maxillary sinuses could be fully visualized with the flexible endoscope. IP is an important differential diagnosis in the clinical finding of unilateral nasal polypoid lesions. The prelacrimal approach is an effective and safe method in the treatment of IP with limited patient morbidity.
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23
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Makihara S, Kariya S, Naito T, Uraguchi K, Matsumoto J, Noda Y, Okano M, Nishizaki K. Attachment-oriented endoscopic surgical management for inverted papillomas in the nasal cavity and paranasal sinuses. Auris Nasus Larynx 2019; 46:748-753. [PMID: 30833129 DOI: 10.1016/j.anl.2019.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/03/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The treatment of all forms of sinonasal inverted papilloma (IP) is a complete, wide, local resection. The main surgical purpose is to remove all diseased mucosa and mucoperiosteum, together with a cuff of normal-looking mucosa at the attachment site, followed by drilling and/or coagulation. Our aim is to present our experiences in endoscopic surgical management of IP by using attachment-oriented excision. METHODS We present 20 cases of sinonasal IP. The data collected includes the histopathological diagnosis, staging, extension of the tumor, tumor attachment site, approach to surgery, serum squamous cell carcinoma antigen (SCCA) level, and recurrences. RESULTS All patients underwent endoscopic surgery. A Caldwell-Luc operation was required in addition to the endoscopic surgery in one case. There was one case of recurrence (5%). After the additional operation, there was no recurrence. The tumor attachment sites vary, and the case of recurrence had a wide attachment site at the primary surgery. No major intra- or post-operative complications were observed. CONCLUSION The present study shows that attachment-oriented excision for IP is useful for complete resection of IP. Surgeons should choose the surgical approach according to the location of the tumor attachment site rather than the Krouse staging system.
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Affiliation(s)
- Seiichiro Makihara
- Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Shin Kariya
- Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Tomoyuki Naito
- Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Kensuke Uraguchi
- Department of Otolaryngology, Kochi Health Sciences Center, Kochi, Japan
| | - Junya Matsumoto
- Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Yohei Noda
- Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mitsuhiro Okano
- Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Otorhinolaryngology, International University Of Health And Welfare, School of Medicine, Narita, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Sinonasal inverted papilloma associated with small cell neuroendocrine carcinoma: A case report and literature review of rare malignancies associated with inverted papilloma. Auris Nasus Larynx 2018; 46:641-650. [PMID: 30545727 DOI: 10.1016/j.anl.2018.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 10/05/2018] [Accepted: 10/17/2018] [Indexed: 12/29/2022]
Abstract
We report a rare case of sinonasal inverted papilloma (IP) associated with small cell neuroendocrine carcinoma (SNEC). To our knowledge, this is the first report to describe SNEC found during the treatment of sinonasal IP. Surgery and five cycles of cisplatin plus etoposide with concurrent intensity modulated radiation therapy were performed. Neither local recurrence nor distant metastasis was noted during 6 years of post-diagnostic follow-up. The prognosis of SNEC is very poor. Treatment planning for sinonasal IP should consider a possible association with this rare but aggressive malignancy, whose treatment is completely different from that of squamous cell carcinoma, a malignancy which is commonly associated with IP. We also performed a PubMed review of the literature to identify the incidence and pathological diagnosis of associated malignancy. Among a total of 5286 cases of sinonasal IP (61 studies), the incidence of associated malignancy was 8.02% in squamous cell carcinoma, 0.19% in transitional cell carcinoma, 0.04% in mucoepidermoid carcinoma, 0.02% in verrucous cell carcinoma and 0.02% in adenocarcinoma. The incidence of associated malignancy was significantly higher in East and Southeast Asia (11.0%) and North America (10.4%) than in Europe (3.9%) (p=0.04 and p=0.03, respectively; T-test).
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25
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Lee JJ, Ahmad Z AM, Kim D, Ryu G, Kim HY, Dhong HJ, Chung SK, Hong SD. Comparison Between Endoscopic Prelacrimal Medial Maxillectomy and Caldwell-Luc Approach for Benign Maxillary Sinus Tumors. Clin Exp Otorhinolaryngol 2018; 12:287-293. [PMID: 30458603 PMCID: PMC6635712 DOI: 10.21053/ceo.2018.01165] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/04/2018] [Indexed: 11/26/2022] Open
Abstract
Objectives Endoscopic prelacrimal medial maxillectomy (EPMM) was previously reported to treat maxillary inverted papilloma. This study aimed to compare prelacrimal recess approach with the conventional Caldwell-Luc approach (CLA) to remove benign maxillary sinus tumors and to evaluate the usefulness of this approach based on our experience. Methods Ten patients who underwent EPMM at our hospital from January 2013 to December 2017 were reviewed. We also reviewed 30 patients who underwent benign maxillary sinus tumor resection via CLA during the same period. From medical records, postoperative pathological results, complications due to surgery, and recurrence rate were evaluated. Results There were eight inverted papilloma, one ameloblastoma, and one ossifying fibroma in the EPMM group. In the CLA group, all 30 cases were inverted papilloma. There were no cases of failure at gross total removal during surgery, and no recurrences were observed during follow-up in either groups. Mean follow-up period was 13.0 months in CLA group and 10.8 months in EPMM group. Regarding postoperative complications, 11 patients of the CLA group (37%) and three patients of the EPMM group (30%) had numbness around the cheek and upper lip area after surgery (P=0.715). In the CLA group, there were eight patients who had numbness lasting more than 3 months after surgery, and two patients had numbness for more than 1 year. However, facial numbness disappeared within 3 months in all patients in the EPMM group, in which epiphora was not observed. Conclusion EPMM is the effective surgical approach for resecting benign maxillary sinus tumor compared with CLA. Although facial numbness was reported in EPMM, the duration of numbness was shorter than CLA.
