Author(s)
Yash Mittal, MBBS
Pradeep Pradhan
Anurita Swarup
kalyan Chidambaram
Chappity Preetam, MS, DNB, MNAMS
Affiliation(s)
AIIMS, Bhubaneswar; All India Institute of Medical Sciences, Bhubaneswar;
Abstract:
Introduction: Management of sino-nasal malignancies is challenging due to the close proximity of vital structures. Traditionally, open approaches have been considered the treatment of choice. But with better delineation of tumour extent, lower complication rates, shorter hospital stay and same survival rates as compared to open approaches, endoscopic management is emerging as an effective alternative.
Methods: A retrospective review of 18 cases of PNS malignancy, who underwent a purely endoscopic excision in a tertiary care setting from 2014 to 2019 was done. The clinical, surgical and post-treatment follow up data was reviewed.
Results: The age range was from 16 to 62 years. The average hospital stay was 5.3 days. The blood loss ranged from 200 ml to 1200ml. Use of image guidance, piecemeal removal, frozen section, drilling and preservation of nasolacrimal duct were vital steps to improve outcomes. A margin positivity on histopathology was seen in 3 cases (17.6%); however, the margin negative rates were seen to be similar to traditional approaches. The results are comparable to external approach, but the chance of CSF leak is higher. This mandates good reconstruction.
Conclusions: Endoscopic approach helps to reduce blood loss, hospital stay and complications in comparison to external approaches. Skin, subcutaneous tissue, maxillary sinus anterolateral wall bony erosion, frontal sinus anterior table erosion, sphenoid sinus lateral wall invasion are contra-indications for a pure endoscopic approach as per our experience. A small subset of malignant pathologies can be planned for endoscopic management with adequate pre-operative planning and stringent post-operative follow up.