Efficacy of exenteration of the orbit and sinus in malignant tumors of the ethmoidal labyrinth

Abstract

Background: Diagnosing malignant tumors of the ethmoidal labyrinth early, with advanced techniques, is important, because late diagnosis may lead to intracranial spread to the eye or base of the skull. Purpose: To assess the efficacy of exenteration of the orbit and sinus in the presence of the tumor of the ethmoidal labyrinth spreading to the eye. Material and Methods: Sixty-two patients with a malignant tumor of the ethmoidal labyrinth spreading to the eye received surgery during 2017 through 2022. Of these, 42 (75.8%) were females and 20 (32.2%) were males, with patient age ranging from 55 to 75 years. Diagnostic assessment included computed tomography (CT) of the paranasal sinuses and orbit and tumor biopsy from the nasal cavity. Patients underwent a radical surgical procedure, an exenteration of the orbit and sinus. One month after surgery, they received preventive radiotherapy, with a dose of 40-45 Gy applied to the bed of the primary tumor. Results: Intraoperative course was unremarkable, and no postoperative complications were found. All the patients (100%) showed no evidence of tumor recurrence or regrowth and no metastasis over a 6-month and 3-year follow-up. Conclusion: A radical surgical procedure, an exenteration of the orbit and sinus followed by postoperative radiotherapy for a moderately differentiated tumor of the ethmoidal labyrinth spread to the orbit allowed achieving a positive treatment outcome, both in terms of local status (i.e., no tumor recurrence or regrowth) and disease process (no metastasis), over a 3-year follow-up in all the patients (100%). The decision of the extent of surgery should be made by a multispecialty team including an otorhinolaryngologist, eye cancer specialist and neurosurgeon