Management of the Orbit during Endoscopic Sinonasal Tumor Resection

Abstract

Objectives:

The primary aim of the study was to evaluate intraoperative management of the orbit during endoscopic resection of benign and malignant sinonasal tumors.

Methods:

Retrospective chart review and prospective imaging assessment was performed of 215 cases managed at a tertiary care referral center between July 2009 and December 2012.

Results:

A total of 41 patients met predetermined criteria for inclusion. Squamous cell carcinoma (17.1%) and inverted papilloma (31.7%) were the most common malignant and benign pathologies, respectively. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) most commonly demonstrated lamina papyracea erosion (78.1%), followed by extension into the periorbita (43.9%), lacrimal system (24.4%), orbit (14.6%), and orbital apex (7.3%). Procedures performed to address orbital involvement included endoscopic resection of lamina papyracea (85.3%), dacryocystorhinostomy (DCR) (26.8%), optic nerve decompression (7.3%), and orbital exenteration (4.8%). Ophthalmologic involvement was required in 31.7% of cases; anterior orbitotomy (26.8%) and open DCR (17.1%) were the most common adjunct open procedures. Orbital complications most commonly included epiphora (7.3%) and diplopia (5.1%), with no cases of change in visual acuity or orbital hematoma. CT reliably predicted invasion of the lamina papyracea and lacrimal system (P < .05), while MRI reliably predicted invasion of the periorbita (P < .05). Irregular tumor margin along the periorbita on MRI was statistically significant (P < .05) for ophthalmologic involvement.

Conclusions:

CT and MR imaging provide complementary information for assessment of tumor extension to the orbit. This typically requires endoscopic and adjunct open approaches for effective tumor extirpation and can be achieved safely with low rate of complications.