Turbinate-Conserving Medial Maxillectomy for Sinonasal ... · choice for sinonasal IP arising from...
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Poster Design & Printing by Genigraphics ® - 800.790.4001 Mikiya Asako, M.D. & Ph.D. Kansai Medical University, JAPAN Email: [email protected] Phone: +81-72-804-0101 Inverted papilloma is the most frequent variant, representing almost 70% of all sinonasal papillomas and between 0.5 and 7% of all nasal tumors, It has an incidence of 0.52-1.5 per 100,000 cases a year. An association between inverted papilloma and malignancy is controversial. A synchronous carcinoma has been established at diagnosis in 7-8% of cases and the risk of metachronous carcinoma has shown to be less than 3%. The indication of the endoscopic surgery for sinonasal inverted papilloma has been expanded since Dr. Krouse had reported the classification staging system of the inverted papilloma in 2000. Krouse's classification system is probably the most widely used. We had reported most of the T3 cases and the partial of the T4 cases can be treated as endonasal endoscopic surgery. Basically, as our cases of sinonasal papillomas in our hospital have mainly been treated using the endoscopic surgical approach. In recent years, many papers supported the endoscopic medial maxillectomy (EMM) for maxillary inverted papillomas. EMM is one of the best approaches for maxillary tumor arising from the lateral and/or frontal wall of the maxillary sinus. On the other hand, the function of turbinate mucosal membrane will be sacrificed. We presents, turbinate-conserving medial maxillectomy, so-called ‘Swinging- turbinate procedure’, providing wide surgical fields compare favorably with EMM. Turbinate Turbinate - - Conserving Medial Maxillectomy for Sinonasal Inverted Papilloma Conserving Medial Maxillectomy for Sinonasal Inverted Papilloma Mikiya Asako, MD, PhD; Hisashi Ooka, MD; Yohei Takada, MD; Kazuyasu Baba, MD, PhD; Hideyuki Murata, MD, PhD; Kohei Kawamoto, MD, PhD; Satoko Hamada, MD, PhD; Kouichi Tomoda MD, PhD Kansai Medical University, Department of Otorhinolaryngology Japan A total of 57 patients underwent surgery for sinonasal inverted papilloma from January 2006 to August 2011. Most of the T3 cases in Krouse classification could treated with endonasal approaches. We performed eight cases of Swinging-turbinate procedure and eleven cases of EMM. Most of those cases were T3 in Krouse classification. Only one case was recurrence in Swinging-turbinate procedure, that seemed to be the seeding recurrence by piecemeal resection using microdebrider. Figure 2,3 shows a T3 case aged 68 Y.O. Male (case 15 in Table 1). Figure 4 shows post operative view at 7M after operation. No recurrence has occurred in 28 M follow up. EMM is one of the best approach to anteromedial maxillary IP. EMM contribute the excellent operation field, on the other hand EMM have to sacrifice the inferior turbinate and nasolacrimal duct. Many author had reported the various turbinate conserving medial maxillectomy in a few years. We report a new idea of turbinate conserving maxillectomy, called Swinging-turbinate procedure. Swinging-turbinate procedure provide the wide surgical fields compare favorably with EMM conserving the mucosal and nasolacrimal functions. IP of epithelial origin does not therefore have the capacity to invade the underlying bone on its own. However, the surface border between the inverted papilloma and bone is usually pathological and irregular with crevices and variable inflammatory changes. This may lead to mucosal tissue embedded within bony crevices, and such crevices in the deep plane could be potential areas for tumor recurrences. It follows this that important thing is to grind down the bone surface of the base portion of the tumor. It is not important for the operation result that surgical approach is the external or endonasal approach. How to treat the surface border between the inverted papilloma and bone is important. For these reasons, EMM and/or Swinging-turbinate procedure is the ideal methods for the treatment of anteromedial maxillary IP. In addition, swinging- turbinate procedure have an advantage in conserving turbinate function, however, is of equal surgical results. The data used in this study were obtained retrospectively from database that prospectively collects information concerning all patients with IP. From 2006 to 2011, 57 patients with sinonasal inverted papilloma were treated in our hospital (table 1). The extension of papilloma was evaluated preoperatively by nasal endoscopy and CT/MRI in all cases using Krouse classification. When