Role of endoscopy in the management of benign and malignant sinonasal tumors

BACKGROUND: Sinonasal malignancies are a diverse group of tumours, some of which are unique to the nose. These tumours are uncommon and account for less than 1 percent of all neoplasms. They produce little in the way of symptoms at the outset when most are mistaken for rhinosinusitis. The introduction of endoscopic endonasal surgery in the 1980s, underpinned by access to CT and then MRI, revolutionized our approach to the diagnosis and management of virtually all rhinological conditions. Beginning with inflammatory and infective conditions, it was rapidly extended to the interfaces with the orbit and skull base, encouraging cross-specialty interaction. It was thus a natural progression to the resection of benign sino nasal tumors and then, albeit with some trepidation, to malignant tumors. The aim of our study is to demonstrate the role of endoscopy in the management of benign and malignant sinonasal tumors. MATERIALS AND METHODS: In our study a total of 35 patients were included of which 24 benign tumors and 11 malignant tumors were present. All the patients underwent endoscopic excision of the tumors. Of the 11 malignant tumor patients, 8 patients underwent adjuvant treatment with chemotherapy and radiotherapy. All patients were followed up for a period of up to 24 months and looked for recurrence of disease, overall survival rate and disease free survival rate. RESULTS: Of the 24 benign tumor patients, one patient with inverted papilloma had recurrence within the 24 month follow up period. The recurrence rate for benign tumors who underwent endoscopic excision was 4.02%. Of the 11 malignant tumor patients, who underwent endoscopic excision one patient with squamous cell carcinoma of the maxilla had recurrence within the follow up period. The recurrence rate was 9 %. The disease free survival rate was 91% for malignant tumors. CONCLUSION: Though the sample size and period of study is small, in the hand of experienced and skilled surgeons, complete endoscopic removal is attainable in most cases of sinonasal tumors. The combination of removal of tumors endoscopically and endoscopic surveillance in the outpatient setting has allowed a less radical surgical approach while resulting in decreased morbidity and better tumor control