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Affiliation(s)
- Jung Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Al-Magribi Ahmad Z
- Department of Otorhinolaryngology-Head and Neck Surgery, Najran University, Najran, Saudi Arabia
| | - Donghyeok Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gwanghui Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hun-Jong Dhong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Kyu Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Intranasal endoscopic prelacrimal recess approach for maxillary sinus inverted papilloma. Eur Arch Otorhinolaryngol 2018; 275:2297-2302. [PMID: 30078130 PMCID: PMC6096575 DOI: 10.1007/s00405-018-5078-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/25/2018] [Indexed: 12/12/2022]
Abstract
Purpose This study aims to determine the indications and effectiveness of transnasal endoscopic prelacrimal recess approach (PLRA) in patients with maxillary sinus inverted papilloma (IP). Methods We retrospectively analyzed 71 patients treated in our institution for maxillary sinus IP between August 2008 and April 2015. 20 patients underwent endoscopic surgery via PLRA. All the patients who had postoperative follow-up for 3 years were enrolled. Demographic data, surgical technique, location of IP attachment, intra- and postoperative complications, follow-up duration and recurrence were recorded. Results The outpatient follow-up period was 3–10 years after surgery. Recurrence of IP was seen in 6 (8.5%) of 71 patients, including 1 patient in the PLRA group. The recurrence rate was 5% in the PLRA group. Six of 71 patients experienced postoperative complications, but none was observed in the PLRA group. Conclusion Transnasal endoscopic PLRA is a minimally invasive, safe and effective method for maxillary sinus IP. The indication for PLRA is tumor pedicle located on the antero-inferior or infero-lateral wall or at multiple attachment sites of the maxillary sinus.
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Robinson SR, Baird R, Le T, Wormald PJ. The Incidence of Complications after Canine Fossa Puncture Performed during Endoscopic Sinus Surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900215] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with extensive disease affecting the maxillary sinus may require a canine fossa approach for complete removal of disease. This study was designed to determine the complications associated with this procedure. Methods We performed a retrospective study of 21 patients who had undergone a canine fossa puncture at an academic hospital complex in Adelaide, Australia. Results A total of 37 canine fossa punctures were made in 21 patients. Twenty-eight of the 37 (75.7%) sides in which a canine fossa puncture was performed experienced a complication. The most common complaint was of cheek swelling in 14 (38%) followed by facial pain in 12 (32%), facial numbness in 11 (30%), cheek pain in 10 (27%), dental numbness in 10 (27%), gingival complications in 9 (24%), and facial tingling in 6 (16%) of sides. Most complications (75.5%) resolved within the 1st month after surgery. Six patients (28.6%) had persistent complications with facial tingling in 3 patients (50%) followed by facial numbness and tingling in 1 patient (11%), facial numbness alone in 1 patient (8.3%), and facial pain in 1 patient (7.1%). Conclusion Canine fossa antrostomy is a technique that provides additional access to the maxillary sinus. Surgeons need to be aware that, although minor, a significant number of patients will experience both transient and long-term complications.
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Affiliation(s)
- Simon R. Robinson
- Department of Surgery–Otolaryngology Head and Neck Surgery, Adelaide and Flinders Universities, South Australia, Australia
| | - Robert Baird
- Department of Surgery–Otolaryngology Head and Neck Surgery, Adelaide and Flinders Universities, South Australia, Australia
| | - Tong Le
- Department of Surgery–Otolaryngology Head and Neck Surgery, Adelaide and Flinders Universities, South Australia, Australia
| | - Peter John Wormald
- Department of Surgery–Otolaryngology Head and Neck Surgery, Adelaide and Flinders Universities, South Australia, Australia
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Sautter NB, Cannady SB, Citardi MJ, Roh HJ, Batra PS. Comparison of Open versus Endoscopic Resection of Inverted Papilloma. ACTA ACUST UNITED AC 2018; 21:320-3. [PMID: 17621817 DOI: 10.2500/ajr.2007.21.3020] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Lateral rhinotomy with medial maxillectomy has served as the standard for surgical management of inverted papilloma (IP) in the pre–endoscopic era; since the late 1980s, endoscopic techniques have emerged as the minimally invasive alternative. The objective of this study was twofold: (1) to compare operative parameters, complications, and recurrence rates and (2) predictive factors for recurrence for open versus endoscopic cases of IP resection. Methods Retrospective data analysis was performed on 68 patients with histopathologically confirmed IP treated at a tertiary care medical center from January 1983 to May 2005. Parameters for comparison included operative time (OT), estimated blood loss (EBL), length of hospital stay (HS), complications, and recurrence rate. Predictive factors for recurrence including open versus endoscopic cases, primary versus secondary IP, and tumor by Krouse stage were analyzed. Results The average age at time of presentation was 57.4 years with a male/female ratio of 2.2:1. Forty-nine patients underwent endoscopic resection, 13 patients underwent open resection, and 6 patients underwent limited open resection. Average OT and EBL were statistically similar for the three groups, whereas the average HS was statistically shorter (p = 0.002) for the endoscopic group. Biopsy-proven recurrence was noted in 11 (22%) endoscopic cases, 5 (39%) open cases, and 3 (50%) limited open cases. After reresection, all patients were free of disease. Mean follow-up was 16 months, 56 months, and 69 months for the endoscopic, open, and limited open groups, respectively. Analysis of predictive factors indicated that the surgical approach and primary versus secondary IP, regardless of approach, did not statistically impact recurrence rate. Chi-square analysis illustrated that patients with advanced-stage IP had a higher risk of recurrence (p = 0.002), regardless of surgical technique. Conclusion In this series, endoscopic resection of IP was associated with shorter HS and equivalent EBL and OT compared with the open groups. The overall recurrence rate was lower in the endoscopic group with acceptable morbidity compared with the open and limited open groups. Thus, the endoscopic approach may serve as a superior alternative to the open approaches for successful extirpation of IP.