the papilloma involved the anteromedial wall of the maxillary sinus, we performed the turbinate-conserving medial maxillectomy, so-called ‘ Swinging- turbinate procedure. This approach consists of submucosal turbinectomy of the inferior turbinate, and open the medial bony wall of the inferior miatus at the submucosal layer. The nasolacrimal duct will be conserved with the inferior miatus mucosa. And the opening site of the inferior miatus will be connected to the opening site of the ostium. At this moment, swing the mucosal tract including nasolacrimal duct back and forth to conserve nasolacrimal duct. The detail procedure will be shown in schematic drawing (Figure 1). The fuge opening of the maxillary sinus is available without damage to the turbinate mucosa and nasocriminal duct function. The feelings of the surgery is like a ‘endoscopic endonasal Caldwel-Luc’s surgery’. Swinging- turbinate procedure provides not only wide surgical fields but also the good results compare favorably with EMM. Swinging- turbinate procedure can conserve the nasolacrimal duct and the mucosal function of the inferior turbinate. Swinging- turbinate procedure can easily move to EMM if necessary. Swinging- turbinate procedure is probably the first choice for sinonasal IP arising from the frontal wall of the maxillary. The indication of the endoscopic surgery for sinonasal inverted papilloma (IP) has been expanded since Dr. Krouse had reported the classification staging system of the inverted papilloma in 2000. Krouse's classification system is probably the most widely used by ENT surgeons. We had reported most of the T3 cases and the partial of the T4 cases can be treated as endonasal endoscopic surgery. In recent years, many papers supported the endoscopic medial maxillectomy (EMM) for maxillary inverted papillomas. EMM is one of the best approaches for maxillary tumor arising from the lateral and/or frontal wall of the maxillary sinus. On the other hand, the function of turbinate mucosal membrane and nasolacrimal duct will be sacrificed in EMM. We estimate the turbinate-conserving medial maxillectomy, so-called ‘ Swinging- turbinate procedure’, providing wide surgical fields compare favorably with EMM. INTRODUCTION METHODS AND MATERIALS CONCLUSIONS DISCUSSION RESULTS REFERENCES Table 1. sinonasal IP cases Figure 1. approaches in Swinging-turbinate procedure Figure 2. A T3 case for Swinging-turbinate Procedure (case 15 in Table 1) ABSTRACT CONTACT Fifty cases out of Fifty seven was T1 to T3 case in Krouse classification. Seven cases were T4. Four cases were resected by surgery, and two cases were treated concurrent radiotherapy/chemo-radiotherapy. One case of T4 was IP with simultaneous occurrence of adenoid cystic carcinoma. This case was not complete resectable, but the patient’s family does not want the further therapy because of her advanced age. We experienced seven recurrence cases. Case 3 is seeding recurrence after Swinging-turbinate procedure. Most of the other cases are multi- revision surgery or the case without operative diagnosis. In terms of the T2 case, all recurrence cases are external approach such as Caldwel- Luc’s or Denker. In T3 cases, most of the recurrence cases are ESS. RESULTS Figure 3. Intraoperative findings in Swinging-turbinate procedure CT MRI T2 Figure 4. 7M after operation Figure 5. seeding recurrence in case3 An arrow shows recurrence tumor in lateral wall of maxillary sinus. Arrow heads show neovascular vessel Figure 6. Krouse classification and surgical approaches Circle population is recurrence cases. Two cases of external approach for T2 and Four cases of ESS and one case of Swinging for T3 were recurrence. *1: Swinging procedure switched to EMM during operation; *2: Extended central drainage procedure for advanced case ; *3: endoscopic modified Lathrop procedure for the bilateral frontal case. 1. Krouse JH. Development of a staging system for inverted papilloma. Laryngoscope. 2000 Jun;110(6):965-8. 2. Wormald PJ, Ooi E, van Hasselt CA, Nair S. Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy. Laryngoscope. 2003 May;113(5):867-73. 3. Krouse JH. Evolution in the management of inverted papilloma. Otolaryngol Head Neck Surg. 2009 Mar;140(3):336-7. 4. Asako M, et al. Endoscopic Approach to Sinonasal Inverted Papilloma Using the Swinging Technique of Nasolacrimal Duct and Inferior Turbinate. Practica oto- rhino-laryngologica. 2010 June;103(6): 541-546 (in Japanese)
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Transcript of Turbinate-Conserving Medial Maxillectomy for Sinonasal ... · choice for sinonasal IP arising from...
