Hanyang Med Rev.  2009 Aug;29(3):245-254. 10.7599/hmr.2009.29.3.245.

Surgical Management of Sinonasal Cancer

• Rho YS

• KMID: 1505101
• DOI: http://doi.org/10.7599/hmr.2009.29.3.245

Abstract

Sinonasal cancers account for less than 1% of all malignancies and comprise 3% of all head and neck malignancies. The most common malignant neoplasm in the sinuses and nose is squamous cell carcinoma, which accounts for 70% of these neoplasms. Most of these arise in the maxillary antrum, and only 10% to 30% occur in the nasal cavity or ethmoid sinus. It is well known the surgery is primary treatment for sinonasal malignancies. Adjunctive irradiation and/or chemoradiatioin has resulted in improved locoregional control and increased survival rates. The goal of surgical resection is to remove the cancer en bloc, with clear margin devoid of neoplastic cells. For maxillary sinus neoplasms, maxillectomy is a standard surgical procedure. Neoplasms involving the ethmoid, frontal, or sphenoid sinuses may require a craniofacial approach because of frequent invasion into the skull base. The proximity of the nasal cavity and paranasal sinuses to the adjacent structures including the orbit, dura, brain, cranial nerves, and carotid arteries mandates careful radiologic and neurologic evaluations throughout the course of the disease. Surgical advances now permit complex tumor removal and reconstruction surrounding these structures resulting in functional and cosmetic improvements when compared to earlier techniques.

Keyword

Sinonasal cancer; Surgery

MeSH Terms

Brain
Carcinoma, Squamous Cell
Carotid Arteries
Cranial Nerves
Ethmoid Sinus
Head
Maxillary Sinus
Maxillary Sinus Neoplasms
Methods
Nasal Cavity
Neck
Nose
Orbit
Paranasal Sinuses
Skull Base
Sphenoid Sinus
Survival Rate

Figure

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  Fig. 1 The various facial incision for maxillectomy is illustrated.

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  Fig. 2 Intraoperative photograph of the partial maxillectomy. (a) Infrastructure maxillectomy (b) Medial maxillectomy, (c) Suprastructure maxillectomy.

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  Fig. 3 The osteotomies required for a total maxillectomy and Intraoperative photograph of the total maxillectomy defect.

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  Fig. 4 Axial and coronal CT scans demonstrate poor prognostic factors in sinonasal cancer. (a) Intracranial extension (dura, brain), (b) Orbital invasion, (c) Extension to pterygoid plates, infratemporal fossa, nasopharyngeal extension.

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  Fig. 5 Coronal CT scan and axial MRI view accurately demonstrate the extent of orbit invasion from left-sided maxillary sinus tumor.

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  Fig. 6 Intraoperative photograph of the radical maxillectomy with pterygoid extension (a) Lateral extension of lateral canthotomy incision. (b) Ligation of the internal maxillary artery. (c) Posterior osteotomy behind the pterygoid plate.

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  Fig. 7 Standard subfrontal approach.

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