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Affiliation(s)
- Nathan B Sautter
- Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Dubin MG, Sonnenburg RE, Melroy CT, Ebert CS, Coffey CS, Senior BA. Staged Endoscopic and Combined Open/Endoscopic Approach in the Management of Inverted Papilloma of the Frontal Sinus. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900504] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The endoscopic management of inverted papilloma has gained increasing popularity over the last 10 years. Although early concerns over an increased risk of recurrence seem to have been allayed, the appropriate management of lesions involving the frontal sinus and frontal recess still has to be determined. Methods We performed a retrospective review of the results of all patients with inverted papilloma from 2000 to 2004. Results A total of 18 patients were treated between October 2000 and January 2004. Six patients had frontal sinus involvement at the time of initial evaluation. One of these patients had isolated frontal sinus involvement. These patients were managed with either initial endoscopic resection with determination for the need for an additional procedure at the time of endoscopic resection (n = 5) or open/endoscopic approach for isolated frontal sinus involvement (n = 1). Of the five patients who had their disease managed endoscopically, three patients were determined at the initial procedure to need an osteoplastic flap and, subsequently, were managed successfully with a combined approach. One other patient was initially successfully managed endoscopically but ultimately required an osteoplastic flap for definitive management. The fifth patient was managed entirely endoscopically with multiple procedures. All patients treated with this protocol remain disease free with an average follow-up of 13.3 months. Conclusion The limitations of endoscopic resection of inverted papilloma of the frontal recess can be managed with staged procedures. Initial endoscopic resection of ethmoid/maxillary disease with subsequent open treatment of the frontal sinus has been successful in our experience.
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Affiliation(s)
- Marc G. Dubin
- Department of Otolaryngology–HNS Johns Hopkins University, Baltimore, Maryland
| | - Robert E. Sonnenburg
- Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology, Allergy, and Sinus Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher T. Melroy
- Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology, Allergy, and Sinus Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles S. Ebert
- Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology, Allergy, and Sinus Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles S. Coffey
- Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology, Allergy, and Sinus Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brent A. Senior
- Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology, Allergy, and Sinus Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Kamel R, Khaled A, Kandil T. Inverted Papilloma: New Classification and Guidelines for Endoscopic Surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900407] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Surgery is the gold standard in the management of inverted papilloma (IP); however, the approach and extent of the surgical procedure are still controversial. Moreover, there is still no universal staging system of IP to plan surgery and/or evaluate results. We performed a retrospective study. Methods A new classification depending on the origin of the lesion was used to plan surgery in 70 cases of IP. Conservative transnasal endoscopic excision was performed in lesions arising from the nasal septum and lateral nasal wall (type I IP, 42 cases) and radical transnasal endoscopic medial maxillectomy was performed in lesions arising from the maxillary sinus (type II IP, 28 cases). Results Excluding cases with a follow-up of <2 years, follow-up for periods ranging between 2 and 13.3 years with a median of 78 months showed recurrence in a single case of type I (3.2%) and 2 cases of type II (9.5%). Conclusion The new classification system, based on the origin of IP, is a simple tool for grading IP. It can be used to define cases suitable for conservative excision or radical medial maxillectomy. Both could be performed transnasally and endoscopically.
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Affiliation(s)
| | | | - Tarek Kandil
- Student's Hospital, Cairo University, Cairo, Egypt
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Miyazaki T, Haku Y, Yoshizawa A, Iwanaga K, Fujiwara T, Mizuta M, Yoshida A, Satou S, Tamaki H. Clinical features of nasal and sinonasal inverted papilloma associated with malignancy. Auris Nasus Larynx 2018; 45:1014-1019. [PMID: 29548524 DOI: 10.1016/j.anl.2018.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/16/2018] [Accepted: 02/27/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Nasal and sinonasal inverted papilloma (IP) are rare benign tumors and have the potential to exhibit malignancy in approximately 10% of cases. This study aimed to analyze the clinical features of IP associated with malignancy. Furthermore, we reviewed our therapeutic strategy and the clinical course of malignant IP. METHODS Overall, 70 patients with IP at our institution were retrospectively analyzed from April 2006 to December 2015; of these, six (9%) had associated malignancy. Data was collected on sex, age, presenting symptoms (nasal bleeding, rhinorrhea, facial or cheek pain, and nasal obstruction), bone destruction, and extent of disease on CT and MRI. Categorical data of patients with and without malignancy were compared using the chi-square test. A p value of <0.05 was considered statistically significant. Our therapeutic strategy for IP with malignancy, particularly the surgical procedure, i.e., the external incision or the endoscopic nasal approach, varied based on when the carcinoma was detected. In addition, we considered postoperative radiation therapy depending on histological examination. RESULTS Nasal bleeding (p<0.001), pain (p=0.040), bone destruction (p<0.001), and extent of disease (p=0.026) on CT and MRI findings were significantly associated with malignancy. Carcinoma was diagnosed preoperatively in two (33%) and postoperatively in four patients (67%). We operated five patients (one case was not treated because of end-stage pancreatic cancer). Two patients underwent endoscopic sinus surgery (ESS) alone, two ESS plus Denker's method, and one ESS plus anterior craniotomy. Three patients underwent surgery only, and two patients received postoperative radiotherapy. The median follow-up period was 69.3 months. One patient died of the disease and the remaining patients are alive without recurrence. CONCLUSION For IP patients exhibiting these clinical findings preoperatively, we should suspect complication with malignancy and plan a treatment. Even if postoperative histology does not confirm malignancy, we should ensure careful observation because of metachronous malignant transformation or the possibility to overlook small malignant lesions. Our result suggests that our strategy for malignant IP could be a reasonable option.
