There exists no real area of anatomical safety in the temporal region. It seems, however, possible to define areas of relative safety that would be of great help for the surgeon or the morphologist wishing to approach pathologies of this region.
Respiratory epithelial adenomatoid hamartoma (REAH) is a relatively recent diagnosis that is gaining more interest in sinus surgery. REAH of the olfactory cleft was often misdiagnosed, and interpreted as nasal polyposis (NP). We present a retrospective case series of 27 patients who were diagnosed and treated for REAH of the olfactory cleft, in the past 7 years, in our department. The aim of this study is to present the diagnostic modalities and the results and follow-up after surgery. The male to female ratio was 2.9:1, with a mean age of 56 years. Almost half of these patients were operated at least once before on their sinuses. The most common presenting symptoms of isolated REAH are olfactory disorders. All cases were treated surgically with endoscopic sinus surgery, without recurrences in the follow-up period. Knowledge and identification of REAH of the olfactory cleft are fundamental. Knowledge, identification, and adequate treatment of these lesions are fundamental, as they limit the number of recurrences.
Surgical resection followed by radiotherapy can be considered like the optimal treatment modality for limited esthesioneuroblastoma. However, therapeutic management of locally advanced tumors remains a challenge. The aim of our study was to access and compare the oncologic results of the different treatment modalities in advanced esthesioneuroblastoma. We performed a systematic review using the Medline, and Cochrane database in accordance with PRISMA criteria and included all the cases of advanced esthesioneuroblastoma published between 2000 and 2013. We also retrospectively included 15 patients with an advanced esthesioneuroblastoma managed at our tertiary care medical center. Long-term survival rates defined as the time from diagnosis or randomization to the date of death or last follow-up were evaluated for each treatment with Kaplan-Meier survival curve analyses. 283 patients have been included. The mean follow-up was 78 months. Five-year highest survival rates were obtained in patients treated by surgery associated with radiotherapy. Ten-year highest survival rates were obtained in patients treated by the association of surgery, radiotherapy and chemotherapy (p = 0.0008). Within the surgical group, 5-year highest survival rates were obtained in patients treated by endoscopic resection (p = 0.003). Surgical resection combined with radiotherapy offers the gold standard of care. Adjuvant chemotherapy seems to improve the long-term survival in patients with locally advanced esthesioneuroblastoma. Endoscopic resection in advanced tumors should be discussed on a case-by-case basis.
Eight patients benefited from endoscopic surgical resection. According to the Kadish classification, one patient was stage A, three patients were stage B, and four patients were stage C. According to the Dulguerov classification, one patient was stage T1, five patients were stage T2, and two were stage T4. Reconstruction of the base of the skull was performed in three patients. No postoperative complications were noted. The mean follow-up period was 95 months. The 5-year overall survival was 87.5% and the 5-year recurrence-free survival was 75%. To date, there have been no local recurrences but two patients had lymph node recurrences. Seven patients are disease-free and one is deceased.
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