Orbital Exenteration in Surgery of Malignant Neoplasms of the Paranasal Sinuses: The Value of Preoperative Computed Tomography

Abstract

\s=b\ The extension of paranasal sinus malignant neoplasms into the orbit presents one of the arguments for carrying out orbital exenteration. One method of assessing the extension is computed tomography (CT), but its reliability is still questionable. Therefore, the preoperative CT images were compared with the pathoanatomic features of the surgical specimens in 15 patients who underwent orbital exenteration as part of a procedure for paranasal sinus malignant neoplasm. Ophthalmic symptoms were present in eight patients and in each instance the CT images documented the extension of the tumor accurately. In only four of seven patients without ophthalmic symptoms did CT scanning appear to match the factual situation. Apparently CT scanning is not always reliable in patients without ophthalmic symptoms.(Arch Otolaryngol Head Neck Surg. 1989;115:977-980) The indications for orbital exenteration as part of a procedure for malignant neoplasms of the paranasal sinuses have been the subject of con¬ troversy until now. Until about a de¬ cade ago exenteration of the contents of the orbit was considered inevitable in patients with tumor extension into the periorbital fascia, the floor, and the medial wall of the orbit as well as in large T3 and T4 tumors.14 Afterward a gradual shift toward a more conserva-

Preoperative imaging to predict orbital invasion by tumor

“…Two of the studies incorrectly predicted that invasion was present, and one incorrectly predicted that it was not. 13 We obtained similar results in our study. MRI differentiates periorbita from bone poorly, both of which have low signal intensity with T1-and T2-weighted sequences.…”

Assessment of ultrasonography and computed tomography for the evaluation of unilateral orbital disease in dogs

“…Unfortunately, the sensitivity of CT for use in detecting invasion of the orbital bone in human patients with invasive periorbital carcinomas is not reliable, and bone invasion may be visible histologically, even though destruction cannot be seen on CT images in patients without clinical signs of orbital disease. 48,49 This could also have been the case in dogs of our report in which the tumor was in close contact with the orbital wall. In dogs with suspected bone involvement detected during ultrasonography that had negative results for the CT images, the periosteum may have actually been involved, which may explain ultrasonographic findings of subtle irregularities of the orbital bone.…”

Orbital exenteration: Surgical and reconstructive strategies

“…Graamans and Slootweg [16] demonstrated a close correlation between ophthalmological symptoms and pathohistological findings. On the other hand, if the ophthalmological findings were normal, tomographic findings could be misleading, as a comparison with pathohistological and intraoperative findings revealed.…”