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Affiliation(s)
- Takuya Miyazaki
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
| | - Yasuharu Haku
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Akira Yoshizawa
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Ken Iwanaga
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Takashi Fujiwara
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Masanobu Mizuta
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Atsuhiro Yoshida
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Shinichi Satou
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Hisanobu Tamaki
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
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Wang F, Yang Y, Wang S, Chen H, Wang D, Wang Q. Management of maxillary sinus inverted papilloma via endoscopic partial medial maxillectomy with an inferior turbinate reversing approach. Eur Arch Otorhinolaryngol 2017; 274:4155-4159. [PMID: 28936551 DOI: 10.1007/s00405-017-4749-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023]
Abstract
The aim of this study is to evaluate the efficacy of endoscopic treatment for maxillary inverted papilloma (IP) through partial medial maxillectomy with an inferior turbinate reversing approach. A retrospective analysis of patients treated in our institution for maxillary sinus IP between July 2011 and August 2015 was performed. Demographics, operative technique, characteristics of tumors, complications, postoperative follow-up, and recurrence were evaluated. Twenty-two patients were enrolled in the study. All tumor attachments were identified intraoperatively. Adequate visualization was obtained following our approach. All inferior turbinate and nasolacrimal ducts were preserved. The median follow-up time was 41 months. One recurrence occurred at the follow-up time of 27 months. Postoperative hemorrhage and numbness at the ipsilateral frontal teeth were reported in two and one patients, respectively. Endoscopic surgery through partial medial maxillectomy using an inferior turbinate reversing approach provides full access to the maxillary sinus and preserves the inferior turbinate and nasolacrimal duct.
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Affiliation(s)
- Feng Wang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Yang Yang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Shenqing Wang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Haihong Chen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Dehui Wang
- Department of Otolaryngology, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Qinying Wang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China. .,, 79 Qingchun Road, Hangzhou, 310001, China.
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Zydroń R, Marszałek A, Bodnar M, Kosikowski P, Greczka G, Wierzbicka M. The analysis of expression of p16 protein in group of 53 patients treated for sinonasal inverted papilloma. Braz J Otorhinolaryngol 2017; 84:338-343. [PMID: 28479047 PMCID: PMC9449244 DOI: 10.1016/j.bjorl.2017.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/19/2017] [Accepted: 03/28/2017] [Indexed: 01/04/2023] Open
Abstract
Introduction Sinonasal inverted papilloma constitute relevant therapeutic problem due to destructive character of growth, tendency to recur and the possibility of malignant transformation. Therefore, many attempts to identify risk factors for inverted papilloma occurrence have been undertaken, as well as research to find markers that would allow for the earlier detection of tumors and the application of adequate therapy. A widely known risk factor of inverted papilloma is HPV infection. One of the markers of HPV infection and the ongoing effect of this change (although arousing some controversy) is the expression of the p16 protein. Objective The aim of the study was to analyze the correlation between the expression of p16 as a surrogate of HPV infection in analyzed histopathological material and epidemiological variables, recurrences or malignant transformation. Methods The retrospective study includes a group of 53 patients (18 women and 35 men) undergoing treatment for sinonasal inverted papilloma in the period of 2002–2012. The intensity of the p16 protein in histopathological material was scored as: 0 – no expression, 1 – diffuse expression (borderline) and 2 – positive expression; or 0 – no expression/diffuse expression (borderline); 1 – positive expression. The Ethics Committee agreement was obtained (1089/12; 245/13). Results and conclusion There was no statistically significant relationship between the expression of p16 and the age of patients, cigarette smoking, tumor location, tumor staging according to the Krouse and Cannady classification, the presence of dysplasia or the occurrence of relapse.
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Affiliation(s)
- Roland Zydroń
- Poznan University of Medical Sciences, Department of Otolaryngology and Oncological Laryngology, Poznan, Poland.
| | - Andrzej Marszałek
- Nicolaus Copernicus University in Torun, Collegium Medicum, Department of Clinical Pathomorphology, Bydgoszcz, Poland; Poznan University of Medical Sciences & Greater Poland Cancer Center, Oncologic Pathology and Prophylaxis Department, Poznan, Poland
| | - Magdalena Bodnar
- Poznan University of Medical Sciences, Department of Otolaryngology and Oncological Laryngology, Poznan, Poland; Nicolaus Copernicus University in Torun, Collegium Medicum, Department of Clinical Pathomorphology, Bydgoszcz, Poland
| | - Paweł Kosikowski
- Poznan University of Medical Sciences, Department of Otolaryngology and Oncological Laryngology, Poznan, Poland; Poznan University of Medical Sciences, Department of Clinical Patomorphology, Poznan, Poland
| | - Grażyna Greczka
- Poznan University of Medical Sciences, Department of Otolaryngology and Oncological Laryngology, Poznan, Poland
| | - Małgorzata Wierzbicka
- Poznan University of Medical Sciences, Department of Otolaryngology and Oncological Laryngology, Poznan, Poland
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"TuNa-saving" endoscopic medial maxillectomy: a surgical technique for maxillary inverted papilloma. Eur Arch Otorhinolaryngol 2017; 274:2785-2791. [PMID: 28374054 DOI: 10.1007/s00405-017-4549-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/21/2017] [Indexed: 12/18/2022]
Abstract
The maxillary sinus is the most common site of sinonasal inverted papilloma. Endoscopic sinus surgery, in particular endoscopic medial maxillectomy, is currently the gold standard for treatment of maxillary sinus papilloma. Although a common technique, complications such as stenosis of the lacrimal pathway and consequent development of epiphora are still possible. To avoid these problems, we propose a modification of this surgical technique that preserves the head of the inferior turbinate and the nasolacrimal duct. A retrospective analysis was performed on patients treated for maxillary inverted papilloma in three tertiary medical centres between 2006 and 2014. Pedicle-oriented endoscopic surgery principles were applied and, in select cases where the tumour pedicle was located on the anterior wall, a modified endoscopic medial maxillectomy was carried out as described in this paper. From 2006 to 2014 a total of 84 patients were treated. A standard endoscopic medial maxillectomy was performed in 55 patients (65.4%), while the remaining 29 (34.6%) had a modified technique performed. Three recurrences (3/84; 3.6%) were observed after a minimum follow-up of 24 months. A new surgical approach for select cases of maxillary sinus inverted papilloma is proposed in this paper. In this technique, the endoscopic medial maxillectomy was performed while preserving the head of the inferior turbinate and the nasolacrimal duct ("TuNa-saving"). This technique allowed for good visualization of the maxillary sinus, good oncological control and a reduction in the rate of complications.
