Advantages of the open approach in sinonasal tract tumors with midfacial and suprastructure invasion

Abstract

Abstract BACKGROUND. In case of rhinosinusal malignant tumors, it is important to have a unified and simple terminology. The suprastructure refers to the ethmoid sinus, the sphenoid sinus, the frontal sinus and the olfactory area of the nose. The mesostructure includes the maxillary sinus, excepting the orbital wall, and the respiratory part of the nose. MATERIAL AND METHODS. We will present two clinical cases admitted and surgically treated in our department. The first one is a left-side suprastructure mass in a 39-year-old male patient, with a particular evolution. The second one is a left-side midfacial and suprastructure tumor with 3 prior negative biopsies in a 57-year-old patient. In both cases, we performed an external surgical approach. DISCUSSIONS. For an external approach in mesostructure malignant tumors, we propose a combined approach using lateral nasal rhinotomies, sub-labial rhinotomies and midfacial degloving. The external approach in malignant tumors of the supra-structure is centred on a classical incision for the frontal sinus or a hemicoronal or coronal approach. There are some clear advantages of the open approach to be considered. CONCLUSION. The advantages of the external approach are represented by a direct visualization and control of the tumor during the ablative time; a better control for negative margins; a better control of haemostasis; a better chance for en-bloc resection versus piece-meal resection.