Poster Design & Printing by Genigraphics® - 800.790.4001
Mikiya Asako, M.D. & Ph.D.Kansai Medical University, JAPANEmail: [email protected]: +81-72-804-0101
Inverted papilloma is the most frequent variant, representing almost 70% of all sinonasal papillomas and between 0.5 and 7% of all nasal tumors, It has an incidence of 0.52-1.5 per 100,000 cases a year. An association between inverted papilloma and malignancy is controversial. A synchronous carcinoma has been established at diagnosis in 7-8% of cases and the risk of metachronous carcinoma has shown to be less than 3%. The indication of the endoscopic surgery for sinonasal inverted papilloma has been expanded since Dr. Krouse had reported the classification staging system of the inverted papilloma in 2000. Krouse's classification system is probably the most widely used. We had reported most of the T3 cases and the partial of the T4 cases can be treated as endonasal endoscopic surgery. Basically, as our cases of sinonasal papillomas in our hospital have mainly been treated using the endoscopic surgical approach.
In recent years, many papers supported the endoscopic medial maxillectomy (EMM) for maxillary inverted papillomas. EMM is one of the best approaches for maxillary tumor arising from the lateral and/or frontal wall of the maxillary sinus. On the other hand, the function of turbinate mucosal membrane will be sacrificed.
We presents, turbinate-conserving medial maxillectomy, so-called ‘Swinging- turbinate procedure’, providing wide surgical fields compare favorably with EMM.
TurbinateTurbinate--Conserving Medial Maxillectomy for Sinonasal Inverted PapillomaConserving Medial Maxillectomy for Sinonasal Inverted PapillomaMikiya Asako, MD, PhD; Hisashi Ooka, MD; Yohei Takada, MD; Kazuyasu Baba, MD, PhD; Hideyuki Murata, MD, PhD;
Kohei Kawamoto, MD, PhD; Satoko Hamada, MD, PhD; Kouichi Tomoda MD, PhDKansai Medical University, Department of Otorhinolaryngology Japan
A total of 57 patients underwent surgery for sinonasal inverted papilloma from January 2006 to August 2011. Most of the T3 cases in Krouseclassification could treated with endonasal approaches. We performed eight cases of Swinging-turbinate procedure and eleven cases of EMM. Most of those cases were T3 in Krouse classification. Only one case was recurrence in Swinging-turbinate procedure, that seemed to be the seeding recurrence by piecemeal resection using microdebrider. Figure 2,3 shows a T3 case aged 68 Y.O. Male (case 15 in Table 1).
Figure 4 shows post operative view at 7M after operation. No recurrence has occurred in 28 M follow up.
EMM is one of the best approach to anteromedial maxillary IP. EMM contribute the excellent operation field, on the other hand EMM have to sacrifice the inferior turbinate and nasolacrimal duct. Many author had reported the various turbinate conserving medial maxillectomy in a few years. We report a new idea of turbinate conserving maxillectomy, called Swinging-turbinate procedure. Swinging-turbinate procedure provide the wide surgical fields compare favorably with EMM conserving the mucosal and nasolacrimal functions.IP of epithelial origin does not therefore have the capacity to invade the underlying bone on its own. However, the surface border between the inverted papilloma and bone is usually pathological and irregular with crevices and variable inflammatory changes. This may lead to mucosal tissue embedded within bony crevices, and such crevices in the deep plane could be potential areas for tumor recurrences. It follows this that important thing is to grind down the bone surface of the base portion of the tumor.
It is not important for the operation result that surgical approach is the external or endonasal approach. How to treat the surface border between the inverted papilloma and bone is important. For thesereasons, EMM and/or Swinging-turbinate procedure is the ideal methods for the treatment of anteromedial maxillary IP. In addition, swinging-turbinate procedure have an advantage in conserving turbinate function, however, is of equal surgical results.
The data used in this study were obtained retrospectively from database that prospectively collects information concerning all patients with IP.From 2006 to 2011, 57 patients with sinonasal inverted papilloma were treated in our hospital (table 1). The extension of papilloma was evaluated preoperatively by nasal endoscopy and CT/MRI in all cases using Krouse classification.