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Oya R, Shikina T, Takenaka Y, Uno A, Horii A, Inohara H. Endoscopic repair through the medial wall of maxillary sinus for blowout fracture of the inferior orbital wall: a case report. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2017.1303605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Ryohei Oya
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takashi Shikina
- Department of Otorhinolaryngology Head and Neck Surgery, Ikeda Municipal Hospital, Osaka, Japan
| | - Yukinori Takenaka
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Atsuhiko Uno
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Arata Horii
- Department of Otorhinolaryngology Head and Neck Surgery, Niigata University Graduate School of Medicine and Dentistry, Niigata, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Suzuki M, Nakamura Y, Yokota M, Ozaki S, Murakami S. Modified transnasal endoscopic medial maxillectomy through prelacrimal duct approach. Laryngoscope 2017; 127:2205-2209. [PMID: 28295338 DOI: 10.1002/lary.26529] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/04/2017] [Accepted: 01/17/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We previously reported a modified endoscopic medial maxillectomy (modified transnasal endoscopic medial maxillectomy through prelacrimal duct approach [MTEMMPDA]) to resect inverted papilloma (IP), for which the inferior turbinate (IT) and nasolacrimal duct (ND) can be preserved. MTEMMPDA is a safe and effective method to obtain wide, straight access to the maxillary sinus (MS). However, there are few reported cases of patients who underwent MTEMMPDA, and even fewer of patients who underwent partial osteotomy of the apertura piriformis and the anterior wall of the MS. In this study, we analyzed the outcomes of 51 patients who underwent MTEMMPDA. STUDY DESIGN Retrospective review. METHODS All patients who underwent MTEMMPDA at our hospital between January 2004 and December 2015 were included in this study. RESULTS Fifty-one patients with sinonasal IP in the MS underwent MTEMMPDA. Recurrence was seen in the MS of one patient (follow-up of 2-138 months). The IT remained unchanged in all 51 patients without atrophy. We have not observed epiphora, eye discharge, dry nose, or persistent crusting after this surgery. Although seven patients had numbness around the upper lip after surgery, this had disappeared by 1 year after surgery. Additional partial osteotomy of the apertura piriformis and the anterior wall of the MS were done in eight patients. Deformation of the external nose was not seen. CONCLUSION This approach appears to be a safe and effective method to resect IP in the MS, even if there is additional partial osteotomy of the apertura piriformis and the anterior wall of the MS. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2205-2209, 2017.
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Affiliation(s)
- Motohiko Suzuki
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Yoshihisa Nakamura
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Makoto Yokota
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Shinya Ozaki
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Shingo Murakami
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
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Transection of Nasolacrimal Duct in Endoscopic Medial Maxillectomy: Implication on Epiphora. J Craniofac Surg 2016; 26:e616-9. [PMID: 26468843 DOI: 10.1097/scs.0000000000002115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Management of the nasolacrimal system is usually recommended during medial maxillectomy via external approach because of reported higher rates of postoperative epiphora. Association of the endoscopic medial maxillectomy (EMM) with epiphora, however, is not clearly stated. In this study, we attempted to evaluate whether patients develop epiphora after simple transection of the nasolacrimal duct during EMM. PATIENTS AND METHODS Medical records of 26 patients who underwent endoscopic tumor resection for inverted papilloma (IP) were retrospectively reviewed. Patients who underwent EMM with nasolacrimal canal transection were included and recalled for lacrimal system evaluation. Twelve patients were eligible for inclusion and fluorescein dye disappearance test (FDDT) was performed for each patient. Patient demographics, tumor data, surgical procedures, and follow-up time were recorded. RESULTS Of the 12 patients included in the study, 6 underwent canine fossa transantral approach concurrently with EMM. The mean duration of follow-up was 21.1 months (range, 6-84 months). Eight patients were graded as 0, whereas 4 patients were graded as 1 according to FDDT. All test results were interpreted as negative for epiphora. All patients were completely symptom free of epiphora. CONCLUSIONS Epiphora after EMM with nasolacrimal canal transection among patients with sinonasal tumors appears to be uncommon. Therefore, prophylactic concurrent management of nasolacrimal system including stenting, dacryocystorhinostomy (DCR), or postoperative lacrimal lavage are not mandatory for all patients.
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Khandekar S, Dive A, Mishra R, Upadhyaya N. Sinonasal inverted papilloma: A case report and mini review of histopathological features. J Oral Maxillofac Pathol 2016; 19:405. [PMID: 26980974 PMCID: PMC4774299 DOI: 10.4103/0973-029x.174644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Inverted papilloma is a benign epithelial growth in the underlying stroma of the nasal cavity and paranasal sinuses. The pathogenesis of this lesion remains unclear although allergy, chronic sinusitis and viral infections have been suggested as possible causes. The tumor is well known for its invasiveness, tendency to recur and association with malignancy. Recurrence rates of inverted papilloma are unacceptably high, which actually represents residual disease in most cases. In this study, we have presented a case report and reviewed the histological features of sinonasal inverted papilloma.
