Suárez Carlos, Ferlito Alfio, Lund Valerie J, Silver Carl E, Fagan Johannes J, Rodrigo Juan Pablo, Llorente José L, Cantù Giulio, Politi Massimo, Wei William I, Rinaldo Alessandra
Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Head Neck. 2008 Feb;30(2):242-50. doi: 10.1002/hed.20736.
Malignant ethmoid and maxillary sinus tumors frequently involve the orbit. Orbital involvement is an important prognostic predictor of recurrence-free, disease-specific, and overall survival. Most authors agree that orbital preservation as opposed to orbital exenteration or clearance does not result in significant differences in local recurrence or actuarial survival. The eye can be safely preserved in most patients with ethmoid or maxillary sinus cancer invading the orbital wall, including malignancies that invade the orbital soft tissues with penetration through the periorbita provided that they can be completely dissected away from the orbital fat. Malposition of the globe and nonfunctional eyes frequently result when patients have not had adequate rigid reconstruction of the orbital floor, particularly if they have received postoperative radiotherapy. This underscores the importance of such reconstruction. Isolated defects following orbital exenteration may be reconstructed with a temporalis muscle flap. Microvascular free-tissue transfer is the best option for repair of defects following orbital exenteration and total maxillectomy, although an obturator still has a role in selected patients.
恶性筛窦和上颌窦肿瘤常累及眼眶。眼眶受累是无复发生存、疾病特异性生存和总生存的重要预后预测指标。大多数作者一致认为，与眼眶内容剜除术或清除术相反，保留眼眶不会导致局部复发或实际生存率出现显著差异。对于大多数侵犯眶壁的筛窦或上颌窦癌患者，包括那些通过眶隔侵犯眼眶软组织并可从眶脂肪完全分离的恶性肿瘤患者，眼睛可以安全保留。当患者没有对眶底进行充分的坚固重建时，特别是如果他们接受了术后放疗，眼球异位和无功能眼经常会出现。这突出了这种重建的重要性。眼眶内容剜除术后的孤立缺损可用颞肌瓣重建。微血管游离组织移植是眼眶内容剜除术和全上颌骨切除术后修复缺损的最佳选择，尽管在特定患者中闭孔器仍有作用。
