"Operative risk and post-operative morbidity are significantly less than with open procedures," study authors write. "Recurrences are more frequent, but are detected early and are easily resected with minimally invasive techniques." Study patients had about a 50 percent recurrence rate compared to the usual recurrence rate of up to 44 percent, a fact that did not surprise Dr. Kountakis.
"When you deal with a tumor, even a benign tumor, sometimes it's better to cut it out with clean margins, do what's called an oncologic surgery. In this paper we are discussing tumors that are very large. To be able to do that, you would have to take half the face off these patients. For the largest of these tumors, there is no such thing as an oncologic procedure where you have enough room to have clean margins."
In fact, two of the study patients had previously undergone open procedures. More than half the study patients were still disease-free after two years with only one endoscopic procedure; two patients required three procedures. Patients need close follow- up for five years to be considered disease-free, Dr. Kountakis notes. Scarring and tissue destruction caused by the open procedure can impede follow up.
Open procedures involve incisions made along the nose or under the lip, lifting the face in a technique called facial degloving, and moving bone - potentially the upper jaw and cheekbone and sometimes brain out of the way. Complications include eye loss, cerebral spinal fluid leaks and disfigurement, which may require reconstructive surgery.
With the endoscopic approach, Dr. Kountakis uses tiny scopes and cameras to enter the natural opening of the nose where he obliterates the growth with a device that pulverizes and suctions. At points where it adheres to the sinu
Contact: Toni Baker
Medical College of Georgia