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Affiliation(s)
- Shubhangi Khandekar
- Department of Oral and Maxillofacial Pathology, V.S.P.M.D.C.R.C, Nagpur, Maharashtra, India
| | - Alka Dive
- Department of Oral and Maxillofacial Pathology, V.S.P.M.D.C.R.C, Nagpur, Maharashtra, India
| | - Rakesh Mishra
- Department of Otorhinolaryngology, Hind Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Upadhyaya
- Department of Oral and Maxillofacial Pathology, C.D.C.H, Lucknow, Uttar Pradesh, India
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Ungari C, Riccardi E, Reale G, Agrillo A, Rinna C, Mitro V, Filiaci F. Management and treatment of sinonasal inverted papilloma. ANNALI DI STOMATOLOGIA 2016; 6:87-90. [PMID: 26941894 DOI: 10.11138/ads/2015.6.3.087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The aim of this paper is to describe the surgical experience of 35 patients with Inverted Papilloma (IP) of paranasal sinuses and its recurrence rate after a year of follow-up. MATERIALS A retrospective chart review was performed on patients presenting with IP of paranasal sinuses. Thirty-five patients comprised the focus of this study. For all patients was performed a pre-surgery TC, and for more 5 patients it was necessary to perform a Magnetic Resonance (MR) with gadolinium. RESULTS Among 35 patients selected, 18 patients underwent to open surgery, 4 patients had a combined approach with endoscopy and open surgery, while 13 patients were managed only with an endoscopic approach, with a minimum of 1 year of follow-up. Our results highlighted that the global percentage of success 12 months after the treatment was 93% and it not vary according to the tipology of the approach used if a radical excision of the lesion is achieved. More in depth, among 35 cases, only 2 patients were found to have recurrences and were treated with coronal and endoscopic approach. CONCLUSION It is fundamental to underline that surgery must be carried on in a radical manner to treat these tend to recur. A complete removal of the lesion and bone peripheral border filing are essential to perform a correct and definitive treatment. Also, endoscopic approach can be taken into account when tumors are localized median to a sagittal plan crossing the orbit median wall and when they did not massively compromised paranasal sinus walls.
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Affiliation(s)
- Claudio Ungari
- Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Italy
| | - Emiliano Riccardi
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Gabriele Reale
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Alessandro Agrillo
- Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Italy
| | - Claudio Rinna
- Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Italy
| | - Valeria Mitro
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Fabio Filiaci
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Italy
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Nygren A, Kiss K, von Buchwald C, Bilde A. Rate of recurrence and malignant transformation in 88 cases with inverted papilloma between 1998-2008. Acta Otolaryngol 2016; 136:333-6. [PMID: 26838581 DOI: 10.3109/00016489.2015.1116123] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Conclusions The recurrence rate of IP in the current study is comparable to international and national studies. When the primary tumour was located in the frontal or the sphenoid sinus, the tumour seemed more likely to recur. Some recurrences were more than 2 years after primary surgery, suggesting continued need for long-term follow-up. The rate of malignant transformation in inverted papilloma cases has not changed in Denmark. Objectives Inverted papillomas are benign tumours located in the nasal cavity and paranasal sinuses. They are known for their tendency to recur after surgery and show invasive growth, causing bone remodulation and the association with malignant transformation. The introduction of endoscopic sinus surgery and computer aided sinus surgery over the last decades has made this tumour more approachable with less cosmetic and functional damage. The objective of this study is to establish whether the recurrence rate and the rate of malignant transformation of IP have changed with the application of these new techniques. Method A retrospective study between 1998-2008 including 88 cases with inverted papilloma. Results In total, 25.3% had recurrence. Combined surgical approach with endoscope/open approach had the lowest rate of recurrence. A malignant transformation in the postoperative histological examination was found in 8.9%.
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Affiliation(s)
- Alexander Nygren
- a Department of Otolaryngology , Head & Neck Surgery, Copenhagen University Hospital , Copenhagen , Denmark
| | - Katalin Kiss
- b Department of Pathology , Copenhagen University Hospital , Copenhagen , Denmark
| | - Christian von Buchwald
- a Department of Otolaryngology , Head & Neck Surgery, Copenhagen University Hospital , Copenhagen , Denmark
| | - Anders Bilde
- a Department of Otolaryngology , Head & Neck Surgery, Copenhagen University Hospital , Copenhagen , Denmark
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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Nomura K, Arakawa K, Fujishima F, Yamazaki Y, Ozawa D, Nomura Y, Hidaka H, Yoshida N, Katori Y. Minimally Invasive Treatment for Hard Palate-Invading Maxillary Keratocystic Odontogenic Tumor. TOHOKU J EXP MED 2015; 237:267-72. [PMID: 26567556 DOI: 10.1620/tjem.237.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Keratocystic odontogenic tumor (KCOT) is one of the benign developmental odontogenic cystic lesions arising from impacted teeth. In comparison to other odontogenic cysts, such as radicular cysts and dentigerous cysts, KCOT is known to be more aggressive and is associated with a relatively high recurrence rate. Traditionally, KCOT has been treated with total resection through sublabial incision. Marsupialization is advocated to reduce surgical invasion. However in all the cases, marsupialization was performed in the oral cavity. With the recent development of appropriate instruments and the endoscopic modified medial maxillectomy (EMMM) technique, which allows preservation of the inferior turbinate and nasolacrimal duct, an exclusive endoscopic approach to KCOT becomes possible. However, when the KCOT invades the hard palate, total resection of the tumor requires subtotal maxillectomy including hard palate. Consequently, as the maxillary sinus connects to the oral cavity, life-long use of a prosthesis becomes mandatory. Here we report a case of a seventeen-year-old female with a hard palate-invading KCOT who was successfully treated with the EMMM approach. The KCOT was fenestrated to the nasal cavity, leading to preservation of the hard palate. The lesion invading the hard palate was found to remain unchanged over one year upon follow-up. The trans-nasal approach with EMMM is a direct, minimally invasive method providing a direct field of view for the treatment of maxillary odontogenic cysts. Marsupialization of the KCOT with the EMMM technique might be a viable treatment option if the maxillary KCOT invades surrounding structures.