When the papilloma involved the anteromedial wall of the maxillary sinus, we performed the turbinate-conserving medial maxillectomy, so-called ‘ Swinging- turbinate procedure. This approach consists of submucosal turbinectomy of the inferior turbinate, and open the medial bony wall of the inferior miatus at the submucosal layer. The nasolacrimal duct will be conserved with the inferior miatus mucosa. And the opening site of the inferior miatus will be connected to the opening site of the ostium. At this moment, swing the mucosal tract including nasolacrimal duct back and forth to conserve nasolacrimal duct. The detail procedure will be shown in schematic drawing (Figure 1). The fuge opening of the maxillary sinus is available without damage to the turbinate mucosa and nasocriminal duct function. The feelings of the surgery is like a ‘endoscopic endonasal Caldwel-Luc’s surgery’.
Swinging- turbinate procedure provides not only wide surgical fields but also the good results compare favorably with EMM. Swinging- turbinate procedure can conserve the nasolacrimal duct and the mucosal function of the inferior turbinate. Swinging- turbinate procedure can easily move to EMM if necessary. Swinging- turbinate procedure is probably the first choice for sinonasal IP arising from the frontal wall of the maxillary.
The indication of the endoscopic surgery for sinonasal invertedpapilloma (IP) has been expanded since Dr. Krouse had reported the classification staging system of the inverted papilloma in 2000. Krouse's classification system is probably the most widely used by ENT surgeons. We had reported most of the T3 cases and the partial of the T4 cases can be treated as endonasal endoscopic surgery.
In recent years, many papers supported the endoscopic medial maxillectomy (EMM) for maxillary inverted papillomas. EMM is one of the best approaches for maxillary tumor arising from the lateral and/or frontal wall of the maxillary sinus. On the other hand, the function of turbinate mucosal membrane and nasolacrimal duct will be sacrificed in EMM. We estimate the turbinate-conserving medial maxillectomy, so-called ‘ Swinging- turbinate procedure’, providing wide surgical fields compare favorably with EMM.
INTRODUCTION
METHODS AND MATERIALS
CONCLUSIONS
DISCUSSIONRESULTS
REFERENCESTable 1. sinonasal IP cases
Figure 1. approaches in Swinging-turbinate procedure
Figure 2. A T3 case for Swinging-turbinate Procedure (case 15 in Table 1)
ABSTRACT
CONTACT
Fifty cases out of Fifty seven was T1 to T3 case in Krouse classification. Seven cases were T4. Four cases were resected by surgery, and two cases were treated concurrent radiotherapy/chemo-radiotherapy. One case of T4 was IP with simultaneous occurrence of adenoid cysticcarcinoma. This case was not complete resectable, but the patient’s family does not want the further therapy because of her advanced age. We experienced seven recurrence cases. Case 3 is seeding recurrence after Swinging-turbinate procedure. Most of the other cases are multi-revision surgery or the case without operative diagnosis. In terms of the T2 case, all recurrence cases are external approach such as Caldwel-Luc’s or Denker. In T3 cases, most of the recurrence cases are ESS.
RESULTS
Figure 3. Intraoperative findings in Swinging-turbinate procedure
CT MRI T2 Figure 4. 7M after operation
Figure 5. seeding recurrence in case3An arrow shows recurrence tumor in lateral wall of maxillary sinus.Arrow heads show neovascular vessel
Figure 6. Krouse classification and surgical approachesCircle population is recurrence cases. Two cases of external approach for T2 and Four cases of ESS and one case of Swinging for T3 were recurrence.
*1: Swinging procedure switched to EMM during operation; *2: Extended central drainage procedure for advanced case ; *3: endoscopic modified Lathrop procedure for the bilateral frontal case.
1. Krouse JH. Development of a staging system for inverted papilloma. Laryngoscope. 2000 Jun;110(6):965-8.
2. Wormald PJ, Ooi E, van Hasselt CA, Nair S. Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy. Laryngoscope. 2003 May;113(5):867-73.
3. Krouse JH. Evolution in the management of inverted papilloma. Otolaryngol Head Neck Surg. 2009 Mar;140(3):336-7.
4. Asako M, et al. Endoscopic Approach to Sinonasal Inverted Papilloma Using the Swinging Technique of Nasolacrimal Duct and Inferior Turbinate. Practica oto-rhino-laryngologica. 2010 June;103(6): 541-546 (in Japanese)
