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CNAA / Theses / 2008 / July /

Diagnosis and surgical treatment of craniofacial tumors


Author: Corneliu Cojocaru
Degree:doctor of medicine
Speciality: 14.00.14 - Oncology and Radiotherapy
Year:2008
Scientific adviser: Gheorghe Tibirna
doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Oncology
Scientific consultant: Valerii Timirgaz
doctor habilitat, associate professor (docent), State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 29 July, 2008
Approved by NCAA on the 18 September, 2008

Abstract

Adobe PDF document0.42 Mb / in romanian

Thesis

CZU [617.51+617.52]-006-07

Adobe PDF document 12.95 Mb / in romanian
184 pages


Keywords

Paranasa sinuses, eye-soket, skull base, craniofacial tumors surgery, had and neck tumors

Summary

Our day, new directions in medicine has been raised up - craniofacial surgery, skull base surgery. Their goal is developing and implementation into practice of a new treatment method of patients with craniofacial pathology. The study covered 180 patients with craniofacial tumors that affect cranium bones, spread on the eye-socket and paranasal sinuses, with the age varying between 10 and 75 years. The gender of the patients was as follows: 101 men and 79 women. All the patients were examined and operated in hand an Neck and Microsurgery Department of PMSI “Institute of Oncology”, Republic of Moldova between 1997 and 2005.

The majority of analyzed patients with malignant tumors had epithelial tumors - planeocellular cancer from paranasal sinuses and skin. In 76 cases (42% from the total lot of patients, 64.1% from the malignant tumors), with begin tumors - polypus of paranasal sinuses - in 25 cases (14% from the total lot of patients, 37% from the benign tumors) and 14 cases osteoma (8% from the total lot of patients, 22% from benign tumors). In this scientifi c work, the basic diagnostic method was CT and NMR that allow a high precision defi ning of tumor spreading. These methods have a high importance in evaluating of radically performed operation and postop complications. A work classifi cation of craniofacial of craniofacial tumors with bone destruction, eye-socket, paranasal sinuses and skull-base has been elaborated.

Beginning from the diagnostic logarithm data being examined in 4 groups: I - with predominant affection of maxilla sinus, II - with predominant affection of the eye-socket, III - with predominant affection of the skull-base, IV - skin tumors with spread to cranium bones. The defi ning of informativity of each method different clinical cases made it possible creation of a diagnostic algorithm of patients with craniofacial tumors with extension to paranasal sinuses, eye-socket and skull-base with the goal of selection of the most informative diagnostic method for each patient, taking into consideration the specifi c of tumors and surgical treatment tactics. Based on the result of the study, there were proposed 2 new access for surgical treatment of craniofacial tumors that imply destruction of the bone with affection of paranasal sinuses, eye-socket and skull-base.

On the base of the result of this work it was registered a certifi cate of invention nr.3223 G1 Int. CI.: A61B 17/00 (2006.01), publication decision 2007.01.31, BOPI nr.1/2007. The essence of the invention consists in the fact that optionally it is tilted the external carotid artery , then, the surgical site, the frontal, the temporoorbital, the lateral part of the face that belong to tumor localization area, the nose, the superior lip, nasal and bucal mucosa are cleansed. Then, the incision from the superior lip up to the base of the lateral surface of the nose fi ll the medial angle of the eye, depending on the tumor spresding, is made. The incision can be extended on the eyebrow or the middle of the forehead on the frontal and temporal areas. Then, an skin fl ap free from epidermis, that i clued the detaced periost from the supraorbital or frontal or temporal area is prepared. The content of the orbita is moved down and laterally and the vault of the orbita, the lateral wall of the ethmoid bone, anterior wall of the maxilar sinus till the vasculonervous infraorbital peduncle are uncovered. Then, the tumor is removed by resection of the orbital with the affected cells of the ethmoidal bone, nasalcavity wall and the superior orbital wall. In case of ncesity, tamponade of the created cavity using a tampon with ointment and one end led through the nasal orifi ce is left. Then, hermetical Mastics of the skull base, periost of orbita is made and the facial skin is sutured using atraumatic techniques.

From 180 patients with craniofacial tumors with bone destruction and paranasal sinuses, eye-socket, skull-base spreading - 117 patients with malignant tumors and 63 with benign tumors had followed surgical treatment using the new surgical access and the specifi c postoperative treatment (radiotherapy and chemotherapy). The preliminary results show a high degree (93.9%) of recovery of patients with benign tumors, in 7.1% were registered local recidivation in a period of 5 yers after treatment, more frecvently seen in angiofi bromas and hemengiomas. In malign tumors cases, the surviring rate of 5 yers (in patients that has been folowwed) was 67%. More favorable was after treatment evolution at patients with planocellular cancer and basocellular cancer (75%). Non favorable evolution has been seen in patients with non differentiated cancer, angiosarcoma and soft tissue sarcoma (survival rate of this patients is 1.5 years).