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Affiliation(s)
- Kazuhiro Nomura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
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Zhou B, Huang Q, Shen PH, Cui SJ, Wang CS, Li YC, Yu ZK, Chen XH, Ye T. The intranasal endoscopic removal of schwannoma of the pterygopalatine and infratemporal fossae via the prelacrimal recess approach. J Neurosurg 2015; 124:1068-73. [PMID: 26339855 DOI: 10.3171/2015.3.jns132702] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study was undertaken to analyze the results of a novel surgical method-the endoscopic prelacrimal recess approach (PLRA)-in patients with tumors involving the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). The surgical technique and indications for this approach are also discussed. METHODS The authors analyzed data from 7 cases involving patients who underwent resection of PPF and ITF tumors by means of the endoscopic PLRA from 2004 to 2013. Preoperative and postoperative imaging studies were available in all cases and were reviewed. The surgical specimens were all confirmed to be schwannomas. RESULTS All tumors were completely resected via endoscopic PLRA. There were no recurrences noted over a 28-month follow-up period. In 4 cases, the patients experienced postoperative facial numbness during the first two weeks after surgery, which gradually lessened thereafter. One patient continued to have mild facial numbness at most recent follow-up. The numbness had fully resolved in the other 3 cases. CONCLUSIONS The intranasal endoscopic removal of schwannoma from PPF and ITF via PLRA can spare the whole lateral nasal wall, resulting in a reduction in morbidity. This is a novel minimally invasive surgical method for PPF and ITF tumors.
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Affiliation(s)
- Bing Zhou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing
| | - Qian Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing
| | - Ping-Hung Shen
- Department of Otolaryngology, Kuang-Tien General Hospital, Department of Biotechnology, Hung-Kuang University, Taichung, Taiwan
| | - Shun-Jiu Cui
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing
| | - Cheng-Shuo Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing
| | - Yun-Chuan Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing
| | - Zhen-Kun Yu
- Department of Otolaryngology, Nanjing Tongren Hospital, Nanjing; and
| | - Xiao-Hong Chen
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing
| | - Ting Ye
- Department of Otolaryngology, Beijing Tiantan Hospital, Beijing, China
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Pagella F, Pusateri A, Giourgos G, Tinelli C, Matti E. Evolution in the treatment of sinonasal inverted papilloma: pedicle-oriented endoscopic surgery. Am J Rhinol Allergy 2015; 28:75-81. [PMID: 24717892 DOI: 10.2500/ajra.2014.28.3985] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the literature, the global endoscopic sinus surgery (ESS) success in the treatment of sinonasal inverted papilloma (IP) is 95%. This study was designed to describe a conservative endoscopic approach, based on research of the tumor's pedicle and treatment concentrated on its site of attachment, and to compare the results of this technique with the outcome of standard endoscopic treatment. METHODS Retrospective analysis of the patients treated in our institution for paranasal inverted papilloma (IP), between 2002 and 2011 with a minimum of 18 months follow-up was performed. Group A received a standard ESS including whole sinus demucosization (maxillary, ethmoid, frontal, or sphenoid sinus) and bony wall drilling. Group B patients instead underwent pedicle-oriented endoscopic surgery (POES); in this group, bony demucosization and drilling were selectively conducted around the site of pedicle attachment of the tumor. RESULTS The cohort included 73 patients (median age, 60.5 years; median follow-up, 58 months). Group A/group B consisted of 37/36 patients. IP persistence-recurrence for group A/group B was 0/1 cases. Oncological success for global endoscopic/group A/group B was 98.6% (72/73)/100% (37/37)/97.2% (35/36). We noticed a significant difference in surgical operative time and postoperative complication rate among the groups, in favor of POES technique. CONCLUSION Our data confirm the efficacy of the endonasal endoscopic treatment for sinonasal IP. Moreover, the even more conservative endoscopic treatment proposed (POES) seems to offer good control of the disease, shorter operating times, avoidance of unnecessary surgery with respect to uninvolved structures, and permits a follow-up aimed at the site of the pedicle attachment.
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Affiliation(s)
- Fabio Pagella
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia, Pavia, Italy
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Modification of endoscopic medial maxillectomy: a novel approach for inverted papilloma of the maxillary sinus. The Journal of Laryngology & Otology 2015; 129:159-63. [PMID: 25619402 DOI: 10.1017/s0022215114003144] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe modification to endoscopic medial maxillectomy for treating extensive Krouse stage II or III inverted papilloma of the nasal and maxillary sinus. METHOD Ten patients with inverted papilloma arising from the nasoantral area underwent diagnostic nasal endoscopy, contrast-enhanced computed tomography scanning of the paranasal sinus and pre-operative biopsy of the nasal mass. They were all managed using endoscopic medial maxillectomy and followed up for seven months to three years without recurrence. RESULTS Most patients were aged 41-60 years at presentation, and most were male. Presenting symptoms were nasal obstruction, mass in the nasal cavity and epistaxis. In each case, computed tomography imaging showed a mass involving the nasal cavity and maxillary sinus, with bony remodelling. The endoscopic medial maxillectomy approach was modified by making an incision in the pyriform aperture and removing part of the anterolateral wall of the maxilla bone en bloc. CONCLUSION Modified endoscopic medial maxillectomy providing full access to the maxillary and ethmoid sinuses is described in detail. This effective, reproducible technique is associated with reduced operative time and morbidity.
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Suh JD, Ramakrishnan VR, Thompson CF, Woodworth BA, Adappa ND, Nayak J, Lee JM, Lee JT, Chiu AG, Palmer JN. Inverted papilloma of the sphenoid sinus: risk factors for disease recurrence. Laryngoscope 2014; 125:544-8. [PMID: 25418985 DOI: 10.1002/lary.24929] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/06/2014] [Accepted: 08/25/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Surgical treatment of inverted papilloma (IP) of the sphenoid sinus is complicated by close proximity to vital structures of the skull base. Identifying the site of tumor attachment and achieving complete removal can be challenging compared to IP at other sites. The objective of this study is to illustrate the clinical presentation, management, and risk factors for tumor recurrence for sphenoid IP. STUDY DESIGN Retrospective study. METHODS A multi-institutional, retrospective review of endoscopic resections of IP based within the sphenoid sinus was performed from 1996 to 2014. Demographic and tumor data, operative notes, complications, and recurrence rates were collected. Statistical analysis was performed to identify risk factors for tumor recurrence. RESULTS Forty-eight patients (31 males, 17 females) were identified. Mean age was 57 years, with a median follow-up of 13.6 months (range 6.8-36). Rate of tumor recurrence was 14.6%, with median time to recurrence of 13.1 months. Patients with dysplasia/carcinoma in situ (CIS) had a 3.6 greater rate of recurrence (RR) compared to patients with no dysplasia, approaching significance (RR = 3.6; P = 0.08). Patients with IP attachment sites overlying the optic nerve or carotid artery had a 4.76 greater rate of recurrence compared to other sites (RR = 4.76; P = 0.073). CONCLUSION Sphenoid sinus IP is associated with a 14.6% rate of recurrence after surgery. Potential risk factors for tumor recurrence identified in this study include attachment sites over the optic nerve and carotid artery or evidence of dysplasia or CIS. Close follow-up in the postoperative period is essential for these patients to monitor for tumor recurrence.
