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KUANetal.

TABLE XVI.3 Evidence surrounding the role of orbital bony resection.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Wanget al. 678

1. Recurrence 2. OS

IP invading the orbit required more aggressive treatment compared to those limited to the nasolacrimal system Endoscopic resection of orbital IP preserved the orbit without recurrence Endoscopic resection of orbital IP provided low rates of recurrence (0/13, 0.0%) and high rates of orbital preservation (13/13, 100.0%) Open resection afforded orbital preservation (5/6, 83.3%) at low risk of recurrence (1/6, 16.7%) An open surgical approach led to high rates of recurrence (8/10, 80.0%) and orbital exenteration (8/10, 80.0%) Open resection led to high recurrence rates (3/4, 75.0%)

2021

4

Retrospective case series

Patients with

periocular IP resected via EEA ( n = 22)

Shinet al. 683

2015 4

Retrospective case series

Patients with tumors involving the orbit ( n = 15; n = 1with IP resected via EEA) Patients with benign or malignant sinonasal tumors involving the orbit; ( n = 41; n = 13with IP resected via EEA)

1. Recurrence 2. Orbital preservation 1. Recurrence 2. Orbital preservation 1. Recurrence 2. Orbital preservation 1. Recurrence 2. Orbital preservation

Christianson et al. 336

2015 4

Retrospective case series

Saldana et al. 681

2013 4

Retrospective case series

Patients with IP

invading the orbit and open resection ( n = 6) invading the orbit and open resection ( n = 10)

Elner et al. 679

1995 4

Retrospective case series

Patients with IP

Johnson

1984 4

Retrospective case series

Patients with sinonasal tumors invading the orbit ( n = 47; n = 4 with IP resected openly)

1. Recurrence

et al. 680

Abbreviations: EEA, endoscopic endonasal approach; IP, inverted papilloma; OS, overall survival.

resection specimens confirming that bony resection is vital in addressing IP lesions. 687 The areas of skull base attachment should be definitively managed (e.g., drilled, cauterized, or completely resected; can spare dura when there is no malignancy) to decrease the risk of recurrence. Mucosal stripping, however, is not adequate for complete removal (Table XVI.4). 410 Special consideration must be taken for frontal sinus lesions with skull base involvement. The Draf III or peri orbital suspension techniques can be used to access the superior and lateral extents of the sinus. 359,690 Combined open and endoscopic approaches, like the transpalpebral orbitofrontal craniotomy, may also be utilized if the tumor cannot be completely accessed endoscopically. 691,692 Role of orbital resection for inverted papilloma

Harm

Small potential for orbital injury. Baseline risk of epistaxis and postoperative pain.

Cost

Associated costs with surgery.

Benefits–harm assessment

Preponderance of benefits over harms.

Value

Determining involvement of orbit on preoperative imaging is helpful for preoperative planning and patient counseling. There are limited data to suggest that lamina resection may lead to orbital soft tissue seeding/recurrence.

judgments

Policy level Recommendation. Intervention Perform resection or drilling of hyperostotic focus for orbital IP with lamina papyracea involvement.

Role of skull base resection for inverted papilloma Aggregate grade of evidence C (Level 4: six studies) Benefit Lower recurrence rates with reduced morbidity.

Aggregate grade of evidence

C (Level 4: six studies)

Benefit

Lower recurrence rates with improved orbital preservation.

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