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Humbert M, Bastit V, Perreard M, Roussel LM, Senol MK, Hitier M, Patron V. Review of olfactory cleft roof anatomy. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:289-295. [PMID: 37926654 DOI: 10.1016/j.anorl.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Progress in skull-base endoscopic surgery has improved our knowledge of olfactory cleft (OC) anatomy. This article presents a review of current knowledge concerning the OC roof: descriptive anatomy, radiological exploration, and endoscopic observation. The OC is a narrow area in the most superior part of the nasal cavity. Its roof is the thinnest structure separating the nasal cavities from the brain; it comprises three superimposed tissues: nasal mucosa, ethmoid cribriform plate (ECP), and dura mater. The ECP comprises the anterior ECP containing the ethmoidal slit (ES) medially and the cribroethmoidal foramen (CEF) laterally; and the posterior ECP, comprising the olfactory foramina. The OC roof is bordered anteriorly by the nasal bone roof, laterally by the lateral ethmoid masses, and posteriorly by the jugum and anterior wall of the sphenoid sinuses. Imaging is crucial for analyzing this wall, providing precise detailed information on conformation and anatomic relations with adjacent structures such as the anterior ethmoidal artery. Understanding OC roof anatomy and correct interpretation of imaging are essential for safety in present-day functional endoscopic sinus surgery and anterior skull-base oncologic surgery.
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Affiliation(s)
- M Humbert
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; Inserm 1086 ANTICIPE, université de Normandie, Normand, Caen, France.
| | - V Bastit
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; Inserm 1086 ANTICIPE, université de Normandie, Normand, Caen, France
| | - M Perreard
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; Inserm 1086 ANTICIPE, université de Normandie, Normand, Caen, France
| | - L M Roussel
- Service d'ORL, CLCC Henri-Becquerel, 76038 Rouen, France
| | - M K Senol
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France
| | - M Hitier
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; Inserm COMETE, Université de Normandie, Caen, France
| | - V Patron
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; EA 7451 BioConnecT, Université de Normandie, UNICAEN, Caen, France
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Leleu T, Bastit V, Doré M, Kammerer E, Florescu C, Alfonsi M, Troussier I, Bensadoun RJ, Biau J, Blais E, Coutte A, Deberne M, Wiazzane N, Dupin C, Faivre JC, Giraud P, Graff P, Guihard S, Huguet F, Janoray G, Liem X, Pointreau Y, Racadot S, Schick U, Servagi-Vernat S, Sun XS, Thureau S, Villa J, Vulquin N, Wong S, Patron V, Thariat J. Histosurgical mapping of endoscopic endonasal surgery of sinonasal tumours to improve radiotherapy guidance. Cancer Radiother 2021; 26:440-444. [PMID: 34175228 DOI: 10.1016/j.canrad.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/21/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Endoscopic endonasal surgery (EES) is becoming a standard for most malignant sinonasal tumours. Margin analysis after piecemeal resection is complex and optimally relies on accurate histosurgical mapping. Postoperative radiotherapy may be adapted based on margin assessment mapping to reduce the dose to some sinonasal subvolumes. We assessed the use of histosurgical mapping by radiation oncologists (RO). MATERIAL AND METHODS A French practice survey was performed across 29 ENT expert RO (2 did not answer) regarding integration of information on EES, as well as quality of operative and pathology reportsto refine radiotherapy planning after EES. This was assessed through an electronic questionnaire. RESULTS EES was ubiquitously performed in France. Operative and pathology reports yielded accurate description of EES samples according to 66.7% of interviewed RO. Accuracy of margin assessment was however insufficient according to more than 40.0% of RO. Additional margins/biopsies of the operative bed were available in 55.2% (16/29) of the centres. In the absence of additional margins, quality of resection after EES was considered as microscopically incomplete in 48.3% or dubious in 48.3% of RO. As performed, histosurgical mapping allowed radiotherapy dose and volumes adaptation according to 26.3% of RO only. CONCLUSIONS Standardized histosurgical mapping with margin and additional margin analysis could be more systematic. Advantages of accurate EES reporting could be dose painting radiotherapy to further decrease morbidity in sinonasal tumours.
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Affiliation(s)
- T Leleu
- Department of radiation oncology, centre François-Baclesse, Caen, France
| | - V Bastit
- Department of surgery, centre François-Baclesse, Caen, France
| | | | - E Kammerer
- Department of radiation oncology, centre François-Baclesse, Caen, France
| | - C Florescu
- Department of radiation oncology, centre François-Baclesse, Caen, France
| | | | | | | | - J Biau
- CJP, Clermont-Ferrand, France
| | - E Blais
- AP-HP, Pitié-Salpêtrière, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - X S Sun
- CHU, Besançon Montbéliard, France
| | | | | | | | | | - V Patron
- Department of ENT surgery, CHU Caen, Caen, France
| | - J Thariat
- Department of radiation oncology, centre François-Baclesse, Caen, France; Unicaen, Normandie Université, Caen, France; GORTEC, France.