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Affiliation(s)
- Jeffrey D Suh
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles
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Dean NR, Illing EA, Woodworth BA. Endoscopic resection of anterolateral maxillary sinus inverted papillomas. Laryngoscope 2014; 125:807-12. [PMID: 25418039 DOI: 10.1002/lary.25033] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Endoscopic medial maxillectomy (EMM) has become the surgical procedure of choice for resection of maxillary sinus inverted papillomas (IPs). Traditionally, IPs pedicled on the anterior and/or lateral walls of the maxillary sinus have required an adjuvant Caldwell-Luc approach due to decreased visualization with transnasal endoscopy in these locations. The objective of the current study is to evaluate outcomes following endoscopic resection of anterolateral maxillary sinus IPs. STUDY DESIGN Prospective case series. SUBJECTS AND METHODS Over 6 years, a total of 35 patients underwent EMM for maxillary sinus IPs located on the anterolateral maxillary wall. Demographics, operative technique, pathology, complications, recurrence, and postoperative follow-up were evaluated. RESULTS The majority of patients were male (71%) with a mean age of 56 years (range 27-83). Most patients (71%) were referred for recurrence after previous attempts at surgical resection. Adequate visualization was obtained following EMM in the majority of patients with use of a 70-degree endoscope and angled instrumentation. The addition of transseptal surgical access was critical to the removal of IPs in 16 patients. No Caldwell-Luc approaches were required. Pathologic dysplasia was identified in nine patients, and three had carcinoma. There were no recurrences with a mean disease-free interval of 29 months (10-72 months). CONCLUSION In the present study, EMM provided excellent surgical access to anterolateral maxillary sinus IPs. The transseptal approach allowed enhanced visualization to this challenging location, previously considered accessible only with external procedures.
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Affiliation(s)
- Nichole R Dean
- Departments of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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He S, Bakst RL, Guo T, Sun J. A combination of modified transnasal endoscopic maxillectomy via transnasal prelacrimal recess approach with or without radiotherapy for selected sinonasal malignancies. Eur Arch Otorhinolaryngol 2014; 272:2933-8. [PMID: 25145643 DOI: 10.1007/s00405-014-3248-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 08/13/2014] [Indexed: 11/27/2022]
Abstract
An external approach for resection of sinonasal tumors is associated with increased morbidity. Therefore, we employed a modified transnasal endoscopic maxillectomy combined with pre and/or postoperative radiotherapy for early stage maxillary carcinomas. It aims to evaluate our early experience with endoscopic resection of selected malignant sinonasal tumors. The medical and radiology records of patients who underwent endonasal endoscopic resection of malignant sinonasal tumors between 2008 and 2012 were retrospectively reviewed. Ten cases of selected malignant tumor were performed to resect by modified transnasal endoscopic maxillectomy. All the patients were without evidence of disease at a mean follow-up of 26.8 months. No major complications were recorded. The mean hospitalization stay was 6.6 days. In very carefully selected cases of malignant tumors, modified transnasal endoscopic maxillectomy is acceptable. The postoperative complication rate is low, cosmetic outcome is excellent and patients do not require a long hospitalization.
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Affiliation(s)
- Shuangba He
- Department of Otolaryngology, Head and Neck Surgery, Anhui Provincial Hospital, Anhui Medical University, Hefei, 230001, Anhui Province, People's Republic of China,
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Vorasubin N, Vira D, Suh JD, Bhuta S, Wang MB. Schneiderian papillomas: comparative review of exophytic, oncocytic, and inverted types. Am J Rhinol Allergy 2013; 27:287-92. [PMID: 23883810 DOI: 10.2500/ajra.2013.27.3904] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sinonasal papillomas are benign epithelial neoplasms arising from Schneiderian mucosa. The three subtypes, exophytic, oncocytic, and inverted (inverted papilloma [IP]), should be distinguished from one another histopathologically. This study (1) highlights the histopathological and clinical differences between the Schneiderian papilloma subtypes and (2) identifies clinical features that potentially predict papilloma subtypes. METHODS A retrospective review was performed of patients with Schneiderian papillomas over an 11-year period. RESULTS Seventy patients with sinonasal papillomas who underwent sinus surgery were identified. There were 50 (71%) male and 20 (29%) female subjects diagnosed at an average age of 53 years (range, 13-80 years). Exophytic (n = 25), oncocytic (n = 9), and IP (n = 37) were identified. IP was associated with transformation into squamous cell carcinoma in three (8%) cases and dysplasia in three (8%) cases. Neither oncocytic nor exophytic subtypes were associated with dysplasia or malignancy. On multivariate analysis of potential predictors of papilloma subtype, history of chronic rhinosinusitis (CRS) and location of papilloma were significantly associated with papilloma subtype. Using classification and regression tree model, papilloma subtypes can be predicted based on presence or absence of CRS and papilloma location with nominal 82.4% accuracy. CONCLUSION The inverted and exophytic type are the most common sinonasal papillomas, with the inverted type having an 8% rate of malignant transformation in this study. In contrast, the oncocytic type was not associated with dysplasia or malignancy in our series despite reports in the literature indicating malignant potential. History of CRS and papilloma location can provide clues to the histological subtype, which is important for surgical planning and patient counseling.
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Affiliation(s)
- Nopawan Vorasubin
- Head and Neck Surgery, University of California-Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095-1624, USA.
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