title: Management of the orbit during endoscopic sinonasal tumor surgery.
abstract: BACKGROUND
  The primary aims of the study were to report preoperative imaging characteristics and intraoperative management of the orbit during endoscopic resection of benign and malignant sinonasal tumors.
  
  
  METHODS
  This study was a case series at an academic tertiary care center. Retrospective chart review and prospective imaging assessment was performed on 159 cases treated between July 2009 and December 2012.
  
  
  RESULTS
  A total of 41 patients met predetermined inclusion criteria. Squamous cell carcinoma (17.1%) and inverted papilloma (31.7%) were the most common malignant and benign histology, respectively. Preoperative computed tomography (CT) scanning most commonly demonstrated erosion of the lamina papyracea (80.5%), whereas magnetic resonance imaging (MRI) most commonly illustrated loss of fat plane between tumor and extraocular muscle (53.1%). Endoscopic procedures to address the orbital interface included lamina papyracea resection (85.4%), dacryocystorhinostomy (26.8%), periorbita resection (26.8%), optic nerve decompression (7.3%), and orbital exenteration (2.4%). Oculoplastic surgery involvement was required in 31.7% of cases. Orbital complications included epiphora in 3 (7.3%) and diplopia in 2 (5.1%) patients. Postoperatively, no recurrences were noted in the benign group, whereas 6 (28.6%) recurrences were noted in 21 patients in the malignant group treated with intent to cure. Two patients died of disease due to distant metastases from mucosal melanoma and squamous cell carcinoma.
  
  
  CONCLUSIONS
  This represents the largest series to date on endoscopic management of the orbit in benign and malignant sinonasal tumors. A majority of these cases can be managed by a purely endoscopic approach with low complication and recurrence rates, although a subset still require adjunct open approaches for successful tumor extirpation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Brandon
authors.initials: B
authors.lastname: Christianson
authors.affiliation: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Carlos
authors.initials: C
authors.lastname: Perez
authors.affiliation: University of Texas Southwestern Medical School, Dallas, TX.
authors.forename: Brian
authors.initials: B
authors.lastname: Harrow
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL.|Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Pete S
authors.initials: PS
authors.lastname: Batra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003608:Dacryocystorhinostomy; D004724:Endoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009669:Nose Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D009915:Orbit / Q000000981:diagnostic imaging / Q000601:surgery*; D018308:Papilloma, Inverted / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: computed tomography; endoscopy; magnetic resonance imaging; neoplasm; orbit; tumor