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ICAR SINONASAL TUMORS

TABLE XI.3 Evidence surrounding management of the nasolacrimal system and role of dacryocystorhinostomy.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Rotsides et al. 347 2019 3

Rate of postop epiphora

Overall, very low rate of epiphora in either group, and no difference noted between transection and marsupialization

Retrospective cohort

All patients underwent endoscopic medial maxillectomy with NLD transection ( n = 13) versus NLD marsupialization ( n = 16)

Sadeghi and Joshi 348

2012 3

Prospective cohort

Endoscopic medial

Rate of postop epiphora

1. No significant difference between maxillectomy with and without DCR with respect to epiphora 2. Concurrent DCR not indicated during endoscopic medial maxillectomy and NLD transection 1. During endoscopic procedures, NLD stenting is not required 2. No increased incidence of epiphora 3. Recurrence most common within the first 2 years postoperatively 1. No evidence of epiphora postoperatively 2. Concurrent DCR or NLD may not be required after medial maxillectomy

maxillectomy with

concurrent DCR ( n = 5) versus

without DCR ( n = 7)

1. Rateof postop

Lombardi et al. 320

2011

4

Retrospective case series

All patients either went purely endoscopic or combined open/endoscopic

epiphora

2. Tumor

recurrence

resection of sinonasal IP ( n = 212)

Imre et al. 346

2010 4

Retrospective case series

All patients underwent endoscopic medial maxillectomy with transection of the NLD( n = 12)

Rate of postop epiphora

Abbreviations: DCR, dacryocystorhinostomy; NLD, nasolacrimal duct.

XII MARGIN ANALYSIS An essential tenet of oncologic surgery is achiev ing negative margins whenever possible. For sinonasal neoplasms, this is true for malignancies, and may apply to some benign tumors such as IP. 106,130,135,140,160,174,181,186,240,241,243,254,360–377 Numer ous studies have shown an association between negative surgical margins and improved recurrence and survival in SNM, underscoring the practi cal importance of this concept (Table XII.1). 106, 130,140,160,161,174,181,186,240,241,243,254,360–367,370–378 Several considerations factor into the process of obtaining nega tive margins including the optimal techniques, location and size of margins, role of frozen section analysis, and when to defer to permanent sections upfront. When endoscopic approaches were first introduced as a potential technique for tumor removal, this was met with concerns that endoscopic approaches can not achieve en bloc resections and were therefore not oncologically sound. Certainly, it is the case that endoscopic resections are more likely to be piecemeal

TOE approaches are characterized for multiportal surgery in the management of intracranial tumors, with respect to sinonasal tumors, orbital transposition and periorbital suspension in TOE surgery were described for the manage ment of frontal sinus tumors. 358,359 Through retrospective and prospective case series done by Karligkiotis et al. and Tilak et al., respectively, periorbital suspension or orbital transposition allows for improved access to far lat eral and superior frontal sinus tumors through a combined transnasal and transorbital corridor with minimal orbital and globe morbidity. 358,359 Aggregate grade of evidence : C (Level 4: three stud ies) Orbital management in the setting of sinonasal tumor pathology is a critical component of surgical planning and has continued to evolve with improvements in anatomical understanding and endoscopic instrumentation. Further investigation should target the specific roles of endo scopic and open craniofacial techniques when considering surgery in the setting of orbital involvement by sinonasal tumors.