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Related Experiment Videos

Craniofacial resection for paranasal sinus cancers.

G P Bridger1, B Kwok, M Baldwin

  • 1Department of Otolaryngology, Prince of Wales Hospital, Randwick 2031, New South Wales, Australia.

Head & Neck
|November 21, 2000
PubMed
Summary

Combined anterior craniofacial resection (CFR) with radiotherapy offers comparable survival for advanced paranasal sinus cancers. This aggressive approach, utilizing free-flap reconstruction, yields favorable outcomes despite a high rate of orbital exenteration.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Head and Neck Surgery

Background:

  • Combined anterior craniofacial resection (CFR) has been established for over 25 years for paranasal sinus cancers.
  • Free revascularized tissue transfer flaps, introduced in 1980, enable immediate reconstruction of sino-orbital cranial defects after tumor resection.
  • This study evaluates outcomes of primary CFR and postoperative radiotherapy for skull base-invading paranasal sinus cancers over 21 years.

Purpose of the Study:

  • To assess the survival rates and morbidity associated with a management strategy of primary combined anterior craniofacial resection (CFR) and postoperative radiotherapy.
  • To analyze the long-term outcomes for patients with paranasal sinus cancers invading the skull base.
  • To identify prognostic indicators and compare survival across different pathologies.

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Main Methods:

  • A retrospective review of 73 patients with newly diagnosed paranasal sinus cancers treated between 1975 and 1996.
  • The cohort included predominantly advanced lesions (31% advanced, >6 sites involved) and a high rate of orbital exenteration (31 patients).
  • Free tissue transfer flaps were used for reconstruction of major defects since 1980.

Main Results:

  • The 5- and 10-year cancer-specific survival (CSS) rates were 69% and 69%, respectively. Overall survival (OS) at 5 and 10 years was 61% and 48%.
  • The 5-year recurrence-free rate was 59%. Olfactory neuroblastoma showed the best prognosis (84% CSS), while squamous cell carcinoma had the poorest OS.
  • Orbital involvement and skull base erosion were not poor prognostic indicators; performance status 0 correlated with improved OS. No operative mortality was observed.

Conclusions:

  • An aggressive approach combining CFR, postoperative radiotherapy, and free-flap reconstruction achieves survival comparable to less advanced lesions and superior to other treatments.
  • The study highlights a high rate of orbital exenteration (42%) and identifies squamous cell cancers as associated with greater morbidity and poorer survival.
  • This policy demonstrates effective management for extensive paranasal sinus cancers involving the skull base.