Application Of Intranasal Endoscopic Surgery In Benign Sinonasal Tumors Or Occupying Lesions

Objective:Endoscopic endonasal approach has been used successfully in the last 10 years for the resection of benign tumors in nasal cavity and paranasal sinus. With the maturity of the intranasal endoscopic surgery technology, related devices and equipment such as dynamical systems and image-guided systems have continued to develop. The wide use of these devices and technologies make surgery more accurate and security, and provides objective guarantees to explore more difficult operations, also expanding their field of application from inflammatory disease and gradually expanded to benign tumors or lesions. The intranasal endoscopic surgery has been carried out in recent 20 years in the Department of Otorhinollslaryngology Head and neck surgery, the affiliated hospital of Sichuan Medical University. Along with the surgical methods, surgical equipment and surgeon skill improvement, the application of intranasal endoscopic surgery in benign sinonasal tumors or occupying lesions has become mature. In this study, the clinical date were retrospectively analyzed in our department in order to explore the application of intranasal endoscopic surgery in benign sinonasal tumors or occupying lesions, and summarize the surgical experience in our hospital. Methods:Collected the clinical date of patients with benign sinonasal tumors or occupying lesions who accepted the endonasal endoscopic surgery in our department from January 2002 to December 2013. Their medical data including gender, age, the first symptom, location of lesions, diagnosis, surgical procedures, complications, prognostic and so on, were analyzed. The assessment of extent and surgical selection was based on preoperative nasal endoscopy, biopsy and imaging examination. The one person two-handed and/or two persons four-handed technique was used during operation. The patients were regular follow-up with endoscopy and imaging examination. Follow-up data was obtained through correspondence, telephone and e-mail, observing the complications, the improvement of symptoms and signs, and recurrence. Results:(1)A total of 359 patients in this study, there were 172 cases with inverted papilloma,63 cases with hemorrhagic and necrotic polyps, 54 cases with cyst of nasal cavity and paranasal sinuses,25 cases with hemangioma,11 cases with angiofibroma of nasopharynx,8 cases with angiofibroma of nasal cavity,7 cases with osteoma,4 cases with ossifying fibroma,3 cases with schwannoglioma,3 cases with ameloblastoma,2 cases with pleomorphic adenoma,1 case with myxoinoma,1 case with neurofibroma, 1 case with fibroma of the nasal cavity,1 case with mixed tumor,1 case with leiomyoma,1 case with giant cell reparative granuloma,1 case with benign mesenchymona; (2) There were 6 cases with complications:the facial swelling with 5 cases who underwent the endonasal endoscopic surgical combined modified Caldwell-Luc approach, including 4 cases with inverted papilloma and one case with hemorrhagic and necrotic polyps of maxillary sinus, the spontaneous regression were observed in 1-3 days after anti-inflammatory treatment. There was periorbital ecchymosis in 1 cases with ethmoid sinus cyst, similarly, the spontaneous regression were observed in 3 days but without treatment. The rates of complication are 1.7%(6/359); (3) The follow-up period ranged from 6 months to 148 months,20 patients were found to have recurrence. The recurrence rates of the patients were 5.6%(20/359), among these 20 patients, there were 16 cases with inverted papilloma,1 case with angiofibroma of nasopharynx,1 case with schwannoglioma,1 case with ossifying fibroma,1 case with giant cell reparative granuloma. All of these patients underwent the endonasal endoscopic surgical or combined other approach again. Conclusions:(1) The benign sinonasal tumors or occupying lesions were different types of Pathology, there are nonspecific with their clinical symptoms, nasal endoscopy and radiographic examination. (2) The benign sinonasal tumors or occupying lesions most originate from the maxillary sinus, followed by nasal cavity and ethmoid sinus, very few patients originated in the frontal sinuses and sphenoid sinus. (3) Preoperative imaging examination for evaluating benign sinonasal tumors or occupying lesions of the invasion is of great significance. (4) Endonasal endoscopic surgery surgery provides a safe, effective, minimally invasive surgical proccedures for the benign sinonasal tumors or occupying lesions.