Endoscopic-assisted maxillectomy: Operative technique and control of surgical margins

Deganello, Alberto; Ferrari, Marco; Paderno, Alberto; Turri‐Zanoni, Mario; Schreiber, Alberto; Mattavelli, Davide; Vural, Alperen; Rampinelli, Vittorio; Arosio, Alberto Daniele; Ioppi, Alessandro; Cherubino, Mario; Castelnuovo, Paolo; Nicolai, Piero; Battaglia, Paolo

doi:10.1016/j.oraloncology.2019.04.002

Cited by 34 publications

(47 citation statements)

References 42 publications

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“…Indication to maxillectomy was given in keeping with general principles of oncologic HN surgery [3]. Tumors with critical posterior and/or superior extension towards the skull base were managed as described by Deganello et al [14]. The present study was approved by the local ethics board (protocol number: NP3616).…”

Section: Methodsmentioning

confidence: 99%

“…The ablative phase consists of maxillectomy, which can be tailored according to tumor extension. During assessment of tumor margins and osteotomy planning, endoscopy and surgical navigation, respectively, can aid the surgeon in achieving a resection with free margins [13][14][15]. With the infrequent exception of early cancers which are radically excised, treatment also includes adjuvant radiation [16,17].…”

Section: Introductionmentioning

confidence: 99%

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Malignant tumors of the maxillary sinus: Prognostic impact of neurovascular invasion in a series of 138 patients

et al. 2020

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Background: Maxillary sinus cancer is a rare disease with heterogeneous biologic behavior. The pattern of neurovascular invasion is known to be an important prognosticator in head and neck cancers, but has not been studied in maxillary malignancies. Materials and methods: Patients undergoing surgery-based treatment with curative intent for a malignancy of the maxillary sinus at the Unit of Otorhinolaryngology-Head and Neck Surgery of the University of Brescia between November 2000 and October 2018 were included. A description of the characteristics of the patients, tumors, and treatments has been performed along with uni-and multi-variate analysis of prognostic factors. Tumors were classified based on the presence of perineural (P 0 /P 1) and lymphovascular invasion (V 0 /V 1

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Malignant tumors of the maxillary sinus: Prognostic impact of neurovascular invasion in a series of 138 patients

et al. 2020

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“…To date, most of the research around this issue has been based on surgical technique, with refinements in open surgical approaches being claimed as a solution to partially improve margin control [41][42][43][44]. More recently, Deganello et al demonstrated the benefit of guiding the medial and posterior margin delineation through an endoscopic transnasal approach [13].…”

Section: Current Standard Of Carementioning

confidence: 99%

“…Sinonasal tumors are frequently irregular in shape having invaded neighboring structures, which are characterized by unique anatomical complexity. For this reason it is not uncommon to set suboptimal cutting trajectories, which results in a high rate (21-45%) of positive margins [13,39,40,45].…”

Section: Osteotomiesmentioning

confidence: 99%

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Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study

et al. 2019

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To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer. Materials and methods: Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using realtime tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared. Results: The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001). Conclusion: This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting-with rigorous assessment of oncological outcomeswould be the proposed next step.

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Endoscopic‐assisted total maxillectomy with precise surgical margins

et al. 2022

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In traditional open maxillectomy, identifying the posterior margin is difficult because of its deep location and bleeding from the pterygoid venous plexus. Here, we present our endoscope‐assisted total en bloc maxillectomy technique and discuss its merits and demerits compared to previously reported methods. We developed an endoscope‐assisted total en bloc maxillectomy procedure. We reviewed a series of total maxillectomies performed with and without endoscopic assistance to verify the advantages of endoscopic assistance over conventional total maxillectomy. We analyzed (1) the precision using the distance of the remaining pterygoid process, (2) the operation time, and (3) blood loss. The length of the remnant pterygoid process was significantly shorter in the endoscopic assistance group. The operation time and blood loss were not significantly different between the two groups. Endoscopic assistance makes total maxillectomy more precise without requiring additional time and is a reasonable option for total maxillectomies.

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Endoscopic-assisted maxillectomy: Operative technique and control of surgical margins

Cited by 34 publications

References 42 publications

Malignant tumors of the maxillary sinus: Prognostic impact of neurovascular invasion in a series of 138 patients

Malignant tumors of the maxillary sinus: Prognostic impact of neurovascular invasion in a series of 138 patients

Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study

Endoscopic‐assisted total maxillectomy with precise surgical margins

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