Endoscopic removal of sinonasal tumors

Yıl 2006, Cilt: 16 Sayı: 2, 72 - 79, 20.03.2006

Erkan Tarhan Alper Nabi Erkan Cüneyt Yılmazer Can Alper Çağıcı Özcan Çakmak

Öz

Objectives: To evaluate the efficacy of endoscopic surgery for sinonasal tumors.Patients and Methods: Clinical records of 20 patients’ 10 males, 10 females; mean age 34; range 12 to 63 years who underwent endoscopic tumor resection with diagnosis of sinonasal tumor between January 1998 and August 2004 were retrospectively reviewed. Patients who were operated by transnasal endoscopic surgery or by combined endo­ scopic or external surgical methods were included in the study. Patients were reviewed for age, sex, pathologic diag­ nosis and tumor location, surgical techniques, need for additional surgery, complications, recurrence and follow-up periods.Results: There were five osteoms, one fibrous dysplasia, one ossifying fibroma, seven inverted papillomas, one oncocitic papilloma, three angiofibromas, one schwanno- ma and one esthesioneuroblastoma. The patients’ follow up period ranged between 6 months and 6 years mean 26 months . The fibrous dysplasia involving the posterior ethmoid sinuses was subtotally resected due to its close proximity to the optic nerve. One of the inverted papilloma of maxillary sinüs was resected by a combined endoscop­ ic and Caldwell-Luc approach. A combined endoscopic intranasal and external frontoethmoidectomy approach was performed for the removal of frontal sinüs schwannoma. Recurrence was observed in one of the inverted papilloma cases. Total removal of the tumors was achieved in ali other cases without any complication or recurrences.Conclusion: Low recurrence rates in our series showed that the endoscopic resection of nasal-paranasal sinüs tumors in selected cases may be an appropriate method as solely or combined with other surgical techniques for experienced surgeons.

Anahtar Kelimeler

Nasal Cavity, paranasal sinüs neoplasms, endo­ scopic surgical procedures, recurrence

Endoskopik sinonazal tümör rezeksiyonu

Öz

Amaç: Sinonazal tümörlerde endoskopik cerrahinin etkinliği değerlendirildi.Hastalar ve Yöntemler: Ocak 1998-Ağustos 2004 tarihleriarasında sinonazal tümör tanısıyla endoskopik tümör rezeksiyonu yapılan 20 hastanın kayıtları retrospektif olarak incelendi. Sadece transnazal endoskopik cerrahi yapılan veya kombine endoskopik ve eksternal cerrahi yöntemler uygulananhastalar çalışmaya alındı. Hastaların yaşları, cinsiyetleri, tümörün patolojik tanısı, yerleşimi, ek cerrahi girişim gereksinimi, uygulanan cerrahi tedavi modalitesi, komplikasyonları, rekürrens gelişimi ve takip süreleri belirlenerek elde edilen sonuçlar değerlendirildi.Bulgular: Olguların beşi osteom, biri fibröz displazi, biri ossifying fibrom, yedisi inverted papillom, biri onkositik papillom,üçü anjiofibrom, biri schwannom, biri estesionöroblastomdu.Hastaların takip süresi 6 ay-6 yıl arasındaydı ort. 26 ay .Posterior etmoid kaynaklı fibröz displazili olguda optik sinireyakın komşuluk nedeniyle endoskopik subtotal rezeksiyonyapıldı. Nazal pasaj ve maksiller sinüsü tutan inverted papillomlu bir hastaya kombine endoskopik ve Caldwell-Luc yaklaşımla tümör rezeksiyonu yapıldı. İnverted papillom tanısıyla endoskopik olarak ameliyat edilen bir olguda cerrahi sonrası nüks gelişti. Frontal sinüse yerleşmiş schwannom olgusunda kombine endoskopik ve eksternal frontoetmoidektomiyaklaşımıyla tümör rezeke edildi. İnverted papillomlu bir hastada rekürrens izlendi. Diğer tüm olgularda komplikasyonsuzolarak total endoskopik tümör eksizyonu yapıldı, bu hastalarda takipte nüks görülmedi.Sonuç: Çalışmamızdaki düşük rekürrens oranları, seçilmişolgularda, özellikle de deneyimli ellerde, endoskopik yaklaşımla tümör rezeksiyonunun tek başına ya da diğer yaklaşımlarla kombine edilerek, düşük morbiditeyle ve güvenle uygulanabilecek bir yöntem olabileceğini göstermektedir

Anahtar Kelimeler

Nazal kavite, paranazal sinüs neoplazileri, endoskopik sinüs cerrahisi, rekürrens

Kaynakça

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