Endoscopic endonasal management of pediatric benign tumours of the nose and paranasal sinuses

Objectives: Pediatric sinonasal benign tumors are rare (≤2/100000/year) and different histopathologic types can be observed. Purpose of the study is to define the appropriate endoscopic technique to be employed according to the different histology of the tumors and to assess the impact of surgery in facial growth. Methods: Retrospective analysis of pediatric patients affected by sinonasal benign tumors, treated at the Departments of Otorhinolaryngology of the University of Insubria-Varese from 2002 to 2010, using a pure endoscopic approach, was done. Preoperative endoscopic examination and radiological assessment (CT and/or MR and/or angiography) were performed in all patients, according to the clinical suspicion. In presence of fibro-osseous lesions (FOLs) the cavitation technique is preferred. When there is a soft tissue tumor with involvement of the cancellous bone, the bony site of origin must be removed. Finally soft tissue tumors without bony involvement need a subperiosteal dissection and drilling out the underlining bone. Results: The patients eligible for the present analysis were 47, with mean age of 12.7 years. The histotypes encountered were angiofibroma (JNA) in 26 cases, FOLs in 6 cases, glioma in 4 cases, craniopharyngioma in 2 cases, pituitary adenoma in 2 cases and miscellaneous in 7 cases. The radical resection was obtained in 42 patients. We observed persistence in 5 JNA, among which 1 case underwent surgical revision whereas the other 4 cases are still in a strict follow-up. The follow-up ranges from 12 to 115 months (mean, 60 months). In our series, there was no evidence of any significant impact in facial growth after endoscopic endonasal resection of the tumors. Conclusion: The endoscopic endonasal technique proved to be a safe and effective approach for the treatment of benign sinonasal tumors, even in pediatric patients. It is mandatory to perform preoperative radiological imaging in order to evaluate the features and extension of the disease and the paranasal sinuses‟ anatomy