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Gérard M, Le Guevelou J, Jacksic N, Lequesne J, Bastit V, Géry B, Jeanne C, Batalla A, Lacroix J, Kammerer E, Lasne-Cardon A, Thariat J. Postoperative radiotherapy after flap reconstructive surgery in patients with head and neck cancer: A retrospective monocentric study with flap delineation to assess toxicity and relapse. Cancer Radiother 2020; 24:851-859. [PMID: 33129717 DOI: 10.1016/j.canrad.2020.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Flaps are increasingly used during reconstructive surgery of head and neck cancers to improve functional outcomes. There are no guidelines as to whether the whole flap or its anastomotic border should be included in the primary tumour target volume of postoperative radiotherapy to prevent local relapses. Relapse and toxicity rates can increase substantially if the whole flap received full dose. Our aim was to determine whether flaps were included in the primary tumour target volume and to report the patterns of relapse and toxicity. MATERIALS AND METHODS Consecutive patients in 2014 through 2016, with or without a flap, receiving postoperative radiotherapy were selected in a retrospective monocentric control study. Flaps were homogenously delineated blind to treating radiation oncologists using a flap-specific atlas. Tumour recurrence, acute and late toxicity were evaluated using univariate and propensity score analyses. RESULTS A hundred patients were included; 54 with a flap. Median flap volume included in the tumour volume was 80.9%. Twelve patients experienced local recurrences: six with a flap, among whom two within their flap (3.7%). Patients with flaps had larger median tumour volumes to be irradiated (25cm3 versus 58cm3, p<0.001) and higher acute/late toxicity rates (p<0.001) even after adjustment on biases (more advanced T stage, oral cavity, active smoking in patients with flaps). Locoregional recurrence and survival rates were similar between patients with/without a flap. CONCLUSION Recurrences within a flap were rare in this series when including the whole flap body in the 60Gy-clinical target volume but inclusion of the flap in the primary tumour target volume increased toxicity. Multicentric studies are warranted.
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Affiliation(s)
- M Gérard
- Normandie Université, 3, rue General-Harris, 14000 Caen, France; Université de Caen Normandie (UniCaen), esplanade de la Paix, CS 14032, 14032 Caen cedex, France; Commissariat à l'énergie atomique (CEA), 3, rue General-Harris, 14000 Caen, France; Centre national pour la recherche scientifique (CNRS), 3, rue General-Harris, 14000 Caen, France; CervOxy group, Imagerie et stratégies thérapeutiques des pathologies cérébrales et tumorales (ISTCT), boulevard Henri-Becquerel, BP 5229, 14074 Caen cedex 5, France; Groupement d'intérêt public Cyceron, boulevard Henri-Becquerel, BP 5229, 14074 Caen cedex 5, France; Department of radiation oncology, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France
| | - J Le Guevelou
- Department of radiation oncology, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France
| | - N Jacksic
- Department of radiation oncology, centre lutte contre le cancer Eugène-Marquis, Rennes, France
| | - J Lequesne
- Department of clinical research, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France
| | - V Bastit
- Department of head and neck surgery, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France
| | - B Géry
- Department of radiation oncology, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France
| | - C Jeanne
- Department of tissue pathology, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France
| | - A Batalla
- Department of medical physics, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France
| | - J Lacroix
- Department of radiology, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France
| | - E Kammerer
- Department of radiation oncology, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France
| | - A Lasne-Cardon
- Department of head and neck surgery, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France
| | - J Thariat
- Department of radiation oncology, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, rue General-Harris, 14000 Caen, France.
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Le Guevelou J, Bastit V, Marcy P, Guzène L, Gérard M, Larnaudie A, Coutte A, Beddok A, Calugaru A, Johnson A, Géry B, Lasne-Cardon A, Thariat J. Radiothérapie postopératoire des cancers ORL : recommandations de délinéation des lambeaux. Cancer Radiother 2020. [DOI: 10.1016/j.canrad.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bastit V, Bon-Mardion N, Picquenot JM, Rainville V, Moldovan C, François A, El Ouakif F, Jardin F, Marie JP, Di Fiore F, Clatot F. Benefit of cetuximab addition to a platinum-fluorouracil-based chemotherapy in an unselected population of metastatic head and neck cancer patients and effect of KRAS Lcs6 variation on cetuximab response. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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