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Anterior craniofacial resection for malignant ethmoid tumors—A series of 91 patients
Author(s) -
Cantù Giulio,
Solero Carlo L.,
Mariani Luigi,
Salvatori Pietro,
Mattavelli Franco,
Pizzi Natalia,
Riggio Egidio
Publication year - 1999
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/(sici)1097-0347(199905)21:3<185::aid-hed1>3.0.co;2-8
Subject(s) - medicine , cribriform plate , craniofacial , esthesioneuroblastoma , surgery , anterior cranial fossa , adenoid cystic carcinoma , ethmoid sinus , stage (stratigraphy) , radiation therapy , carcinoma , skull , paleontology , psychiatry , biology
Background Anterior craniofacial resection is now recognized as the best treatment for ethmoid tumors involving the cribriform plate with or without invasion of anterior cranial fossa. Methods Ninety‐one patients underwent an anterior craniofacial resection for ethmoid malignant tumors at the Milan Cancer Institute between 1987 and 1994. The patient population was divided into two sections (30 and 61 patients) based upon some important variants (type of craniotomy, antibiotic treatment, postoperative care). Results The mean age was 53.4 years (range, 24 to 78 years). There were 62 men and 29 women. Forty‐nine patients had a recurrence after previous treatments (surgery and/or radiotherapy). The subdivision by histology was as follows: 50 cases of adenocarcinoma, 16 cases of epidermoid and undifferentiated carcinoma, 8 cases of esthesioneuroblastoma, 5 cases of adenoid cystic carcinoma, 5 cases of melanoma, and 6 rare tumors. The stages (according to our new staging) were as follows: 37 cases with T2, 27 cases with T3, and 27 cases with T4. The mean follow‐up was 47 months. Seven patients died after surgery (6 in the first series). The survival at 3 and 5 years was, respectively, 52% and 47%, and the disease‐free survival (DFS) was 30% and 24%, with a statistically significant difference at multivariate analysis in favor of patients without prior treatment ( p = .033) or T2 versus T3 and T4 ( p < .007). Conclusions An anterior craniofacial resection should be performed in cases of ethmoid tumors reaching or eroding the cribriform plate. A scrupulous intra‐ and postoperative approach is necessary to avoid severe complications. The patients often survive for a long time with recurrence ongoing. Our new staging identifies the critical extensions of ethmoid tumors. © 1999 John Wiley & Sons, Inc. Head Neck 21: 185–191, 1999.