Endoscopic medial maxillectomy for maxillary sinus tumours: clinical indications and their outcome

Vijaynivas, A (2015) Endoscopic medial maxillectomy for maxillary sinus tumours: clinical indications and their outcome. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Medial maxillectomy is a procedure commonly used for the removal of benign and low-grade malignant tumors of the medial aspect of the maxilla, the lateral nasal wall, the ethmoid sinuses, and the lacrimal sac. The endoscopic approach allows superior illumination and magnification, as well as providing the ability to treat diseases that extend beyond the limits of the traditional external medial maxillectomy. Indications for endoscopic medial maxillectomy include sinonasal neoplasms, inverted papilloma, and intractable inflammatory maxillary disease. This is a prospective study conducted between October 2012 to September 2014 where endoscopic medial maxillectomy was done for twenty four patients comprising of thirteen benign tumours and eleven malignancy patients. AIMS AND OBJECTIVES: 1. To evaluate the role of endoscopic medial maxillectomy for benign and malignant maxillary sinus tumours. 2. To assess the disease clearance, post operative healing status, recurrence, complications and benefits of the procedure. 3. To study the role of extended medial maxillectomy in adjacent sinuses. MATERIALS AND METHODS: This is a prospective study conducted in upgraded institute of otorhinolaryngology madras medical college from October 2012 to September 2014.the study was done with the concurrence of oncologist and with ethical clearance. This is a prospective study conducted in our institute between October 2012 to September 2014. Twenty four patients underwent endoscopic medial maxillectomy over the period of two years. There were eleven males and thirteen females. The most common presenting feature was nasal obstruction and swelling in the nasal cavity. The other co morbid conditions include diabetes and hypertension in two patients. The most common clinical finding was mass in the middle meatus. All the patients underwent clinical examination followed by diagnostic nasal endoscopy. CT scan of the paranasal was performed in all the cases. All the patients had involvement of the maxillary sinus and three patients had involvement anterior ethmoid sinus. One patient had extension of the mass to septum. All the patients were managed by endoscopic medial maxillectomy. In one patient who had involvement of the septum was in addition to medial maxillectomy partial septal resection was done. Histopathological examination revealed thirteen patients with inverted papilloma, six patients had adenoid cystic carcinoma, and three patients with squamous cell carcinoma, two patients had adenocarcinoma, Patients with adenoid cystic carcinoma and squamous cell carcinoma were subjected to post op radiotherapy. Three patients with adenocarcinoma were subjected to chemo radiation post operatively. All the patients are under follow up and one patient with adenoid cystic carcinoma had recurrence was subjected to total maxillectomy. OBSERVATION AND RESULTS: A total of twenty four patients comprising of thirteen benign tumour patients and eleven malignancy patients were selected for the study. Minimum age group for benign tumour cases was eighteen and maximum was seventy five and for malignancy it was forty one and seventy five. Nine patients in addition to the other clinical features presented with anemia and lose of weight. six patients had maxillary tenderness, one patient had maxillary swelling, there was neither no loosening or falling of teeth nor palatal anesthesia in any of the selected cases nor palatal anesthesia. The patient with external swelling had infra orbital anesthesia. All the patient had medial wall of the maxillary sinus involvement, inaddition 27% of the patient with malignancy had inferior wall involvement, 18 % of the patients had anterior ethmoids involvement. the subsite involvement was preoperatively assessed with diagnostic nasal endoscopy which revealed the involvement of ethmoid and other adjacent sinuses, with CT scan and MRI in patients with adenoid cystic carcinoma , the opacification in the maxillary sinus was precisely differentiated into tissue or fluid , also the origin and the extention of the tumour. Also CT scan analysis of the neck node involvement was done and one patient with squamous cell carcinoma had neck node metastasis. This also helped in the radiotherapy planning. None of the cases had retropharyngeal or other nodes. CONCLUSION: Endoscopic medial maxillectomy is by far the best treatment for benign maxillary tumours of the medial wall especially the inverted papilloma. In this study early stage of malignancies of maxillary sinus has been included with good results. Endoscopic medial maxillectomy is associated with minimum morbidity and is in accordance to oncological principles and preserves the normal physiology of nose and paranasal sinuses. Endoscopic technique allows for direct visualization of the surgical site and hence precise localization of the pathological lesion and hence adequate excision especially for the posterior aspect of maxillary sinus adjoining ethmoid and frontal sinus with preservation of normal structure if possible, with an average same number or even lower recurrence as with external medial maxillectomy. Cosmetically it is an excellent treatment for benign tumours for malignancies endoscopic medial maxillectomy offers best surgical approach in terms of tumour clearance and with minimal morbidity. The avoidance of scar and cosmetically better results without compromising the oncologic principles is the main advantage. The apparent reduction of hospital stay is a major point to be considered in favour of endoscopic medial maxillectomy for both patients and surgeons in the management of tumours of maxillary sinus. Easy post operative follow up with diagnostic endoscopy as an office procedure also assists the surgeon to pick up early recurrence and treat more radically when needed. However good results are dependent on appropriate patient selection who are also motivated to comply with regular post operative follow up.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Endoscopic Medial Maxillectomy ; benign and malignant tumours.
Subjects: MEDICAL > Otolaryngology
Depositing User: Devi S
Date Deposited: 07 Oct 2018 09:22
Last Modified: 07 Oct 2018 09:22
URI: http://repository-tnmgrmu.ac.in/id/eprint/9742

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